Dermatology

Physical appearance can have a significant impact on the psychosocial health of children and adolescents, especially with identity and self-esteem.

The mother of a healthy 10-year-old girl brings her child to the office for evaluation of new onset “eczema.” The rash is asymptomatic and began on the patient's upper eyelids, later spreading to her chest and extremities over several weeks. The child complains of difficulty riding her bicycle.

Although pediatric atopic dermatitis and acne have some similarities among children with skin of color and lighter-skinned children, there are important differences when these common skin conditions affect darker skin types.

A father brings his 12-year-old son to the clinic for evaluation of a skin eruption that has been on the back of the boy’s neck for a year, but which just began to extend behind his ear. The rash is asymptomatic, and the otherwise healthy patient is annoyed that he has to spend a beautiful morning in a physician’s office.

The mother of a 4-year-old boy, whose family recently emigrated from Haiti, brings him to the pediatric mobile clinic for evaluation of a rash that had begun 11 days earlier as an eruption of vesicular, pruritic papules on the bilateral lower extremities and had spread to the buttocks and medial thighs with sparing of the face. The skin eruption was followed by desquamation of the skin on his palms and soles.

The parents of a 4-year-old boy who lives in eastern Maryland near the Pennsylvania line are worried about an expanding rash on his back, which started as a small red bump a week ago following a summer picnic. The boy has had a low-grade fever and has not been acting like himself for a few days.

An adolescent girl is referred by her pediatrician to dermatology for evaluation of a birthmark on her face.

The parents of a healthy 6-month-old boy with eczema bring him to the office for evaluation of a rapidly progressive rash on his arms, legs, face, and back. He had a low-grade fever and loose stools for 2 days last week.

Alarmed parents bring their healthy 14-month-old son to the office for evaluation of a rash that appeared on his face and arms 3 days ago. He had a fever and runny nose at that time, but the fever has since resolved and he is behaving normally.

Anxious parents of a healthy 4-month-old boy come to the office for an urgent consultation for a pink nodule on the baby’s fifth finger that has doubled in size over the last month.

The mother of a healthy 15-year-old boy brings him to the office for evaluation of a darkening hairy patch on his left upper chest and shoulder.

The anxious parents of a previously healthy 19-month-old boy bring the child to the emergency department for evaluation of progressive rash that began 4 months ago. The skin eruption began as small blisters on his knees, which became tense and ruptured, eventually evolving to red-pink scaly plaques. Over the next few months, the boy developed similar lesions on his hands, elbows, neck, perineal area, and face, with sparing of the mucous membranes.

A baffled mother brings her 14-year-old son for evaluation of an asymptomatic bump that appeared on the side of his right third finger 1 week ago.

The parents of a 4-year-old girl are worried about a bald area on the back of her scalp that has been present since birth.

The anxious parents of a 9-year-old boy bring him to clinic for the evaluation of progressive sores in his mouth for 2 days and a rash that erupted last night. Nine days earlier, he had felt warm and had a cough with wheezing and abdominal pain.

A healthy 14-year-old girl who is an avid violin player is brought to the office for evaluation of facial acne. The examination notes a rash on her left neck that has been present for a few years. The patch is mildly tender and itchy but otherwise asymptomatic.

Parents of a 6-year-old boy bring him to your office for urgent consultation for a rash that blossomed on his trunk and extremities 2 weeks ago following an upper respiratory infection and that shows no sign of improving. What’s the diagnosis?

Two siblings, 5-year-old Emmanuel and 3-year-old Cassandra, are brought to your emergency department (ED) in July 2014 by their parents. Both children are up to date on their immunizations and have not had significant medical problems in the past. They were referred to you by their pediatrician for 1 day of high fevers, rash, and pain in the extremities. Emmanuel had 1 episode of gum bleeding last night. His sister has been unwilling to walk since this morning.

A healthy 10-year-old boy is brought to your office by his worried father for evaluation of an asymptomatic birthmark on his left ankle. It has grown proportionately and does not cause pain or interfere with normal function. What’s the diagnosis?

The mother of a 7-year-old girl brings her to the office for evaluation of eczema. On review of symptoms, she mentions concern about a bald spot above her daughter’s right ear, noticeable when she braids her hair.

The parents of a 3-year-old girl with a history of a slowly regressing infantile hemangioma on her right forehead were afraid that she was developing a new hemangioma near her right eye.

The mother of a 16-year-old girl brings her to the office for evaluation of a painful rash on her hands and feet and oral ulcers that make it difficult to eat and drink.

An anxious mother of a 10-year-old boy brings him to the office for evaluation of a new mole that appeared on his back in the last 24 hours. What is causing the rapidly developing pigmented lesion in this patient?

Laws that ban texting while driving have indeed reduced crash-related hospitalizations among all age groups, according to a recent report.

Rashes and fevers are among the most common complaints seen in the pediatrician’s office. The differential diagnosis is often large and ranges from entities the pediatrician sees commonly such as erythema infectiosum to the less common diseases such as Kawasaki syndrome, to more potentially serious conditions such as vaccine preventable illnesses and everything in between.