Pediatric Dermatology

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What is the purpose of a pediatric dermatologist?

A pediatric dermatologist specializes in the diagnosis and management of diseases of the skin, hair, and nails in children. The clinical presentation and treatment of skin diseases are often different in the pediatric and adult populations. A pediatric dermatologist has expertise in the management of patients ranging in age from newborns to young adults.

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When should you consider a skin biopsy in a pediatric patient?

The ability to perform a skin biopsy in the outpatient setting is often limited by the age of the patient and willingness to tolerate a procedure while awake. A skin biopsy should be reserved for situations where there is diagnostic uncertainty and where information gathered from the procedure will change management. A skin biopsy may be helpful in patients who do not respond to empiric or conventional therapy.

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List five strategies to make procedures in pediatric patients easier

• Preoperative application of a topical anesthetic can decrease the pain associated with a procedure.

• Anxiolytic medications can be given to lessen a child’s anxiety.

• The use of vibration or a cold sensation directly on the skin can mitigate the perception of pain.

• Distraction with talk, music, or a video can help make a patient more comfortable during a procedure.

• Conscious sedation or general anesthesia may be necessary when a patient cannot otherwise tolerate an in-office procedure with local anesthetics.

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What are congenital melanocytic nevi and what is their associated risk of melanoma?

Congenital melanocytic nevi (see Fig. 57.1 ) are nevi that present at birth or shortly thereafter. They are classified as either small (< 1.5 cm), medium (1.5–19.9 cm), or large (≥ 20 cm) based on the projected size of the nevus in an adult. Small and medium congenital melanocytic nevi are quite common (1 in 100), whereas large congenital pigmented nevi are rare (1 in 20,000). The controversy surrounding these lesions concerns their malignant potential. The lifetime risk for development of melanoma in small and medium congenital melanocytic nevi is less than 1%, while the risk in large congenital melanocytic nevi is less than 5%.

Alikhan A, Ibrahimi OA, Eisen DB. Congenital melanocytic nevi: where are we now? J Am Acad Dermatol . 2012;67(4):495.e1–1.

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What is dermal melanocytosis?

A blue-black patch or patches found in up to 90% of newborns with darker skin types. The most common location is the sacral region ( Fig. 57.1 ), but dermal melanocytosis may occur on any portion of the body. This skin finding typically fades within the first 3 years of life.

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Which disease should be considered in a newborn with fragile skin and easy blistering?

A child with skin that blisters with minimal trauma should be evaluated for epidermolysis bullosa, an inherited mechanobullous disease. There are multiple subtypes, but clinically there are four important variants: epidermal, junctional, dystrophic, and Kindler Syndrome (see Chapter 6 ).

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What is the most likely diagnosis for a newborn with congenital absence of skin on the vertex of the scalp?

Aplasia cutis congenita. This condition may be an isolated finding or associated with ectopic neural tissue, epidermolysis bullosa, or limb defects. Aplasia cutis congenita generally heals by second intention, creating a scar with overlying alopecia.

Browning JC. Aplasia cutis congenita: approach to evaluation and management. Dermatol Ther . 2013;26(6):439–444.

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What is the most common cause of diaper dermatitis, and what are the treatment strategies?

Irritant contact dermatitis due to urine and feces is the most common cause of diaper dermatitis. The treatment consists of application of barrier creams or ointments and frequent diaper changes to minimize exposure to irritants.

Blume-Peytavi U, Kanti V. Prevention and treatment of diaper dermatitis. Pediatr Dermatol . 2018;35 Suppl 1:s19–s23.

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What organism commonly complicates irritant diaper dermatitis?

Candida albicans . The use of an azole topical antifungal medication is an effective treatment for this secondary skin infection.

Blume-Peytavi U, Kanti V. Prevention and treatment of diaper dermatitis. Pediatr Dermatol . 2018;35 Suppl 1:s19–s23.

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Crusted purpuric papules and a scaly seborrheic-like eruption in the scalp and groin are seen in what serious disease of childhood?

This constellation of findings suggests Langerhans cell histiocytosis ( Fig. 57.2 ). The disease can vary from a mild skin-limited eruption to a severe, life-threatening, systemic disease. Traditionally, this disease has been treated by pediatric oncologists.

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What diagnosis and workup should you consider in an infant with annular erythema in a sun-exposed distribution?

This eruption is consistent with neonatal lupus erythematosus and is confirmed by the detection of maternal autoantibodies to SS-A/Ro and/or SS-B/La. An electrocardiogram should be performed to evaluate for congenital heart block, which can be lethal without intervention.

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At what age does atopic dermatitis typically begin?

Atopic dermatitis generally first appears between 3 and 6 months of age. In approximately 90% of patients who develop atopic dermatitis, onset is by 5 years of age.

Eichenfield LF, Tom WL, et al: Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol . 2014;70(2):338–351.

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