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Psychodermatology

Introduction Psychodermatologic disorders include psychophysiologic skin conditions that compromise quality of life and primary psychiatric disorders associated with somatic expression of stress that results in skin findings. A number of primary psychodermatoses are reviewed, including trichotillomania, delusions of parasitosis, skin picking, and other self-induced skin lesions. After a discussion of disorders with psychiatric implications, the cutaneous findings of other “outside disorders” including child abuse, graft-vs-host disease,…

Genital disorders

Introduction Children may present to their pediatrician, dermatologist, urologist, or gynecologist with anogenital skin disease. This portion of the chapter highlights some of the most commonly encountered conditions affecting infants, prepubertal children, and adolescents. Recognition of these cutaneous disorders not only enables patients to receive appropriate treatment for their dermatologic disease, but can also alleviate concerns regarding child abuse. However, if child abuse is suspected, a…

Oral cavity

Introduction A comprehensive skin examination should always include close inspection of the mucous membranes, particularly the mouth. Clinical findings in the oral mucosa may provide clues to the diagnosis of an underlying systemic disease ( Fig. 9.1 ), and some cutaneous disorders are associated with specific oral findings ( Fig. 9.2 ). Many lesions commonly identified in the skin occur in the mouth ( Fig. 9.3…

Disorders of the hair and nails

Introduction Diseases of the hair and nails are an important part of pediatric dermatology. Both hair and nails are composed of keratin, produced by the hair follicle and nail matrix. Some diseases are specific to these structures, while others affect the skin and other organ systems. In many cases, important diagnostic clues to skin and systemic disease can be found in related abnormalities of the hair…

Collagen vascular disorders

The connective tissue (collagen vascular, rheumatic) disorders represent a group of diseases characterized by inflammatory changes of the connective tissue of skin, muscle, joints, and viscera. Among these, juvenile idiopathic arthritis, lupus erythematosus, juvenile dermatomyositis, systemic sclerosis (scleroderma), morphea, eosinophilic fasciitis, Sjögren syndrome, mixed connective tissue disease (MCTD), and antiphospholipid antibody syndrome (APS) exhibit specific cutaneous findings. Juvenile idiopathic arthritis Juvenile idiopathic arthritis (JIA) is a…

Vasculitic disorders

The term vasculitis refers to inflammation of blood vessels, a finding that can be seen in association with a variety of clinical manifestations and as either a primary or secondary phenomenon. Along with vessel inflammation there is deposition of fibrinoid material in vessel walls and the presence of nuclear fragments (nuclear dust) resulting from disintegration of neutrophilic nuclei (karyorrhexis) within the vessel wall and surrounding tissues…

Urticarias and other hypersensitivity disorders

The hypersensitivity syndromes are a group of disorders mediated by immunologic or hypersensitivity reactions to foreign proteins such as food or drugs or to infectious agents, immunizations, and malignancies. Although diagnosis of these disorders is often relatively easy, difficulties commonly arise in determining the underlying cause. The most common hypersensitivity reactions are drug reactions, and the skin is a common target. The overall incidence of drug…

Photosensitivity and photoreactions

Sunlight emits a wide spectrum of radiation energy, extending from radio waves through infrared, visible, and ultraviolet (UV) light to X-rays. , The wavelength range of visible light is 400 to 800 nm and is relatively harmless, except for individuals with photosensitivity disorders, such as porphyria, solar urticaria, and polymorphous light eruption (PMLE). The infrared range is 800 to 1800 nm. The UVA and UVB wavelengths…

Infestations, bites, and stings

Parasites are a fascinating and important cause of skin disease in children. They produce their effects in various ways: mechanical trauma from bites or stings, injection of pharmacologically active substances that induce local or systemic effects, allergic reactions in a previously sensitized host, persistent granulomatous reactions to retained parts, direct invasion of the epidermis, or transmission of infectious disease by blood-sucking insects. Arthropods Arthropods are elongated…

Skin disorders caused by fungi

Fungi are a group of simple plants that lack flowers, leaves, and chlorophyll and get their nourishment from dead or living organic matter, thus depending on plants, animals, and humans for their existence. Fungal infections that affect humans may be superficial, deep, or systemic and can occasionally be fatal. Although they do not rank as pathogens with the bacteria or viruses, a number of species once…

Exanthematous diseases of childhood

Several viral and bacterial illnesses may be accompanied by localized or generalized skin eruptions called exanthems . These eruptions may be the first manifestation of a disorder and often are the reason for parents and patients to pursue medical evaluation. Prompt recognition and diagnosis of exanthems is desirable and may dictate that other examinations be performed to assess for systemic associations. Although identification of the exact…

Viral diseases of the skin

Viruses are ultramicroscopic organisms that grow only within living cells. The antigenic material responsible for viral immunologic reactions is present in the outer protein membrane (capsid) of the virus. The nucleoprotein core is composed of either deoxyribonucleic acid (DNA) or ribonucleic acid (RNA). Lacking ribosomes, viruses depend on the use of the host cells’ enzyme systems, blending with metabolic material of the host cell and often…

Bacterial, mycobacterial, and protozoal infections of the skin

The normal skin of healthy infants and children is resistant to invasion by most bacteria because the cutaneous surface provides a dry mechanical barrier from which contaminating organisms are constantly removed by desquamation. Under normal conditions the skin is sterile at delivery and for a short period thereafter. During the process of vaginal birth it acquires organisms from the birth canal, which gradually increase in number…

Bullous disorders of childhood

Blisters or bullae are round or irregularly shaped lesions of the skin or mucous membranes that result from the accumulation of fluid between the cells of the epidermis and sometimes between the epidermis and dermis. The term bullae refers to blistering lesions 0.5 cm in diameter or larger; those smaller than 0.5 cm in diameter are called vesicles . The classification of bullous or vesiculobullous disorders…

Infantile hemangiomas, vascular malformations, and other vascular disorders of infancy and childhood

Classification of vascular lesions Vascular birthmarks, or congenital vascular anomalies, are common lesions that may present in a variety of fashions. There has traditionally been a significant amount of confusion regarding the nomenclature of these lesions, and the term hemangioma was widely used in the medical literature in reference to a variety of different vascular anomalies. , In 1982, Mulliken and Glowacki proposed a classification system…

Nail Disorders

Introduction Nails are specialized cutaneous appendages composed of hard keratins similar to those found in hair, and are unique to primates. In humans, nails function as a stabilizing unit to aid in tactile sensation, grasping, and scratching. Well-manicured or adorned nails in adolescents and adults may be perceived as an attribute of social acceptability and serve as a source of personal satisfaction. Although abnormalities of the…

Hair Disorders

Introduction This chapter covers neonatal hair patterns, genetic hair shaft abnormalities, and the conditions in which hypo- or hypertrichosis are present in the neonatal period. There are many syndromes in which hypotrichosis or atrichia occur, and those in which it is a prominent feature are discussed. Localized alopecia can occur physiologically, with trauma, and as a nevoid disorder, either alone or associated with other nevi. Diffuse…

Neonatal Mucous Membrane Disorders

Introduction Examination of the mucous membranes is an important, yet often overlooked, part of the neonatal evaluation. This chapter discusses abnormal cutaneous findings of the oral, genital, and ocular systems. Many of these abnormalities provide important clues to the diagnosis of underlying disease and/or developmental syndromes in the newborn infant. Disorders of the oral mucous membranes Developmental defects, growths, and hamartomas See Table 30.1 . TABLE…

Selected Hereditary Diseases

Approach to the child with a genetic skin condition To effectively care for an affected newborn and provide information for anxious parents, an organized diagnostic approach is essential. The physical exam requires special attention to ectodermal involvement by assessing the hair, teeth, nails, palms and soles of the feet. Moving beyond the skin, a child should be examined for dysmorphic features, associated major or minor congenital…

Neoplastic and Infiltrative Diseases

Introduction Skin disorders characterized by infiltrative lesions can be present at birth or develop during the first few months of life. Some represent frank neoplasms, both benign and malignant, whereas others are the result of metabolic errors. In most instances, diagnosis is facilitated by skin biopsy, in which certain cell types can be identified by special stains and immunologic markers. Others require special enzyme assays for…