1. Childhood rashes The following items will be discussed: @ Acrodermatitis enteropathica @ Dermatosis affecting the napkin area @ Gianotti- Crosti syndrome Papular acrodermatitis of childhood @ Erythema toxicum neonatorum @ Neonate rashes @ Blueberry muffin babies @ Subcutaneous fat necrosis of the newborn @ Neonatal fat necrosis of the newborn @ Langer

2. Acrodermatitis enteropathica It is an eczematous skin rash related to zinc deficiency. It may be congenital or acquired secondary to prematurity or dietary deficiency. The congenital form is due to a mutation in a trasnsmembrane zinc uptakeprotein & is inherited in an autosomal recessive fashion. Features include: @ Red inflamed patches of dry skin, particularly around body orifices such ass the mouth, anus, eyes & skin on elbows, knees, hands & feet. It may look like ATOPIC DERMATITIS @ Patches evolve into crusted, blistered, pus filled eroded lesions @ There is usually sharp demarcation between affected & normal skin @ Skin around nails becomes inflamed (paronychia) & their may be nail ridging @ Mental retardation @ Diffuse hair loss on the scalp, eyebrows & eye lashes. @ Secondary infection with candida albicans & Staph aureus @ Red glossy tongue & nail ulcers @ diarrhea @ Impaired wound healing @ Deat Treatment is with zinc supplement

3. Acrodermatitis enteropathica

5. Disorder Dermatosis affecting the napkin area Features Psoriasis Scattered beefy red papules which may coalesce into well defined plaques, often lacks scale. Look for other skin/ nail signs of psoriasis or a family history Primary candidiasis Erythema with satellite pustules, may be sharply demarcated with a raised edge, involves groin folds, often follows systemic antibiotics. Acrodermatitis enteropathica Treatment resistant eczematous looking rash, may blister or become crusty, look for perioral involvement Granuloma gluteale infantum Red papule granulomastous nodules, a foreign body reaction to talc or barrier preparations, benign & self limiting Langerhans cell histiocytosis Erythema & scale, progresses to purpuric nodules, extremely rare & may be serious

6. Gianotti-Crosti syndrome papular acrodermatitis of childhood It is a rare eruption that often follows an upper respiratory tract infection& can be associated with mild systemic upset.. It affects children at any age with an equal sex distribution. It is a reaction of the skin to a viral infection: Hepatitis B, Epstein Barr virus are the most frequently reputed etiology. Other incriminated virus: Hepatitis A, cytomegalovirus, coxsacki virus, adenovirus, enterovirus, rubella… The rash consists of multiple small monomorphus lichenoid papules that may be skin colored or red. It is non-itchy, symmetrical & affects the face, extremities, buttocks, palms & soles. It may be associated with a low grade fever, lymphadenopathy & hepatosplenomegaly. The rash is self limiting & normally settles in 2 – 8 weeks. Differential diagnosis: Acrodermatitis enteropathica, erythema multiformis, hand,foot & mouth disease, Henoch - Shonlein purpura, Kawasaki disease, lichen planus, papular urticaria, scabies. Treatment is with emollient. Topical steroid may exacerbate the condition.

7. Gianotti- Crosti syndrome

8. Erythema toxicum neonatorum

9. It appears in up to half of neonates carried to term, usually between day 2 - 5 after birth. it clears up by 2 weeks of age. It appears as blotching erythematous macules with central vesicles, papules or pustules. It does not require treatment. It is due to activation of immune system. Some neonates are more sensitive than others& develop erythematous spots all over the body or may be due to hypersensitivity to detergents in bed sheets & clothing

10. Neonate rashes

11. Neonate rash Milia in neonateCutis marmorata in neonate Napkin dedrmastitis in neonate

12. Childhood rashes Mongolian spot in neonateMiliaria crystallina Acne neonatorumCraddle cap (seborrheic dermatitis)

13. Blue berry muffin babies Blueberry muffin babies present with widespread rash of blue red papules & nodules at birth, The rash is due to congenital infection in utero

14. Disease Causes of blue berry muffin baby Additional features ToxoplasmosisHepatosplenomegaly, lymphadenopathi\y, Hydrocephalus, retinitis& seizures. Prognosis is poor Herpes zosterScarring limb contractures, encephalitis, malformed limbs, growth retardation Human immunodeficiency virus Babies may have opportunistic infections & hepatosplenomegaly CytomegalovirusMay be severe with deafness, mental retardation & seizures RubellaMental retardation, deafness, microcephaly, cataracts, hepatosplenomegaly, pneumonitis, myocarditis, encephalitis, retinopathy

15. Subcutaneous fat necrosis of the newborn It is a rare condition seen in babies of 2-3 weeks of age. It presents with one or more erythematous subcutaneous nodules that may coalesce into plaques. It is often precipitated by cold 7 seen on the trunk, arms buttocks, thighs & cheeks. Rarely, the skin may ulcerate & necrotic fat exude. It can be associated with significant hypercalcemia that may require treatment. The condition is self limiting & resolves over a few months

16. Subcutaneous fat necrosis of the newborn

17. Neonatal herpes simplex infection It occurs during delivery with Direct spreads from vaginal Lesions, when lesions do occur they are typically papules that progress to grouped vesicles. The infection may be limited to the skin, involve the central nervous system or can be disseminated. Untreated disseminated infection has a mortality of over 8O%

18. Langerhans cell histiocytosis It is a part of clinical histiocytosis which are characterized by abnormal proliferation of histiocytes. It is clinically derived into three groups: 1. Unifocal LCH( older name is eosinophilic granuloma which is now a misnomer) 2. Multifocal unisystem LCH. The triad of diabetes insipidus,exophthalmos& lytic bone lesion is known as Hand- Schuller- Christian triad. 3. Multifocal multisystem LCH. Also called Letter –Siwe disease @ Some consider LCH a reactive process. Argument with: Occurrence of spontaneous remission, extreme secretion of multiple cytokines by dendretic cells& by standers cells in lesional tissue, favorable prognosis& good survival rate without organs involvement @ Neoplastic process: Argument supporting: Clonality is an important attribute of cancer; activating mutation of protooncogen in the Raf family. BRAF gene

19. Unifocal LCH (Eosinophilic granuloma) Age affected Over 6 years Prognosis Good Slowly progressive single lesion in bone, skin or soft tissues. Often an osteolytic lesion in a long or flat bone, it may also present as an ulcer, otitis media (mastoid lesion) or tooth disruption (jaw lesion). Treated with curettage or low dose radiotherapy. 1O% progress to multifocal disease Multifocal System LCH 3 – 6 yearsModerateClassical triad of diabetes insipidus (pituitary involvement), exopthalmos & lytic bone lesions. It may also present with a seborrheic dermatitis-like rash, ulceration, bone pain & chronic cough. Treated with radiotherapy & chemotherapy. Spontaneous remission is possible. Lung involvement is a poor sign Multifocal Multisystem LCH (Malignant Letterer- Siwe disease) Less 3 years Poor Rapidly progressive multisystem disease. Patient may be systemically unwell with as generalised skin eruption, multiple LCH lesions, anemia, hepatosplenomegaly, lymphadenopathy& lung involvement. Treatment is with immunosuppressives & chemotherapy. It is often fulminant & fatal

20. Langerhans cell histiocytosis