Inflammatory papule/pustule on face

affects 20% of newbors

occurs mostly:  2-4 wks

Benign, will resolve on its own

Presumed d/t hormonal withdrawal

??

Epidermal cyst filled with keratin

tiny 1-2 mm white papules on face,nose

occurs 40% of newborn

if seen in mouth Epstein Pearls (85% occurance)

??

Flat, Blue-black Macule over lumbosacral area

Fades to yellow green

 90% seen:  Native Americans, AA, Asians

No tx, fades as child ages

mistaken for child abuse

???

Benign tumor of capillary endothelial cells

Usually not seen at birth, dev 2-4 wks later

Immediate tx if: occular obstruction, airway obstruction, cardiac decompensation

Regress as age, 90% by age 9

Red, Rubbery Nodule

Stork bite, Kiss

??

Prednisone dose:  2-3 mg/kg for 6-12 wks

Interferon tx if not responding or involved respiratory or life threatening

**significant side effects

Associated with eosinophilia in blood

disappears by day 7 of life

onset 24-48 hrs of age

few-100

Splotchy, erythematous macules on face, trunk, extremities

Not toxic

??

Greasy, yellowish scale

without tx, spontaneously resolves in 8-12 months

??

Seborrhea=Cradle Cap

in infants, mostly found in scalp

LESS in BETTER

LOW potency hydrocortisone or steroid cream

DO NOT USE: KERATOLYTIC shampoo -Nizoral

makes scaling & flaking worse

Scrape will bleed

Whitish plaque on erthematous base

Present on buccal mucosa

Cause:  Candida albicans

???

Nystatin suspension 3-4x daily

Flucanazole-Diflucan 6mg/kg Day 1

Then 3 mg/kg for 2 wks

Breast feeders:  Tx mom's nipple also

Acne occurance for:

neonatal?

adolescents?

neonatal:  2-4 wks of age & resolves 4-6 months of age

adolescents:  can begin as early as 8-10 yrs

Cystic acne, deeper lesions or nodules may develop

large cysts may connect & form sinus tracts

Self esteem may be affected

Obstuction of follicular mouth

Wide opening develops that is filled with a plug of stratum corneum cells

oxidized melanin causes black appearance

Obstruction of sebaceous follicle beneath the follicular opening

Produces cystic swelling of follicular duct beneath the epidermis

??

Which type of acne vulgaris is thought to be a precursor of inflammatory acne lesions

red papules, pustules, nodule, cysts?

Closed comedone / Whitehead

not open comedone/blackhead

Medicine of Choice:  Benzoyl Peroxide

Oral ABX: Clindamyacin

Topical ABX:  Retin A (nite) & Adalapene (differin)

Oral contraceptives for females

When all fails:  Isotretinoin (Accutane)

Freezes secretions

Kills comedone plug

Blocks bacteria

Overgrowth of Staph & Strep

Yellow honey+Crusty+Blood

occurs in warm climates

begins as small vesicles that are easily ruptured

exposed areas are common sites:  face, extremeties

Topical MUPIROCIN-Bactroban  TID 1st Line

System:  ABX 2nd generation

Cephalexin-Keflex

Cefadroxil-Duricef for immunocompromised

Proper hand washing

Grouped vesicles on erythematous base

Tingling & pain 85% only with reoccurance

Incubation 2-12 days

Tzanck smear:+ Epidermal multinucleated giant cells

Primary HSV

Recurrent HSV

Eyes

Cheeks

Lips

Chin

*groups/clusters of vesicle on red base

Swollen, painful, erythematous lesion with deep rooted vesicles on distal phalanx

Considered pyoderma or cellulitis

Herpetic Whitlow

Thumb suckers

Acyclovir-Zovirax

oral:  20 mg/kg 4x a day

topical:  5-6x a day

Penciclovir-Denavir

topical:  every 2 hrs

Avoid precipitating factors

in sunlight wil break out

Benign viral induced tumor

Fleshy, pearly white, white yellow smooth plaque with central umbilication

incubation 7-10 weeks

??

Molluscum Contagiosum

Cause by pox virus that induces epidermal cell proliferation

1-15 mm diameter in grps with little depressions/ doughnuts=Hallmark

Contagious

Where is this type of Molluscum Contagiosum found?

Type I

Type II

Type I:  face, neck, extremities

Type II:  Genital lesions

Remove papule is curative

Infants & small children:  drop cantharidin or trichloroacetic acid

25% applied with wooden stick to central umbilication & then neutralized w/ alcohol is less traumatic

Cryotherapy effective but can cause pain

Occurs in warm climate months

Bacteria

Initial insult, then Staph & Strep

Yellow honey+Crusty+Blood

??

Erosions, covered by moist, honey-colored crust

Begins as small vesicles that easily erupt

Seen on exposed areas:  Face & Extemities

May occur in diaper area of infants

Benign viral tumor that causes prolifertion of epidermal cells

Cause:  HPV

Common wart

Flat wart

Plantar wart

Veneral wart

Can be found anywhere

Solitary papule with irregular scaly surface

Multiple

Flat-topped

Broad skin colored

Papule

Usually in groups

Affinity for face & extremeties

Weight bearing areas of feet

Papule is pushed into the skin

Multiple, Confluent Papules with irregular surface

Appears genital mucosa & or adjacent skin

Well demarcated LESION with central clearing, scaling, may be erythema

Alopecia common complaint & may have broken hairs

Kerion present

Tinea Capitis

FUNGAL INFECTIONS

ORAL GRISEOFULVIN

10-20 mg/kg 6wks-6 months

Also Terbinafine & Itraconazole

Adjunct: Nizoral-Ketoconazole, Selsun Blue shampoo

Take medication with whole milk or ice cream

Griseofluvin gets enhanced absorption in the GI tract with a fatty meal

Well demarcated LESION with papular border & central clearing, may be scaling, erythema, RED RAISED BORDER

Contagious, self contamination

Same for Tinea Cruris

Topical antifungals 90% effective

Oxiconazole

Clotrimazole

Econazole

Ketoconazole

creams applied 1-2x daily 2-4 wks

Non-pharm: cotton fabrics, frequent airing, no under

at nite

Well defined border PLAQUES in groin with wide spread erythema

Intensely pruritic, beefy red, pt feels miserable

Same as for Tinea Corporis

Topical antifungals

Oxiconazole

Clotrimazole

Econazole

Ketoconazole

cream appled 1-2x daily for 2-4 wks

Non-pharm: cotton fabrics, frequent airing, underwear during sleep

Cracked, Thick, Exaggerated, Erythematous, Scaling, Superficial  (CT EESS)

Macerated, moist, pruitic skin between toes

Skin breakdowns=Superinfection

Cracks b/w digits & skin peeling away=Maceration

Athlete's foot

Topical antifungal & or topical steroid combination cream-effective

Bethamethasaone 0.05% & Clotrimazole 1%

BID 12 wks

Multiple oval MACULES with fine scales distributed on neck, chest, upper back, shoulders

nl overgrowth of yeast on skin, frequent asx

Color dependent on pt' natural color

Tinea Versicolor

Pityrosporumovale  "P. orbiculare"

Tx for Tinea Versicolor

ONLY ANTIFUNGALS,       NO STEROIDS

Oxiconazole

Clotrimazole

Econazole

Ketocanazole

cream applied 1-2x daily for 2-4 wks

Selenium sulfide-Selsun Blue applied nightly for 6-8 wks

Rash with satellite lesions

Grows best in warm, moist areas

Will often follow antibiotic use

Infants-males greater

Children/Adolescents-girls greater

Beefy, red papules or plaques

located in skin folds of infants with satellite lesions

KOH preparation-Budding yeast hyphae

tx:  topical antifungal applied 3-5 days

Educate caregiver:

Frequent diaper changes

Hygiene

"Air out" between changes

GABHS

Sandpaper rash 24-48 hrs of exposure

children 2-10 yrs

Scarlatina-Scarlet Fever

2nd DZ

Fine macules & papules

Begining of Neck

Spreading down the Trunk to Extremities

numerous 1-2 mm papular elevation-sandpaper feel

Fever subsides

previous upper reddened area now desquamates

NO palms or sole involvement

Scarlatina-Scarlet diseas

2nd dz.

TOC:  Amoxicillin 40-5- mg/kg/day

Penicillin, Ampicllin

PCN allergy: Erythromycin

TMP/SMX, some fluoroquinolones, tetracyclines

unreliable for tx GABHS

Highly contagious RNA virus of Paramyxovirus

Tranmission: direct/indirect transfer of nasopharyngeal secretions

contagious 5 days after exposure till 4-5 days after rash disappears

Maculopapular, erythematous rash starts on

forehead & face, spreads downward to neck, body, & extremities

Fever high 105 F