pediatric dermatology update - acp · 5/1/2013 1 pediatric dermatology update alaska acp &...
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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