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College of Health and Medical Science

Department of Pediatrics and Child health Nursing

OVERVEIW OF PEDIATRICS SKIN PROBLEMS

By Ashenafi Z
JANUARY, 2024
01/01/2025
2 Presentation outline
 Introduction
 Inflammatory& allergic reactions of the skin
 Bacterial skin infection
 Viral skin infections
 Fungal skin infection
 Parasitic skin infestation
 Non infectious inflammatory dermatoses
 Benign tumors and skin cancer 01/01/2025
3 Morphology of skin lesions

 Type of the lesion

 Size of the lesion
 Shape of the lesion DIAGNOSIS
 Distribution and arrangement
 Margination

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 Primary lesions
4
o macula - spot
o Flat, change in skin color <1.0cm
o No elevation or depression
o Not identified by mere touch
o Patch ---- >1.0cm
Papule
 Papula - pimple
 Small solid elevation
 < 0.5cm in diameter
 Epidermal, dermal or 01/01/2025

 combined changes
 Nodule
5  Nodulus - ‘small knot’
 Palpable, solid, round lesion
 big papule

Blister (vesicle, bullae)

 Vesicula - ‘little bladder’
 Bulla - ‘bubble’
 Small raised fluid filled lesion ~ 0.5cm
 Vesicle < Bullae

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 Pustule
6  Small pus containing swelling
 Usually ass. with infection
 from papules or vesicles
 May develop denovo e.g. acne
Wheal
 Round or flat topped red, purple papule
 Disappears in hours or a day or two
 Due to edema in the upper dermis
 If lower----SC---Angioedema
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 Plaque
7 palpable lesions >1 cm in
size and have a flat surface
Tumor
Elevated, palpable, solid mass or cystic
elevation >2 cm in diameter extends deeper
into the dermis
Cyst
Encapsulated fluid-filled or semisolid mass
in the subcutaneous tissue or dermis

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 Secondary lesions
8 Erosion, ulcer
 Types of tissue loses varying in their
depth and breadth
 Erosion: confined to the epidermis
 Ulcers: larger defect involving the dermis
and SC
Fissures
Linear crack in the skin, may extend to
dermis
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 Scales
 Flakes secondary to desquamated, dead
9 epithelium
 Varies in color and texture
Crust
 dried residue of serum, blood, or pus on skin
surface
Scar
 skin mark left after healing of a wound or lesion
Keloid
 hypertrophied scar tissue
 Secondary to excessive collagen formation
during healing (elevated, irregular, red) 01/01/2025
 Diagnostic evaluation of skin problems
1 1. History and physical examination
0 The diagnosis of a skin disorder is made chiefly by visual
inspection, but some skin disorders may require additional testing
2. Skin biopsy
Is performed to obtain tissue for microscopic examination
by scalpel excision or by a skin punch instrument that removes a
small core of tissue. Eg malignancy and exact dxs
3. Skin scraping
Tissue samples are scraped from suspected fungal lesions with a
scalpel blade moistened with oil and examined microscopically
. 01/01/2025
 4. Wood’s light examination
1 Is a special lamp that produces long-wave ultraviolet rays, where it is
1 possible to differentiate epidermal from dermal lesions and hypo
pigmented and hyper pigmented lesions from normal skin.
5. Tzanck smear
The Tzanck smear is a test used to examine cells from blistering skin
conditions and The secretions from a suspected lesion are applied to a
glass slide, stained, and examined
6. Culture and sensitivity
To confirm the causative agent and drugs to which they are sensitive

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 1.Inflammatory& allergic reactions of the skin
1  Dermatitis is an inflammation of the skin.
2  It is a common condition and not life-threatening or contagious.
 Several types of dermatitis (eczema) Causes
Atopic dermatitis Allergies
 Contact dermatitis Genetic factors
Seborrheic dermatitis Physical and mental stress
 Neuro dermatitis Irritants
Stasis dermatitis
Perioral dermatitis
S/S :- redness, swelling, itching and skin lesions. 01/01/2025
 Contact dermatitis
1  Acute or chronic inflammatory skin disorder
3  Characterized by well demarcated skin lesions
 History of exposure to suspected offending
agent
Types:- Irritant contact dermatitis
Allergic contact dermatitis
Causes
 Irritant substances Ex: Detergents,
hair metals, perfumes, strong acids &
alkalis induce irritant contact dermatitis
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 S/S
o Erythematous
1
4 o Macular, papular or papulo-vesicular
eruptions,
o chiefly involving the exposed part of the
body
o Pruritus is common
Mgt
 Avoid the agent
 Topical steroids and if severe systemic for
a short time
 Antipruritics
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 Treat the complications

 Atopic dermatitis
1  Is the cutaneous expression of the atopic state to environment.
5  Chronic superficial inflammation of skin characterized by pruritis
 It affects 10-30% of children worldwide
 2/3rd of patients have family members with
asthma, hay fever, and very dry skin
Causes
 Exact cause is not known
 Genetics
 Activated by the immune system (IgE)
 Contact with the external trigger 01/01/2025

and infection
1
6
S/S :-Pruritus, redness, papule,
thickening of skin
Exacerbations & remissions of s/s
Common over face & neck, behind
the knee & back of the hand.

Mgt:- Removal of allergen

Relief of pruritus
fluid & nutrition
Topical drugs
Systemic drugs
01/01/2025

Prevention of infection
 Seborrheic dermatitis
1  Called dandruff in the scalp
7  Cause not fully understood
 Associated factors:
 Genetics
 Immunosuppression
 Yellowish red, often greasy, or white
dry scaling macules and papules
Mgt
 Selenium sulfide shampoo
 Ketoconazole shampoo
 Topical steroids 01/01/2025
 Acne
 result from blockages in sebaceous gland follicles
1 Causes:- exactly unknown
8  Family history
 Hormonal activity
 Hyperactive sebaceous glands
 Accumulation of dead skin cells
Types:- Acne vulgaris :- adolescent
Acne Rosacea:- uncommon < 30 yrs
S/S:- Whiteheads or blackheads of Nodules /red
lesion pustules, Scarring, Comedo
Mgt:- cleaning and removal of oils
 Keep the skin clean
 Antibiotics 01/01/2025

 Corticosteroids
 2. Bacterial skin infection
1 Boil (furuncle)
9  inflammation of hair follicles accumulation
of pus & dead tissue
Etiology:- staphylococcus auerus or
streptococcus
S/S:- Red, shiny, & swollen pus-filled lump
Tenderness, warm&/or painful
Fever & swollen lymph nodes if sever
 When the lump is ready to rupture, a pointy
white or yellow central area is noticed.
Mgt:- Surgical drainage(incision & drainage)
Systemic antibiotics 01/01/2025

Vitamin A & E supply for recurring cases.

 carbuncle
 extension of a furuncle that has invaded several
2 follicles & large & deep seated.
0
Etiology:-usually staphylococcal infection
C/F:- painful lésion, Fever, malaise
Common sites for the lesion/thick & inelastic
skin , Back of the neck ,Shoulder
hips ,thigh
Mgt:- Extraction (surgical drainage)
o Antibiotics
o analgesics
o Topical RX – 1% GV
o Warm moist compresses 01/01/2025

o
 Impetigo

2 superficial skin infection
1 More common in children and contagious
 caused by either Staphylococci or
Streptococci
 Two clinical syndromes
1.Non bullous
 most common 70 percent
 The face (especially around the nares)
commonly affected.
 vesicle or pustule that quickly evolves into a
honey-colored crusted plaque. 01/01/2025

 Surrounding erythema may be present.

 Bullous
2  Mainly affects newborns and infants

2  Always caused by S. aurous strains that produce

exfoliative toxins.
 Clear yellow fluid that subsequently becomes dark
yellow and turbid
 Appear in various skin areas, esp. the buttocks
Mgt
 Removal of the crusts
 Antibiotics
 Topical agents –GV applied 2-3x daily
 Avoid contact and sharing of clothes
Complications:-AGN (PSGN),Rheumatic fever,
Cellulitis 01/01/2025
 CELLULITIS
2  Inflammation of subcutaneous tissue
3  S. aureus and group A streptococci most
common etiologic agents
 Preceded by a history of an antecedent
lesion
 erythema, local pain, and tenderness and
variable degrees of systemic SxS
 Tender and hot, vaguely demarcated lesion
with swelling of the affected limb
 Regional lymph nodes may be involved.
 Mgt based on purulent/ non purulent SSTIs
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 Parenteral antibiotics for at least ten days

 3.Viral skin infections
Herpes zoster
2  is an infection caused by the vzv
4  Common in immune-suppressed patients
 painful vesicular eruption along the area of distribution
of the sensory nerves from one or more posterior
ganglia
S/S:- Pain (burning, tearing or sharply cutting)
 Itching, constant aching, or deep, shooting pain.
 Rashes and Blisters follow the path of the nerve
crust and Scar
Mgt:- Acyclovir
Antihistamine to reduce itching
Minimize pain
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Reduce viral shedding

 Herpes simplex
 Infection of the skin or mucous membrane by
2
HSV-1 and HSV-2
5  cause a wide variety of mucocutaneous
infections
 produce both primary and recurrent
infections
 Herpes labialisis caused usually by HSV -1,
and herpes genitalis commonly by HSV-2.
 Prodromal of tingling, itching, or burning
sensation usually precedes any visible skin
changes by 24 hours
 Erythema are often noted initially, followed
soon by grouped, often umbilicated vesicles 01/01/2025

 Treatment :- Acyclovir
 Warts

2  Non cancerous skin growths

6  Caused by direct contact with a virus called the
HPV (Human papillomavirus)
 Which causes a rapid growth of cells on the
outer layer of the skin
S/S:- Small, fleshy, grainy bumps ,Flesh-
colored, white, pink
 Rough to touch & usually painless
 one or more tiny black dots, which are
sometimes called wart seeds
Mgt:- Salicylic acid(Podophylin)
 Freezing (cryotherapy )
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 Minor surgery
 MOLLUSCUM CONTAGIOSUM
2  Large double stranded DNA viral infection
7  Affects children age 2-6 yrs and immunosuppressed
individuals
 Spread by person to person contact
S/S:- Small raised pink bumps with dimple in center,
“umbillicated”
The face, eyelids, neck, axillae, and thighs
commonly involved
Mgt
 Mostly self-limited
 Immunotherapy 01/01/2025

 avoid shared baths and towels

 Fungal skin infection
2  Clinical forms dermatophytosis
8 (Ringworm, Tinea)
 Tinea corporis (body)
 Tinea capitis (scalp)
 Tinea cruris ( groin & axillae)
 Tinea unguium(Fungal nails)
 Tinea pedis (Athlete's foot)
Diagnosis
 Primarily based on the appearance &
location of the lesion.
 Skin scraping 01/01/2025
 Mgt
2  Topical anti fungal creams can clear the
9 condition in two weeks
o Whitfield’s ointment
o Clotrimazole1% cream
 Systemic treatment
First line:- GriseofulvinV
Ketoconazole
 Keep the area clean
 Shampoo hair
 Minimize sweat & moisture
 Avoid contact 01/01/2025
 Tinea versicolor(Pityriasis versicolor)
o common fungal infection of the skin
3 o interferes with the normal tanning of the skin appears as a
0 tissue-thin coating
o occurs when the fungus becomes overgrown on the skin of
hair follicles
o patches of discolored skin that grow slowly the only sign
o The patches can be various colors, including white, pink, tan
or dark brown.
o Usually affects the back, chest, neck or upper arms & can
cause mild itching.
Treatment Wash and dry the affected area,
o apply Antifungal creams, lotions or shampoos
o Ketoconazole2% cream 01/01/2025

o Flucoconazole for 2-4 wks.

 4. Parasitic skin infestation
3 Scabies
1 infestation of the skin by the itch mite sarcoptes scabiei
 disease of people living in substandard hygienic
conditions
 spread of scabies is determined by the extent and
duration of physical contact
 Children and sexual partner of an affected individual are
most at risk.
S/S:- intense pruritus, particularly at night.
 Threadlike burrows are the classic signs
 Preferred sites are the inter digital spaces, wrist flexors,
anterior axillary folds, ankles, buttocks, umbilicus and
belt line, groin, genitals and areolas . 01/01/2025
 Mgt
3  permethrin 5% cream is standard therapy
2  Benzyl Benzoate Lotion (BBL 25%)
 Sulphur (5%) applied to the entire body
 Warm, soapy bath to remove the scaling
debris
 All bedding and clothing should be
washed in a very hot water and dried on
hot climate
 Contacts should be traced

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 Pediculosis: lice infestation
 They inject their digestive juices and excrement into the skin, which
3 causes severe itching
3  Serves as a vector of human disease
 They depend on the host for their nourishment, feeding on human
blood approximately five times each day
 disease of unwashed people or those who live in close quarters and
do not change their clothing
Types Pediculosis capitis
o Pediculosis corporis and
o Pediculosis pubis
S/S:- eggs are visible to the naked eye
 Itching and scratching, Reddish brown dust
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 Mgt
3
 Lindane(1%,1-2oz apply for 4 mins) then
4
 Wash with a shampoo/lotion containing or Pyrethrin(1%)
 Permethrin1% is applied to affected areas of the skin and
to hairy areas
 All articles, clothing, towels, and bedding that may have
lice or nits should be washed in hot water—at least 54°C
(130°F)
 All family members and sexual contacts must be treated
 personal hygiene education

01/01/2025
 5.Non infectious inflammatory dermatoses
3 Psoriasis
5  Is a chronic noninfectious inflammatory and
incurable skin disease
 An autoimmune-related disease
 Characterized by inflammation and altered
keratinocyte proliferation
 has a complex multifactorial genetic basis
Risk factors
 Family history(50% pts)
 medical conditions and medication
 Stress Obesity
 Smoking infections 01/01/2025

 Injury to the skin

 Classifications
3 Non pustular forms pustular forms
6 Plaque psoriasis Pustular psoriasis
Guttate psoriasis Pustolosis palmaris
Psoriatic arthritis Erythrodermic psoriasis
Signs and symptoms
 Thick silvery scales
 Itchy, dry, red patches and painful
 Pitted, discolored, and crumbling nails
 Positive Auspitz’s sign
 Koebner phenomenon
 The scalp, face, elbows, knees, lower back,
and genitalia are most often affected 01/01/2025
 Management
 Treatment is palliative and aims to slow rapid turnover
3 of the epidermis
7 Has 4-tier process
1. Topical therapy
o emollients, vitamin D analogs
o mid- to high-potency corticosteroids
2. Phototherapy
 Narrow-band UVB(311 nm; NB-UVB) radiation
3. Systemic therapy
 Methotrexate (0.2-0.7 mg/kg/wk
 retinoids (0.5-1.0 mg/kg/day)
 cyclosporine (3-5 mg/kg/day) 01/01/2025
 6.Benign tumors and skin cancer
3
8 Common benign tumors in children
Epidermal inclusion cyst
Pilomarticoma
Milium
Pilar cyst
Ereptive vellus hair cysts
Syringoma

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 skin cancer
3 Skin cancer can be classified in to two
9 Melanoma and
Non melanoma
Non melanoma is classified in to two
Basal cell carcinoma and
Squamous cell carcinoma

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