Pediatric Rashes

Question 1

Symptoms of Atopic Dermatitis?

Answer 1

Dry plaques of itchy skin

Question 2

Preventative Treatment options for Atopic Dermatitis

Answer 2

Maintenance of skin care, designed to repair and maintain a healthy skin barrier
Topical anti-inflammatory medications to suppress inflammatory responses
Itch control
Managing infectious triggers
Bathing and lubricating
Overhydrating- bonds between cells are broken
Bathing – warm water, avoid prolonged baths, and bubble baths
Apply lubrication within 2 minutes after bath
Baths containing baking soda or colloidal oatmeal relieve pruritus
Dilute bleach baths 5-10 minutes twice weekly
Environmental humidity

Question 3

First line treatment for Flares Atopic Dermatitis

Answer 3

Topical Steroids- Class VII is least potent
Moderate Potency (class III, IV, and V) is go to for everyday practice

Question 4

What corticosteroids are okay to go on the face?

Answer 4

Low-potency used on areas with thin stratum corneum such as face, skin folds, diaper area, infants

Question 5

1st line treatment options for Mild Acne

Answer 5

Benzoyl peroxide or topical retinoid -or- topical combination

Question 6

Symptoms of Impetigo

Answer 6

1. Nonbullous, classic, or common impetigo begins as 1- to 2- mmerythematous papules or pustules that progress to vesicles which rupture leaving moist, honey-colored crusts on the lesions
2. Bullous impetigo occurs sporadically, develops on intact skin and
   is more common on infants and young children

Question 7

Common pathogens of Impetigo

Answer 7

S. aureus and S. pyogenes (GAS) normally coexist so treat

both

Question 8

Involvement of skin with Impetigo

Answer 8

Superficial layers of skin (epidermis); face hands, neck,

extremities or perineum

Question 9

Treatment for Impetigo

Answer 9

Topical antibiotics if minor (nonbullous, localized to one
area - bacitracin, mupirocin
Oral antibiotics recommended for multiple lesions or
nonbullous impetigo with infection in multiple family
members, childcare groups or athletes-
amoxicillin/clavulanate 50 to 90 mg/kg/d for 7-10 days
cephalexin: 40 mg/kg/d for 7 to 10 days

Question 10

If there is concern for MRSA with Impetigo what antibiotic is used?

Answer 10

Clindamycin: 10 to 25 mg/kg/d for 7 to 10 days

Question 11

Physiology of Cellulitis

Answer 11

Results from a previous skin distribution at the site or recent URI.

Question 12

Symptoms of Cellulitis

Answer 12

fever, pain, malaise, irritability, anorexia, vomiting, and
chills; recent sore throat of respiratory infection

Involvement:
Tender, swollen, warm areas of skin with poorly
demarcated boarders

Question 13

Common Pathogens with Cellulitis

Answer 13

Staphylococcus aureus, Group A strep, H influenzae

Question 14

Treatment of Cellulitis

Answer 14

Hospitalization is recommended if the child is a neonate or
febrile infant, is acutely ill or toxic, or has periorbital
cellulitis
Neonates require full septic work up and initiation of
empiric vancomycin
Streptococcal infection: penicillin 20-50 mg/kg/d q 6-
8 hrs for 10 days
Staphylococcus: Trimethoprim-sulfamethoxazole 8
to 12 mg/kg/d given BID if the child is > 2 months

Question 15

Symptoms of Tinea Capitis

Answer 15

Slight scale suggesting “dry scalp”, mild eczema, mild
seborrhea. Papule at base of hair follicle, becomes
pustular. Alopecia either patchy or in circles with broken
off hairs (“salt and pepper”). Occipital adenopathy. Large
fungating tender mass with purulent drainage (kerion)

Question 16

Treatment of Tinea Capitis

Answer 16

TOPICAL ANTIFUNGALS ARE INEFFECTIVE  Griseolfulvin: Griseofulvin approved by the FDA (25 mg/kg/day for
6 to 8 weeks is current practice by pediatric
dermatologists???)
AND either 2% ketoconazole or 1% selenium
sulfide to reduce shedding of spores and reduce
transmission. May also be used on asymptomatic
family members

Question 17

Signs and Symptoms of Tinea Corporis

Answer 17

Superficial fungal skin infection found on the non-hairy skin of the body. Annular, oval, or circinate pattern with 1+ flat, scaling, mildly erythematous circular patches or plaques with red, scaly borders. Lesions spread peripherally and clear centrally. Often prominent over hair follicles

Question 18

Treatment of Tinea Corporis

Answer 18

topical antifungals such as miconazole or clotrimazole

usually effective

Question 19

Areas of Involvement with Tinea Versicolor

Answer 19

Trunk, neck, and arms

Question 20

Symptoms of Tinea Versicolor

Answer 20

1. Mildly pruritic or not

2. Common in hot, humid areas and in those who sweat a lot (active teen boys in the summer)

Question 21

Organisms involved with Tinea Versicolor

Answer 21

Etiology: yeast (malassezia furfur)

Question 22

Treatment of Tinea Versicolor

Answer 22

topical antifungals, keratolytics, or oral (ketoconazole)
antifungals.
Selenium sulfide 2.5% lotion or 1% shampoo
applied in a thin layer sever hand widths beyond lesions
for 30 minutes twice a week for 2-4 weeks followed by
monthly applications for 3 months
Recurrence is common

Question 23

S&S of Herpes Simplex 1

Answer 23

High fever and severe mouth pain

Involvement
Tongue, buccal mucosa, gums, tonsils, palate, lips and skin around mouth. Gums swollen and friable (if child has teeth) Vesicles which rupture to ulcers.
Foul odor, bleeding and fissuring of lips
Submental adenopathy

Question 24

Treatment of HSV 1

Answer 24

Acyclovir may shorten course if started early 20 to 20
mg/kg/dose orally 5 times x day for 5 days max of
1000mg/day

Question 25

S&S of PEDICULOSIS

Answer 25

Lice in the head, body, or pubic area. Itchy

Question 26

Treatment of Pediculosis

Answer 26

Apply pediculicide: permethrin 1% or pyrethrin plus piperonyl butoxide Second step remove nits with fine tooth comb, Third step cleanse the environment May return to school after pediculicide treatment

Question 27

S&S of Scabies

Answer 27

Insect infestation: sarcopti scabeii Finger and toe webs, wrists, axilla, genitalia, burrows intense itching that is worse at night, Characteristic lesions include curving S-shaped burrows, especially on webs of fingers and sides of hands, folds of wrists and armpits, forearms, elbows, and belt line, buttocks, genitalia, or proximal half of foot and heel

Question 28

Treatment for Scabies

Answer 28

Treated with permethrin (whole family for as young as 2 months old – apply a thin layer to entire body, excluding the eyes and reapplied in 7 days) Can use antihistamine cream for itching

Question 29

S&S of Molluscum Contagiosum

Answer 29

Benign, common childhood viral skin infection with little health risk Untreated lesions usually disappear within 6 months to 2 years but may take up to 4 years to completely disappear Not always treated

Question 30

S&S of Seborrheic Dermatitis

Answer 30

Chronic inflammatory dermatitis r/t overproduction of sebum Infants – erythematous, flaky to thick crusts of yellow, greasy waxy appearing scales on the scalp and face, behind ears Adolescent – mild flakes with some erythema and yellow greasy scales on the scalp, forehead, nasal bridge, and eyebrows Not pruritic and has no pustules

Question 31

Treatment of Seborrheic Dermatitis

Answer 31

Cradle cap – mineral oil may be applied to scalp for 5-10 minutes before shampooing; scales can be removed with a soft brush or toothbrush; frequent shampooing is generally effective; no medicated shampoos approved for under 2 years old If facial dermatitis – daily ketoconazole, low dose corticosteroids, calcineurin inhibitors

Question 32

S&S of Diaper Dermatitis

Answer 32

red rash on the buttocks or diaper area

Question 33

Treatment of Diaper Dermatitis

Answer 33

Topical antifungal applied to skin at every diaper change until rash is gone plus an additional 1-2 days (nystatin, miconazole, clotrimazole, ketoconazole, ciclopirox); avoid antifungals with steroids combos; keep area dry and cool, avoid powders and rubber pants Or 1% hydrocortisone if no yeast is present