Seborrheic Dermatitis, Psoriasis and Impetigo in Children – Pediatrics | Lecturio

Seborrheic Dermatitis, Psoriasis and Impetigo in Children – Pediatrics | Lecturio


[Music] in this lecture we will discuss a variety of common pathologic rashes in children let’s start with seborrhoeic dermatitis this is a chronic inflammatory derma ptosis it happens very commonly it’s present in about 5% of the general population and in children often involves areas of high density of sebaceous glands around the nose in the ears wherever there are sebaceous glands it causes inflammation of the epidermis and it’s not a disease of the sebaceous glands themselves so here is a very classic case of cradle cap it’s remarkably common and it occurs in the first two months of life and then again rears its ugly head during adolescence cradle cap is an erythema TISS scaly eruption found on the scalp it’s probably bothering the parents more than it is the child later it can spread to flexural areas like under the neck or in the groin or under the armpits unlike eczema this is not very itchy so in infants it’s usually asymptomatic maybe slightly paretic and here’s an example of it under this child’s neck and then in adolescence it comes back typically as dandruff patients can get peri ocular redness and crusting as well patience will have increased sebum production in response to androgens also a fungus with perhaps my favorite name of any fungus malassezia furfur will grow in that area in the infants we can often treat this with simply mineral oil or a little bit of combing in severe cases or in adolescents we can simply use a dandruff shampoo we generally treat with emollients so four scales on the scalp will give shampoo and combing and maybe ketoconazole shampoo if it’s resistant for body wide eruptions we’ll treat with mild topical corticosteroids and we may mix with an antifungal such as ketoconazole to kill that malassezia furfur let’s skip to another common childhood inflammatory problem which is psoriasis this is one of the chronic inflammatory derma Tosi’s and it is autoimmune in nature it’s pretty common though it happens in one to two percent of the general population with different forms and different severity remember this is an interaction between genes and the environment so patients with HLA type c particularly HLA cwo 6:02 are going to have an increased risk of psoriasis and homozygotes have an even further two and a half times higher risk than heterozygotes psoriasis is generally a well demarcated Aerith ominous popular lesion with plaques and it has a silvery scale to it mainly on extensor surfaces the clinical presentation is diagnostic they will have itching they will generally have a bilateral distribution and you may see nail pitting on their nail exams these are all findings of psoriasis psoriasis is generally triggered by some sort of problem a patient has an underlying risk for it and then they have flares I think would be minor trauma upper respiratory infections stress cold low sunlight levels so sunlight helps and some medications if you were to look pathologically you would notice an epidermal hyperplasia and peri chaotic scale these patients have accumulation of neutrophils within the superficial epidermis when we see these patients we recommend avoiding rubbing or scratching because remember minor trauma makes it worse and we give them emollients or moisturizers sunlight exposure helps tar preparations will help and we can put them on topical steroids or vitamin D analogues we’ll move on to another common infection in skin and this is impetigo we see this a lot in children this is a common superficial bacterial infection of the skin and it’s usually caused by group a strep or Staphylococcus it’s highly contagious and usually starts on the face and the hands and then spreads patients classically have a honey colored crusted lesion moving on there’s a more significant bacterial infection than it can encourage children which is bolus impetigo bolus impetigo is also caused by staph and group a strep we see it more commonly in people with less rigorous bathing it causes flaccid thin-walled Bolle or tender shallow lesions surrounded by the remains of the blister roof that often pops this is commonly implicated in staph scalded skin syndrome patients with impetigo have bacteria in their epidermis that evoke innate humoral response they suffer epidermal injury and they have local serous exudate not posterior which forms a scale or a crust these patients will have accumulation of neutrophils beneath their stratum corneum the pathogenesis of blister formation is somewhat interesting basically the bacteria produce a toxin the toxin Cleaves desmo glean one desmo glean one is responsible for cell to cell adhesion with that breakdown of cell to cell adhesion these Bolle can now form in the upper epidermal layers how do we treat impetigo well untreated lesions usually last two to three weeks and then generally resolve but we can gently remove the crust to prevent spread and then we’ll provide topical antibiotics such as MU Pearson which is very effective against staff and group a strep we may in severe cases also provide oral antibiotics such as a first generation cephalosporin cephalexin which can be given twice a day in cellulitis or clindamycin if we’re suspecting mersa or there’s invasive disease remember these lesions heal without scarring and generally these patients do well so that’s a summary of a few common infections or skin findings in children thanks for your time [Music] you

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