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Pediatric Visual Diagnosis

Pediatric Visual Diagnosis . Ilana Greenstone MD Division of Emergency Medicine Montreal Children’s Hospital McGill University Health Center. Objectives. Recognize common pediatric dermatologic conditions Expand differential diagnosis Review treatment plans

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Pediatric Visual Diagnosis

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  1. Pediatric Visual Diagnosis Ilana Greenstone MD Division of Emergency Medicine Montreal Children’s Hospital McGill University Health Center

  2. Objectives • Recognize common pediatric dermatologic conditions • Expand differential diagnosis • Review treatment plans • Identify skin manifestations of systemic disease

  3. Terminology • Macules, Papules, Nodules • Patches and Plaques • Vesicles, Pustules, Bullae • Colour • Erosions – when bullae rupture • Ulcerations and excoriations

  4. Atopic Dermatitis • 3-5% of children 6 mo to 10 yr • Described in 1935 • Ill-defined, red, pruritic, papules/plaques • Diaper area spared • Acute: erythema, scaly, vesicles, crusts • Chronic: scaly, lichenified, pigment changes

  5. Atopic Dermatitis Hints to diagnosis • Generalized dry skin • Accentuation of skin markings on palms and soles • Dennie-Morgan lines • Fissures at base of earlobe • Allergic history

  6. Atopic DermatitisTreatment • Moisturize • Baths only • Anti-histamine • Topical steroids to red and rough areas • Prevex HC • Desacort • Immune modulators

  7. Superinfected Eczema • Red and crusty • Usually S. aureus • Cephalexin 40 mg/kg/day divided TID for 10 days • More potent topical steroid • Topical antibiotic – Fucidin • Anti-histamine • Refer to Dermatology

  8. Scabies • Intense pruritus • Diffuse, papular rash • Between fingers, flexor aspects of wrists, anterior axillary folds, waist, navel • May be vesicular in children < 2 years • Head, neck, palms, soles • Hypersensitivity reaction to protein of parasite

  9. ScabiesTreatment • 5% permethrin cream for infants, young children, pregnant and nursing mother • Kwellada-P or Nix • Cover entire body from neck down • Include head and neck for infants • Wash after 8-14 hours • Can use Lindane for older children

  10. Tinea corporisRingworm • Face, trunk or limbs • Pruritic, circular, slightly erythematous • Well-demarcated with scaly, vesicular or pustular border • Id reaction • Mistaken for atopic, seborrheic or contact dermatitis • Treament: Terbinafine (Lamisil)

  11. Pityriasis Rosea • Begins with herald patch • Large, isolated oval lesion with central clearing • More lesions 5-10 days later • Christmas tree distribution • Treatment: anti-histamines

  12. Eczema • Differential Diagnosis • Atopic dermatitis • Scabies • Tinea corporis • Pityriasis rosea • If vesicular, check for HSV1, HSV2, VZV • Beware of superinfection • Think of immune deficiency if difficult to treat

  13. Urticaria • Transient, well-demarcated wheels • Pruritic • Part of IgE-mediated hypersensitivity reaction • May leave central clearing • Triggers are numerous

  14. Kawasaki DiseaseDiagnostic Criteria • Fever for 5 or more days • Presence of 4 of the following: • Bilateral conjunctival injection • Changes in the oropharyngeal mucous membranes • Changes of the peripheral extremities • Rash • Cervical adenopathy • Illness can’t be explained by other disease

  15. Kawasaki DiseaseLab Features •  WBC •  ESR, positive CRP • Anemia • Mild  transaminases •  albumin • Sterile pyuria, aseptic meningitis •  platelets by day 10-14

  16. Measles Scarlet fever Drug reactions Viral exanthems Toxic Shock Syndrome Stevens-Johnson Syndrome Systemic Onset Juvenile Rheumatoid Arthritis Staph scalded skin syndrome Kawasaki DiseaseDifferential Diagnosis

  17. Kawasaki DiseaseDifficulties with Diagnosis • Clinical diagnosis • No single test • Diagnosis of exclusion • Atypical KD • Do not fulfill all criteria • More common in < 1 year and > 8 years

  18. Kawasaki DiseaseTreatment • Admit to monitor cardiac function • Complete cardiac evaluation • CXR, EKG, echo • IV Ig • ASA

  19. Kawasaki DiseaseTreatment • IV Ig 2 g/kg as single dose • Expect rapid resolution of fever • Decrease coronary artery aneurysms from 20% to < 5% • ASA - low dose vs high dose • 80-100 mg/kg/day until day 14 • 3-5 mg/kg/day for 6 weeks • Repeat echocardiogram at 6 weeks

  20. Coxsackie VirusHand-Foot-and-Mouth • Painful, shallow, yellow ulcers surrounded by red halos • Found on buccal mucosa, tongue, soft palate, uvula and anterior tonsillar pillars • Oral lesions without the exanthem = herpangina • Exanthem involves palmar, plantar and interdigital surfaces of the hands and feet +/- buttocks

  21. Erythema InfectiosumFifth Disease • Parvovirus B19 • Mostly preschool age • Recognized by exanthem • Contagious before rash • Resolution between 3 and 7 days

  22. Roseola • 6 to 36 months • Human herpesvirus 6 • High fever without source and irritability for 3 days • Rash develops as fever decreases

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