Pediatric Dermatology: Clinical Pearls

Sheila Fallon-Friedlander, MD

  • Beware the midline congenital lesion! Worrisome areas include
    • 1) glabella
    • 2) vertex, occipital scalp
    • 3) lumbosacral area spine
  • Associated signs which raise concern in bumps
    • 1) surrounding/underlying vascular stain or hemangioma
    • 2) hair collar sign
    • 3) Pits
    • 4) gluteal cleft asymmetry
    • 5) tufts of hairs, polyps
  • 3)   Signs which increase concern for infantile bumps:
    • 1) Congenital
    • 2)   Abrupt, rapid growth
    • 3)   Adherent to underlying tissue
    • 4)   Rock hard /firm consistency
  • 4) Although rare, rhabdomyosarcomas are a concern, as they frequently present in the facial area, may appear vascular, & are frequently miss-diagnosed as infantile hemangiomas
  • 5) When hair loss is noted in a child, look for
    • Scale, lymphadenopathy, pustules, exclamation point hairs
    • The pattern of loss- is it “Friar Tuck”? Unilateral?

Your differential includes:

  • Tinea capitis
  • Alopecia areata
  • Trichotillomania
  • 6) When treating warts in children, remember
    • The treatment should not be worse than the disease
    • You must take into account the family’s desire to treat, but…..do no harm to the child.
    • Home therapy is the place to start
    • IL candida really helps a lot of patients
    • When trying to buy time, remember cimetidine & zinc