Pediatric Dermatology: Clinical Pearls

James Treat, MD

3 points to remember about pediatric dermatology:

  • It may be possible to prevent atopic dermatitis with emolliation started before 3 weeks of age
  • Excess Hair around congenital scalp lesions may indicate ectopic brain tissue
  • Topical timolol can be very effective for early superficial hemangiomas.

Acne: Clinical Pearls

James Treat, MD

5 things to remember about treating acne in pediatric patients:

  • Children who develop acne between the ages of 1 and 7 should have an endocrine workup
  • When needed oral erythromicin can be used off-label as a systemic antibiotic in children under 8.
  • Neonatal acne is in part caused by malassezia yeasts.
  • Pre-adolescent acne can be treated similarly to adolescent acne except that doxycycline should not be used in children under 9 or those who have not developed their secondary teeth
  • Isotretinoin MUST be given with food

Infectious Disease: Clinical Pearls

James Treat, MD

5 pearls for treating infectious disease in children:

  • Gianotti Crosti can be induced by molluscum contagiosum and may mark the end of the infection
  • Tonsillectomy should be considered in children with severe psoriasis that correlates with GRoup A Streptococcal infection
  • ‪If you see Guttate psoriasis in children under 5, look at their perianal area for the Strep infection
  • Leishmaniasis can present as a non-healing ulcer in patients who have traveled to Central AMerica or Middle East
  • Exuberant hand foot and mouth is caused by coxackie A6

Dermoscopy Clinical Pearls

Ashfaq Marghoob, MD

  1. Shiny white structures seen with polarized dermoscopy are important clues for malignancy
  2. The key features seen in malignancy: dermoscopic asymmetry, blue-black-gray color, shiny white structures (includes negative network), and blood vessels
  3. Never monitor palpable lesions unless you know for sure they are benign
  4. Shiny white blotches and strands is a new criterion for BCC
  5. The 2-step algorithm, pattern analysis, 3-step algorithm, chaos and clues and the AC rule can be condensed into the TADA algorithm.

Clinical Pearls: Pediatric Infectious Disease

Albert Yan, MD

A few clinical pearls from Dr. Albert Yan’s presentation on Pediatric Infectious Disease at the 2015 Fall NPPA conference:

  • Interrupted skin integrity in premies and infants may indicate infection first and foremost
  • Epidermolysis bullosa-like neonatal presentations may indicate widespread HSV infection
  • Eczema herpeticum may recur and should be monitored for recurrences to determine if prophylaxis is needed
  • Superinfection of atopic dermatitis with fever, grouped pustules, cellulitis, facial infection can suggest group A strep infection
  • Itchy papules and blisters at sites of exposure can indicate carpet beetle dermatitis
  • Head lice infestations resistant to conventional otc agents may respond to newer pediculicide

Advanced Systemic and Topical Therapy in Pediatrics

A few clinical pearls from Dr. Albert Yan’s presentation on Advanced Systemic and Topical Therapy in Pediatrics at the 2015 Fall NPPA conference:

  • N-acetylcysteine compounded into a topical formulation may inhibit keratinocyte proliferation and help with keratinizing disorders (ichthyosis, and possibly epidermal nevi and PPK)
  • N-acetylcysteine administered systemically can be help in mediating glutamate metabolism and help with neuropsychiatric disorders such as trichotillomania and neurodermatitis