1. Irritant dermatitides

2. Juvenile Plantar-Palmar Dermatosis
AKA sweaty sock syndrome
Location
Plantar surfaces of feet and big toes, palms
Timing
Toddlers and school-age
Fall or winter
Resolution by adolescence
Description
Chronic, red, scaly patches with fissuring

3. Juvenile Plantar-Palmar Dermatosis
Due to wetting of skin during day followed by drying at night
Treatment
Shoes that breathe
Charcoal insoles
Lubrication of feet at night
Topical steroids in severe cases

4. Irritant dermatitides
Lip-licking eczema
Thumb sucking eczema

5. Other rashes

6. Pityriasis rosea Benign self-limited disorder Timing Description
Most common adolescents and young adults
Prodrome of malaise, h/a
Description
Herald patch
Pink, slightly scaly
May clear centrally

7. Pityriasis rosea 5-10 days later Inverse pityriasis Description
Small lesions: trunk, proximal extremeties
Inverse pityriasis
Lesions predominate on face and distal ext (palms/soles)
Description
Small, round papules
Enlarge to 2mm ovals
Scaly surface
Raised, but can be macular
Erythematous, hyper or hypopigmented
May create “christmas tree” pattern over thorax

8. Pityriasis rosea Course Treatment Etiology unknown
Peaks in several weeks
Duration 2-3 mos
Treatment
No treatment required
Oral erythromycin and UV light may hasten resolution
Etiology unknown
?infectious?

9. Keloids Extend beyond margin of the wound Most common in Blacks
Treatment
Intralesional steroids
Combination with surgical excision
Often recur

10. Granuloma Annulare Unclear etiology… no treatment required
Annular eruption
Begins as papule that gradually extends peripherally to form a ring
Raised, indurated
Overlying epidermis intact
Same color as adjacent skin
Extensor surfaces
Resolves over months

11. Contact Dermatitis

12. Categories Irritant contact derm Caustic agents (non-allergic)
Allergic contact derm
T-cell mediated (type 4- delayed)
Poison Ivy or Nickel
Initial rxn needs 7-14 day sensitization period
Reexposure provokes rapid rxn (hours)

13. Rhus Dermatitis (Poison Ivy)
Description
Linear streaks
erythematous papules and vescicles
Large patches (heavy exposure)
Impressive swelling (face, digits, genitalia)
Contact
Sap of plants, objects, smoke
Wash skin immediately
Can not spread after 20min

14. Photocontact and Phototoxic Reactions
Photocontact (Phototoxic)
True cell-mediated delayed hypersensitivity
Sun exposure precipitates urticarial eruption
Marked by sun exposed areas only
Precipitated by
Tetracycline
Sulfa
Thiazides
NSAIDS
Fluoroquinolones
Griseofulvin
Topical agents

15. Phototoxins Agents applied to skin:
Non-immunologic exaggerated sunburn rxn
Photodermatitis most common
Plant-derived photosensitizers:
Psoralens (lemons, limes, figs, dill, parsley, parsnips, carrots, celery)
Macules: Bullae: Hyperpigmented patch
May have bizarre patterns mimicing abuse

16. Phototoxic Rxn (Psoralens)
Lemons
Limes
Figs
Dill
Parsley
Parsnips
Carrots
Celery

17. Treatment of Contact Derm
Localized: topical steroids
Severe or Widespread: systemic steroids
1mg/kg/day tapered over 2wks
Identification of trigger and avoidance are key!!

18. Fungal infections

19. Id Reaction Aka autoeczematization
Widespread secondary eczematous dermatitis
Contact derm
Tinea (particularly at start of therapy)

20. Classification Dermatophytes Yeasts Tinea (ringworm fungi) Candida
Diaper dermatitis
Pityrosporum
Tinea versicolor
Both have been implicated in seborrhea

21. Tinea corporis Description Acquisition Course
Pruritic, annular lesion with central clearing
Border: microvesicles rupture then scale
Acquisition
Direct contact with infected kittens
Trichophyton tonsurans
Course
May expand up to 5cm over several weeks

22. Tinea Corporis Diagnosis Treatment Confirmed by KOH
Loose scales at margin
Long, branching, septate rods of uniform width that cross borders of epidermal cells
Treatment
Glabrous skin areas: topical antifungals
Multiple or widespread: oral griseofulvin

23. Tinea Pedis Aka: Athlete’s foot Location: Timing: Mostly adolescents
Web spaces b/w toes
Sides of toes
May involve the plantar or dorsal surfaces
Timing: Mostly adolescents
Acquisition: contaminated showers, etc
Warm, moist environments
Description:
Scaling and fissuring
Vesiculopustular lesions and maceration
Intense burning or itching

24. Tinea Pedis Dx: Tx: Clinical grounds Confirmed by KOH
Antifungal creams or powders
Reducing foot moisture
Oral antifungals if severe