Classic Pediatric Rashes

Transcription

(+)Randolph J. Cordle, MD, FACEP
Medical Director, Levine Children's
Hospital, Division of Pediatric Emergency
Medicine, Department of Emergency
Medicine, Carolinas Medical Center,
Charlotte, North Carolina; Fellowship
Director, Pediatric Emergency Medicine
Fellowship
Classic Pediatric Rashes
Do children with rashes still stump you? The speaker will
review pediatric rashes, from classic childhood exanthemas
to unusual and life-threatening cutaneous disorders. Measles,
varicella, roseola, Kawasaki's disease, impetigo, and
staphylococcal scalded skin syndrome will be presented
using a case-based format.
• Review the common and no-longer common pediatric
exanthems.
• Differentiate among benign and life-threatening pediatric
rashes.
• Discuss the various treatment choices for these
conditions.
WE-216
Wednesday, October 7, 2009
1:30 PM - 2:20 PM
Boston Convention & Exhibition Center
(+)No significant financial relationships to disclose
Randy Cordle MD, FACEP, FAAP, PEM.
Classic Rashes:
Infants and Children
Randy Cordle FACEP, FAAP, PEM
Medical Director: Division of Pediatric Emergency Medicine
Program Director: Pediatric Emergency Medicine Fellowship
Mandatory Objectives Slide
¾ Provide Visual Review
¾ Benign vs. More Serious Rashes
¾ Identify Common Childhood Rashes
¾ Broad Brush Strokes Re: Treatment
¾ A Few “Can’
Can’t Miss”
Miss” Rashes
Levine Children’
Children’s Hospital
Carolinas Medical Center
Bottom Line Objective
¾ Put a picture in your brain.
¾ Make it easier to “Google”
Google” the rash.
¾ Things I’
I’ve Seen Confused.
¾ Improve Communication: Colleagues.
¾ Decrease Over Testing.
¾ The Phone Call……
..
Call……..
Communication
¾ Macule <1cmÆ
<1cmÆPatch >1cm
¾ Papule <1cmÆ
<1cmÆPlaque >1cm
¾ Nodule small deeper, Tumor big
¾ Petechia <3mm, Purpura >3mm
¾ Vesicle <1cm, Bullae >1cm
¾ Pustule = pus
¾ Wheal= comes and goes
¾ Enanthem= Mucous membrane c Exanthema
Communication
¾ Sick or Not
¾ Distribution
¾ Pattern of Lesions
¾ Level(s) of skin effected
¾ Primary and Secondary Lesions
Classic Exanthems
¾ 1st- Measles
¾ 2nd- Scarlet Fever
¾ 3rd- Rubella
¾ 4th-Duke’
Duke’s diseasedisease- mixed viral causes.
¾ 5th- “5ths disease”
disease” Parvovirus
th
¾ 6 - Roseola
Zitelli Teaching Slide Set
Subcutaneous Fat Necrosis
¾ Occurs at sites of trauma
¾ Often follows forceps trauma to face.
¾ Firm nodule follows erythematous mark.
¾ Usually goes away over a months.
Erythema Toxicum
Neonatorum
¾ Full term infants on day 22-3 of life
¾ Up to 50% of newborns will have this
¾ 1-2 mm firm yellowyellow-white papules
surrounded by erythema
¾ Blanches with pressure
Erythema Toxicum
Neonatorum
¾ Lesions sterile but may contain Eos
¾ Not on palms and soles
¾ Fades in 77-10 days
¾ “Flea bite”
bite” dermatosis of newborn
Acropustulosis of infancy
¾ Off and on 3 week pruritic episodes.
¾ Makes them fussy.
¾ Wanes by 3 years.
¾ Usually starts in first 3 months.
¾ Effects palms and soles (+others areas)
¾ Intraepidermal sterile pustules.
¾ Treat locally applied steroids.
Contributed by Dr. Randolph Cordle
Transient Neonatal Pustular
Melanosis
¾ Unknown etiology.
¾ Usually present at birth.
¾ 1-2 mm vesiculopustules first.
¾ Followed by hyperpigmented macules
with collarette of scale.
¾ Most frequent on forehead and neck.
Transient Neonatal Pustular
Melanosis
¾ Occur anywhere on body.
¾ Lesions sterile.
¾ Many neutrophils if stained.
¾ Fades in a few weeks to months.
¾ No treatment necessary.
Miliaria Crystallina
¾ A normal baby rash
¾ Very superficial 11-2 mm vesicles.
¾ Secondary to obstructed eccrine glands.
¾ Contain retained sweat.
¾ Common on head, trunk, and neck in
infants and areas of sunburn in kids.
¾ Leave a thin white scale after rupture.
Miliaria Rubra
¾ AKAAKA- Prickly Heat
¾ A normal baby rash.
¾ Basically miliaria crystallina but the
sweat in the eccrine ducts ruptures out
into the surrounding tissue.
¾ Flexural areas
¾ Exacerbated by heat and humidity
¾ Spontaneous resolution
Copyright 2009 Challenger Corporation. All rights reserved.
Sebaceous Gland Hyperplasia
¾ Normal full term baby rash
¾ Reaction to maternal androgens.
¾ Usually 11-2 cm papules
¾ Usually located in places on the face
where teenagers get “zits.”
zits.”
¾ Resolve by 44-6 months of age.
Seborrheic Dermatitis
¾ Greasy yellow scale on salmon patch.
¾ Intertriginous areas often first effected.
¾ Scalp involved in infants.
¾ Can become thick and adherent.
¾ Weeping and fissuring
¾ Transient post inflammatory
depigmentation common.
Seborrheic Dermatitis
¾ Associate with Pityrosporum infection.
¾ Treatment
¾Comb scale after emollients.
¾Keratolytic shampoos (H and S).
¾Low potency local steroids.
¾Sometimes azole antifungals.
¾Secondary bacterial and candidal infection?
Diapers
¾ 2 month old with a diaper rash
¾ Mother states, “She lets me know when
she needs changed by crying like she is
in pain.”
pain.”
Irritant Diaper Dermatitis
¾ Red and Raw
¾ Not in skin folds
¾ Superficial with light scale
¾ Only in areas of diaper contact
¾ History is important
Irritant Diaper Rash
¾ Treatment
¾Diaper off or changed more
frequently
¾Barrier ointment qid
¾1% hydrocortisone cream
Irritant Diaper Rash
¾ If rash there greater than 5 days, any
hint of satellite lesions or if they have
thrush, then treat with nystatin or
clotrimazole orally and on skin.
¾ Apply barrier cream last.
¾ Always look in the mouth.
Candidal Diaper Dermatitis
Candidal Diaper Dermatitis
¾ Treatment
¾ Rash greater than 5 days.
¾ Satellite lesions.
¾ Intertriginous areas.
¾ Expands outside the diaper.
¾ Associated with “thrash.”
thrash.”
¾Common
¾Nystatin cream or ointment qid.
¾Treat 33-4 days after rash gone.
¾Azoles work well also.
¾New ideas
¾Always treat orally if thrush or persistent.
¾Consider oral nystatin in all cases.
¾Consider miconazole orally for thrush.
¾Consider fluconazole if suppressed.
Seborrheic Diaper Dermatitis
¾ Usually face, scalp, or posterior
auricular areas will also be affected.
¾ Salmon colored greasy lesions.
¾ Often yellow scale
¾ Mostly intertriginous areas
¾ Dandruff of the diaper area
Contributed by Dr. Bernard Cohen: Derm Atlas
Seborrheic Diaper Dermatitis
¾ Starts 33-4 weeks of age.
¾ Usually gone by 33-4 months of age.
¾ Possibly due to Pityrosporum yeast.
¾ Tx of choice = ketoconazole cream
¾antifungal and antianti-gram positive.
¾ Hydrocortisone cream also useful Bid.
¾ Persistent: consider immunodeficiency.
Acrodermatitis Enteropathica
¾ Due to Zn deficiencydeficiency- Give Zn
¾ Brain atrophy!
¾ Periorofacial, acral and diaper areas.
¾ Irritable with behavior changes.
¾ Autosomal recessive form rare.
¾ Nutritional form not so rare
¾Especially if parenteral nutrition.
Cutis Marmorata
¾ A vascular pattern with cold stress.
¾ Key: Symmetric and wide spread.
¾ Goes away with warming skin.
¾ If persistent consider trisomies.
cutis marmorata telangiectatica congenita
Heel stick pustules
¾ Can occur after heel stick sampling.
¾ Present days to couple week later.
¾ Watch for secondary infection.
¾ Typically clear with time.
Harlequin Color Alteration
¾ A vascular phenomena of young infants.
¾ Side down turns red lasting 55-20 min.
¾ Often recurs until about 4 months.
¾ No known serous associations.
¾ Blanches with palpation
Umbilical Cord
¾ Simple Granulomas: Cauterize
¾Stay off the skin.
¾ Differentiate from
¾Patent UrachusUrachus- urine output
¾Omphalocele
¾Hernia
¾OmphalitisOmphalitis- life threatening infection
Omphalitis
¾ Can progress to myonecrosis, necrotizing
fascitis, sepsis and death.
¾ Polymicrobial: G+, GG- and anaerobes.
¾ Culture blood and wound.
¾ Consider Nafcillin and Gentamicin.
¾ Add Clindamycin for anaerobes
¾ Especially if necrotizing fascitis.
¾ Consider vancomycin.
¾ Check child for neutropenia.
Rhus Contact Dermatitis
¾ Type 4 TT-Cell mediated reaction.
¾ Does not spread.
¾ Timing depends on contact
concentration and area of body.
¾ Rash occurs only after prior exposure.
¾ Erythema, vesicles, itching.
¾ Can cause great deal of swelling.
Rhus Contact Dermatitis
¾ Treatment
¾Calamine (no diphenhydramine).
¾Oral antihistamine.
¾Wash off immediately after exposure!
¾Rarely steroids needed.
¾When used give at least 2 weeks with taper.
¾Socks on hands at night.
Impetigo Contagiosum
¾ Group A – B Hemolytic Strep
¾Occasionally Staph
¾ Moist hot areas
¾ ErythemaÆ
ErythemaÆ pustulesÆ
pustulesÆ yellow crusts
¾ Mupirocin to small areas (intranasal?)
¾ Antistreptococcal antibiotics orally
Impetigo Bullosa
¾ Generally phage group II Staph
¾ Typically seen on extremities
¾ Primarily seen in infants and toddlers
¾ At granular layer–
layer– easily ruptures
¾ Antistaphylococcal antibiotics
¾ MupirocinMupirocin- intranasal if recurrent
¾ Local wound care
Staphylococcal Scalded Skin
Staphylococcal Scalded Skin
¾ Exfoliative toxintoxin- Phage II S. aureus
¾ Binds to desmogleindesmoglein-1 in epidermis.
¾ Superficial separation plane
¾ Fever, irritability and skin pain.
¾ Sand paper rash Æexfoliates.
¾ Mucosa typically spared (not SJS)
¾ Axillae typically involved.
¾ Most under 5yo.
¾ Treat like a second degree burn.
¾ IV antibiotics (consider MRSA)
¾+ Nikolsky sign
¾Fragile blisters
¾Relatively minimal fluid loss
¾ <5% mortality
Staph Toxic Shock Syndrome
¾ Starts: flu with macular rash
¾ Flexural areas accentuation
¾ Conjunctival hyperemia
¾ Nikolsky negative
¾ Often tachycardic then hypotension
¾ Often platelets drop: petechiae
¾ Follows retained foreign bodies or URI
¾ Peel after 5 daysdays- hands and feet especially
¾ Edema, cyanosis, pulmonary edema, myocarditis
¾ At least 3 organ systems involved
¾Mucous membranesmembranes- erythema
¾MuscularMuscular- CPK >2X normal
¾GIGI- nausea, vomiting, pain, diarrhea
¾RenalRenal- Bun or Cr >2X normal
¾Platelets <100K
¾HepaticHepatic- SGOT, SGPT, TB >2X normal
¾CNSCNS- altered
¾ Treatment
¾ Fluids, fluids, fluids
¾ Remove foreign body / pus
¾ AntiAnti-staphylococcal antibiotic
¾ Cover MRSA, GNR, anaerobe until DX certain
¾ Clindamycin for ribosomal / protein effects
¾ IVIG often used
¾ PressorsPressors- assess SVR and CO
¾ Admission ICU
Case
¾ 18 month old presents with decreased
PO intake, irritability, apparent sore
throat, mostly shoddy anterior cervical
nodes on left side and one that is 1.7
cm in size and nonnon-tender.
¾ Seen by PCP twice= Viral syndrome
¾ Now with red cracked lips and tongue.
You consider possibilities…
¾ WBC 19,000/uL
¾ CRP 8 mg/dL
¾ Urine with leukocytesÆ
leukocytesÆ 15/HPF
¾Negative nitrite and Gram stain.
¾ Hgb 9.5
¾ Platelet count 460,000/uL
¾ LP with 22WBCs
Atypical Kawasaki’s
¾ Primarily in infants.
¾Risk of aneurisms higher as well.
¾ Consider in infants>children with
¾5+ days of unexplained fever
¾2 or more clinical features of Kawasaki’
Kawasaki’s
¾ Also consider in infants <6 months with
¾6+ days unexplained fever and evidence of
systemic inflammation.
If CRP >3mg/dL or ESR 40mm/Hr then
Supplemental Lab and Echocardiogram
¾ Albumin 3 g/dL or less.
¾ Anemia for age
¾ ALT elevation over normal for age
¾ Platelets >450,000/uL after 7 days
¾ WBC >15,000/mm3
¾ Urine WBC 10+/HPF
Classic Criteria
¾ Fever greater than 390C (102.20F) +4/5
¾ConjunctivitisConjunctivitis- bulbar, bilateral, no exudate
¾Mucous membrane changes
¾RashRash- variable local or diffuse
¾Enlarged cervical nodesnodes- often
nontender/unilateral
¾Peripheral changeschanges- swelling and peeling.
Work Up Result
¾ Echo += treat
¾ Echo – but 3+ supp. labs += treat.
¾ Echo – and <3 supp. labs +=
¾Fever abates: unlikely Kawasaki's
¾Fever persists: repeat echo and consult.
Kawasaki Tidbits
¾ Number 1 acquired cause of heart
disease in preschool age.
¾ Vasculitis
¾Gallbladder hydrops
¾Pancreatic lesions
¾Renal lesions
¾Pulmonary lesions
¾ArthritisArthritis- sometimes persistent.
Kawasaki Treatment
¾ IVIG 2g/kg as single infusion
¾Give slowly to prevent headache (12 Hr)
¾ High dose aspirin 2020-25mg/kg q 6 Hrs.
¾Generally 14 days then decrease dose to 335mg/kg/day until platelet count normal.
¾ 1515-25% untreatedÆ
untreatedÆ aneurisms
¾ Steroids/IIbIIIa inhibitors etc. not
standard first line treatment.
Rocky Mountain Spotted Fever
¾ Dermacentor andersoni (wood) tick
¾ Dermacentor variabilis (dog) tick
¾ Amblyomma americanus (lone star) tick
¾ Rickettsia rickettsii
¾ South central US
¾ All year (most AprilApril-September)
¾ Many without known tick exposure
¾ Present with N, V, HA, F
¾ Malaise, Photophobia, Abd. Pain
¾ Blanching rash on wrists and ankles
¾ Rash to palms/solesÆ
palms/solesÆ centripetal
¾ Becomes petechial over days
¾ Common Findings
¾ Hyponatremia, thrombocytopenia, leukopenia
¾ Relative bradycardia, splenomegaly
¾ SerologySerology- IgM often negative early on
¾ Treatment
¾ Doxycycline
¾ Second line likely quinolone
¾ Chloramphenicol still listed by many
Keratosis pilaris
¾ Typically seen in young children.
¾ Medial thighs, upper arms and face.
¾ PalpablePalpable- like 80 grit sandpaper.
¾ Due to perifollicular scale build up.
¾ More common in those with atopy.
Molluscum
¾ Endemic in children
¾ A poxvirus
¾Briefly consider Monkey Pox and Small Pox
¾ Spread by contact
¾ Often linear distribution.
¾ Can be sexually transmitted
¾ Curette or cantharidin if symptomatic
Pityriasis alba vs. T. versicolor
¾ P. alba
¾ Atopic patients; post inflammation
¾ Poorly demarcated (blots)
¾ Usually improves with time.
¾ T. versicolor
¾ Pityrosporum fungusfungus- spaghetti and meatballs.
¾ Light to dark pigmentation.
¾ Well demarcated “rain drops”
drops”
¾ Selenium sulfide shampoo or azole antifungal.
Scabies
¾ You know these critters!
¾ Face often involved in infants.
¾ Norwegian scabies impressive with
secondary inflammation and even
scarring.
¾ Diagnosis: should be by scrapping!
¾ Treatment: 5% permethrin
¾A family affair!
Contributed by Patricia Treadwell M.D.
Measles
¾ AKA: Rubeola, Red measles, 9 day
measles, Didn’
Didn’t get your shot measles.
¾ 9-10 d incubation
¾ Late winter and early spring
¾ Prodrome: Fever, malaise, coryza, dry
cough, conjunctivitis (more injection
than drainage), photophobia, lethargy.
¾ Koplik spots: 11-2 days after onset.
Measles
¾ Rash fades after about 3 days and is
clear about 3 days after starts fading.
¾ May show desquamation.
¾ May have adenopathy.
¾ Contagious 4 days before till 4 days
after rash presents.
¾ Attack rate >90%
Measles
¾ Rash first seen on day 33-4 of prodrome.
¾ Blanching, blotchy, red, maculopapular
rash which starts at hair line.
¾ Cephalocaudad spread over 33-4 days.
¾ Palms and soles involved (Syphilis,
RMSF, Ehrlichiosis, Lyme’
Lyme’s disease,
Neisseria, etc.)
¾ Older lesions do not blanch.
Why Vaccinate?
¾ Otitis
¾ Pneumonia
¾ Effusions
¾ Encephalitis
¾ Obstructive laryngotracheitis.
¾ Subacute sclerosing panencephalitis.
Varicella
¾ Year round availability.
¾ Incubation: 1010-20 days.
¾ Prodrome: malaise, coryza, low grade
fever occur in some cases.
¾ Rapidly changing painful lesions.
¾ ThinThin-walled vesicles to ulcers to crusts.
¾ Rash in crops (usually 3).
Varicella
¾ Centrifugal from scalp and trunk.
¾ Scales typically gone by 10 days.
¾ All stages present at the same time.
¾ Scar secondary to infection.
¾ Contagious: 1 day before rash till all
lesions completely crusted (7 days).
Why Vaccinate?
¾ Increase risk of mortality and morbidity
in adults compared with children.
¾Secondary bacterial infection common.
¾Flesh eating bacteria.
¾Pneumonia, hepatitis, encephalitis, and
Reye syndrome, disseminated hemorrhagic
disease all occur.
¾ Exposure:
¾Consider immunizing close contacts.
¾VZIG for immunosuppressed.
Hand Foot and Mouth Disease
¾ Coxsackie A16 (non(non-polio enterovirus)
¾ Incubation 22-6 days
¾ Peaks in late summer / early fall.
¾ Contagious
¾Primarily fecalfecal-oral with early respiratory.
¾Fomite transmission.
¾ Enanthem
¾Painful shallow yellow ulcers / red halos.
¾Typically on labial and buccal mucosa.
¾Occasionally on tongue, uvula, palate, etc.
¾May appear vesicular at first.
¾If no exanthem = herpangina.
¾ Prodrome:
¾Brief: Enanthem within 2 days of prodrome
¾Low grade fever
¾Malaise
¾Soreness in mouth
¾Anorexia
¾ Exanthem
¾Starts after enanthem.
¾Red macules on palmar and plantar aspect
of distal extremities.
¾Occasionally elsewhere (buttocks).
¾Quickly become grey vesicles on red base.
¾May be pruritic.
¾ NOT HSV
¾Usually more pain, fever, wide spread in
mouth with associated bleeding.
¾Usually more systemic toxicity and
adenopathy as well.
Erythema Infectiosum
¾ AKAAKA- Fifth Disease
¾ Parvovirus B 19
¾ Preschool and young children.
¾ Rash is most striking part of infection.
¾ Constitutional symptoms mild if present.
¾HA, N, arthralgias and myalgias.
¾ Year round but peaks in winter.
Erythema Infectiosum
¾ Day 1 Slapped Cheeks
¾ Day 2 Slapped Cheeks start to fade
¾ Day 2 Macular / slightly papular lacy
rash develops on extensor surfaces.
¾ Day 3 Rash extends to flexor surfaces.
¾ May involve buttocks and trunk
¾ Resolves in about a week
¾ Can cause aplastic crises in those with
hemoglobinopathies/hemolytic anemia.
Ex-Lax Burns
¾Looks like scald injury
¾Seems more common in “over dose”
¾Each square 15 mg of Senna
¾Irritant contact dermatitis
¾Pathology unclear
¾Likely anthraquinone related effect leading
to higher concentration of digestive
enzymes.
Roseola Infantum
¾ Human Herpes Virus 6 (most common).
¾ Febrile illness in irritable child.
¾ May cause febrile seizure.
¾ 3 months to 3 years most common.
¾ Incubation: 1010-15 days.
¾ Fever lasts 3 days. (> 102F)
¾ Rash within one day of defervescence.
Roseola Infantum
¾ RoseRose-colored maculopapules.
¾ Centrifugal rash starts on trunk.
¾ Rash lasts 3 hours to 3 days.
¾ Commonly seen late fall / early spring.
¾ =Exanthem subitum and Sixth disease.
Pityriasis rosea
¾ Self limited harmless rash.
¾ All ages but primarily young adults.
¾ Peak incidence in winter.
¾ Cause: probably viral.
¾ Occasional cold symptoms as prodrome
Pityriasis rosea
¾ Herald patch
¾Usually singular and large.
¾Oval pink and scaly lesion.
¾May have central clearing.
¾May look like T. corporis.
Pityriasis rosea
¾ Subsequent Exanthem
¾About 1 week later smaller scaly lesions
occur in arborarbor-like pattern on trunk.
¾These reach 11-2 cm size.
¾Slowly fade away over 4 months.
Cold Panniculitis
¾ Due to adiponecrosis.
¾ Common upper thighs and legs
¾Young ladies in skirts waiting on the bus.
¾Kids playing in the snow.
¾ Treatment symptomatic.
¾ Popsicle panniculitis
Kerion
¾ An inflammatory reaction to tinea.
¾ EndothrixEndothrix->black dot= T. tonsurans.
¾ ExothrixExothrix->Wood lamp+=Microsporum
¾ Griseofulvin 88-12+weeks.
¾ Can use terbinafine or azoles.
¾ Do not I and D.
¾ Can culture with tooth brush/swab.
¾ Consider 4 weeks of steroids with taper.
Contact Dermatitis
¾ Many types
¾ Irritant
¾ Allergic
¾ Photodermatitis
¾ Atopic
¾ Dyshidrotic eczema
¾ Nummular
¾ Seborrheic
¾ Others
¾ Treatment
¾ Treat Itch
¾ Steroids
¾ 1mg/kg prednisone
for 2 weeks with
taper.
¾ Local steroids in small
areas.
¾ Not Dose Packs
¾ Autoeczematization
Dyshidrotic Eczema
n
A special form of hyperhidrotic eczema.
n
Often seen in winter.
Itches and burns.
Vesicles on palms and soles.
Can effect tops and sides of hands/feet.
Lateral aspects of fingers and palms.
Treat with drying and steroids.
Recurs
– They have normal sweat glands.
n
n
n
n
n
n
Creeping Eruption
Dead End Host
Natural Host
Eggs in Stool
Eggs-->Larva
Eggs--->Larva
Larva into dermis
Creeping Eruption
¾ Cutaneous Larva Migrans.
¾ Cat and Dog Hookworms (nematode).
¾Ancylostoma braziliense
¾Ancylostoma caninum (eosinophilic colitis)
¾ Endemic in SE USA and Caribbean.
¾ Found primarily in damp sandy soil.
¾ Pruritus worse in previously exposed.
Creeping Eruption Treatment
¾ Typically none except antipruritic agent.
¾ Ivermectin (0.2mg/kg)(0.2mg/kg)- Single Dose
¾Itching resolves completely and parasite
dies within a few days.
¾ ThiabendazoleThiabendazole- Topical and/or oral
¾Often GI side effects.
¾ AlbendazoleAlbendazole¾200mg BID X 3 days
Creeping Eruption
¾ Usually a self limited dermal disorder.
¾ Rarely the larvae penetrate into deeper
tissues leading to systemic toxicity such
as fever, pulmonary infiltrates
(Loeffler’
(Loeffler’s syndrome), eosinophilic
enteritis, muscle infiltration etc.
¾ Usually spontaneously resolves: months
Creeping Eruption
¾ Diagnosis is usually a clinical one
¾ Biopsy not needed
¾ If occult infection suspected ELISA and
Western Blot tests are available.
Causes of Eosinophilia
¾ Allergies
¾ Drug Hypersensitivity
¾ Parasitic Infections/Infestations
¾ Neoplasia
¾ Dermatologic Diseases
¾ Digestive Diseases
¾ CollagenCollagen-Vascular Diseases
Pubic Lice
Causes of Eosinophilia
¾ Hematologic Disorders
¾ Bacterial Infections (few)
¾ Adrenal Insufficiency
¾ Radiation Therapy
¾ Chronic Renal Disease
¾ Sarcoidosis
¾ Loeffler’
Loeffler’s Syndrome
Pubic Lice
¾Entire life cycle on host
¾ Pediculosis pubispubis- Phthirus pubis
¾May be found in any hairy body area.
¾Intense pruritus of the anogenital
area is the most common symptom.
¾approximately 3030-40 days.
¾Transferred via sexual / fomite
contact.
¾Maculae caeruleaecaeruleae- hyperpigmented
macules secondary to chronic
infestation.
¾“Vagabond’
Vagabond’s disease”
disease”
Pubic Lice
Pediculosis Treatment
¾Pediculosis. h. corporis
¾Has not been incriminated as a vector in
the spread of other diseases.
¾Should be sentinel to look for other
STDs and to consider child sexual abuse.
¾Incubation periodperiod- 6-10 days
¾Improve hygiene and wash / dry clothing at
high temperature is all that is necessary.
¾Phthirus pubis
¾Any of the above drugs will work, but reretreatment at 77-10 days is a must.
¾DOC = 1% permethrin
¾If eyelashes are involved, use petrolatum
ointment 33-4 times daily for 88-10 days.
¾ alternative 1% mercuric oxide
¾ Mechanically remove nits from eye lashes
Control Measures
¾Washing, dry cleaning, or storing (10 days)
clothes may be a good idea.
¾Soaking for 10 minutes (128 F) or washing
with pediculicidal shampoo will disinfect
combs and brushes.
¾Environmental insecticides are not helpful.
Suggested Readings/ References
¾ Habif T.: Clinical Dermatology: A Color Guide to Diagnosis and
Therapy.
¾ Challenger Corporation
¾ www.chall.com
¾ Cohen B.: Pediatric Dermatology
¾ http://dermatlas.med.jhmi.edu/derm/
¾ http://www3.dermis.net/index_e.html
¾ http://www.emedicine.com/
¾ Zitelli Atlas of Pediatric Physical Diagnosis: A must have
reference.
¾ Many slides used from this teaching slide set.
¾ LaxativeLaxative-Induced Dermatitis of the Buttocks Incorrectly Suspected to
Be Abusive Burns. www.pediatrics.org
Control Measures
¾ P. pubispubis¾Treat all sexual contacts.
¾Examine all individuals with close
contact to individual or their personal
articles.

Classic Pediatric Rashes

Transcription

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