Common Pediatric Skin and
Soft Tissue Conditions
Sirous Partovi, M.D.
Erythema Toxicum
Neonatorum
Impressive title - harmless skin condition
Erythematous macule with a central tiny papule,
seen anywhere - except the palms and soles.
The lesions are packed with eosinophils, and
there may be accompanying eosinophilia in the
blood count.
The cause is unknown, and no treatment is
required as the rash disappears after 1-2 weeks.
Miliaria
Prickly heat, sweat rash
Many red macules with central papules,
vesicles or pustules are present.
These may be on the trunk, diaper area,
head or neck.
Subcutaneous Fat Necrosis
Self limited, benign condition
Sharply demarcated reddish to violaceous
plaques or nodules
Etiology uncertain
Onset first few days- weeks of life
Cheeks, back, buttocks, arms, and thighs
Infantile Atopic Dermatitis
Cause is unknown
Red, itchy papules and plaques that
ooze and crust
Sites of Predilection
Face in the young
Extensor surfaces of the arms and legs 810 mo.
Antecubital and popliteal fossa , neck, face
in older
Differential DiagnosisAtopic Dermatitis
Seborrheic dermatitis
Contact dermatitis
Nummular eczema
Psoriasis
Scabies
Eczema- Treatment
Avoidance or elimination of
predisposing factors
Hydration and lubrication of dry skin
Anti-pruritic agents
Topical steroids
Seborrheic Dermatitis
Common, generally self-limiting
Its cause remains ill-understood
There is a genetic predisposition
Most frequent between the ages of 1 to 6
mo.
Greasy, salmon-colored scaling eruption
Hair-bearing and intertriginous areas
The rash causes no discomfort or itching
Seborrheic DermatitisTreatment
Anti-seborrheic shampoo
Topical steroids
Pityriasis Rosea
Mild inflammatory exanthem of
unknown cause, maybe viral
Benign, self limited disorder
Occasionally there are prodromal
symptoms including malaise, headache,
sore throat, fatigue, and arthralgia.
Herald patch- pink in color and scalymimicking tinea corporis
Diaper Rash
Candidal Dermatitis
Starts off in the deep flexures which show
widespread erythema on the buttocksbeefy red color
There are also raised edge, sharp
marginization and white scale at the
border of lesions, with pinpoint pustulovesicular satellite lesions
Seborrheic Dermatitis
Salmon-colored greasy lesions with
yellowish scale and predilection for
intertriginous areas
Involvement of the scalp, face, neck,
and post auricular and flexural areas
Irritant Dermatitis
Rash confined to the convex surfaces of
the buttocks,perineal area, lower
abdomen, and proximal thighs, sparing
the intertriginous creases
Excessive heat, moisture, and sweat
retention
Harsh soaps, detergents, and topical
medications
Viral Exanthems
Smallpox- Variola
Fatality 40 %
First invades upper respiratory tract
From lymph nodes it spreads via
hematogenous spread
Chills, fever, headache, delirium, SZ
Face to upper arms and trunk, and
finally to lower legs
Chickenpox-Varicella
Herpes virus varicellae
Incubation period 10-21 days
Fever, malaise, cough, irritability,
pruritus
Papulesvesicles crusting
Spreads centripetally
Varicella
Complications:
Bacterial superinfection
CNS involvement
Pneumonia
Hepatitis, arthritis
Reye’s syndrome
VZIG
Varicella – Treatment
Oral acyclovir- indications
Healthy nonpregnant teenagers and adults
Children > 1 yr with chronic cutaneous or
pulmonary conditions
Patients on chronic salicylate therapy
Patients receiving short or intermittent
courses of aerosolized corticosteroids
Dose: 80 mg/kg/day in four divided
doses for 5 days
Varicella – Post exposure
VZIG (1 vial/5 kg IM) :
Pts on high dose steroids
Immunocompromised without a history of CP
Pregnant women
Newborns exposed 5 days prior to birth and 2
days after delivery
Neonates born to nonimmune mothers
Hospitalized premature infants < 28 weeks’
gestation
Measles
Rubeola- paramyxovirus
Occurs in epidemics
Incubation 8-12 days
Fever, lethargy, Cough, coryza, conjunctivitis
with clear discharge and photophobia
Koplik spots
Rash begins on the face and spreads to
trunk and extremities
Measles – Post Exposure
Immunoglobulin therapy- indications
All susceptible contacts
Infants 5 mo. To 1 year of age
Immunocompromised
Pregnant women
<5 mo. If mother without immunity
Live measles virus vaccine- contraindication
Immunocompromised- excluding HIV
Pregnancy
Allergy to eggs, or neomycin
Rubella
German Measles
Epidemic nature
Winter-spring
Prodrome
Face  neck  trunk
Lymphadenopathy
Serologic testing
Hand-Foot-Mouth Disease
Enteroviruses
coxsackieviruses A and B
echoviruses
Vesicular lesions, may be petechial
Associated with aseptic meningitis,
myocarditis
Erythema Infectiosum
Fifth disease
Mildly contagious, parvovirus B-19
Pre-school and young school-age children
Prodrome: mild malaise
Rash: “slapped cheek”, circumoral pallor,
peripheral mild macular distribution
Complication
Exanthem Subitum
Roseola Infantum
Children 6-19 months
Abrupt onset of high fever
Febrile seizures
Rash develops after fever dissipates
Mainly on trunk
Infectious Mononucleosis
Acute, self limited illness
Epstein-Barr virus
Oral transmission – incubation 30-50 days
Fever, fatigue, pharyngitis, LA, splenomegaly,
atypical lymphocytosis
Exanthem is seen in 10-15%
Erythematous, maculopapular, morbilliform,
scarlatiniform, urticarial, hemorrhagic, or even
nodular
Bacterial Exanthems
Impetigo
Superficial infection of the dermis
Two types:
Impetigo contagiosa
Bullous impetigo
Etiology
Group A ß hemolytic streptococcus
Coagulase positive S. aureus
Treatment : Keflex, erythromycin, Bactroban
Scarlet Fever
Toxin producing strain of group A -hemolytic
streptococcus
Strep pharyngitis with systemic complaints
Rash from neck to trunk to extremities
Sandpaper feel, erythema, warmth
White and red strawberry tongue
Petechiae in linear form
Complications
Treatment
Staphylococcal Scalded-Skin
Syndrome
Generally in less than 5 years of age
Induced by exotoxin produced by staphylococci
Fever, papular erythematous rash starting
around mouth- not involving oral mucosa
Positive Nikolsky’s sign
Diagnosis: Tzanck test, bacterial culture
Treatment
Complications
Meningococcemia
Usually sudden onset of fever, chills,
myalgia, and arthralgia
Rash is macular, nonpruritic, erythematous
lesions
Petechial rash develops in 75% of cases
Neisseria meningitides
Fever, rash, hypotension, shock, DIC
Treatment: PCN G
Differential Diagnosis
Gonococcemia
HSP
Typhoid fever
Rickettsial disease
Erythema multiforme
Purpura fulminans
Rocky Mountain Spotted Fever
Most common rickettsial infection in US
Abrupt fever, headache, and myalgia
Rash from extremities towards trunk
Maculespetechiae
Treatment
Tetracycline
Doxycycline
Chloramphenicol
Cellulitis
Most common organisms:
S. aureus
S. pyogenes
H. influenza type B (HIB)
Most common sites?
CBC, x-ray?
Cellulitis- Treatment
IV antibiotics in:
Immunocompromised
Ill appearing
Suspected bacteremia
<6 mo. Of age
WBC> 15K
High fever
Rapidly progressing
Periorbital- Orbital Cellulitis
S. aureus, S. pneumoniae, and HIB
CBC, blood culture, CT
LP?
IV antibiotics
Admit
Fungal Infections
Henoch-Schnlein Purpura
No clear etiologic agent, often post viral
2-10 years of age
Palpable purpura over the buttocks and
LE
Transient migratory arthritis
Renal and GI involvement
Kawasaki Syndrome
Unknown etiology
Peak incidence 18-24 months
Clinical findings:
Fever for at least five days
Conjunctivitis
Polymorphous rash
Oral cavity changes
Cervical adenopathy