Pediatric Dermatoses

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These seven Photoclinic cases offer a good look at and a brief overview of common dermatologic conditions of childhood.

First case ►

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These images are of a 5-year-old girl who presented with a generalized macular papular dermatitis. She had no pruritis or pain. She had 101°F axillary temperature taken at home the night before the rash began. She had decreased appetite when seen on the first day of the rash. True temperature was 98.4°F at the office. She stated that she had a sore throat although results of throat examination were normal. Throat strep test was negative. She did not appear or act ill and was extremely talkative. The mother was advised to give her acetaminophen if needed. My impression was viral exanthem.

She returned the next day with more rash at which time these pictures were taken. Rash had been present for 2 days. It presented on the right elbow first and rapidly appeared next on the left elbow, upper arms, and ankles. It then spread over the anterior and posterior trunk and to all extremities and a few spots appeared on her face.

On the 2nd day of rash she was referred to a dermatologist for consultation and was diagnosed with Gianotti-Crosti Syndrome (papular acrodermatitis of childhood, PAC). It is seen  predominantly in children between 1 and 6 years of age and occurs following a viral infection. Multiple viral agents have been implicated.

The eruption is self-limited and may take 8-12 weeks to resolve. In this case the rash  dissipated over the next several days after diagnosis.

Diagnosis is made clinically. No testing is normally necessary. Treatment is supportive.

Next case►

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This picture of a 6-year-old boy's neck and adjoining face shows a papular dermatitis that began 3 days previously. It was pruruitic.

Differential diagnosis includes contact dermatitis, drug eruption, and insect sting reaction. 

He had been around tree cutting with poison ivy vines the day before the rash developed.  Calamine lotion was applied giving the pink coloration. 

He was treated with triamcinolone 0.025% cream topically and rapidly improved. 

His diagnosis was poison ivy dermatitis.

Next case►

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This 10-year-old boy presented with the left lower eyelid showing hyperpigmentation.

The right lower eyelid had a similar appearance. The boy's mother stated this had developed over the previous four months and was associated with his picking at his lower eyelids secondary to pruritis from chronic allergic conjunctivitis and rhinosinusitis.

Diagnosis was hyperpigmentation secondary to repetitive trauma. 

He was treated with loratadine, fluticasone propionate nasal spray, and topical triamcinolone 0.025% cream to eyelids.

Next case►

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This picture of a 9-year-old boy's left cheek shows a long, linear, very finely scaly, hypopigmented, sharply demarcated rash. The boy complained of pruritis. A microscopic KOH preparation revealed no fungus. Fungus culture grew Geotrichum species. He was treated with  
ketoconazole 2% cream topically daily for 30 days with complete clearing.

Diagnosis is tinea corporis of left cheek.

Differential diagnosis includes superficial laceration and contact allergic dermatitis.

Next case►

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This picture of a 7-year-old boy's posterior scalp shows a large area of smooth baldness without scales. The area had been slowly enlarging for several months and several smaller similar areas developed on the scalp. A KOH prep was negative for fungus as was a fungus culture.

He was referred to a dermatologist who clinically diagnosed alopecia areata. He is being treated with intradermal injections and topical applications of a corticosteroid.

Differential diagnosis includes side effects of chemotherapy and scalp radiation.

Next case►

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Shown is an image of a 13-year-old girls' right lumbar arm with a large rash surrounded one half way around by a slightly raised orange-brown sharp border. She had just noticed it in a mirror and did not know when it began. She had a little pruritis with it. 

KOH microscopic exam of scrapings at the edge of the rash were negative. Fungus culture grew Trichophyton mentagrophytes and Nigrospora species. She was treated topically with ketoconazole 2% cream daily with complete clearing.

Diagnosis is tinea corporis, right lumbar.
 
Differential diagnosis includes psoriasis, atopic eczema, and blastomycosis.

This case is notable for the distinctive fungus coloration.

Next case►

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These pictures of a 2-year-old boy's right anterior and lateral trunk show numerous pink macular lesions about 3/4-cm in diameter with central papules. He was asymptomatic except for occasionally pulling at his scalp hair. He was referred to a dermatologist who confirmed the clinical diagnosis of scabies.

The tip-off for this diagnosis was that his mother and a sibling had been treated for scabies since his birth. He was treated with topical permethrin 5% cream with prompt resolution. 

Differential diagnosis includes viral exanthema, drug eruption, and allergic dermatitis.

Back to first case.