Scalp ringworm

Confirm dx: Woods lamp; potassium hydroxide; fungal cx

Tx: Griseofulvin X 1 month; Seleneum/ketoconozole shampoo twice weekly

Skin ringworm

Dx: potassium hydroxide

Tx: Topical tx with antifungal.

Tx lesion +1in beyond border X 1 week after lesion gone.

Beefy red erythema with elevated margins; satelite lesions

Tx: antifungal cream with every diaper change till gone plus few days

Lice

Tx: Permetherin 1%; retreat in one week. remove nits with comb, tweezers, and 1:1 vinegar/water. Eyelashes with vaseling 8-14 dyas. Soak brushes in pediculocide or alcohol for 1 hour.

Pubic Lice

May be a sign of sexual abuse. Test for GC and syphillis. Tx with permetherin 1%, retreat in 1 week.

Female burrows, hatches eggs, intense itching 3 weeks later. Burrows in webs of fingers, elbows, butt, feet, armpits. Itch worse at night. 

Tx: Permetherin 5% to whole body. Leave on 8-12 hours, rinse off and retreat in 1 wk. Treat family. Seal non-washables  X 1 week.

Sudden onset raised wheals and itching.

Tx: avoid allergen, oral antihistamines. NO STEROIDS.

Refer to allergist if lasts >6 wks.

Can be found in HSP

1-5mm papules with puritic center. Found on lower ext, butt, genitalia. Check UA for hematuria. Tx symptomatically. Steroids if organ involvement.

Grouped vesicles on an erythematous base.

HSV 1&2. Clinical dx. Viral Cx is gold standard.

EMERGENCY!--Encephalopathy. 

Sepsis work up. Acyclovir IV.

Cold Sore.

HSV-1. Small clear vesibles become weepy ulcerated then crusted. 

Tx: Oral acyclovir within 3 days. May need to treat impetigo/cellulitis.

EMERGENCY!--Opthol consult!

HSV-1

Flourescein exam: stellate lesions

Acyclovir po or IV if eye involved

Risk of herpetic keratitis (permanent scarring, blindness)

Pharyngitis with ulcerations and white plaques on mucosa, gingiva, tongue, palate, lips, chin, and nasolabial folds.

HSV-1

LAD

Lasts 7-10 days.

Tx: oral acyclovir if in first 3 days

Pain relief.

HHV-3

"Dewdrop on a rose petal"

maculopapular vesicles crusted over; appears in crops

Low fever

Lasts 7-10 days

Highly contagious 1-2 days before and up to 5-6 days after initial interruption

Tx: symptoms,

AVOID ASPIRIN and ADVIL

HHV-3

Reactivation of latent varicella zoster from previous chicken pox or varicella vaccine

Lasts 1-3 weeks. Avoid aspirin/advil.

Hand-Foot-Mouth Disease

Coxsackie virus/Enterovirus 71

Scattered red papules in acral distribution (palms, fingertips, webs, buttocks and toes, oral lesions)

Tx: symptoms

Maculopapular rash with KOPLICK SPOTS

Fever, cough, coryza, conjunctivitis, maculopapular rash; Vitamin A may decrease morbidity and mortality

"German measles", "3-day measles"

Salmon colored--not ill appearing; Blueberry muffin spots

 Renatal rubella: can result in miscarriabe, fetal death, blindness, cardiac defects, sensorineural hearing loss, and developmental delay.

2-3 days of fever then rash

High fever, maculopapular rash starts on neck then spreads out mild periorbital edema

Very common.

EBV

Can have maculopapular rash

No treatment

Comfort measures, massive splenomegaly may require steroids

Flesh colored firm rash, groups of large flat topped, non-pruritic papules (cheecks, butt, extremities)

Usually in kids <3 yoa

Tx: No tx, lesions do not respond to steroids

May last 2-8 wks.

Warts

HPV

Clinical dx. Most spontaneous resolve

Tx: cryodestruction; immunologic (interferon, cimetidine); antiproliferative (retinoic acid, podophyllum)

Molluscum Contagiosum

Poxvirus

Usually found aroud eyes, axillae, and extremities

Will resolve without treatment; dermal curette remove entire papule (painful)

Tx: cantharidin applicaitons, Imiquimod cream, Oral cimetidine, potassium hydroxide, podophyllum

S. aureus/Strep

Honey crusted lesions, systemic antibiotics for 10 days 

Tx: Cephalexin

Home for 24 hours on antibiotics

Ill defined erythematous plaques that are warm and tender to palpation, fever, regional LAD, may have previous injury

Strep/H. flu, staph, MRSA

Tx: Strep-PCN; Staph-Cephalexin, MRSA-Clinda/Bactrim

"Sandpaper rash"

Streptococcus

Preschool/schoolage most common

facial flushing, circumoral pallor, rash spreads neck down (more prominent in warm areas);

White/Red strawberry tongue, desquamation of the skin peeling of distal toes/fingers

Tx: PCN X 10 days (erythromycin if allergic)

Bordatella henselae

Regional LAD, non pruritic

Low fever, malaise, anorexia, fatigue, HA

Indirect fluorescent antibody for serum antibodies

No tx unless concern for systemic/secondary infection then tx with Azithromycin

Resolves 2-4 wks

Borrelia burgdorferi

Begins 2-20 days after TICK bite

Erythema Migrans (bull's eye lesion)

Fever, malaise, HA, arthralgia, stiff neck, mood swings, organ involvement, arthritis

Tx: doxycycline (older child)/Amox (younger child)

Inflammatory disorder of the pilosebaceous unit where excess sebum, keratinous debris, and bacteria accumulate and produce microcomedomes.

Open comedome=blackhead

Closed comedome=whitehead

Tx: Wash twice daily with mild soap. Topical keratolytics (tretinoin, adapalene, tazarotene) X4-6 wks.

Topical antibiotics-clinda; Oral antibiotics (tetracycline)<6 mos; Oral retinoids (accutain--teterogenic); hormonal therapies (oral contraceptives)

HHV7?

Herald patch, christmas tree distribution of pruritic rash with oval scaley plaques, hyper/hypopigmentation, trunk may be spared

No Tx

Sun exposure may help

New lesions for 2-3 wks but the rash can last 4-8 weeks

Erythematous papular or macular lesions, thick silvery scales

Scalp, ears, eyebrows, elbows, knees, gluteal crease, umbilicus, genitalia and nails

Pitting of nails

Tx: Topical steroid creams, NO SYSTEMIC STEROIDS, Scalp oil to lift scales, tar shampoo, UV light (dermatology)

Scratching leaves pinpoint bleeding (auspitz sign)

"cradle cap"

Scalp has yellow greasy scale, red patches occur on face and flexor surfaces

Tx: baby oil/mineral oil to loosen scales, use gentle brush and anti seborrheic shampoo

Low potency topical steroids (hydrocortisone) BID as needed. 

Ketoconazole cream for severe cases only

Eczema--"flairing up".

The itch that rashes

Scaling, vesicles, inflamed papules, plaques and crusts

Dennie lines and morgan lines of eyes, allergic shiners

Infant: cheeks, forehead, scalp, trunk, extensor surfaces of arms legs

Childhood:wrists, neck, ankles, flexural surgaces, Lichenification with chronicity.

Tx: Avoid irritants; stop itch-scratch cycle; moisturize; antihistamines; topical steroids, NO SYSTEMIC STEROIDS