Skin:

Henoch-Schonlein purpura (the most common systemic vasculitis of

childhood)
Pathogenesis
IgA immune mediated leukocytoclastic
vasculitis
Clinical
Palpable purpura
manifestations
Arthritis/arthralgia
Abdominal pain, intussusceptions
Renal disease similar to IgA nephropathy
Laboratory findings
Normal platelet count & coagulation studies
Normal to increased creatinine
Hematuria +/-RBC casts +/- proteinuria
Treatment
Supportive (hydration & NSAIDs) for most
patients
Hospitalizations & systemic glucocorticoids in
patients with severe symptoms
*Follows an infection and presents with tetrad of palpable purpura on the
lower extremities, arthralgias, abdominal pain, and renal disease.
Diagnosis requires the presence of lower extremity purpura or petechiae with
at least 1 of the following:
-Arthritis or arthralgia
-Renal involvement
-Abdominal pain
-Positive histopathology
Labs show normal platelet count and mildly elevated creatinine
Children with atypical presentations, a renal biopsy may be required:
deposition of IgA in the mesangium will be seen.
Treatment: Supportive and consists of hydration and pain control with NSAID.
Atopic Dermatitis (Eczema)
Risk Factors
Low humidity
Relatives with eczema, allergies, or asthma
Clinical Features
Infant: face, scalp, and extensors
Child adult: flexural
Treatment
Topical emollients +/- steroid ointment
Complications
Eczema herpeticum

Vs. Contact
dermatitis

Cellulitis/abscess
Discomfort interfering with daily activities &
sleep
Atopic dermatitis: recurrent rash that affects
the cheeks, scalp, trunk, and extensor surfaces
in infants. It is associated with severe pruritus
and most patients have a family hx of atopic
disorders (asthma, allergic rhinitis)
Contact dermatitis: an inflammatory skin
condition causes by contact with an allergen or
irritant. Symptoms are similar to atopic
dermatitis (including severe pruritus), although
they are typically confined to a specific exposed
area (e.g. perioral area, hands)

Pathogenesis: epidermal dysfunction due to improper synthesis of stratum

corneum components. Allergens can enter the disrupted skin barrier and
generate an inflammatory response. Excessive bathing, dry environments,
stress, overheating, and irritating detergents can trigger flares.
Tx: trigger avoidance, frequent application of thick bland emollients, and use
of hypoallergenic cleansers for bathing and laundry. Moderate and severe
eczema may require topical anti-inflammatory ointments (e.g.
hydrocortisone)
Eczema herpeticum- a potential complication of severe atopic dermitis.
Superinfection with herpes simplex virus can cause a vesicular eruption on
preexisting inflamed skin. Patients often have fever and pain.
-Seborrheic dermatitis- cradle cap in infants. Adherent greasy scales with a
mildly erythematous base are seen on the scalp.
-Nevus simplex:
* e.g. Macular stain, salmon patch, stork bite, angel kiss
* Blanchable, pink red patches that most commonly occur on the eyelid,
glabella, and midline of the nape of the neck. They are typically present at
birth and fade spontaneously by age 1-2, although neck lesions may persist
with no sequelae.
Superficial infantile hemaniomans/ strawberry hermangiomas: benign
capillary tumors of childhood. They appear during the first weeks of life,
initially grow rapidly, and typically regress spontaneously. Some lesion may
require treatment with beta blockers.

Seborrheic dermatitis
Clinical

Features

Associations
Pathogenesis

Treatment

Peaks in infancy & adulthood

Erythematous plaques &/or yellow, greasy scales
Located on scalp, face (e.g. eyebrows/eyelids,
posterior ears, nasolabial folds), umbilicus, diaper
area
Malassezia spp
Affects areas with numerous sebaceous glands. In
infant, these areas include the scalp (cradle cap),
eyelids, nasolabial folds, postauricular area, and
umbilicus
First line: Emollients, nonmedicated shampoos
Second line: Topical antifungals or low potency
glucocoritcoids

Tinea capitis: fungal infection of the scalp that causes pruritic patchy, fine,
white scales that resemble SD (seborrheic dermatitis). But, it does not
involve the eyebrows or nasolabial fols and is uncommon in the first year.
Psoriasis: Chronic inflammatory disorder that affects the extensor surfaces of
the elbows and knees.
Oral Isotretinoin Therapy
Clinical use

Pathophys

Side Effects

Treats severe, recalcitrant

nodulocystic acne associated
with significant scarring that
has not responded to other
therapies including systemic
antibiotics
Retinoids inhibit follicular
epidermal keratinization,
which results in loosening of
the keratin plugs of
comedones and facilitating
their expulsion
Retinoids also reduce the size
of sebaceous glands and
inhibit sebum production
Pseudotumor cerebri
Hyperlipidemia
Chelitis, dry skin
Myalgias
Tertogenic: spontaneous

CI

SSS (Staphylococcal
scalded skin syndrome)

Scarlet fever
Impetigo

Erysipelas
Erythema multiforme

abortion, fetal malformations

Dont give with tetracyclin due
to risk of idiopathic
intracranial HTN- pseudotumor
cerebri.

Exfoliative
toxin targets
desmoglein
1, which is
responsible
for
keratinocyte
adhesion in
the
superficial
epidermis
Cultures are
sterile (toxin
mediated)
Eliminate
inciting
focus of
infection
with
appropriate
anti-staph
antibiotics
Mortality
rate low in
kids, high in
adults

S. aureus or
group A Bhemolytic
streptococcu
s

MC
infectious

Prodrome: fever,
irritability, skin
tenderness
Erythema starts on
face and generalized
within 24-28 hours
Superficial flaccid
blisters develop, with
flexural accentuation
and perioral crusting
NIkolsky sign is
positive (gentle
lateral pressure on
the skin surface
adjacent to a blister
causes slipping and
detachment of a
superficial layer of
skin). Blisters are
fragile and unroofed
reveal a moist
erythematous base
Subsequent scaling
and desquamation
continue for 5 days
Resolves within 1-2
weeks
Localized epidermal
infection
Bullous and nonbullous variants
Acute, self limited
reaction

agent is
Herpes
simplex

Targetoid papule or
plaque
Arofacial distribution
& palmar
involvement
Mucosal lesions and
systemic symptoms
also seen
Targetoid lesions of
EM may have central
bulla, but Nikolsky
sign is negative