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1. COMMON SKIN
CONDITION IN
CHILDREN
SUPERVISED BY DR NADIA

2. ATOPIC
DERMATITIS
Atopic Dermatitis or Eczema
• “Dermatitis” and “eczema” used interchangeably
• •A genetic defect in the proteins supporting epidermal barrier
• •A chronic inflammatory skin condition
• •Eczema, asthma, and allergic rhinitis (triad of atopies)
• Trigger factors: (Infection such as bacterial, viral or fungal), emotional stress, sweating and itching, irritants: hand washing
soaps , detergents, extremes of wathers, allergens, food: egg, peanuts, milk fish, soy wheat, aeroallegerns: house dust mites,
pollen , animal dander and molds.

3. Erosion (from
scratching)
Lines of skin
stress are
prominent
(lichenification
)
Hanifin and rajka criteria
(Must have 3)

4. DIAGNOSTIC AND STEP UP TREATMENT ACCORDING TO
PHYSICAL SEVERITY

5. Prevention is the best treatment
Patients with atopic dermatitis have abnormal skin
barrier function
• Ointments or creams emolliate better than
lotions
• Moisturizers may help repair the skin barrier
Promote skin hydration, Decrease pruritus
• Bathing:in lukewarm water for 5–15 min
followed by applicationof an emollient (within
2–3 min of leaving the water) improves
hydration of the skin.
• Avoids soap and substitute such as aqueous
cream emulyising ointment or Vaseline

6. • Topical corticosteroids :is anti-inflammatory agent
and the mainstay of treatment for acute
dermatitis.
• Apply steroid cream once or twice daily
• Use milder steroids for face , flexures and scalp
• Amount of topical must used by technique the
finger tip (FTU) applying method
• -1 hand/foot/face: 1ftu, 1 arm: 3 FTU, 1 Leg: 6ftu,
front and back: 14 ftu
• Local affects: skin atrophy , telangiectasia,
pupura, atria, acne, hirutisme and secondary
infection
• Systemic affects: adrenal axis, suppression,
cushing syndrom

7. Relief in puritus
Antihistamine to help control pruritus
and aid in sleep
-do not use routinely
-review every 3 months
Secondary infection
-may cuase acute exacerbation eczema
-commonly staphylococcus aureus
-abx:
1.Oral cloxacillin 15mg/kg 6 hourly for 7-
14 days
2. Oral erythromycin/ cephalosprin
-from herpes simplex virus can cause
eczema
Herpiticum-antiviral needed

9. SCABIES

10. DEFINTION
Scabies is an intensified Pruritis skin problem caused by the
Sarcotes scabiei hominis (Mite)
Transmission by skin contact to skin contact

11. • It causes itchy rash on hands
and wrists
• It not affects scalp/ face
Itchy, raised bumps/ lumps
especially in the genital areas,
armpits/ groin
CRUSTED SCABIES/
NORWEGIAN SCABIES
• More severe and extremely
contagious type of Scabies
• People develop thick crusts of
skin that contain thousands of
mites and eggs
• It develops in people with weak
immune system

12. PATHOHENESIS

13. DIAGNOSIS
• Clinical presentation
• Microscopic examination of skin
TREATMENT ALGORITHM

14. DRUGS USED IN TREATMENT OF SCABIES
Drug Category Mode of action Dose Adverse affects
Permethrin Topical
Scabicidal
Kills parasite by
affectingtheir
nerve cells
5% cream-BD for 7days  Burning
 Stinging
 Pruritis
 Hypersensitivity
Crotamiton Topical
antipruritic
agent
Counter irritant
effect bycooling the
skin
10% lotion-OD for 7days  Allergic contact dermatitis
 Rash
 Pruritis
 Hypersensitivity
 Warm sensation
Sulfur Topicalanti
acne agent
It shows
keratolytic action and
also have Scabicidal
action
5-10% -HS-for 3 days  Erythema
 Excessive desquamation
 Skin irritation
 Skin inflammation
 Hypersensitivity

15. Lindane Topical
Scabicidal
Kills parasite by
affecting their nerve
cells
1% lotion-BD
 Local irritation
 Contact dermatitis
 Alopecia
 Conjunctivitis
 Rash
Ivermectin Anti helmenthic
agent
Kills parasite by
affecting their nerve
cells
200mcg/kg/day for 3 days like 1,2, and
8 th day-PO
 Asthenia
 Hypotension
 Peripheral oedema
 Transient
tachycardia
 Insomnia
Benzyl
benzoate
Topical
Scabicidal
Kills parasite by
affecting their nerve
cells
5% lotion-BD for 7 days  Application site
irritation
 Pruritis
 Erythema
 Ocular irritation
 Dandruff

16. NON PHARMACOLOGICAL TREATMENT
• Avoid sharing of clothes and towels
• Treat everyone at home in the
household and close contactcs
• Use properly washed clothes
• Wash clotting and bedding in hot water
or dry cleaning. Cloth that cannot wash
may be stored in sealed plastic for three
days
• Apply soothing lotion like Calamine
• Allow to school after 24 hours

17. STEVEN JOHNSON SYNDROME
Life-threatening mucocutaneous diseases
Within the spectrum of SCAR
• Resemble erythema multiforme majus (EMM)
• Mucosal involvement
• Epidermal necrosis
 when <10% is called Steven Johnson Syndrome
 when 10-30% bullae called Steven Johnson Syndrome-Toxic Epidermal-
Necrolysis (SSJ- TEN)
 when the bullae> 30% is called ToxicEpidermal Necrolysis (TEN).

18. SIGN SYMPTOMS
• Flulike symptoms: -cough -fatigue -fever -headache -muscle & joint pains -sore throat
• Three-ringed sores (shades of pink and red) develop on skin
• Sores & blisters spread to skin (possibly eyes, genitals, lungs, stomach & colon as well)
• Skin eventually dies and falls off (you can lose 10-30% of your body’s epidermis)
• Esophagus, small bowel, colon involvement very common
– Esophageal strictures, impair enteral nutrition, can casue diarrhea
• absorption of oral medications.
• Tracheobronchial mucosa shedding
– Respiratory failure 20% mechanical ventilation
• Vaginal stenosis and penile scarring
• PTSD in survivors
• Renal complications (rare)
-raised blood urea, hyperkalemia and creatinine
• Glucose-hypohlycemia

19. BASIC LESION IS ERYTHEMA
EXUDATIVUM MULTIFORME.
LOOKS SOME "TARGET LESION".
Prof DR Dr Ariyanto Harsono SpA(K) 19

20. • skin can be pushed
slightly aside by
pressure of fingers
• refer to the base of
the blister, and thus
to the level of
epidermal separation
NIKOLSKY SIGN

21. Mucosal Lesion at mouth, eyes, genitals, and maybe anal
(minimal 3 mucosa)
Prof DR Dr Ariyanto Harsono SpA(K) 21

22. • Detachment of large
epidermal sheets in SJS/TEN
overlap

23. ETIOLOGY
• Drugs
1.Antibitics: sulphonamides, amoxicillin, ampicillin,
ethambutol, isoniazid
2.Anticonvulants: phenobarbitone, carbamazepine,
phenytoin
3.Non steroidal anti-inflammatory drugs:
phenybutazone, salicylates
• Infection
1. virus: herpes simplex, enteroviruses,
adenoviruses, measles, mumps
2. Bacteria: streptococcus, salmonella typhi,
mycoplasma penumoniae

24. MANAGEMENT
• Supportive care
-admit to isolation room where possible
-may need IV resuscitation for shock
-good nursing care(barrier bnursing and hand washing)
-use of air fluidized bed, avoid bed sores
-adequate nutrition-nasogastric tube, IV lines, parenteral
nutrional, severe mucosal involvement
• Specific treatment
-eliminate suspected offending drugs
-IV imunnoglobulin at a dose of 0.4 Gm/kg/per day for 5
days. IVIG is a safe and effective in treatment for SJS /TEN
in children, it arrects the progression of the disease and
helps complete re-epithelialization of lesions
• Monitoring
-maintenance body temp ,avoid excessive cooling or
overheating
-carefull monitor of fluid and electrolytes
-i/o cahrting daily weighing and renal profile
PREVENTION
• Skin care
-cultures skin, mucutaneous erosions,tips of
foley’s catheter
-treat infections with abx
-topical antiseptics preparations :saline
wash or KMNo4 wash
-dressing of denuded areas with paraffin
gauze/soffra-tulle
• Eye care
-Frequent eye assement
-Abx or antiseptic eye drops 2 hourly
• Oral care
-good oral hygiene

25. PROGNOSIS
• Death (due to infections, lung problems, disorders
of fluid and electrolyte imbalance,
bronchopneumonia and sepsis.)
• Possible skin scarring and pigment changes
• Difficulty with swallowing, vision, urinating and
skin life
• May lose nails and hair foreverf

26. Staphylococcal Scalded Skin Syndrome
Prof DR Dr Ariyanto Harsono SpA(K) 26

27. STAPHYLOCOCCAL SCALDED SKIN(4S)
• Caused by Staphylococcal exfoliative toxin
• Erythematous tender skin, progressing to desquamation after
24-48hrs
• Nikolsky sign
• 62% < 2yrs, 98% < 5yrs
• BCs usually negative in children
• Usually febrile, may rapidly progress to dehydration/shock
• Rx. Systemic antistaphylococcal abx., emollients, may need IV
fluids

28. • Systemic therapy, either orally, in cases of localized involvement, or parenterally, with a
semisynthetic penicillinase-resistant penicillin, should be prescribed because the staphylococci
are usually penicillin resistant
• Clindamycin may be added to inhibit bacterial protein (toxin) synthesis
• First Line Treatment: – Flucloxacillin, – Clindamycin: may be given orally or parenterally
either alone (or in combination with rifampicin or tetracyclines), – Temocillin, –
Tigecycline – Daptomycin If MRSA is suspected: – vancomycin or – tobramycin
• The skin should be gently moistened and cleansed.
• Application of an emollient provides lubrication and decreases discomfort.
• Topical antibiotics are unnecessary.
Prognosis
• Recovery is usually rapid, but complications such as excessive fluid loss, electrolyte imbalance,
faulty temperature regulation, pneumonia, septicemia, and cellulitis may cause increased
morbidity.