Pediatric Dermatology ===================== þ Natal Teeth - normal variant þ Cutis Marmorata - in fairskinned babies - capillary dilitation with mottling - from exposure to heat or cold - goes away in a few months þ Umbilical Granuloma - benign - treat with silver nitrate sticks þ Opmhalitis þ Mongolian Spots: disappear by 2 months þ Livedo Reticularis - Only when cold and dependent - Goes away with warming - Normal below age 1 month - Sometimes seen after this in kids with Down's, etc. þ Erythema Toxicum - Found in many newborn kids - Pustules and papules full of eosinophils - Goes away in a couple of days, benign - May have eosinophils - Widespread - Otherwise asymtompatic - May be white papules - Don't get on palms and soles - Unclear cause þ Transient Pustules - Seen mostly in black males - Also on palms and soles; may be vesicular there, crusted - No symptoms - Goes away in 2 day to a month - Culture shows neutrophils þ Acropustulosis - Recurrent, on palms and soles as well as other places - Very itchy - Birth to 2 years age, black males, summer - Benadryl and topical or oral steroids - Confused with scabies - Culture shows neutrophils þ Neonatal Acne - Caused by maternal androgens - Goes away in a few months, but sometimes stays until age 11 - Not associated with adolescent acne þ Fungal Skin/Nail Infections þ Infectious Rashes - Ecthyma - "Fifth Disease" = Erythema Infectiousum - Roseola - Scarlatina - Staph Scalded Skin syndrome - Toxic Epidermal Necrolysis (TEN) - Strawberry Tongue, Rash, Fever: consider Scarlet Fever , Toxic Shock Syndrome, Kawasaki's Disease þ Toxic Shock Syndrome þ Measles - usually with conjunctivitis (bulbar and palpebral), photophobia, severe rhinitis, fever, severe malaise - desquamation þ German Measles (Rubella) - no desquamation þ Impetigo - used to be caused mostly by strep; now more often from staph with particular phage that causes desquamation. - Staph impetigo has less "golden crust" than strep. - Mucopiricin (Bactroban) more effective than oral antibiotics, but if around nose may have reservoir of bacteria in nose and should get oral medications. þ Hand Foot and Mouth Disease - caused by coxsackie virus - flat, painless, serpiginous greyish bullae, also sometimes on buttocks, at least in some seasons. - if just in mouth: þ Herpangina - also caussed by Coxsackie virus: mostly posterior þ Herpetic Gingivostomatitis - when primary, not clustered - predilection for anterior pharynx and gums - self-limited, but gets better with acyclovir: use acyclovir if severely ill or requires hospitalization. (Joe Goth, M.D., DDS: suggested local acyclovir ointment.) þ Herpetic Whitlow - if worried about superinfection, do gram stain þ Stevens Johnson Syndrome - bullous lesions, or target lesions, or diffuse erythema, or mucosal lesions, or combinations of all (need 2 mucosal lesions to move from erythema multiforme to Stevens Johnson) þ Varicella - may have bullous mucosal lesions of various sizes, but all discrete. - "dewdrops on a rose petal" - vesiculobullous umbilicated lesions, pruritic but no painful, in various stages of development, including on scalp þ Petechiae and Purpura - meningococcemia - rarely, H. Flu. þ Henoch-Schoenlein Purpura - palpable purpura on legs primarily, patient appears well, maybe from recent URI - arthritis, abdominal pain and bleeding, glomerulonephritis “ARENA” A- abdominal pain, +/- bloody stools R- purpuric rash E- edema N-nephritis A- arthralgias/ arthritis þ Petechiae above nipple line only - sometimes from severe vomiting þ Staphlococcal Rashes: Contiuous range of rashes from staph with phage: - staph impetigo (local toxin only); - staph scarlatina; - staph scalded skin; - toxic shock syndrome þ Viral Exanthem - generalized nonspecific maculopapular nonsandpapery eruption - exclude recent drug for drug rash - exclude oral mucosal lesions other than pharyngitis - exclude "bad news lesions": petechia, target lesions, bullae, vesicles þ Popsicle Panniculitis - from eating popsicles - firm, indurated, disk-like areas of erythema usually in bilateral cheeks - fat necrosis from the effect of the cold - totally benign þ Kawasaki Disease