Pediatric dermatology

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Chapter 58 Pediatric dermatology

Joseph G. Morelli, MD

1. What is the most common skin disease seen in children?

Acne vulgaris is the most prevalent skin condition observed in the pediatric age group, with two peaks of onset. The first is in the neonatal period, and the second is during adolescence.

2. Name the papulopustular facial eruption often associated with inappropriate topical steroid use.

Periorificial dermatitis is a perioral, periorbital, and perinasal, erythematous, slightly scaling papulopustular eruption seen most commonly in preschool children. Treatment of this condition is the discontinuation of topical steroids and the use of the same oral or topical antibiotics that are used for acne vulgaris. Tetracycline and derivatives should not be used in children under 8 years of age.

Nguyen V, Eichenfield LF: Periorificial dermatitis in children and adolescents, J Am Acad Dermatol 55:781–785, 2006.

3. At what age does atopic dermatitis typically begin?

Atopic dermatitis generally first appears between 1 and 4 months of age. By adolescence, over 90% of people who get atopic dermatitis will have manifested the disease.

4. What is the natural history of atopic dermatitis?

By grade school, only one third of children who had atopic dermatitis will continue to have difficulties with the disease. By adolescence, 90% will no longer have symptoms of atopic dermatitis.

5. What organism commonly complicates irritant diaper dermatitis?

Candida albicans. It can be expected to superinfect any diaper dermatitis that has been present for 3 or more days.

6. Red, scaly, itchy, weight-bearing skin surfaces of the feet in children are usually not due to tinea pedis, but to what?

Juvenile plantar dermatosis. This is a nonspecific dermatitis with a debatable relationship to atopic dermatitis. The disorder may persist for months or years but ultimately clears spontaneously during childhood or adolescence (Fig. 58-1).

7. Plant dermatitis, such as poison ivy, is the most prevalent cause of allergic contact dermatitis in children. What are some others?

Neomycin, nickel, and potassium dichromate.

8. One- to 2-mm keratotic papules located on the face, outer upper arms, and thighs are frequently misdiagnosed as folliculitis. What are they really?

Keratosis pilaris. It may be inherited as an autosomal dominant disease or be associated with xerosis and/or atopy. The keratotic plugs are composed of corneocytes and sebum. Keratosis pilaris often spontaneously clears in adulthood.

9. What is the most common cutaneous bacterial infection in children?

Impetigo. This common, contagious, superficial infection is due to streptococci, staphylococci, or a combination of the two organisms.

10. What two organisms are most often responsible for tinea capitis?

Trichophyton tonsurans and Microsporum canis.

11. How is tinea capitis treated?

Oral griseofulvin is the treatment of choice. Oral terbinafine and itraconazole are also used. Topical antifungals have no role in the treatment of tinea capitis. Some authorities recommend twice-weekly shampooing with 2% selenium sulfide or ketoconazole shampoos as a useful adjunctive therapy to griseofulvin, because it is sporicidal and may prevent spread to other children and family members.

image

Figure 58-1. Juvenile plantar dermatosis. Characteristic hyperkeratosis and shiny appearance, with tendency to affect the ball of the foot and the toe pads.

(Courtesy of the Fitzsimons Army Medical Center teaching files.)

Trovato MJ, Schwartz RA, Janniger CK: Tinea capitis: current concepts in clinical practice, Cutis 77:93–99, 2006.

12. What is the hypersensitivity reaction to tinea capitis that is commonly mistaken for a bacterial superinfection?

This very inflammatory condition is called a kerion.

13. Name the three conditions most often misdiagnosed as tinea corporis.

The herald patch of pityriasis rosea, nummular dermatitis, and granuloma annulare.

14. What percentage of children with psoriasis will have guttate psoriasis?

Although psoriasis vulgaris is still the most common type of psoriasis in childhood, up to one third of children with psoriasis will have guttate flares. Guttate psoriasis is most often associated with streptococcal pharyngitis but may also be seen following perianal streptococcal infections.

Tollefson MM, Crowson CS, McEvoy MT, Maradit Kremers HM: Incidence of psoriasis in children: a population-based study, J Am Acad Dermatol 62:979–987, 2010. [Epub ahead of print.]

15. Describe the rash associated with childhood dermatomyositis.

A malar photosensitive rash, with red flat-topped papules on the knuckles (Gottron’s papules) and edematous plaques on the elbows and knees, is often seen in childhood dermatomyositis (Fig. 58-2). Unlike adult disease, childhood dermatomyositis is not related to internal malignancies.

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