Skin Diseases

A 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.

The 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.

The mother of an 8-year-old boy sought medical care for her son, who had complained of a sore throat for 3 days. No fever, drooling, rash, rhinorrhea, cough, congestion, ear pain, neck stiffness, or dyspnea was reported. The boy had not been in contact with any ill persons, although his complaints coincided with a local outbreak of streptococcal pharyngitis.

The 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.

For 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.

A15-year-old girl was referred to a pediatric endocrinologist for evaluation of hyperthyroidism. Her primary concerns were intermittent increases in heart rate and appetite (with a weight gain of 7 kg within the past year), feeling hot at night even in winter, persistent lower extremity edema that had been present since age 4 years, and difficulty in concentrating. She denied having diarrhea, sweating, fatigue, breathing difficulties, hair loss, or changes in hair texture.

The mother of a 4-year-old boy noticed a rash on her son's left shoulder the day before. The otherwise healthy, asymptomatic boy plays outdoors daily in his hometown of West Virginia. Earlier in the week, he told his mother that he had felt a "scab" on his shoulder and had picked it off.

This young girl’s lesions have persisted for several months despite therapy with a multitude of over-the-counter products. The patient’s younger sister is affected as well.

A 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.

A discussion of three types of Genital Lesions: Concealed Penis, Balanoposthitis, and Scrotal Abscess.

Dr Robson reports on his time in 2 Haitian cities severely damaged by the January earthquake. He describes the significant challenges he faced and stresses the need for ongoing volunteer efforts.

A 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.

An otherwise healthy 5-year-old girl presented with 2 papillary lesions just below the left lower outer lip. Five months earlier, she had had a common wart on the dorsal side of the web space between her left thumb and index finger. This wart was treated with electrocautery desiccation and curettage. The pictured lesions appeared after the wart on the left hand had been removed.

I’ve weaned my 2-year-old off the bottle. Now how can I get her to break the thumb-sucking habit?

At 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.

The mother of this 11-month-old Somalian girl expressed concern about a light-colored patch over her daughter’s right brow. She was worried that the infant had vitiligo.

An 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.

A 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.

After 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 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.

Disorders of children’s fingernails and toenails can often be difficult to diagnose or treat. Here I provide tips on identifying and treating some of the nail disorders seen in pediatric practice.

A healthy 9-year-old girl presented with pruritic, darkly colored papules and linear lesions on the left side of her face. She had recently been on a hiking trip with her family. Examination revealed erythematous papules and linear streaks with an overlying black substance that resembled black lacquer paint.

A 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.

Match the photographs of the rashes with the correct diagnosis.

The 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.”

Four 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.

During 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.

17-Year-old girl with a 7-month history of small, red papules on her arms and thighs. Rash is not painful or itchy. Otherwise in good health.

A 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.

A 16-year-old girl has had a left breast lump for 6 months that recently became tender. Except for several small nodules in both breasts and tenderness of the lateral left breast, physical findings are normal and the patient is otherwise healthy.