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Pediatric Dermatology Update

Alaska ACP & AKOMAMay 19, 2013

G. Scott Drew, DO, FAOCDSmith Clinic

Department of Dermatology

Ohio State University College of Medicine and Public Health

Clinical Adjunct Faculty

Ohio University College of Ostoepathic Medicine

Dermatology Residency Faculty

Marian University College of Osteopathic Medicine

Associate Professor of Dermatology

Acne Vulgaris, the # 1 pediatric derm chief complaint

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1. Increased androgens

2. Microcomedones

3. P. acnes

4. Inflammation/PMN’s

Remember the Pathophysiology

Early Comedonal Acne Vulgaris

Papulopustular

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Cystic Acne

Treatment –where to begin?

• Plethora of choices

• No magic bullet

• Education

• Compliance

• Time

• Reassurance

• No picking

Treatment Options-Topical

• Retinoids– Retin A, Tazorac, Differin, et al

• Retinoid combinations– Epiduo, Ziana, et al

• Benzoyl Peroxide– Washes, gels, foams, pads

• Antiobiotics/Anti inflammatories– Clindamycin, dapsone, erythromycin

•

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Acne Conglobata

Therapeutic Options-systemic

• Oral antibiotics– Minocycline and Doxycycline are the war horses

• Hormonal agents– Spironolactone and Oral contraceptives

• Isotretinoin– Category X and I pledge program

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Keloids

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Special Therapeutic Circumstances

• Intralesional injections

• Acne surgery/comedonal extraction

• Systemic steroids

• Etiologies other than Acne vulgaris

• Pregnancy

• Chemical peels

I Pledge 2008

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Sometimes it’s not just acne

Signs of systemic DiseasePolycystic Ovarian Syndrome

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2nd Most Common Peds Derm Chief Complaint: Atopic Eczema

Atopic Dermatitis-Key to management in MAINTAINCE

Pruritis Control

Moisturization

Superinfection elimination

Therapeutics in Atopic Eczema

-Topical Steroids-attention to vehicle

-Antipruritcs-topical and/or oral

-Calcineurin inhibitors tacrolimus/pimecrolimus

-Bland moisturizers and cleansers OTC/Rx

-Education/reassurance

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Atopic Eczema with secondary impetiginization

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Secondary Bacterial Infection

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Secondary Herpetic Superinfection

Regarding HSV, which one is true

A. Differentiating HSV 1 from 2 is an essential part of tx.

B. Recurrences are more severe than primary episodes

C. Prodromes are rareD. Suppressive tx is

indicated if >6 episodes/year

E. Regional adenopathy is uncommon in primary outbreaks

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Herpes Gladiatorum

Secondary Molluscum Superinfection

Molluscum Contagiosum

-Highly contagious amongst pediatric pts, wrestlers, STD-In the genital area, not pathognomonic sign of abuse-Often require no tx in small numbers-treatment modalities include cryo and topical destructive agents.Rarely surgery-In adults, unexplained infections are rare

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One week history of mildy prurutic eruption

Bullous impetigo treatment with topical antibiotics

Impetigo

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This 12 year old boy has impetigo, which one of the following is true

A. Likely has psuedomonas or klebsiella

B. Likely has HSV I

C. Requires gram + oral coverage

D. Will generate a phone call from the principal to mom or doctor

E. Is not contagious

HPV

Common Warts (Verruca Vulgaris)

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Tinea Capitis with Kerion

Scarring from kerion

Tinea Faceii

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Tinea Faceii

Tinea with Secondary Facticial Dermatitis

In Tinea Capitis,

Which is true:

A. It is best treated with low dose Griseofulvin (5mg/kg)

B. Can usually be cleared topically

C. Regional adenopathy is common

D. Candida is the likely cause in these pt.

E. Bed sheets are likely the source of infection

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Tinea Pedis

Disseminated Tinea

Pediatric Pigmented Neoplasms

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Pigmented Neoplasms

Dysplastic Nevi

Becker’s Nevus

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Juvenile Malignant Melanoma

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17y/o with scarring alopecia

A. Scleroderma

B. Morphea

C. Tinea capitis

D. Trichotillomania

E. Psoriasis

Two week pruritic truncal eruption

Pityriasis Rosea

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Granuloma Annulare

Hemangioma

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Acanthosis Nigricans

This lesion has been present since birth. It is (a)

a. Hemangioma

b. Port wine stain

c. Nevus sebaceous

d. Morphea

e. Alopecia areata

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Nevus Sebaceous

Lichen Sclerosus

Segmental Vitiligo

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Epidermolytic Hyperkeratosis

Linear Epidermal Nevus

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Scalp Psoriasis

Scalp Psoriasis

Erythema Multiforme

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Morbilliform Drug Eruption

Cutaneous T Cell Lymphoma