Beruflich Dokumente
Kultur Dokumente
By Emily
Objectives
2 common types
Salmon patch (naevus simplex)
• Common (40% newborns)
• Small flat patches pink or red, poorly defined
borders
• Nape of neck (stork mark), forehead (angel kiss),
eyelids and sacrum
• Worse with crying
• Not associated with extracutaneous findings
Capillary malformations
Port wine stain
• Less common
• Large flat patch of
purple or dark red
skin with well
defined borders
• Persist in childhood
then darkens and
thickens
• Extracutaneous
defects
What's that rash?
Nappy rash
Caused by combination of factors, irritation
to the skin by urine and faeces, occlusion
and candida
Intertriginous areas usually spared
Secondary staph inf = thin-walled pustules
on erythematous base
If persistent and creases involved think
seborrheic dematitis, psoriasis, and
candidiasis
Resolves when stop wearing nappies
Nappy Rash - prevention and
treatment
Nappy off!
Change nappy frequently
Wash bottom at each change, can use
aqueous cream
Use emollient (aqueous cream) and barrier
(zinc oxide)
Low potency topical steroid (hydrocortisone)
Candida - antifungal eg nystatin, can add
low potency steroid for few days
Sebhorrhoeic dermatitis - Emollients and
steroid help, can add ketoconazole
What's that rash?
Cradle cap
Greasy, yellow scaly patches over the scalp
Seborrheic dermatitis of newborn
possibly due to overactive sebaceous glands in the
skin of newborn babies
Possible relationship with skin yeasts (malassezia)
Not itchy
Treatment with mild baby shampoos. Wash
regularly and brush softly to remove scales
Baby oil can help soften scales (not olive oil!)
Resolves by 6-12mths
If fails to improve can try medicated shampoo with
ketoconazole or low potency steroids
What's that rash?
Chicken pox
Begins as an itchy red papules progressing to
vesicles on bright red base (dew drops on a rose
petal) on the stomach, back and face, and then
spreading to other parts of the body
Central umbilication of blisters follows rapidly,
crusting and desquamation within 10 days
Fever, sore throat, anorexia, malaise may precede
rash by several days
Incubation 7-21 days
symptomatic treatment only in immunocompetent
• Cool compress, calamine lotion, antihistamines
?Vaccinate
What's that rash?
Meningococcus
What every parent worries about
Rash is seldom early sign
Classically non-blanching haemorrhagic rash
In early stages rash may be blanching and
macular or maculopapular (sometimes
confused with flea bites)
Important to search whole body for small
petechiae
Give IM Ben Pen and refer
What that rash?
Impetigo
Superficial bacterial skin infection
Strep pyogenes or staph aureus
Round/oval lesions, begin as small pustular
areas and rapidly extend
Lesions rupture, oozy surface with honey-
covered crust
Advice about avoiding spread
Localised lesion- topical antibiotic eg Fucidin
cream
Widespread infection - oral flucloxacillin or
erythromycin
What's that rash?
Molluscum
Viral skin infection Pox virus
aka ‘dimple wart’
Clusters of small round flesh-coloured
umbilicated papules
Often on face, trunk, axillae (warm moist
places)
Harmless but can persist for months,
occasionally a couple of years
No treatment necessary
Can refer for cryotherapy/curratage
What's that rash?
Measles
Prodrome; fever, malasie, dry cough, coryza,
conjunctivitis, photophobia
Koplik spots on buccal mucosa
Rash 3-4th day of illness
Starts on face as blanching red macules and
papules, non itchy
Spreads down trunk and extremities
Rash coincides with high fever
Lesions become confluent, older lesions
develop rusty hue
Contagious 4 days before rash and 4 days
after
What's that rash?
Hand, Foot and Mouth
Common, mild, viral infection caused by
Coxsackie A16
Occurs in young children in summer/autumn
1-2 day fever, anorexia, sore throat followed
by development of 3-6mm elongated, gray,
thin-walled vesicles
May be asymptomatic or severe pruritus and
burning
Symptomatic treatment
Lasts < 1 week
What's that rash?
Eyrthema infectiosum
Fifth disease, slapped cheek, Parvovirus
B19
First sign is firm red cheeks, which feel
burning hot
Rash follows 1-4 days later with a lace
pattern on the limbs and then the trunk
Fades over 2-3wks
Usually well, may have slight fever or
headache
Rare complications
• Arthritis in teenagers/adults, aplastic crisis,
miscarriage
What's that rash?
Herpes simplex
Gingivostomatitis commonest manifestation
of primary herpes infection in kids
Clusters of red papules, evolve into vesicles
and often pustules in 24-48hrs. Vesicles
rupture and crust over. Heal in 10-14days
Cool compress, analgesia, consider aciclovir
Monitor hydration when oral lesions
Can be recurrent
Head Lice
Infest clean and dirty hair
Adult lice are size of sesame seed,
brownish grey, and wiggle their legs
Only adult lice contagious
Spread by head to head contact
They don’t jump/fly
Normally asymptomatic
Can present with itchy scalp
Head Lice- Treatment
Insecticides - malathion, phenothrin,
permethrin, carbaryl
Local policy?
2 applications 7 days apart
Shampoos not effective
Wet-comb conditioned hair with fine
tooth comb until lice removed and rpt
at 3-4 day intervals for 2/52
Electric combs, tea tree - no evidence
What that rash?
Scabies
Sarcoptes scabiei mite
Pruritic burrows pathognomic
(irregular, tortuous, and slightly scaly)
In infants, burrows are widespread with
involvement of trunk, scalp,
extremities, palms and soles
Consider in infants with widespread
dermamtosis that involves the palms
and soles
Scabies - treatment
Permethrin (malathion)
Ivermectin in combination for
‘norwegian scabies’
Not after hot bath
All family members at same time
Whole body treatment inc, scalp, neck,
face, ears and under nails
Rpt week later
Infantile eczema
Eczema
Infants
• Infants less than one year old often have
widely distributed eczema.
• The skin is often dry, scaly and red with
small scratch marks made by sharp baby
nails
• The cheeks of infants are often the first
place to be affected by eczema.
• The napkin area is frequently spared due
to the moisture retention of nappies (but
they can still get nappy rash)
Childhood eczema
Eczema
Toddlers and pre-school
• As children begin to move around, the
eczema becomes more localised and
thickened.
• Toddlers scratch vigorously and the
eczema may look very raw and
uncomfortable
• Often affects the extensor aspects of joints,
particularly the wrists, elbows, ankles and
knees. It may also affect the genitals
• As the child becomes older the pattern
frequently changes to involve the flexor
surfaces of the same joints
• The affected skin often becomes lichenified
Eczema
School children
• Older children tend to have the flexural
pattern of eczema and it most often affects
the elbow and knee creases. Other
susceptible areas include the eyelids,
earlobes, neck and scalp.
• Many children develop a 'nummular'
pattern of atopic dermatitis. This refers to
small coin-like areas of eczema scattered
over the body. These round patches of
eczema are dry, red and itchy and may be
mistaken for ringworm
• Mostly improves during the school years
Treatment of eczema
Advice - loose cotton clothes, avoid wool,
keep cool, nails short, gloves in bed
Emollients
Antihistamines
Topical steroids
Topical immunosuppressant
Bandages (zinc/ ichthammol/ Tar)
Wet wrapping - weeping eczema
?Oral steroids
Immunosuppressant
Phototherapy