RASH DECISIONSETHAN PETTIT, D.O. FAAP

ERYTHEMA TOXICUMUp to 60% of Term infantsHealthy infantsVesicles/pustues with ring of red aroundE=E

• Erythema toxicum=EosinophilsTypically gone by 7 days

PUSTULAR MELANOSIS

NEONATAL HSV?

INFANT NEVUSDilated fetal capillaries

• 40% of newbornsFlat, dull, pinkFront and back

• 95% of front will fade• 50% of back will fade

PORT WINE STAIN

NEVUS FLAMMEUSCaution to Face distributionLaser treatment

HEMANGIOMAS

HEMANGIOMASBenign Proliferation of endothelial cells. 1-3% at birth10% Caucasians by 1 yearMore females than malesMore common in preterm or SGA

HEMANGIOMASProliferation

• Up to yearStabalization

Involution• Typically after 2

HEMANGIOMAS TREATMENTLocation

• Cosmetic vs DangerousLargeUlcerated

ECZEMAATOPIC DERMATITIS

TINEA VS ECZEMA

ECZEMA TREATMENTMoisture, Moisture, Moisture

• Eucerin, Aquaphor, Cedophil, Aveeno, Vanicream• RIGHT out of the bath

Wet to dry wraps

ECZEMA TREATMENTSteroids

• Creams:• Hydrocortisone 1%, 2.5%• Triamcinolone• Desonide

• Sometimes oral steroids

ECZEMA TREATMENTSecondary infections

Cut nails short

Bleach water baths (1/2 cup per tub)

ECZEMA HERPETICUM

ECZEMA HERPETICUM TREATMENTTreat the HSV, Watch for bacterial infection as well

SEBORRHEACradle capScalyGreasyUsually not itchy

SEBORRHEA TREATMENTDandruff shampooAntifungal creamLow potency steroid cream

KERATOSIS PILARIS

HIVES

HIVES TREATMENTSteroids can help in extreme casesAntihistamines

• Benadryl• Zyrtec• Hydroxizine

CHRONIC HIVESMay or may not have an identifiable triggerAllergy testingMost resolve within a few years

PITYRIASIS ALBA

PITYRIASIS ALBAOften starts with erythematous lesionsLeaves behind hypopigmented lesions

Limited treatment options• If topical steroids used with initial lesions, may prevent

hypopigmented• UV sun protection

PITYRIASIS ROSEABenignSelf limited

• Sometimes 6-8 weeksHerald PatchChristmas Tree pattern

INFECTION RASHES

IMPETIGO

IMPETIGOStaph and StrepTypically honey crustedOften the face

IMPETIGO TREATMENTTopical

• Mupirocen• Don’t forget the nose

Topical not enough• Cephalexin

Sometimes MRSA

HERPES SIMPLEX

SCARLET FEVER

VIRAL EXANTHEM

SSSS

STAPH SCALDED SKIN SYNDROMEToxin mediatedTender skinShearing skinLack of mucosal involvement

compared to SJS or TEN (deeper)

MENINGOCOCCEMIA

HENOCH SCHONLEIN PURPURA

Tinea CorporisVs

Granuloma Annulare

KOH

TINEA VERSICOLOR

TINEA VERSICOLORKOH (spaghetti and meatballs)

TreatmentSelenium SulfideTopical antifungal

ACNEGentle CleanserBenzoyl Peroxide

EpiduoTopical Retinoids

Retin Amay take 6-8 weeks

BUG BITES

SCABIES

SCABIES TREATMENT5% PermethrinBedding cleaned in AMTreat all family members (even if not symptomatic)

BED BUGS

FLEAS

STINGS

LOCAL REACTION

WARTS

WART TREATMENTCryotherapy

care to nail bedsSalicylic AcidTapeAbrasion

CALLUS

MOLLUSCUM

NEUROCUTANEOUS

NEUROFIBROMATOSIS TYPE 1Café au lait macules

6 or moreNeurofibromas

often not until after pubertyLisch nodules

CAFÉ AU LAIT

NEUROFIBROMAS

LISCH NODULES

TUBEROUS SCLEROSIS

TS ANGIOFIBROMAS

ACKNOWLEDGMENTSKelly McClean MD, Michigan Board ReviewRobert Colman MD, Whitney Molis MD, Pediatric and Adult allergy P.C. http://www.onlinedermclinic.comhttp://hardinmd.lib.uiowa.edu/pictures22/dermnet/http://www.skinsight.com/imageshttp://dermatlas.comhttp://dermnet.comhttp://dermatologyoutlines.comhttp://www.allergyasthmamichigan.comhttp://0.tqn.com/w/experts/DermatologyGoogle images