Common Skin Disorders

Dr Mohamed Rafa
Msc pediatrics

Skin lesions
- Macule: nonpalpable, circumscribed, flat lesion (1 cm in diameter) –
- Papule: palpable , elevated lesion (1 cm in diameter)
- Purpura: non-blanching papules or macules due to extravasation of RBCs
- Vesicle: fluid-filled, elevated skin lesion (<1 cm)
- Bulla: fluid-filled, elevated skin lesion (>1 cm in diameter)
- Pustule: pus-containing vesicle
- Ulcer: depressed skin lesion with missing epidermis and upper layer of dermis

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What is special?

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Features of dermatological disorders in children are:
• in the newborn, transient skin disorders are common but need to be distinguished
from serious or permanent conditions
• atopic eczema affects up to 20% of children
• skin infections and infestations, especially viral warts and head lice, are common
in school-aged children
• acne is troublesome for many during adolescence.

The newborn
The skin at birth is covered with a chalky-white greasy coat – the vernix caseosa.
In the preterm infant, the skin is thin, poorly keratinized, and transepidermal water
loss is markedly increased when compared with a term infant.
Thermoregulation is also impaired as the preterm infant lacks subcutaneous fat and
is unable to sweat until a few weeks old, whereas the term infant can sweat from
birth.

Bullous impetigo
This is an uncommon but potentially serious
blistering form of impetigo, the most
superficial form of bacterial infection, seen
particularly in the newborn.

It is most often caused by Staphylococcus

aureus.
Treatment is with systemic antibiotics, e.g.
flucloxacillin

Melanocytic naevi moles
Congenital moles occur in up to 3% of neonates and any that are present are
usually small.
Congenital pigmented naevi involving extensive areas of skin (i.e. naevi >9 cm in
diameter) are rare but disfiguring and carry a 4–6% lifetime risk of subsequent
malignant melanoma.

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They require prompt referral to a
paediatric dermatologist and plastic
surgeon to assess the necessity for
further investigation and/or feasibility
of removal.

Melanocytic naevi become

increasingly common as children get
older and the presence of large
numbers in an adult may be
indicative of childhood sun exposure.
Prolonged exposure to sunlight should be avoided and sunscreen preparations with
a sun protection factor of 30 or higher should be applied liberally to exposed skin in
bright weather and reapplied every few hours.
Malignant melanoma is rare before puberty, except in giant naevi.
However, in adults, the incidence of malignant melanoma has been increasing for
many years.
Risk factors for melanoma include a positive family history, having a large number
of melanocytic naevi, fair skin, repeated episodes of sunburn, and living in a hot
climate with chronic skin exposure to the sun.

Albinism
This is due to a defect in biosynthesis and distribution of melanin.
The albinism may be oculocutaneous, ocular, or partial, depending on the
distribution of depigmentation in the skin and eye. The lack of pigment in the iris,
retina, eyelids, and eyebrows results in failure to develop a fixation reflex. There is
pendular nystagmus and photophobia, which causes constant frowning.
Correction of refractive errors and tinted lenses may be helpful.
In a few children, the fitting of tinted contact lenses from early infancy allows the
development of normal fixation. The
disorder is an important cause of
severe visual impairment.

The pale skin is prone to sunburn and

skin cancer. In sunlight, a hat should
be worn and high-factor barrier cream
applied to the skin

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Epidermolysis bullosa
This is a rare group of genetic conditions with many types, characterized by
blistering of the skin and mucous membranes.
Autosomal dominant variants tend to be milder; autosomal recessive variants may
be severe and even fatal.
Blisters occur spontaneously or follow minor trauma.
Management is directed at avoiding injury from even minor skin trauma and treating
secondary infection.
In the severe forms, the fingers and toes may become fused, and contractures of
the limbs develop from repeated blistering and healing.

Mucous membrane involvement may result in oral ulceration and stenosis from
oesophageal erosions.
Management, including maintenance of adequate nutrition and analgesia when
dressings are changed, should be by a multidisciplinary team including a paediatric
dermatologist, paediatrician, plastic surgeon, and dietician.

Collodion baby
This is a rare manifestation of the inherited ichthyoses, a group of conditions in
which the skin is dry and scaly.
Infants are born with a taut, shiny parchment-like or collodion-like membrane.
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Emollients are applied to moisturize and soften the skin.
The membrane becomes fissured and separates within a few weeks, usually leaving
either ichthyotic or far less commonly, normal skin

Nappy rashes
Nappy rashes are common.
Irritant dermatitis, the most common nappy rash, may occur if nappies are not
changed frequently enough or if the infant has diarrhoea.
However, irritant dermatitis can occur even when the nappy area is cleaned
regularly.
The rash is due to the irritant effect of urine on the skin of susceptible infants.
Urea-splitting organisms in faeces increase the alkalinity and likelihood of a rash.
Causes of nappy rashes
Common
• Irritant (contact) dermatitis
• Infantile seborrhoeic dermatitis
• Candida infection
• Atopic eczema
Rare
• Acrodermatitis enteropathica
• Wiskott–Aldrich syndrome

The irritant eruption affects the convex surfaces of the buttocks, perineal region,
lower abdomen, and top of the thighs.
Characteristically, the flexures are spared, which differentiates it from other causes
of nappy rash.

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The rash is erythematous and may
have a scalded appearance. More
severe forms are associated with
erosions and ulcer formation. Mild
cases respond to the use of a
protective emollient, whereas more
severe cases may require mild
topical corticosteroids. While
leaving the child without a napkin
will accelerate resolution, it is
rarely practical at home.
Candida infection may cause and often complicates nappy rashes.
The rash is erythematous, includes the skin flexures, and there may be satellite
lesions. Treatment is with a topical antifungal agent.

Infantile seborrhoeic 
dermatitis
This eruption of unknown cause
presents in the first 3 months of
life.
It starts on the scalp as an
erythematous scaly eruption.
The scales form a thick yellow
adherent layer, commonly called
cradle cap.
The scaly rash may spread to the
face, behind the ears, and then
extend to the flexures and napkin
area.
In contrast to atopic eczema, it is not itchy and the child is unperturbed by it.
However, it is associated with an increased risk of subsequently developing atopic
eczema.
Mild cases will resolve with emollients.

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The scales on the scalp can be cleared with an ointment containing low-
concentration sulphur and salicylic acid applied to the scalp daily for a few hours
and then washed off.
Widespread body eruption will clear with a mild topical corticosteroid, either alone
or mixed with an antibacterial and antifungal agent.

Atopic eczema (atopic dermatitis)

The prevalence of atopic eczema in children is about 20%.
A genetic deficiency of skin barrier function is important in the pathogenesis of
atopic eczema.
Onset of atopic eczema is usually in the first year of life. It is, however, uncommon
in the first 2 months, unlike infantile seborrhoeic dermatitis, which is relatively
common at this age.
There is often a family history of atopic disorders: eczema, asthma, allergic rhinitis
(hay fever).
Around one-third of children with atopic eczema will develop asthma.
Exclusive breastfeeding may delay the onset of eczema in predisposed children but
does not appear to have a significant impact on the prevalence of eczema during
later childhood.
Atopic eczema is mainly a disease of childhood, being most severe and troublesome
in the first year of life and resolving in 50% by 12 years of age, and in 75% by age
16 years

Causes of exacerbation of eczema

• Bacterial infection, e.g. Staphylococcus, Streptococcus spp.
• Viral infection, e.g. herpes simplex virus
• Ingestion of an allergen, e.g. egg
• Contact with an irritant or allergen
• Environment: heat, humidity
• Change or reduction in medication
• Psychological stress
• Unexplained

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Management
A number of treatment modalities are available:
 Avoiding Irritants and Precipitants
 Emollients
 Topical corticosteroids
 Immunomodulators
 Occlusive andages
 Antibiotics, ntiviral gents,   and ntihistamines
 -Dietary limination

INFECTIONS AND
INFESTATIONS

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IMPETIGO
 Children and Adults
 Face common- especially around
nose
 Secondary infection in patients
with eczema
 Sores with Honey-colored crusting
 Contagious
 Causes: Predominantly
Staphylococcus Aureus, sometimes
Stretococcus species
 Treatment- Antibiotics and
Cleanliness

TINEA INFECTION
Fungal Infection “Ringworm”
 Capitis- head
 Corporis- body, arms and
legs
 Faciei- face
 Cruris- groin “jock itch”
 Manuum- hands
 Pedis- feet “athletes foot”
 Unguium- nails
Contagious
 Causes:
Trichophyton rubrum- person to
person
Microsporum canis- from cats
and dogs
Trichophyton verrucosum- farm
animals
 Treatment:
Topical antifungals- Lamisil,
Lotrimin
Oral antifungals-Tinea capitis or
infections that fail topical meds
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MOLLUSCUM CONTAGIOSUM

Infants to young adults

Viral infection
Spread by person to person contact
Small raised pink bumps with dimple in
center, “umbillicated”

Cause: Molluscum Contagiosum virus

spread by contact- direct or indirect
(contaminated ojects like towels)
In young adults- sexually transmitted
Treatment- Self-limited (average 1 year)
 Liquid nitrogen
 Cantharidine- “beetle juice”
 Destruction-
currette, laser…

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SCABIES
Any age
Itchy papules from the neck down
(except infants)
Most common areas: wrists,
fingerwebs, axilla, genitals
Itches worse at night

Cause: Sarcoptes scabiei var humanis

Mites are 0.3mm- microscopic
Mites burrow under the skin. Females lay 2-3 eggs a day
Average infestation is 20 mites
Rash and itching starts 4 weeks after infestation
Mites can live up to 72 hours off a human and 14 days on
Spread by prolonged contact – sharing a bed
Treatment: Elimite
topically, Ivermectin
orally

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 Rashes and systemic disease

Skin rashes may be a sign of systemic disease.

Examples are:
• facial rash in systemic lupus erythematosus or dermatomyositis
• purpura over the buttocks, lower limbs, and elbows in Henoch–Schönlein purpura
• erythema nodosum (Fig. 25.19, Box 25.4) and erythema multiforme (Fig. 25.20,
Box 25.5); both can be associated with a systemic disorder, but often no cause is
identified

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Stevens–Johnson syndrome
Stevens–Johnson syndrome, a severe bullous form of erythema multiforme also
involving the mucous membranes.
It often starts with an upper respiratory tract infection.
Eye involvement may include conjunctivitis, corneal ulceration, and uveitis, and
ophthalmological assessment is required.
It may be caused by drug sensitivity, infection, or both with morbidity and
-sometimes even mortality from sepsis or electrolyte imbalance.

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URTICARIA- HIVES
All ages
Red itchy welts
May get more welts with scratching
Can be associated with Angioedema- can be Life threatening
Welts that come and go- individual lesion must be gone in 24 hours
Can be Medical Emergency if involves airway swelling
Causes:
Medications Viral Illness Foods
Treatment
Antihistamines
Epi-pen; if involves angioedema and airway compromise

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