Pediatric Dermatology Lecture Notes

Introduction

Focus: Pediatric dermatology, particularly rashes and fevers in children.
Challenges: Pediatric rashes can be difficult to diagnose; importance of detailed history and understanding disease trajectories.
Approach: Understand the natural history, not just spot diagnoses.

Importance of detailed history: Where the rash starts, spreads, texture, presence of fever, etc.
Diagnosis often based on history more than initial visual inspection.
Pediatric rashes can be daunting for all levels of medical professionals.

Symptoms: Rash on face, erythematous, weepy, slight temperature.
Diagnosis: Impetigo, classical description (golden crusting, typically caused by Staph aureus or Streptococci).
Treatment: Fusidic acid or flucloxacillin.
Key Points: Highly contagious. Isolation from school/work until lesions crust over or after 48 hours of antibiotic therapy.
Other Treatment Options: Paracetamol for fever if >38°C (not primary treatment).
Incorrect Treatments: Acyclovir (viral), hydrocortisone (less common), chlorhexidine and neomycin (MRSA, not first-line for impetigo).

Symptoms: Vesicles at different stages, some crusted over, history suggests chickenpox.
Infectivity: Up to 3 weeks incubation. Infectious from 2 days before rash until last vesicle crusts over.
Treatment: Supportive, usually paracetamol for fever, antihistamines for itch may help but evidence is weak. No calamine lotion.
Vaccination: Available but not routine in UK; more common in places like Australia and Middle East.

Symptoms: Rash on face, nasal bridge, eyelids, hands. Raised ESR.
Differentials: SLE (less common, ANA more likely), streptococcal infections, Lyme disease.
Key Diagnostic Points: Heliotrope rash, check myositis specific antibodies.

Symptoms: Fever, under 3 months old.
Investigations: Full septic screen (blood cultures, lumbar puncture, urine culture if older).
Key Points: Immediate hospital assessment, empirical treatment with antibiotics (varies by location but often cephalosporins and amoxicillin).
Incorrect Investigations: Stool microbiology, abdominal ultrasound, MRI/CT, unless specific indicators.

Symptoms: Multiple, circular, pruritic lesions.
Diagnosis: Distinguish from other conditions (e.g., tinea corporis, scarlatina, guttate psoriasis, warts).
Treatment: Emollients, steroid ladder starting low and increasing as needed.
Complications: Infections (bacterial, viral), dehydration, erythroderma, psychosocial impact.

Symptoms: Rough, sandpaper-like rash, peri-oral sparing, red oral cavity, cervical lymphadenopathy.
Causative Agent: Streptococcus pyogenes.
Treatment: Penicillin.
Complications: Post-streptococcal glomerulonephritis, rheumatic heart disease, reactive arthritis, sydenham's chorea.

Symptoms: Fever 5+ days, conjunctivitis, rash, adenopathy, strawberry tongue, swollen hands/feet.
Diagnostic Criteria: 'Crash and Burn' mnemonic.
Complications: Coronary artery aneurysms, cardiac issues.
Treatment: High-dose aspirin, IVIG, urgent echocardiogram required.

Symptoms: Well child with non-blanching rash, very low platelets.
Management: Mostly supportive, safety netting, avoid traumatic activities, repeat blood count.
Key Differentials: HSP, trauma, sepsis (less common with similar profile).

Sepsis in Pediatrics: Pediatric sepsis management includes senior review, inotropes early consideration, and differences from adult sepsis protocols.
Sixth Disease (Roseola): High fever followed by blanching rash. Generally benign, no isolation needed.
Resources: Recommended textbooks and resources, including web-based visual aids for diverse skin types (e.g., SkinDeep by Don't Forget the Bubbles).

Pediatric dermatology involves many differential diagnoses and thorough history-taking is crucial. The study of rashes requires awareness of both clinical and supportive management, with attention to potential complications and psychosocial impacts.