 Pruritic lesions wrists/abdomen/feet  Infant uncomfortable  Siblings with few pruritic lesions  Mom denies lesions but constantly rubbing interdigital webs of her hands  What is this?  What is the recommended therapy?

 What is this?  What is the management?  Permethrin 1 % OTC applied to scalp/hair x 10 mins  Others: Permethrin 5%, Lindane 1% shampoo  Treat bedmates and immediate household members  Wash linens/head gear, vacuum floors and furniture  Return to school day after tx  Not necessary to treat pets

 Infected with HPV  Usually on hands/feet/fingers  Spread by nail biting, contact sports, sexual contact  80% spontaneous remission by 2 years  Tx options: liquid nitrogen, laser, topical creams

 Pearly papular, pruritic lesions  Central umbilication  MOLLUSCUM CONTAGIOSUM  Poxvirus  Benign

MILIA

 30 mos old male  Brown, blotchy macules trunk/upper extremities  First appeared at 9 mos as red then turned into blisters  After rubbing lesion, edema within lesion and surrounding erythema  What is the most likely diagnosis?  URITCARIA PIGMENTOSA

 LANGERHAN CELL HISTIOCYTOSIS Erythematous papular rash w/petechiae Seborrheic rash Lytic lesions of skull DI

MONGOLIAN SPOT

24 – 48 hours after birth Wright stain: Eosinophils Erythema Toxicum Neonatorum At birth Wright stain: PMNs Transient Neonatal Pustular Melanosis  Erythema toxicum neonatorum

NEVUS SEBACEOUS  Waxy yellow-orange plaque  Alopecia  Present at birth  Growth after puberty

 Incontinentia Pigmenti  X linked, dominant  3 Phases Blisters/vesicles Warty papules Hyperpigmentation  Assoc. w/ CNS, Optho

 Strawberry hemangiomas  STRAWBERRY HEMANGIOMA  Superficial  Overgrowth after first weeks of life  Rapid growth x 6 mos  Slow regression  Remove if obstruction vital organ, ulceration, hemorrhage, cosmetic disfigurement

Deep Hemangioma  Deep hemangioma

 Port wine stain  Port Wine Stain  Present at birth  Stable and flat  Treat w/pulsed yellow laser  Asso. w/: Sturge Weber Klippel-Treanaunay- Weber

Disease Associations  Sturge-Weber Syndrome Opthalmic branch trigeminal nerve Ipsilateral venous leptomeningeal angiomatosa Seizures, Hemiplegia Mental retardation, Glaucoma  Klippel-Trenaunay-Weber Syndrome PWS + Hemihypertrophy  Kassabach-Merritt Syndrome Rapidly progressive hemangioma Platelet sequestration and coagulopathy

 melanoma  What makes this a melanoma?  Change in size/shape  Irregular borders  Change in surface  Scaling, ulceration, bleeding  Change in color  Burning, itching, or tenderness

Ash Leaf Spot  This is the earliest cutaneous manifestation of what disease?  TUBEROUS SCLEROSIS  Ash leaf present at birth  70-90% patients with TS  Periventricular/Cortical Tubers  Seizures

Tuberous Sclerosis Other cutaneous manifestations Adenoma Sebaceum Periungal fibromas Shagreen patch

Vitiligo

 What is the prognosis?  ALOPECIA AREATA  Sudden onset  No changes of skin  May have assoc. nail pitting  Regrowth in 1 year

Traction AlopeciaTrichotillomania

Tinea corporis SCALY Granuloma Annulare NOT SCALY

 NEUROFIBROMATOS IS  Neurofibromas not seen until after puberty  NF1  NF2 Bilateral acoustic neuroma Present teens/20s

NF1 (von Recklinghausen Disease)  6 or more café au lait macules  2 or more neurofibromas or 1 plexiform neurofibroma  Axillary or inguinal freckling  Optic glioma  2 or more Lisch nodules  Sphenoid dysplasia or thinning of long bones  First degree relative with NF1

Café au lait spots  Coast of what????  NF1 Coast of Cali ○ Smooth borders  McCune-Albright Syndrome Coast of Maine ○ Irregular borders Fibrous Dysplasia Precocious Puberty