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1. A 4-year-old boy presents with erythematous, oozing, excoriated plaques on the cheeks and chin (sparing the nose), trunk, and extensor surfaces of the arms and legs. His parents report that the “rash,” which flares on occasion, has been apparent since the boy was 6 months old, and he does anything he can to scratch the itch.
Diagnosis: Diagnosis of atopic dermatitis (AD) is made by age 5 in 85% to 90% of children who develop the disease, and by age 1 in 60% to 65%. AD persists into adulthood in up to one-third of patients. Although the cause is unknown, AD may be triggered by viral infections, food allergens, or weather, and in turn may trigger an inflammatory progression known as atopic march. Other factors affecting AD development include genetics and hygiene.
For more information:
“A Practical Overview of Pediatric Atopic Dermatitis, Part 2: Triggers and Grading.” Cutis. 2016;97(5):326-329.
“A Practical Overview of Pediatric Atopic Dermatitis, Part 3: Differential Diagnosis, Comorbidities, and Measurement of Disease Burden.” Cutis. 2016;97(6):408-412.
2. A child presents with a history of flaccid bullae and encased fluid progressing from clear yellow to turbid and darkish yellow. The pustules have ruptured, resulting in thin, light brown to golden yellow crusts and a collarette of scale at the periphery of the erosion. Itching is mild.
Diagnosis: Bullous impetigo most commonly affects neonates, hence the occasionally used (and inadvisably employed) name pemphigus neonatorum. Bullous impetigo appears to be less contagious than the nonbullous form and is usually sporadic in presentation. Typical areas of occurrence include the trunk and extremities, as well as intertriginous zones (eg, the diaper area, neck folds, and axillae).
For more information, see “Impetigo Update: New Challenges in the Era of Methicillin Resistance.” Cutis. 2010;85(2):65-70.
3. A 16-year-old Hispanic girl seeks consultation for a perioral rash that first appeared two weeks ago, shortly after she used an OTC depilatory agent. The rash has worsened despite application of topical neomycin ointment. The patient reports pruritus and occasional burning. Examination reveals erythema, hyperpigmentation, and excoriation of the skin around the corners of the mouth.
Diagnosis: An allergic contact dermatitis to both the depilatory agent and neomycin was suspected. The patient was advised to discontinue use of both products, and a medium-potency topical steroid was prescribed. She returned for follow-up in 10 days, at which time the condition had improved by about 75%. Therapy was changed to 1% hydrocortisone cream. The patient was instructed to return for patch testing if the dermatitis recurred.
Reprinted with permission from Emergency Medicine. 2010;42(8):19-20. http://www.mdedge.com/emed-journal/article/71585/dermatology/lesion-scrotum
4. The rash on this 5-month-old baby’s hands manifested several weeks ago. It spread to his arms and trunk and is now essentially everywhere except his face. Despite a number of treatment attempts, including oral antibiotics and OTC topical steroid creams, the problem persists.
Diagnosis: The diagnosis of scabies should be confirmed, whenever possible, with microscopic scabetic findings. In addition, treating the whole family and identifying the source of the infestation are crucial. Diagnosis of scabies is difficult in infants, as any part of an infant’s thin, soft, relatively hairless skin is fair game (whereas, in adults, scabies rarely affects skin above the neck). And although infants with scabies undoubtedly itch—probably just as much as adults—they are inept excoriators and even worse historians. In contrast, adults with scabies will scratch and complain continuously while in the exam room.
For more information, see “Baby Has Rash; Parents Feel Itchy.” Clinician Reviews. 2014;24(9):W3.
1. A 4-year-old boy presents with erythematous, oozing, excoriated plaques on the cheeks and chin (sparing the nose), trunk, and extensor surfaces of the arms and legs. His parents report that the “rash,” which flares on occasion, has been apparent since the boy was 6 months old, and he does anything he can to scratch the itch.
Diagnosis: Diagnosis of atopic dermatitis (AD) is made by age 5 in 85% to 90% of children who develop the disease, and by age 1 in 60% to 65%. AD persists into adulthood in up to one-third of patients. Although the cause is unknown, AD may be triggered by viral infections, food allergens, or weather, and in turn may trigger an inflammatory progression known as atopic march. Other factors affecting AD development include genetics and hygiene.
For more information:
“A Practical Overview of Pediatric Atopic Dermatitis, Part 2: Triggers and Grading.” Cutis. 2016;97(5):326-329.
“A Practical Overview of Pediatric Atopic Dermatitis, Part 3: Differential Diagnosis, Comorbidities, and Measurement of Disease Burden.” Cutis. 2016;97(6):408-412.
2. A child presents with a history of flaccid bullae and encased fluid progressing from clear yellow to turbid and darkish yellow. The pustules have ruptured, resulting in thin, light brown to golden yellow crusts and a collarette of scale at the periphery of the erosion. Itching is mild.
Diagnosis: Bullous impetigo most commonly affects neonates, hence the occasionally used (and inadvisably employed) name pemphigus neonatorum. Bullous impetigo appears to be less contagious than the nonbullous form and is usually sporadic in presentation. Typical areas of occurrence include the trunk and extremities, as well as intertriginous zones (eg, the diaper area, neck folds, and axillae).
For more information, see “Impetigo Update: New Challenges in the Era of Methicillin Resistance.” Cutis. 2010;85(2):65-70.
3. A 16-year-old Hispanic girl seeks consultation for a perioral rash that first appeared two weeks ago, shortly after she used an OTC depilatory agent. The rash has worsened despite application of topical neomycin ointment. The patient reports pruritus and occasional burning. Examination reveals erythema, hyperpigmentation, and excoriation of the skin around the corners of the mouth.
Diagnosis: An allergic contact dermatitis to both the depilatory agent and neomycin was suspected. The patient was advised to discontinue use of both products, and a medium-potency topical steroid was prescribed. She returned for follow-up in 10 days, at which time the condition had improved by about 75%. Therapy was changed to 1% hydrocortisone cream. The patient was instructed to return for patch testing if the dermatitis recurred.
Reprinted with permission from Emergency Medicine. 2010;42(8):19-20. http://www.mdedge.com/emed-journal/article/71585/dermatology/lesion-scrotum
4. The rash on this 5-month-old baby’s hands manifested several weeks ago. It spread to his arms and trunk and is now essentially everywhere except his face. Despite a number of treatment attempts, including oral antibiotics and OTC topical steroid creams, the problem persists.
Diagnosis: The diagnosis of scabies should be confirmed, whenever possible, with microscopic scabetic findings. In addition, treating the whole family and identifying the source of the infestation are crucial. Diagnosis of scabies is difficult in infants, as any part of an infant’s thin, soft, relatively hairless skin is fair game (whereas, in adults, scabies rarely affects skin above the neck). And although infants with scabies undoubtedly itch—probably just as much as adults—they are inept excoriators and even worse historians. In contrast, adults with scabies will scratch and complain continuously while in the exam room.
For more information, see “Baby Has Rash; Parents Feel Itchy.” Clinician Reviews. 2014;24(9):W3.
1. A 4-year-old boy presents with erythematous, oozing, excoriated plaques on the cheeks and chin (sparing the nose), trunk, and extensor surfaces of the arms and legs. His parents report that the “rash,” which flares on occasion, has been apparent since the boy was 6 months old, and he does anything he can to scratch the itch.
Diagnosis: Diagnosis of atopic dermatitis (AD) is made by age 5 in 85% to 90% of children who develop the disease, and by age 1 in 60% to 65%. AD persists into adulthood in up to one-third of patients. Although the cause is unknown, AD may be triggered by viral infections, food allergens, or weather, and in turn may trigger an inflammatory progression known as atopic march. Other factors affecting AD development include genetics and hygiene.
For more information:
“A Practical Overview of Pediatric Atopic Dermatitis, Part 2: Triggers and Grading.” Cutis. 2016;97(5):326-329.
“A Practical Overview of Pediatric Atopic Dermatitis, Part 3: Differential Diagnosis, Comorbidities, and Measurement of Disease Burden.” Cutis. 2016;97(6):408-412.
2. A child presents with a history of flaccid bullae and encased fluid progressing from clear yellow to turbid and darkish yellow. The pustules have ruptured, resulting in thin, light brown to golden yellow crusts and a collarette of scale at the periphery of the erosion. Itching is mild.
Diagnosis: Bullous impetigo most commonly affects neonates, hence the occasionally used (and inadvisably employed) name pemphigus neonatorum. Bullous impetigo appears to be less contagious than the nonbullous form and is usually sporadic in presentation. Typical areas of occurrence include the trunk and extremities, as well as intertriginous zones (eg, the diaper area, neck folds, and axillae).
For more information, see “Impetigo Update: New Challenges in the Era of Methicillin Resistance.” Cutis. 2010;85(2):65-70.
3. A 16-year-old Hispanic girl seeks consultation for a perioral rash that first appeared two weeks ago, shortly after she used an OTC depilatory agent. The rash has worsened despite application of topical neomycin ointment. The patient reports pruritus and occasional burning. Examination reveals erythema, hyperpigmentation, and excoriation of the skin around the corners of the mouth.
Diagnosis: An allergic contact dermatitis to both the depilatory agent and neomycin was suspected. The patient was advised to discontinue use of both products, and a medium-potency topical steroid was prescribed. She returned for follow-up in 10 days, at which time the condition had improved by about 75%. Therapy was changed to 1% hydrocortisone cream. The patient was instructed to return for patch testing if the dermatitis recurred.
Reprinted with permission from Emergency Medicine. 2010;42(8):19-20. http://www.mdedge.com/emed-journal/article/71585/dermatology/lesion-scrotum
4. The rash on this 5-month-old baby’s hands manifested several weeks ago. It spread to his arms and trunk and is now essentially everywhere except his face. Despite a number of treatment attempts, including oral antibiotics and OTC topical steroid creams, the problem persists.
Diagnosis: The diagnosis of scabies should be confirmed, whenever possible, with microscopic scabetic findings. In addition, treating the whole family and identifying the source of the infestation are crucial. Diagnosis of scabies is difficult in infants, as any part of an infant’s thin, soft, relatively hairless skin is fair game (whereas, in adults, scabies rarely affects skin above the neck). And although infants with scabies undoubtedly itch—probably just as much as adults—they are inept excoriators and even worse historians. In contrast, adults with scabies will scratch and complain continuously while in the exam room.
For more information, see “Baby Has Rash; Parents Feel Itchy.” Clinician Reviews. 2014;24(9):W3.