Eczema Herpeticum With MRSA Superinfection
September 13th 2010A 7-month-old boy with a history of severe atopic dermatitis and asthma was brought for evaluation of a generalized rash, fever, and irritability of 2 days’ duration. He had no respiratory symptoms. His medical history was significant for anorexia, without vomiting or diarrhea. He had a strong family history of allergy.
Do These Multiple Asymptomatic Lesions on a Boy’s Chest Require Treatment?
September 9th 2010The lesions on this 10-year-old boy had developed during the past year. They were asymptomatic and appeared only on the anterior chest. The child's older brother had had similar lesions, also on the chest, for more than 10 years. The boys' mother was concerned that her younger son might experience the same "disfigurement" as her older son and wanted to prevent that from happening.
Atopic Dermatitis Superinfection Caused by Staphylococcus sciuri and Enterobacter asburiae
August 9th 2010The rash on this 4-week-old girl had appeared 5 days earlier on her face as thickened scales on an erythematous base and subsequently spread to the scalp, shoulder, chest, abdomen, and extremities. A few bullae were noted on the neck and hands. Initial treatment with cephalexin failed to control the rash, and the infant was admitted to the hospital for further evaluation.
Henoch-Schönlein purpura with gastric wall thickening
August 9th 2010For 3 days, a 7-year-old girl had severe, generalized abdominal pain. The patient described the pain as sharp and achy without radiation; she denied any relieving or aggravating factors. She also reported decreased appetite and energy for the past week.
Boy With Multifaceted Acute Illness
August 5th 2010A 9-year-old previously healthy boy presents to his pediatrician with acute onset of a nonproductive cough, left eye swelling without loss of visual acuity, persistent fever of 3 days’ duration, chills, headache, chest pain, vomiting, and left knee pain with inability to bear weight.
Asymptomatic Papular Rash in Infant With Rhinorrhea
July 7th 2010A 10-month-old boy with an asymptomatic rash is brought to your office by his mother. The rash, which began on the legs and spread to the arms, face, and buttocks, has been present for 3 days. Other than rhinorrhea and nasal congestion for the past 3 to 5 days, the infant has been well, although fussier than usual, especially at night. His appetite is normal. The rash has persisted despite the application of bacitracin, petroleum jelly, and cortisone. He has had no sick contacts with a similar rash or illness. His immunizations are up-to-date.
Boy With Thick Plaques on His Palms and Soles
July 6th 2010At his first well-child visit after a family move, an 8-year-old boy was noted to have bilateral erythematous plaques on the surfaces of his hands and feet. Mother reported that the condition had been present since he was 2 or 3 months old. Patient’s father and other male relatives on the paternal side (uncles, grandfather, great-grandfather) were similarly affected. No other associated symptoms, such as hyperhidrosis, reported. The child did not have a history of eczema, asthma, or food allergies; however, he did have a history of allergic rhinitis and occasional pruritus.
Atypical Dermatitis Herpetiformis
June 10th 2010An 18-year-old boy presented with a several-month history of an intermittent, very pruritic rash on his back that did not improve with topical corticosteroids. Physical examination revealed grouped erythematous papules with a few scattered small vesicles on his posterior neck and bilateral posterior shoulders at the location where his backpack frequently rubbed.
Extensive Miliaria Crystallina
June 10th 2010A healthy term infant born via normal vaginal delivery was noted at birth to have numerous small vesicles involving most of his face and upper chest. He was transferred to the neonatal ICU for suspicion of disseminated herpes simplex. On examination, the infant had small, 1- to 2-mm, superficial, clear vesicles that were confluent on the forehead, eyelids, nose, cheeks, neck, and upper back. A Tzanck test was negative for multinucleated giant cells.
Developing Pattern Recognition: The Key to Pediatric Dermatology
June 9th 2010After completing training in pediatrics, dermatology, and pediatric dermatology, I am convinced that the art of medicine, especially as practiced in the field of pediatric dermatology, consists largely of an ability to use pattern recognition to separate the usual from the rare.
Drug Eruptions: The Benign-and the Life-Threatening
June 9th 2010“Drug rash” is a common pediatric complaint in both inpatient and outpatient settings. This term, however, denotes a clinical category and is not a precise diagnosis. Proper identification and classification of drug eruptions in children are important for determining the possibility of-and preventing progression to-internal involvement. Accurate identification is also important so that patients and their parents can be counseled to avoid future problematic drug exposures.
Toddler With Nonpruritic Rash That Does Not Respond to Corticosteroids
June 9th 2010A 1-year-old boy presented with a 10-day history of a nonpruritic rash that had persisted and spread despite treatment with a topical corticosteroid. Mother reported that he was febrile at the onset of the eruption; he was given over-the-counter antipyretics. On day 3, his pediatrician evaluated his condition and prescribed amoxicillin for his fever and hydrocortisone cream for his atopic dermatitis. Over the next several days, the fever subsided; however, the rash, which had started on the child’s right hand, persisted and spread to his face and elsewhere.
Is this a dermatophyte infection of the scalp?
June 8th 2010The mother of this 7-year-old girl originally thought these peculiar scales in her daughter’s scalp and hair were nits, since there had recently been an outbreak of head lice at the child’s school. However, she was not able to find any lice, and the scales resisted removal with mineral oil and a “nit comb.”
Arm Swelling and Erythema Following Hymenoptera Sting
June 8th 2010Four hours after a 12-year-old boy was stung by a honeybee on his right middle finger, he noticed localized hand swelling, erythema, and tenderness. The following morning, his entire hand was swollen and erythematous, with contiguous erythema on the medial aspect of his forearm and arm. Although the arm was tender to palpation, he was afebrile and felt well. Because of an initial concern for cellulitis or lymphangitis, he was given intravenous antibiotics and antihistamines and was admitted overnight for observation.
Osteoid Osteoma in an Obese 17-Year-Old Boy
June 8th 2010During a well adolescent visit, an obese 17-year-old boy complained of left knee pain of 4 years’ duration. The pain was worse at night. He was able to ambulate. He associated the pain with a left tibial fracture he sustained after falling off a bicycle 4 years earlier; he denied recent trauma.
Hemangiomas: Distinguishing Between Various Types of Vascular Lesions in Infants
June 7th 2010A hemangioma can be concerning to parents, who want to know the prognosis for the lesion as their infant grows. Here, clues to help you identify those that will rapidly involute, those that will grow for a while and then involute over a period of years, and those that without treatment will remain unchanged. Also, which hemangiomas warrant referral.