Special Considerations in the Skin of Pediatric and Elderly Patients



Special Considerations in the Skin of Pediatric and Elderly Patients





Overview

An individual’s age, as well as gender and ethnic background, often influences the presence and severity of various skin disorders. This chapter provides a thumbnail description of dermatologic concerns in pediatric and elderly patients that are not discussed in previous chapters. It is intended to complement the earlier descriptions of common skin disorders and to present some less common conditions and rare skin diseases that may affect a patient seeking medical attention from any health care provider.




Pediatric Skin Disorders


Basics



  • The overwhelming majority of pediatric skin disorders that present to pediatricians, family practitioners, and dermatologists consist of acne, atopic dermatitis, diaper rash, congenital lesions, warts, molluscum contagiosum, as well as a multitude of viral, bacterial, and idiopathic rashes.


  • Common as well as various rare dermatoses and congenital lesions are briefly summarized in Table 27.1.

















Table 27.1 Dermatoses and Congenital Lesions in Pediatric Populations



















































































































































CONDITION DESCRIPTION MANAGEMENT IMAGE
Superficial hemangioma (formerly called “strawberry” or capillary hemangioma) Benign proliferation of endothelial cells that starts as macule and grows into dome-shaped papule or nodule
Most often followed by spontaneous involution (“graying”)
Observation or treatment with intralesional or systemic steroids, or laser ablation, especially if lesions compromise function image
Deep hemangioma (formerly called “cavernous” hemangioma) Deep dermal and subcutaneous red to violaceous nodule; regression often incomplete Observation or treatment with intralesional, systemic steroids, or laser ablation, especially if lesions compromise function image
Macular stains (“angel’s kisses,” “salmon patches”) Red macules located on forehead, eyelids, nose, or upper lip
Most often regress by 2 years of age
None indicated image
Stork bites Red macules on back of neck
Persist in 25% of adults
None indicated image
Nevus flammeus (port-wine stain) Congenital malformation of blood vessels
Usually appears at birth
Laser therapy image
Nevus spilus (speckled lentiginous nevus) Tan patches characterized by numerous darker macules or papules Surgical excision for cosmetic reasons only image
Becker’s nevus (pigmented hairy nevus) Pigmented hairy nevus that is located over chest, shoulder, or back
Often appears at puberty
None; surgical excision or laser ablation for cosmetic reasons only image
Nevus sebaceous Congenital hamartoma, with plaques on head or neck
Thickens at puberty
Small risk of malignant degeneration, mainly to basal cell carcinoma
Excision image
Nevus lipomatosis Solitary or grouped proliferation of fatty tissue
Lesions are asymptomatic, soft, skin-colored to yellow papules, nodules, or plaques, with predilection for upper thighs, pelvic, lumbar, and buttock areas
Surgical excision for cosmetic reasons only image
Epidermal nevi Congenital hamartomas with various presentations: verrucous, inflammatory, linear, multiple, or comedonal Excision, observation, or cryotherapy, with topical steroids for inflammatory type, topical retinoids for comedonal type image
Mongolian spots Macular, flat, blue or blue-gray skin markings that appear at birth or shortly thereafter on the sacral area and back
Most prevalent among Asians and African Americans
Often fade spontaneously
None image
Nevus of Ota Gray-blue melanin pigmentation of sclera of the eye
Seen in Japanese, as well as in Africans, African Americans, and East Indians
Laser therapy image
Acropustulosis of infancy Recurrent crops of small pruritic vesicles that evolve into pustules
Involves the palms and soles, most often in black newborns and infants
Remits spontaneously
Topical steroids image
Gianotti-Crosti syndrome (acrodermatitis papulosa) Self-limited, sometimes pruritic exanthem associated with many viral agents and immunizations
Pale, pink to flesh-colored papules (sometimes flat-topped) in symmetric distribution on extremities
None image
Urticaria pigmentosum Multiple red-brown macules, usually on the trunk Antihistamines and/or topical steroids, if symptomatic image
Solitary mastocytoma (the mastocytosis syndrome can involve multiple organs and become chronic; it is not discussed here) Lesions become a wheal (urticate) when rubbed or stroked; this change is referred to as Darier’s sign, which is explainable on the basis of mast cell degranulation induced by physical stimulation
Most cases resolve spontaneously
Usually yellow-brown rubbery plaque that urticates or blisters (bullous urticaria pigmentosum) after rubbing
Resolves spontaneously
No treatment necessary image
Tinea amiantacea Thick, adherent scale on scalp and in hair Keratolytics, followed by topical steroids when scale is cleared image
Talon noir (tennis heel) Self-limited, multiple, black petechiae of heel after minor trauma Paring, protective heel pad image
Pitted keratolysis Pits in stratum corneum of soles; caused by prolonged occlusion, hyperhidrosis, and bacterial proteinase proliferation
Malodorous
Topical erythromycin, clindamycin, or oral erythromycin
Wearing cotton socks to prevent moisture buildup
image
Lichen striatus Idiopathic linear inflammatory eruption
Consists of papules that coalesce into linear, unilateral plaques that appear most often on extremities
Resolves spontaneously
Topical steroids image
Perianal streptococcal dermatitis (perianal cellulitis) Affects children 3 to 4 years of age
Caused by group A beta-hemolytic streptococci
Bright pink to red erythema that extends 2 to 3 cm from anus; infrequently accompanied by itching, fissuring, pain, and mucoid discharge
May become more of a cellulitis, with possible pain on defecation
Penicillin V combined with topical Bactroban (mupirocin) ointment or cream twice a day image
Juvenile xanthogranuloma Occurs in infancy and early childhood
Lesions composed of histiocytic cells; benign, smooth, firm, red-brown papules and nodules that change to yellow
Resolves spontaneously
None necessary image
Lichen nitidus Occurs on thighs, arms, trunk, and genitalia
Idiopathic, asymptomatic, small (1 to 2 mm), flat-topped, shiny, skin-colored papules
Topical steroids, if necessary image
Hyperhidrosis Usually starts in early teen years
Excessive sweating, particularly axillae, palms, and soles
Topical:
Aluminum and zirconium antiperspirants
Topical 20% aluminum chloride hexahydrate in absolute alcohol, anticholinergics, aldehydes, and tannic acid
Iontophoresis
Systemic:
Oral anticholinergic medications
Injection: botulinum toxin
Surgical:
Liposuction
Sympathectomy
image
Subcutaneous fat necrosis of newborn Firm, erythematous nodules and plaques on trunk, arms, buttocks, thighs, and cheeks in otherwise healthy infants
Self-limited
None necessary image
Lymphangioma circumscriptum Congenital hamartoma of lymphatics
Consists of small clusters of vesicles (“frog spawn”)
Surgical excision, laser ablation, cryosurgery, electrocautery, or sclerotherapy image
Acute hemorrhagic edema of infancy (Finkelstein’s disease) Large, urticarial or annular, targetoid, purpuric plaques found primarily on face, ears, and extremities; presumably immune complex–mediated
Self-limited
None necessary image
Staphylococcal scalded skin syndrome (SSSS) Occurs mostly in neo-nates in neonatal or day care nurseries
Toxin-mediated type of exfoliative dermatitis caused by toxigenic strains of Staphylococcus aureus Lesions range from localized bullous impetigo to extensive blistering and exfoliation
Dicloxacillin image

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Jun 25, 2016 | Posted by in Dermatology | Comments Off on Special Considerations in the Skin of Pediatric and Elderly Patients

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