 The most effective treatment to





eliminate the lesions seen here:
A Topical steroids
B Oral antibiotics
C Treatment of home for fleas
D 5% Permethrin cream to all
household members
E Oral antihistamines
 Think about distribution (exposure)
 Bites on face may be atypical
 Red
 Pruritic
 Soft and nontender
 Intense, hemorrhagic reaction possible
 Fleas: some members of household “spared”
 Clusters of 3
 Grass or sand mites: localized blisters
 More intense reaction
 Erythema and induration
 Ecchymotic
 Painful
 Pruritic
 Vesciculate
 Central necrosis with eschar
 Brown Recluse
 Local pain, erythema, edema within
2hrs
 Honey Bee
 Stinger in skin
 Releases venom for an hour
 Scrape horizontally with fingernail or
card
 Late onset edema
 Peak 48-72hrs
 Delayed hypersensitivity
 Pruritic, painful
 Treatment
 Paste of meat tenderizer and
water
 Symptomatic treatment
 Risk of anaphylaxis




Known history
Mastocytosis
Education on avoidance
EpiPen
 Timing
 Young children
 Chronic/recurrent
 Description
 Highly pruritic papules and wheals
 Central punctum
 Vesiculate centrally
 3-10mm diameter
 Resolution:
 central crust with collarette of scale
 After 4-6wks: target-shaped macule
 Linear or triangular clusters
 Exposed areas
 Cause
 Hypersensitivity to fleas, bedbugs, mosquitoes
 Fleas and bedbugs are not seasonal
 Only youngest child in family may be affected
 >1y/o
 May experience “reactivation”
 New bites incite delayed hypersensitivity at old sites
 Treatment
 Identification and
avoidance of insect
 Repellent
 Topical steroids
 Oral antihistamines
 Good hygiene (secondary
infections)
 Cause
 Mite: Acarus scabiei
 Burrows beneath skin
 Hypersensitivity reaction
 Timing
 4-6 wks after initial contact
 Description
 Intensely pruritic papules, vesicles, pustules, linear
burrows
 fingers/ webs of toes, flexor regions, nipples, waist,
groin/buttocks, palms/soles
 Infants: intense and persistent nodular reaction
 Excoriation and secondary infection
 Diagnosis
 Clinical
 Skin scrapings: mite, eggs, feces
 From linear burrow (black speck)
 Treatment
 5% permethrin (Elimite)
 All household members
 Wash all linens
 Repeat 1 wk later
 Crab lice (Phthirus pubis)
 Sexually transmitted
 Eyelashes and pubic hair
 Bites
 Bluish, pruritic papules: lower abd and
upper thighs
 Intense pruritis
 Children
 Scalp or eyelashes
 Body lice (pediculus humanus corporis)
 Bedding or clothing
 Bites
 Urticarial papules
 Waist, neck, shoulders, axillae
 Excoriations/ secondary infection
 Head Lice (pediculus
humanus capitis)
 Most common
 Excoriations of scalp and
neck
 Occipital adenopathy
 Nits: oval, white 0.5mm dot
glued to hairshaft
 Above and behind ears
 Nonviable shells may
remain attached after
treatment
 Treatment:
 Pediculicide topically (all household members)
 Permethrin cream
 Malathion lotion (second line…flammable)
 Lindane: contraindicated in young… neurotoxic
 Cleaning of linens/clothing
 Nits:
 Diluted vinegar rinse
 Fine-toothed comb
 Acne vulgaris
 Disorder of pilosebaceous apparatus
 Cause: Unknown
 Abnormal follicular keratinization
 Driven by androgens
 Propionibacterium acnes
 Treatment
 Topical retinoic acid, benzoyl peroxide, abx
 Severe: oral abx with topical agents
 The most reliable way to distinguish
these lesions from other lesions
frequently seen on the sole of the
foot:
 A Black dots indicate corns that have received trauma
 B Interruption of dermatoglyphics indicate plantar warts
 C Superficial scaling indicates callus formation
 D Boggy texture indicates plantar warts
 HPV
 Fingers, hands, feet
 Plantar wart: Larger than appearance
 Painful w walking
 Interrupts dermatoglyphics
 Incubation 1-6mos
 Disappear spontaneously over 5yrs
 Local trauma: inoculation of virus
 Periungual common
 Characteristic appearance
 Black dots (thrombosed
capillaries)
 Condylomata acuminata
 Anogenital warts
 Consider sexual abuse
 Controversial <age 3 (vertically
acquired)
 Treatment
 Duct tape
 Salicylic acid
 Pox virus
 Description:
 Dome-shaped papules with
waxy surface
 Single or multiple
 May be pruritic
 5mm
 Location: trunk, face, axillae,
genital area
 Spread by scratching (linear)
 Curdlike core can be expressed from center
 Course: spontaneous remission 2-3yrs
 Treatment
 Watchful waiting
 Curetting after topical anesthetic
 Especially in poorly controlled eczema
 Pathological proliferation of mast
cells in skin
 Other organs involved as well
 Darier sign
 When lesion (or skin) rubbed,
urticaria develops
 Histamine release following trauma to
superficial mast cells
 May form blisters
 75% identified by age 2
 Urticaria pigmentosa
(most common form)
 Oval or round red-brown
 Macules, papules, plaques
 Solitary or innumerable
 Resemble
 Nevi, pigmentary alteration, CALMs
 May be associated with GI symptoms
 Hypotension in severe cases
 Other organ systems can be
affected
 Treatment
 Usually resolves in childhood
 Symptomatic treatment
 Antihistamines
 Immunosuppresants in severe
cases
 Extensive workup rarely needed
 AKA: Nevoxanthoendothelioma
 Present at birth (w/in 1st year)
 Grow slowly and become more yellow
 Benign proliferation of non-Langerhans cell
histiocytes
 Brown to yellow color: lipid-laden histiocytes
 Benign
 Primarily in whites
 Usually solitary nodular lesion
 Multiple small papular lesions possible
 4% extracutaneous
 Iris
 Other locations
 Associations/Complications
 Glaucoma
 Myelomonocytic leukemia
 Nontraumatic Hyphema
 No specific gene defect
 NF-1
 Urticaria pigmentosa
 Niemann-Pick
 Treatment
 Watchful waiting
 Resolve 5y/o
 Surgical excision
 Steroids +/- chemo
 Abnormal immunity
 T-Cells, Neutrophils
 High IgE and eosinophils
 Chromosome q4
 AD
 Variable expressivity
 Description
 Pruritic
 S. aureus superinfection
 Weeping, crusting, cutaneous abscesses
 Abscesses (little pain and inflammation)
 Mucocutaneous candidiasis
 Timing
 Shortly after birth
 Course
 Recurrent focal bacterial
infections
 Decreased bone density with
multiple fractures
 Little pain
 With age: scoliosis and
coarsening of facial features
 Treatment
 Control infections