Pediatric Dermatology Flashcards
Varicella (Chickenpox) dermatologic presentation
- Generalized pruritic vesicular rash beginning on face, neck, or
upper trunk & spreads outward - Mucous membranes may be involved
- Lesions are in different stages of healing (crops)
- Other symptoms may include fever & malaise
- Hx of contact with another infected person within
previous 10-21 days
What is a superinfection?
infection occurring after or on top of an earlier infection, especially following treatment with broad-spectrum antibiotics.
Varicella (Chickenpox) management
usually supportive
* Acyclovir may be useful in immunocompromised patients & pregnant
women
* Varicella Zoster Immune Globulin (VZIG) may be given to patients
exposed to varicella who are at risk for severe disease
* Vaccination does not prevent the disease 100% (more mild)
When are patients non infectious for Varicella (chickenpox)
Contagious from 1-2 days prior to onset, until ALL the lesions have crusted
How is Small Pox different than Chicken Pox?
- Highly contagious/fatal infection due to variola virus
- Abrupt onset of prodrome fever, malaise, & other symptoms about 10-14
days after respiratory exposure & lasting 1-4 days (patients often bedridden) - Rash follows prodrome ~1-4 days later, with lesions on mucous
membranes of mouth, tongue, & oropharynx (enanthem) appearing first
rash follows eruptive phase about 1-4 days later. - Skin lesions (exanthem) begin on face & appear on all parts of body within
24-48 hours (NO CROPS), lesion crusting complete in 2-3 wks
Rubeola (Measles) pathophysiology and transmission
- Direct viral infection of the epidermis
- Highly contagious
- Person-to-person via respiratory droplets
Rubeola (Measles) survives up to ____ hours on surfaces or in air spaces
2
Incubation period of Rubeola (Measles) =
12 days to onset of fever, & 14 until rash
Rubeola (Measles) presentation
- ↑fever, dry cough, rhinitis, conjunctivitis (clear discharge), distinctive rash
- Koplik spots are pathognomonic
- White dots on red base, buccal mucosa 1-2 days prior to onset of rash
- Rash is brick-red (dusky), raised macules & papules (morbilliform) & begins
at hairline & spreads to involve trunk, arms, legs, & eventually hands & feet
Rubeola (Measles) management
- Supportive care
- No specific antiviral therapy available
- Vitamin A 200,000 units orally once daily for 2 days may ↓ mortality in
hospitalized children with measles (mechanism unknown)
Erythema Infectiosum, Fifth Disease pathophysiology
- Multiple synonyms:
- Erythema infectiosum, “slapped cheek” disease
- Caused by Parvovirus B19 (endemic worldwide)
Erythema Infectiosum, Fifth Disease presentation
- Illness usually mild & may include low-grade fever, URI symptoms, & mild malaise-or asymptomatic
- Rash is flat, lacy, reticular, often pruritic, located on cheeks, trunk, & extremities
- Children are NOT contagious once the rash appears
Erythema Infectiosum, Fifth Disease management
- Supportive & symptomatic care
- In pregnancy, infection can lead to hydrops fetalis caused by severe fetal
anemia or fetal loss - Consider perinatology consult
Roseola presentation
– Abrupt onset of high fever which lasts for 3-7 days (occasionally
respiratory or GI symptoms are present)
– Resolution of fever is followed by development of erythematous
maculopapular rash that spontaneously resolves
– May appear 1-2 days after fever breaks
Roseola pathophysiology
- Typically results from HHV-6 (aka “6th disease”)
- Acute, benign infection
- Very common, especially in children <3 years old
- Seroprevalence in most countries approaches 100% in children over 2 years of age
Roseola management
- Supportive & symptomatic care
- Antipyretics & hydration
- Antivirals are not recommended
for an immunocompetent patients
Oral Candidiasis (Thrush)
- Most common fungal infection in
humans - Mainly affects infants or older
children in debilitated state - May occur in patients taking broad
spectrum antibiotics or steroids
(including patients taking inhaled
steroids)
Oral Candidiasis (Thrush) presentation/exam
- Symptoms: mouth soreness, refusal of feedings
- Physical exam: white curd-like plaques predominantly on buccal mucosa
- Lesions easily bleed & CAN be scraped away
Oral Candidiasis (Thrush) Management
- Treatment: Fluconazole or Nystatin oral suspension
- Remove plaques prior with moistened cotton-tipped applicator or piece
of gauze
Diaper Rash types
– Irritant diaper dermatitis
– Candidal diaper dermatitis
Candidiasis - Diaper dermatitis presentation
marginal scaling,
& “satellite pustules” in the area covered
by a diaper in an infant.
Diaper Rash management + ABCDE
Air (allow diaper-free time)
Barrier (creams/pastes)
Cleansing (only after stools)
Diapering (frequent Δ’s)
Education
- Topical medications
- Irritant diaper dermatitis
complicated by secondary
bacterial infection - Fungal diaper dermatitis
suspected to be due to
Candida albicans
Pityriasis Rosea
- Common, acute, self-limited papulosquamous skin rash of childhood
- First sign of disease is often a “herald patch” which may resemble
psoriasis or tinea corporis - Following the herald patch (1-2 weeks later) multiple, similar but
smaller scaling lesions distributed along cleavage (Langer) lines of
trunk, neck, & proximal limbs
Pityriasis Rosea presentation
- Lesions are often oval with long axis paralleling the lines of skin stress
(results in “pine tree appearance”) - Lesions resolve in 6-10 weeks & may be pruritic
- “This rash appeared but it hasn’t gone away”
