DERMATOLOGY

PAEDIATRICS
MEASLES
SIGNS AND SYMPTONS:
• Flat red spots
• Koplik Spots (tiny white spots)
Complications:
• Cough
• Coryza
• Conjunctivitis
Life threatening Complications:
• Sub Acute Sclerosing Pan Encephalitis
• Interstitial pneuemonitis
Differential Diagnosis:
• Rubeola Infantum
• Rubella
• Meningococcemia
• Scarlet Fever
Treatment:
Vitamin A
<6 months – 50000 IU
6 months – 1 year – 200000 IU
1 year – 5 year – 200000 IU
Supportive: Paracetamol, Sedatives, Bed Rest, Expectorants, Humidification of room
Chicken Pox
Signs and Symptoms:
• Tiny fluid filled vesicles
Transmission:
• Respiratory Droplets
Complications:
• Bacterial Infection
• Toxic Shock Syndrome
• Reyes Syndrome due to aspirin
• Pneumonitis
• Encephalitis
Differential Diagnosis:
• Impetigo
• Scabies
• Urticaria
Treatment
• Hydration
• Calamine lotion
• Diphenhydramine
• Paracetamol
• Antibiotics
Prevention
• Vaccine
• Isolation
• Immunoglobins for newborn with infected mother
STEVEN
JOHNSON
SYNDROME
•2 y/o with a rash which developed
when he took a medicine,
•Raised erythermatous non-purpuric
patches with central white and bluish
discoloration on limbs, on the limbs
with a few small vesicular lesions on
the calves.
There is marked conjunctivitis with
photophobia and the lips are cracked
and weeping.
• Rare, severe cutaneous drug reaction characterised by tenderness of skin/mucosa, plus exfoliation.
• Drugs responsible: NSAIDS, antibiotics, sulfa drugs, sulfasalazine, TSM, allopurinol, antiretrovirals and
antiepileptics : barbs, carbmazepine, phenytoin
Signs and Symptoms :
• Skin lesions more widespread than EM and accompanied by involvement of 2 or more mucosal surfaces (eyes, oral
cavity, upper airway or esophagus, GIT, or ano-genital mucosa)
• Fever, malaise, myalgia, arthralgias, nausea, and VD
• Nikolsky sign: lateral mechanical pressure causes epidermal detachment
• There are erosions on buccal, ocular, genital mucosae, conjunctival hyperemia, and keratitis.

Differential Diagnosis: SUEK

S: SLE, SSS
U: Urticaria
E: EM
K: Kawasaki disease
Phototoxic drug eruptions
Thermal burns
MANAGEMENT:
Rapid diagnosis and elimination of causative agent
• Ocular lesions: topical treatment (cryopreserved amniotic membrane to the ocular surface during acute phase of the
disease limits long-term sequelae
• Oral lesions: should be managed with mouthwashes, and glycerine swabs.
• Vaginal lesions: observed closely
• PAIN RELIEF: Topical anesthetics(diphenhydramine, lidocaine) provides relief from pain
• Antibiotic therapy: for secondary bacterial infection, systemic antibiotics: for urinary or cutaneous infections and for
suspected bacteremia (Staph. Aureus or Pseudomonas aeruginosa)
• High- dose IV immunoglobulin

COURSE AND PROGNOSIS:

• Mortality rate is 5%
• Outcome worse in older children
• New lesions occur in crops and complete healing may take 4-6 weeks; ocular scarring, visual impariment, and
strictures of oesophagus, bronchi, vagina, urethra or anus remain.
PREVENTION:
• Aware of drug sensitivty and possible cross reactants.
• Re-exposure to offending agent can lead to a faster, more severe SJS episode so it should be avoided
ERYTHEMA MULTIFORME
EM is characterised by ‘target lesions’ of the skin andmucous membranes most commonly precipetated by HSV.
CLASSIFICATION:
• EM Minor: mild, onset of papules, some evolve into target lesions. No prodrome or mucosal involvement.
• EM Major: associated with mucosal lesions and systemic symptoms.

CLINICAL FINDINGS:
• Skin lesions appear abruptly 3 to 14 days after precipitant (herpes labialis in 50%) and new lesions can continue to
appear for up to 10 days.
• Fever, malaise, and mucous membrane involvement.
• Skin lesions : TYPICAL 1-3CM TARGET OR IRIS LESIONS. ORAL, OCULAR, AND GENITAL MUCOUS MEMBRANES ARE
INVOLVED.
Differential Diagnosis: BUDS- VP
B: Bullous disease
U: Urticaria
D: Drug reaction
S: Secondary syphillis
V: Viral xanthems
Psoriasis

MANAGEMENT:
IN MOST CASES OF EM, THE RASH SELF RESOLVES IN 5-15 DAYS
For EM management, precipitant should be treated or removed.
• Prophylactic acyclovir (in recurrent EM cases secondary to HSV)
• Azathioprine, dapsone, or cyclosporine: in severe refractory cases
• Oral lesions: anaesthetic rinses
• Ocular lesions: topical treatment
• SYMPTOMATIC RELIEF: Systemic anti-histamines (diphenhydramine, cetrizine HCl),
emollients (vaselines, moisturisers) and topical steroids.
COURSE AND PROGNOSIS
• EM appears 3-14 days after insult (HSV, infection, drug, etc)
• Lesions can be pruritic or painful.
• Systemic systems and mucosal involvement may be present
• Typically resolves within 2 weeks with no sequelae, but recurrences are common .
SCABIES
A TRANSMISSIBLE ECTOPARASITE
INFECTION CHARACTERISED BY
SUPERFICIAL BURROWS, INTENSE
PRURITIS, AND SECONDARY
INFECTION.

A 3 y/o presents w limited HX of rash

limited to feet and ankles. The papular
rash is both pruritic and erythematous.

Lesions seem to spare face.

Areas of lichenification from repeated
scratching.
Some lesions in webbing of her hands
Other family members are also
affected.
CLINICAL FINDINGS:
• Pruritis
• Delayed hypersensitivity reaction (intensely itching popular rash) occurring 30 to 40 days
after infestation is acquired
• Burrows: scaly wavy line up to 1 cm long

MANAGEMENT:
• PERMETHRIN CREAM 5%: treatment of choice. (applied to skin from neck down,
should remain on skin for 12-24 hours)
• Lindane cream and lotion also used
• All skin-skin contacts to be treated at same time
• (systemic antibiotics in case of concomitant bacterial infection)

ETIOLOGY OF SCABIES:
Skin to skin contact
SACROPTES SCABIEIE
DERMATITIS:
Atopic Dermatitis
• 4 y/o boy has dry, scaly rash in his
antecubital and popliteal fossa.
There are areas of lichenification.
His rash becomes worse in the
winter months.
• CHRONIC PRURITIC SUPERFICIAL
INFLAMMATION OF THE SKIN
Clinical Findings
• Infancy : Red, weeping, and crusted
lesions on face, scalp, diaper area
and extremities
• Adults: erythema/ lichenification
• Dry, cracked skin
• Itchiness (pruritus)
• Rash on swollen skin
• Small, raised bumps
• Oozing and crusting
• Thickened skin
• Darkening of the skin around the
eyes
•
Management:
• Corticosteroid creams or ointments x 3
• Emollients (vaseline)
• Bathing should be minimised
• Resistant cases: oral corticosteroids

Course and Prognosis:

• Unpredictable
• Improves by 3 to 4 years of age often.
• Exacerbated by woolen garments.

Complications:
• Asthma and Hay Fever
• Food Allergies
• Chronic Itchy Scaly Skin
• Skin Infections
• Mental Health Disorders
DIAPER DERMATITIS:
Irritant diaper dermatitis:
• Candidal
• Staphylococcal

CANDIDAL DIAPER DERMATITIS:

• RED-PINK TENDER SKIN THAT HAS 1-2MM PUSTULES AND
PAPULES, at the periphery of dermatitis called satellite lesions.
• occasionally associated w oral thrush
• common sequel of oral or parenteral antibiotic
MANAGEMENT:
• Topical anti-fungal therapy

STAPHYLOCOCCAL DIAPER DERMATITIS:

• Thin walled pustules on an erythematous base
• Larger than those with candida, rupture rapidly and dry.
• Producing scaling around red base.
MANAGEMENT:
• Topical anti biotics
Dermatitis can be cleared by:
• Frequent diaper change
• Gentle, thorough cleansing of the area
• Application of lubricants and barrier pastes
TINEA CORPORIS:
• Lesions are multiple or single
• Red papules or pustules which rupture
and form papulosquamous lesions.
• PRURITIC ANNULAR LESIONS WITH
CENTRAL CLEARING

Caused by:
Trichophyton; superifical fungal infection of non-hairy skin
DIAGNOSIS:
KOH examination of the skin
TREATMENT:
• Topical anti fungal creams (ketoconazole, miconazole, cotrimazole)
• (oral therapy with griseofulvin incase of widespread lesions)
MOLLUSCUM CONTAGIOSUM
Poxvirus infection characterised by skin-colored, smooth,
waxy, umbilicated papules 2 to 10 mm in diameter.

Transmission:
Venereal, direct skin to skin contact

TREATMENT:
Destroying each lesion by freezing; by removing the central
core of the papule with a needle, a comedo extractor,
-Tip of #11 scalpel blade, or by
-Trichloracetic acid application
HERPES SIMPLEX: precipitated by over exposure to sunlight, febrile illnesses, physical or
emotional stress, or immunosuppression.

DIAGNOSIS:

1- cultures for the virus, seroconversion and a progressive increase in serum antibodies to the
sppropriate serotype
2- biopsy findings
3- Tzanck preparation of the base of a lesion often reveals multinucleated giant cells
4- HSV SHOULD BE DISTINGUISHED FROM HERPES ZOOSTER, WHICH RARELY RECURS AND CAUSES
MORE SEVERE PAIN AND LARGER GROUP OF LESIONS ALONG A DERMATOME

1- Acyclovir
2- neomycin-bacitracin ointment and systemic antibiotics (incase of secondary bacterial infection)
1- lesions may appear anywhere on the skin or mucosa but most frequent around the mouth, on the lips,
on the conjunctiva and cornea, and on the genitalia.

2- skin lesions involving the nose, ears, or fingaers, may be partocularly painful. The vesicles persist for a
few dyas, and then begin to dry forming a thin yellowish crust.

3- individual herpetic lesions may cause atrophy and scarring.

COMPLICATIONS:

1- Typical EM
2- Eczema herpeticum
HSV-1: herpes labialis, herpetic stomatitis, and keratitis.

1- gingivostomatitis
2- irritability, fever, ginigival inflammation, and painful ulcers of mouth
HSV-2:

1- Occurs on the vulva and vagina or penis of young adults. Illness accompanied by fever, malaise, and tender
inguinal lymphadenopathy. HSV-2 infection may occur in newborns and cause severe disseminated disease.
 BACTERIAL
INFECTIONS OF THE
SKIN
IMPETIGO:
There are two types of impetigo: non-bullous and bullous

Predominant organism: Staphylococcus aureus

CLINICAL FINDINGS:
1- Impetigo begins as a reddish macule that becomes vesicular. It ruptures easily, leaving superficial, moist
erosions.
2- tends to spread peripherally in sharply marginated irregular outlines.
3- heavy, honey-colored crusts.
4- pruritis is common.
5- regional adenopathy

DIAGNOSIS:
Cultures of fluid from intact blister or moist plaque.

TREATMENT: Topical bactericidal ointment.

Systemic administration of oral and parenteral antibiotics in case of extensive lesions.
COMPLICATION: PCOS

1- Pneumonia
2- Cellulitis
3- Osteomyelitis
4- Septicemia, Septic arthritis
CELLULITIS:
CELLULITIS:

1- CAUSED BY: Streptococcus pyogenes, and Staph. Aureus

2- spreading bacterial infection of the skin. Streptococci spread rapidly beneath the
skin and produce enzymes that inhibit the ability of tissue to control infection.

CLINICAL FINDINGS:

1- first symptoms are: redness, pain, and tenderness over an area of skin
2- infected skin becomes hot and slightly swollen. Fluid-filled blisters which
may be small (vesicles) or large (bulla) appear too.
COMPLICATIONS:

1- Lymphadenitis
2- Lymphangitis
3- Sepsis
4- Skin abscess

DIAGNOSIS:

1- Bacterial culture (from blood, pus, or tissue specimens)

MANAGEMENT:

1- Antibiotics (such as cephalexin) that are effective against both

streptococci and staphylococci are used.
2- IV antibiotic incase of serious infection.
ERYSIPELAS:
Erysipelas is one form of streptococcal cellulitis in which the skin is bright red or swollen. PLUS EDGES OF INFECTED
AREA RAISED.
1- superficial cellulitis
2- caused by group A beta-hemolytic streptococci.
1-Face involvement (bilaterally), arms, legs, are the most
common sites.

2-Peripheral lymphadenopathy and patches of peripheral

redness occasionally occur.

3- high fever, chills and malaise are common. Erysipelas

COULD BE RECURRENT AND RESULT IN CHRONIC
LYMPHEDEMA.

MANAGEMENT:

1- Penicillin V or erythromycin given for 2

weeks.
•STAPHYLOCOCCAL SCALDED SKIN
SYNDROME:

•1- Acute, wide spread erythema and

epidermal peeling caused by staphylococcal
exotoxin.

2- SSSS almost always occurs in infants. <6 y/o ,

immunosuppressed children
1- Group 2 coagulase-positive staphylococci are
responsible that excrete exfoliatin

INFANTS: LOCALISED CRUSTED INFECTION

(IMPETIGO-TYPE) AT THE DIAPER AREA OR THE
UMBILICAL STUMP

SPORADIC CASES: START WITH SUPERFICIAL

CRUSTED LESION AROUND NOSE OR EAR

PAINFUL, BLISTERS ARISE ON ERYTHEMATOUS

SKIN, BREAK TO PRODUCE EROSIONS

MALAISE, CHILLS, FEVER. Loss of protective skin

barrier leads to sepsis, fluid and electrolyte
imbalance.

NIKOLSKY’S SIGN: EPIDERMIS PEELS OFF EASILY

(IN LARGE SHEETS, WHEN RED AREAS ARE
RUBBED)
DD:

1- Drug hypersensitivity (TEN)

2- Viral exanthemas
3- Scarlet fever

1,2,3 do not cause a painful rash

4- Acquired Bullous diseases (pemphigus vulgaris,

bullous pemphigoid)
5- Genetic bullous diseases (epidermolysis bullosa)
6- Thermal burns

4,5,6 have bullae, erosions and easily losened epidermis

MANAGEMENT:

1- Systemic penicllinase-resistant anti-staphylococcal antibiotics (cloxacillin, dicloxacillin, cephalexin)

2- Incase of widespread disease: treat skin as if it were burned: hydrolysed polymer gel dressings.
Replacement of stratum corneum and healing within 5 to 7 days.
 NEONATAL
DERMATOLOGY
MONGOLIAN SPOTS:
ERYTHEMA TOXICUM:
CUTIS MARMORATA:
MILIA:
SCLEREMA: