Pediatric dermatology
Differences in adult and neonatal skin
Adult Skin
Neonatal Skin
Surface
Dry
Vernix (gelatinous)
Full thickness
2.1 mm
1.2 mm
Epidermal
thickness
> 50um
40-50 um
20-25 um in premature
Dermoepidermal
Junction
Ridged
Flat
Dermis
Normal
Less collagen &
elastic fibers
Melanosomes
Normal
Fewer
Hair
Normal
Less
Classification of pediatric skin diseases






Infective disorders:
Bacterial, Viral, Fungal
Infestations:
Scabies, Pediculosis, Parasitic
Inflammatory/ Immunological disorders:
Eczemas, Psoriasis, Lichen planus
Genetic/Nevoid disorders :
Hemangiomas, Linear epidermal nevus,
Epidermolysis bullosa, Tuberous sclerosis,
Neurofibromatosis, etc.
Neoplastic disorders:
Langerhans cell histiocytosis, Mastocytosis
Neonatal Dermatoses
Physiological
•
Vernix caseosa
• Mongolian spot
• Physiological scaling
• Sebaceous hyperplasia
• Sucking blisters
• Physiological jaundice
• Miliaria
• Milia
• Erythema toxicum neonatorum
• Transient neonatal pustulosis
• Neonatal Acne
Mongolian spot

Single or multiple slate gray or blue macules of
size 3 to 10 cms

Seen at birth

Seen over lumbosacral region, buttocks,
shoulders

Fade within the first 3-4 years of life
Physiological scaling

Seen in 75% normal infants

Occurs within first week of life

First around the ankles, later on hands and feet
and soon becomes generalized

Maximum intensity by eighth day, subsides by
3-4 weeks

No treatment required
Sucking blister

One or two solitary blisters

Present at birth

Seen over fingertips / hands / forearm

Caused by vigorous sucking

Heals rapidly without treatment within 2 weeks
of life

Differential diagnosis: Herpes simplex, Bullous
impetigo, Epidermolysis bullosa
Miliaria
Superficial vesicles resulting from sweat retention
in stratum corneum
A. Miliaria crystallina:

Following fever, phototherapy

Tiny clear vesicles seen over forehead, neck

Erythema absent

Peels off within 24 hrs
Miliaria
B. Miliaria rubra (prickly heat)

Seen in hot weather

Non follicular papules on erythematous base

1 to 4 mm in diameter

Trunk, face

Subside in 2 to 3 days

Itching, secondary infection is common
Infantile and Childhood dermatoses
Infective and inflammatory diseases have been
discussed in respective chapters. Certain common
and genetic-naevoid conditions seen in infants and
children will be discussed including:

Cradle cap, Diaper dermatitis

Nevus depigmentosus, Linear epidermal nevus

Haemangiomas, Vascular malformations

Sturge Weber syndrome

Neurofibromatosis, Tuberous sclerosis

Epidermolysis bullosa

Ichthyosis
Cradle cap

Seborrhoeic dermatitis of scalp

Thick, greasy, adherent scales on scalp

Commonly begins in the first 3 months

Self limiting

Apply oil for few hours to soften scales, rinse, 1%
hydrocortisone cream can be used
Diaper dermatitis (Napkin rash)

Irritant dermatitis in the perineal region

Due to occlusion, fricton and prolonged skin
contact with urine, faeces and fabrics

Wetness leads to maceration of skin

Secondary infection by C.albicans is common
Nevus Depigmentosus

Single, well circumscribed, hypopigmented or
depigmented macule or patch

Seen at birth

Stable in size and distribution

Seen over trunk and proximal extremities
Linear epidermal nevus

Congenital hamartomas of embryonal ectodermal
origin

Seen in early childhood as a linear raised warty
lesion

Located over neck, trunk and extremities
Hemangiomas

Incidence more in preterm infants

Female predilection

Begin at one month of age

Undergo a proliferative phase followed by
stabilization and eventual spontaneous involution
Complications

Ulceration, bleeding

Secondary infection

Mutilation and scarring

Cosmetic disfigurement
Vascular malformations

Stable dilatations of superficial or deep
vasculature

Can be capillary, arterial, venous, lymphatic or
mixed
Clinical types:

Salmon patch

Portwine stain

Sturge-Weber syndrome

Klippel-Trenaunay syndrome
Salmon Patch

Present in 30 to 40% of neonates

Superficial, red or pink flat lesions

Seen over forehead, upper eyelid, glabellar area,
nape of neck

Resolution in first year of life
Portwine Stain (Nevus flammeus)

Present at birth

Common sites are face, neck and mucous
membrane

Flat pink-red lesion

Sharply unilateral in distribution

Persist in childhood and darker in adulthood
Complications

Glaucoma, Choroidal angiomas
Sturge-Weber Syndrome

Portwine stain in distribution of first branch of
trigeminal nerve

May be associated with seizures, ipsilateral
glaucoma, behavioral problems, mental
retardation

Characteristic intracranial S-shaped calcifications
Neurofibromatosis (NF)

Riccardi classified NF into eight distinct clinical
types in 1982

Autosomal dominant disorder

Affects skin, soft tissue, nervous system, bone,
other organs

Classical skin lesions are café au lait macules,
neurofibromas
Neurofibromatosis - 1
(Von Recklinghausen’s disease)
Diagnostic criteria for NF-1
Presence of two or more of the following:

Six or more café au lait macules larger than 5 mm

Two or more neurofibromas of any type or 1
plexiform neurofibroma

Axillary or inguinal freckling

Two or more Lisch nodules (brown coloured small
nodules on iris surface)

Optic glioma

A distinctive osseous lesion

A first-degree relative with NF-1
Neurofibromatosis - 2

Bilateral acoustic neuromas

Multiple CNS tumors

Few café au lait macules

Few neurofibromas

No axillary freckling

No Lisch nodules
Tuberous sclerosis (Bourneville’s disease)

Syn. EPILOIA (Epilepsy, Low IQ, Adenoma
sebaceum)

Ash leaf macules/ hypopigmented macules

Adenoma sebaceum (angiofibroma) begins at

2-5 years of age as small pink papules on midface

Shagreen’s patch (yellowish brown plaque on
lumbo - sacral area)

Koenen’s tumors (periungual fibroma)

Mental retardation

Seizures
Epidermolysis bullosa

Inherited bullous disorders characterized by
blister formation in response to mechanical
trauma

Onset at birth or shortly after

Seen on sites of trauma and friction

Types: Simple, Junctional, Dystrophic

Some subtypes, especially the milder EB forms,
improve with age

Autosomal recessive types have bad prognosis
with severe mucosal, esophageal involvement
and atrophic scarring of skin
Ichthyosis









Inherited disorder of keratinization
Characterized by the accumulation of scales on the
skin surface, dry skin
Fish like scales most prominent over the trunk,
abdomen, buttocks and legs
May be associated with ectropion, eclabion, nail
dystrophy, internal organ involvement
Types:
Ichthyosis vulgaris
X-linked ichthyosis
Lamellar ichthyosis
Collodion baby / Harlequin fetus
Adolescent Dermatoses

Acne

Dandruff

Striae

Pseudo-acanthosis nigricans

Contact dermatitis to cosmetics, perfumes,
artificial jewellery / accessories (metals)

Hyperhidrosis
Acne vulgaris

Characterized by comedones, papules, pustules
and nodules

Common in males

Seen around puberty

Sites: face, upper part of the chest, back,
shoulders
Complications

Psychological impact

Hyperpigmentation

Scarring
Dandruff (Pityriasis sicca/capitis)

Most common condition affecting the scalp

Causative organism: Malassezia species

Seen as mild, moderate or severe scaling of scalp

May or may not associated with itching

Simple dandruff does not cause hair loss
Striae (stretch marks)

Seen as pinkish white lines around knees, axillae,
outer aspect of thighs, lumbosacral region

Sudden increase in height or weight causes
rupture of connective tissue beneath an intact
epidermis
Pseudo-acanthosis nigricans

Weight gain in puberty produces dark, thick,
velvety skin in neck, axillae, groins

Asymptomatic
Side effects of cosmetic products

Cosmetic products like eye liner, ‘fairness’
creams, lipstick, nail polish, henna can produce
contact reactions

Reactions may be immediate or delayed
Types of reactions

Folliculitis

Acneiform eruptions

Contact dermatitis

Pigmentary changes
Child abuse

Includes physical abuse, neglect, sexual
exploitation
Cutaneous manifestations
 Bruises
 Traumatic
 Thermal
alopecia
burns
 Sexual
abuse: Vaginal tears, anal tears,
hematomas
 Sexually
transmitted infections
Care of newborn

Gentle handling

Avoid frictional trauma

Use gentle soaps, cleansers

Too frequent bathing may lead to dryness

Maintain hygiene after feeds, diaper changes

Keep body folds dry and ventilated
Skin care in pre-terms

Gentle handling

Use adhesive tape sparingly

Avoid frictional trauma
General principles of skin care in children
Bathing, soaps and cleansers
 There is no need to use special cleansing
products
 Excessive cleansing, scrubbing and incomplete
rinsing lead to irritation
Shampoos
 Should be isotonic to tears and less irritating to
eyes
 Shampooing twice a week controls normal flaking
Care of the diaper area
 Frequent diaper changes with gentle cleansing
and limiting use of plastic or rubber diaper cover
Differences in treatment of
Paediatric and Adult Patients

Conservative management is best

Surface area is more in children as compared
with adults

Percentage of absorption of topical drugs is
more

Try to use lowest effective dose of medications

Do not use treatments which may retard growth
or mental development

Avoid off-label uses of medications
Thank you