Pediatric Dermatology Basics

Pediatric Dermatology Basics

Pediatric Dermatology Basics

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Neonatal Skin - Fresh & Fragile

  • Physiological Findings:
    • Vernix Caseosa: Waxy, white, protective coating.
    • Lanugo: Fine, soft hair; sheds weeks 1-2.
    • Acrocyanosis: Peripheral cyanosis; resolves with warming.
    • Cutis Marmorata: Mottled vascular pattern; cold stress.
    • Physiological Desquamation: Peeling, esp. post-term.
  • Benign Transient Rashes:
    • Erythema Toxicum Neonatorum (ETN): "Flea-bitten" rash; macules, papules, pustules on erythematous base. Appears day 2-5, spares palms/soles.

      ⭐ ETN smear shows numerous eosinophils.

    • Transient Neonatal Pustular Melanosis (TNPM): Pustules at birth → collarettes of scale → pigmented macules. Neutrophils on smear.
    • Milia: Tiny white keratin cysts; face (nose, chin).
    • Miliaria: Sweat duct obstruction.
      • Miliaria Crystallina: Superficial clear vesicles.
      • Miliaria Rubra (Prickly Heat): Erythematous papules/pustules.
    • Sebaceous Gland Hyperplasia: Yellowish papules on nose/cheeks; maternal androgens.

Neonatal Erythema Toxicum Neonatorum rash

Birthmarks - Unique Stamps

  • Vascular Birthmarks:
    • Nevus Simplex (Salmon Patch/Stork Bite): Common, flat, pink patches (nape, eyelids, glabella). Usually fade by 1-2 years.
    • Port-Wine Stain (Nevus Flammeus): Dark red/purple vascular malformation. Permanent, grows with child. If V1 ophthalmic trigeminal distribution, suspect Sturge-Weber syndrome. Infant with port-wine stain in V1 trigeminal distribution
    • Infantile Hemangioma (Strawberry Nevus): Bright red, raised. Proliferate in first months, then involute. Propranolol for complicated cases (e.g., visual obstruction).
  • Pigmented Birthmarks:
    • Mongolian Spot (Congenital Dermal Melanocytosis): Blue-grey macules, lumbosacral area. Common in Asian/darker skin. Fade in childhood.
    • Café-au-Lait Macules (CALMs): Light brown, flat. Multiple (>6 lesions, >5mm prepubertal, >15mm postpubertal) suggest Neurofibromatosis Type 1 (NF1).
    • Congenital Melanocytic Nevus (CMN): Brown/black. Risk of melanoma ↑ with size (especially giant CMNs >20cm).
  • Epidermal Nevi:
    • Nevus Sebaceous (of Jadassohn): Yellowish, waxy, hairless plaque (often scalp). Risk of secondary benign/malignant neoplasms (e.g., BCC) in adulthood.

⭐ Port-wine stain in the V1 trigeminal nerve distribution is highly suggestive of Sturge-Weber syndrome, which can involve ipsilateral glaucoma and leptomeningeal angiomas causing seizures and neurological deficits.

Pediatric Infections - Tiny Invaders

  • Impetigo: S. aureus, Group A Strep. Honey-colored crusts (non-bullous); flaccid bullae (bullous). Topical/oral antibiotics.
  • Molluscum Contagiosum: Poxvirus. Flesh-colored, umbilicated papules. Spontaneous resolution common.
  • Scabies: Sarcoptes scabiei. Intense nocturnal pruritus. Burrows (interdigital, wrists, axillae). Permethrin 5% cream. Treat contacts. Scabies burrows on child's hand
  • Tinea Capitis: Dermatophytes. Scalp scaling, alopecia, black dots, kerion. Oral griseofulvin.

    ⭐ Wood's lamp: Microsporum spp. fluoresce green.

  • Viral Warts (Verrucae): HPV. Common (vulgaris), flat (plana), plantar. Salicylic acid, cryotherapy.
  • Hand-Foot-Mouth Disease (HFMD): Coxsackie A. Oral, hand, foot vesicles. Supportive care.

Inflammatory Dermatoses - Itchy Issues

  • Atopic Dermatitis (AD): "Itch that rashes"; chronic, relapsing.
    • Infants: Face, extensors. Spares diaper area.
    • Children: Flexures.
    • Associated with atopic march. Filaggrin mutations.
    • Tx: Emollients, topical steroids, TCIs.
  • Seborrheic Dermatitis (SD): Greasy scales, erythema.
    • Infants: "Cradle cap" (scalp), face, diaper area.
    • Malassezia implicated.
    • Tx: Antifungal shampoos, mild topical steroids.
  • Psoriasis: Well-demarcated silvery plaques.
    • Extensors, scalp, nails. Auspitz sign, Koebner.
    • Guttate psoriasis: Post-streptococcal.
  • Contact Dermatitis:
    • Irritant (ICD): Direct injury (e.g., diapers, soaps).
    • Allergic (ACD): Type IV hypersensitivity (e.g., nickel). Patch test.

⭐ Infantile atopic dermatitis typically affects the face (cheeks, chin, forehead) and extensor surfaces, often sparing the diaper area.

Infantile atopic dermatitis on face

High‑Yield Points - ⚡ Biggest Takeaways

  • Neonatal acne (first weeks, resolves) vs. Infantile acne (3-6 months, may scar, more persistent).
  • Erythema toxicum neonatorum: Benign "flea-bitten" rash with eosinophils, resolves in days.
  • Mongolian spots: Common benign blue-grey lumbosacral macules, typically fade during childhood.
  • Infantile hemangiomas: Characteristically proliferate then involute; propranolol for problematic lesions.
  • Atopic dermatitis: Key feature is intense pruritus; distribution varies with age (infant vs. child).
  • Diaper dermatitis: Irritant contact is most common; Candidal infection presents with satellite pustules.

Practice Questions: Pediatric Dermatology Basics

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Which type of dermatitis is evaluated through patch testing?

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Flashcards: Pediatric Dermatology Basics

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The most common form of vascular ectasia is _____

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The most common form of vascular ectasia is _____

nevus flammeus

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