Common Pediatrics Rashes

Primary skin lesions

Primary skin lesions Macule A macule is an area of color change less than 1.5 cm diameter. The surface is smooth. Patch A patch refers to a large area of color change, with smooth surface. Papule Papules are small palpable lesions. The usual definition is that they are less than 0.5 cm diameter, although some authors allow up to 1.5 cm. They are usually visibly raised above the skin surface, and may be solitary or multiple. Papules may be sessile, pedunculated, filiform, or verrucous.

Primary skin lesions Plaque A plaque is a palpable flat lesion greater than 0.5 cm diameter. Most plaques are elevated, but a plaque can also be a thickened area without being visibly raised above the skin surface. Nodule A nodule is an enlargement of a papule in three dimensions (height, width, length). Vesicle Vesicles are small blisters less than 0.5cm diameter. They are fluid-filled papules, and may be single or multiple. Pustule A pustule is a purulent vesicle. It is filled with neutrophils, and may be white, or yellow. Not all pustules are infected.

Primary skin lesions Bulla A bulla is a large fluid-filled blister. It may be a single compartment or multiloculated. Wheal A wheal is an edematous papule or plaque caused by swelling in the dermis. Whealing often indicates urticaria. Purpura Purpura is bleeding into the skin. This may be as petechiae (small red or brown spots), or as ecchymoses (bruises). Telangiectasia Telangiectasia is the name given to prominent cutaneous blood vessels.

Secondary skin lesions Scaling Scaling is an increase in the dead cells on the surface of the skin (stratum corneum). The scale can be psoriatic-type (large white or silver flakes), pityriasis-type (branny powdery scale), or lichenoid (tightly adherent to skin surface). Lichenification Lichenification is caused by chronic rubbing which results in palpably thickened skin with increased skin markings and lichenoid scale. It occurs in chronic eczema eg. atopic dermatitis or lichen simplex. Exfoliation Exfoliation is the stratum corneum peeling off, usually occurring after acute inflammation.

Secondary skin lesions Crusting Crust occurs when plasma exudes through an eroded epidermis. It is rough on the surface and is yellow or brown in color. Bloody crust appears red, purple or black. Excoriation An excoriation is a scratch mark. It may be a linear erosion or a picked scratch. Excoriations may occur in the absence of a primary dermatosis. Erosion An erosion is caused by loss of the surface of a skin lesion, it is a shallow moist or crusted lesion.

Secondary skin lesions Fissure A fissure is a thin crack within epidermis or epithelium, and is due to excessive dryness. Ulcer An ulcer is full thickness loss of epidermis or epithelium. It may be covered with a dark-colured crust called an eschar. Erythroderma Erythroderma is a term used to indicate red skin over the entire body.

A 10-year-old girl with atopic dermatitis reports itching that has recently become relentless, resulting in sleep loss. Her mother has been reluctant to treat the girl with topical corticosteroids, because she was told that they damage the skin, but she is exhausted and wants relief for her child. 1. What is atopic dermatitis? 2. What causes it? 3. What questions would you ask the parent? 4. How should the problem be managed?

Atopic dermatitis clustered lichenified follicular papules

Atopic dermatitis Scaly erythematous plaque

Atopic dermatitis uniform symmetric 2 mm hypopigmented follicular papules

Atopic dermatitis symmetric lichenified scaly red plaques

Atopic dermatitis symmetric red scaly crusted excoriated plaques

Atopic dermatitis symmetric red scaly crusted excoriated plaques

Atopic dermatitis acute red edematous annular scaly and crusted plaques

TOPICAL CORTICOSTEROID POTENCY Generic name -> Trade name and strength Class 1--superpotent Betamethasone dipropionate = Diprolene gel/ointment, 0.05%; Diflorasone diacetate = Psorcon ointment, 0.05% Clobetasol propionate = Temovate cream/ointment, 0.05%; Halobetasol propionate = Ultravate cream/ointment, 0.05% Class 2--potent Mometasone furoate = Elocon ointment, 0.1%; Amcinonide = Cyclocort ointment, 0.1%; Betamethasone dipropionate = Diprosone ointment, 0.05%; Desoximetasone = Topicort cream/ointment, 0.25%; gel 0.05%; Fluocinonide = Lidex cream/ointment, 0.05%; Halcinonide = Halog cream, 0.1% Class 3--upper mid-strength Betamethasone dipropionate = Diprosone cream, 0.05% Betamethasone valerate = Valisone ointment, 0.1% Diflorasone diacetate = Florone, Maxiflor creams, 0.05% Triamcinolone acetonide = Aristocort cream, 0.5% Fluticasone propionate = Cutivate ointment, 0.05% Class 4--mid-strength Mometasone furoate = Elocon cream, 0.1%; Desoximetasone = Topicort LP cream, 0.05%; Fluocinolone acetonide = Synalar-HP cream, 0.2%; Synalar ointment, 0.025%; Flurandrenolide = Cordran ointment, 0.05%; Triamcinolone acetonide = Aristocort, Kenalog ointments, 0.1% Class 5--lower mid-strength Betamethasone dipropionate = Diprosone lotion, 0.05%; Betamethasone valerate = Valisone cream/lotion, 0.1% Fluocinolone acetonide = Synalar cream, 0.025%; Flurandrenolide = Cordran cream, 0.05%; Hydrocortisone butyrate = Locoid cream, 0.1%; Hydrocortisone valerate = Westcort cream, 0.2%; Prednicarbate = Dermatop emollient cream, 0.1%; Triamcinolone acetonide = Kenalog cream/lotion, 0.1%; Fluticasone propionate = Cutivate cream, 0.05% Class 6--mild Alclometasone dipropionate = Aclovate cream/ointment, 0.05%; Triamcinolone acetonide = Aristocort cream, 0.1%; Desonide = DesOwen cream, 0.05%,Tridesilon cream, 0.05% Fluocinolone acetonide = Synalar cream/solution, 0.01%; Betamethasone valerate= Valisone lotion, 0.1% Class 7--least potent Hydrocortisone (0.5, 1.0, 2.5%) = Cortaid, Cortizone 10 (OTC), 2.5% (Hytone) is Rx only

A 3-month-old girl developed an asymptomatic scaly red eruption in the diaper area and the face. The lesions in the diaper area were well circumscribed and red-orange in color. 1. What is the rash? 2. What causes it? 3. How do you manage it?

Seborrheic dermatitis symmetric red scaly confluent plaques

Seborrheic dermatitis symmetric red scaly confluent plaques

Seborrheic dermatitis symmetric red greasy scaly patches

Seborrheic dermatitis thick tenacious scale with crust and underlying erythema

Seborrheic dermatitis confluent red papules extending from the creases

A 6-month-old boy presents with a diaper rash consisting of confluent, bright red papules and plaques with scattered pustules, overlying scale, and satellite lesions at the periphery. 1. What is the rash? 2. What causes it? 3. How do you manage it?

Candidal Diaper dermatitis confluent bright red papules and plaques with scattered pustules, overlying scale, and satellite lesions at the periphery

A mother describes to you a diaper rash that cleared rapidly with frequent application of a barrier paste and air drying after diaper changes. She wants to know why this happens. 1. What is the cause of this rash? 2. How do you manage it?

Irritant/Contact diaper dermatitis symmetric uniform 2-3 mm red eroded papules

A 2-month-old healthy boy developed a pustular eruption in the diaper area 2 days ago. A Gram stain showed neutrophils and Gram positive cocci. 1. What is the rash? 2. What causes it? 3. How do you treat it?

Staphylococcal pustulosis 3-5 mm pustules, some ruptured and drying with a collarette of scale

A 10-year-old boy developed asymptomatic relapsing and remitting hypopigmented minimally scaly patches on his facial cheeks. 1. What is the rash? 2. What causes it? 3. How do you manage it?

Pityriasis alba hypopigmented patch with fine scale

A healthy adolescent developed a large scaly red patch on the back followed a week later by a widespread papulosquamous eruption. The lesions were primarily truncal and only minimally pruritic. 1. What is the rash? 2. What causes it? 3. How do you mange it and what is the expected outcome?

Pityriasis rosea symmetric oval 0.5-3.0 cm red patches with central trailing scale

Pityriasis rosea multiple widespread round to oval 1-3 cm almost confluent plaques

An 18-year-old boy was evaluated for facial acne An 18-year-old boy was evaluated for facial acne. He had multiple open and closed comedones and a few red papules and pustules on his malar and temporal areas. 1. What causes acne vulgaris? 2. What are the different types? 3. How do you manage it?

Acne vulgaris open and closed comedones

Acne vulgaris symmetric grouped uniform 2 mm papules with a central dark scaly core

Acne vulgaris multiple symmetric deep tender nodules, violaceous cysts, pustules, and comedones. BEFORE Rx (isotretinoin)

Acne vulgaris symmetric grouped uniform 2 mm papules with a central dark scaly core. AFTER

A 17-year-old boy complained of dry scaly sandpaper like papules on the extensor surfaces of his upper arms and thighs for as long as he could remember. His father had similar lesions. 1. What is the rash? 2. What causes it? 3. How do you manage it?

Keratosis pilaris symmetric sandpaper like follicular papules

Keratosis pilaris symmetric red sand paperlike follicular papules

An 8-year-old boy demonstrated an annular scaly plaque on the neck extending into the scalp with broken hairs and a prominent right occipital lymph node. 1. What is the rash? 2. What causes it? 3. How do you treat it?

Tinea capitis annular scaly plaque with occipital adenopathy

Tinea capitis

ID reaction / autoeczematization / Tinea capitis patches of scale and erythema over neck and trunk with pruritic pustules

Tinea capitis / kerion boggy occipital area

ID reaction

A 10-year-old boy developed an expanding annular plaque on the anterior neck. A potassium hydroxide preparation showed branching hyphae. 1. What is the rash? 2. What causes it? 3. How do you treat it?

Tinea corporis concentric red scaly annular plaques

A 16-year-old soccer player complained of intense itching and burning in the groin for one week. He attributed the rash to playing matches in the rain for the preceding two weeks. 1. What is the rash? 2. What causes it? 3. How do you treat it?

Tinea cruris Erythematous, hyperpigmented scaly plaques centered on the inguinal creases and extending down the medial thighs

A 20-year-old man had an extensive itchy rash involving the soles, undersurfaces of the toes, and web spaces of both feet. 1. What is the rash? 2. What causes it? 3. How do you treat it?

An 8-year-old girl was evaluated for multiple hypopigmented macules on her face. A potassium hydroxide preparation made from a scraping of fine scale from the macules showed pseudohyphae and spores. 1. What is the rash? 2. What causes it? 3. How do you treat it?

Pityriasis versicolor Well-demarcated hypopigmented macules with minimal scale

Pityriasis versicolor

Pityriasis versicolor Red macules Brown macules Hyphae and spores White macules

An otherwise-healthy 6-year-old boy presents for evaluation of multiple papules on his arms, legs, and trunk. He has developed over 50 of these lesions, which are asymptomatic, over the last 4-5 months. 1. What is the most likely etiology? 2. What causes it? 3. How do you treat it?

Molluscum contagiosum pearly 3-4mm papules, some with a central dell

Molluscum contagiosum 5 mm pearly papule with central white scale

A 9-year-old healthy boy developed persistent warts on his hands that spread to his upper lip and hard palate. 1. What are the different types of warts? 2. What is the etiology? 3. What are his treatment options?

Warts multiple 1-3 mm rough topped papules

Warts 1 cm eroded rough brown papule with central crust and hemorrhage

A 19-year-old notes diffuse, intense itching A 19-year-old notes diffuse, intense itching. He reports that his girlfriend has the same itching. Examination of the skin reveals interdigital lesions, with small papules, vesicles, and excoriations on the hands, and indurated nodules on the genitalia. 1. What is the rash? 2. What causes it? 3. How do you treat it and what is the expected outcome?

Scabies generalized, symmetric, linear red papules and pustules

Scabies generalized, symmetric, linear red papules and pustules

Scabies multiple, symmetric red excoriated papules, vesicles, and pustules

Scabies multiple, elongated, excoriated red edematous papules

Scabies Scabies mite under scope

A 7-year-old girl is sent home after the school nurse detects head lice. She will not be permitted to return to school until the absence of infestation is documented. 1. What is the technical term for head lice? 2. How does it develop? 3. What treatment strategy is most likely to allow her to return to school with a minimal risk of infecting her classmates, i.e. How do you treat it?

Pediculosis capitis excoriated crusts and live crawlers

Pediculosis capitis nits on hair shafts and fecal material on the skin above the ear

Pediculosis capitis adult female head louse

Pediculosis capitis viable head louse egg