RASH
DECISIONS
ETHAN PETTIT, D.O. FAAP
ERYTHEMA TOXICUM
Up to 60% of Term infants
Healthy infants
Vesicles/pustues with ring of red around
E=E
• Erythema toxicum=Eosinophils
Typically gone by 7 days
PUSTULAR
MELANOSIS
NEONATAL HSV?
INFANT NEVUS
Dilated fetal capillaries
• 40% of newborns
Flat, dull, pink
Front and back
• 95% of front will fade
• 50% of back will fade
PORT WINE STAIN
NEVUS FLAMMEUS
Caution to Face distribution
Laser treatment
HEMANGIOMAS
HEMANGIOMAS
Benign Proliferation of endothelial cells.
1-3% at birth
10% Caucasians by 1 year
More females than males
More common in preterm or SGA
HEMANGIOMAS
Proliferation
• Up to year
Stabalization
Involution
• Typically after 2
HEMANGIOMAS
TREATMENT
Location
• Cosmetic vs Dangerous
Large
Ulcerated
ECZEMA
ATOPIC DERMATITIS
TINEA VS ECZEMA
ECZEMA TREATMENT
Moisture, Moisture, Moisture
• Eucerin, Aquaphor, Cedophil, Aveeno, Vanicream
• RIGHT out of the bath
Wet to dry wraps
ECZEMA TREATMENT
Steroids
• Creams:
• Hydrocortisone 1%, 2.5%
• Triamcinolone
• Desonide
• Sometimes oral steroids
ECZEMA TREATMENT
Secondary infections
Cut nails short
Bleach water baths (1/2 cup per tub)
ECZEMA HERPETICUM
ECZEMA HERPETICUM
TREATMENT
Treat the HSV,
Watch for bacterial infection as well
SEBORRHEA
Cradle cap
Scaly
Greasy
Usually not itchy
SEBORRHEA TREATMENT
Dandruff shampoo
Antifungal cream
Low potency steroid cream
KERATOSIS PILARIS
HIVES
HIVES TREATMENT
Steroids can help in extreme cases
Antihistamines
• Benadryl
• Zyrtec
• Hydroxizine
CHRONIC HIVES
May or may not have an identifiable trigger
Allergy testing
Most resolve within a few years
PITYRIASIS ALBA
PITYRIASIS ALBA
Often starts with erythematous lesions
Leaves behind hypopigmented lesions
Limited treatment options
• If topical steroids used with initial lesions, may prevent
hypopigmented
• UV sun protection
PITYRIASIS ROSEA
Benign
Self limited
• Sometimes 6-8 weeks
Herald Patch
Christmas Tree pattern
INFECTION RASHES
IMPETIGO
IMPETIGO
Staph and Strep
Typically honey crusted
Often the face
IMPETIGO
TREATMENT
Topical
• Mupirocen
• Don’t forget the nose
Topical not enough
• Cephalexin
Sometimes MRSA
HERPES SIMPLEX
SCARLET FEVER
VIRAL EXANTHEM
SSSS
STAPH SCALDED SKIN SYNDROME
Toxin mediated
Tender skin
Shearing skin
Lack of mucosal involvement
compared to SJS or TEN (deeper)
MENINGOCOCCEMIA
HENOCH SCHONLEIN PURPURA
KOH
TINEA VERSICOLOR
TINEA VERSICOLOR
KOH (spaghetti and meatballs)
Treatment
Selenium Sulfide
Topical antifungal
ACNE
Gentle Cleanser
Benzoyl Peroxide
Epiduo
Topical Retinoids
Retin A
may take 6-8 weeks
BUG BITES
SCABIES
SCABIES TREATMENT
5% Permethrin
Bedding cleaned in AM
Treat all family members (even if not symptomatic)
BED BUGS
FLEAS
STINGS
LOCAL REACTION
WARTS
WART TREATMENT
Cryotherapy
care to nail beds
Salicylic Acid
Tape
Abrasion
CALLUS
MOLLUSCUM
NEUROCUTANEOUS
NEUROFIBROMATOSIS
TYPE 1
Café au lait macules
6 or more
Neurofibromas
often not until after puberty
Lisch nodules
CAFÉ AU LAIT
NEUROFIBROMAS
LISCH NODULES
TUBEROUS SCLEROSIS
TS ANGIOFIBROMAS
ACKNOWLEDGMENTS
Kelly McClean MD, Michigan Board Review
Robert Colman MD, Whitney Molis MD, Pediatric and Adult
allergy P.C.
http://www.onlinedermclinic.com
http://hardinmd.lib.uiowa.edu/pictures22/dermnet/
http://www.skinsight.com/images
http://dermatlas.com
http://dermnet.com
http://dermatologyoutlines.com
http://www.allergyasthmamichigan.com
http://0.tqn.com/w/experts/Dermatology
Google images