Pictures and

Pizza
Mia Mallory, M.D.

Erythema Toxicum

Very common in 50% of newborns

Self limited-gone within 5-7 days

Unknown etiology

Smear of a pustule reveals

eosinophilia

Milia

Epithelial lined cysts arising from

hair follicles

Common on face and around eyes

They are persistent after months to

years but may resolve spontaneously

No apparent cause

Mongolian Spot

Most commonly located over lumbosacral

area and buttocks
Can be 1-10 cm and can be single or
multiple
90% of African Americans, 81% of Asian
and 9.6% of Caucasian infants have these
spots
Melanocyte accumulation deep in the
dermis
Usually fade by age 7

Molluscum
contagiousum

Multiple skin-colored papules with waxy surfaces

Usually have umbilicated centers, although some

have protruding white centers

Caused by Poxvirus and are spread by scratching

Many spontaneously remit but may persist for

years

Treatment is varied from cryotherapy,

evisceration, curettage and topical therapy (etc.
Aldara, podophyllin)

Erythema
Multiforme(Minor)

Acute hypersenstivity syndrome with a

variety of causes (viruses, foods, drugs,
bacteria and immunizations)
Erythematous wheals that develop into
target-shaped lesions
Central depression with an
erythematous periphery
Self limited with mild systemic
manifestations

Stevens-Johnson
Syndrome

EM majorwidespread bullous eruption

with at least 2 mucous membranes
involved
Prominent constitutional symptoms which
include fever, arthralgias, vomiting and
diarrhea
Conjunctival involvement can progress to
corneal scarring
Fluid losses and secondary infection are
major risks
Treatment is supportive, steroids are not
proven to be efficacious

Scabies

Caused by Acarus scabiei which

burrows under the skin
Papules, pustules and vesicles which
are highly pruritic and highly
contagious by direct contact
Burrow caused by female mite is
pathognomonic sign and more intense
rxn is seen in infants
Rx consists of topical
permethrin(Elimite), avoid Lindane

Granuloma Annulare

Nodule that gradually extends

peripherally to form a ring which is raised
and indurated and sometimes segmented
Overlying epidermis is intact and same
color as adjacent skin
Resolve spontaneously within months to
years
Confused with ringworm, but raised
thickened border with lack of scales,
crusts or vesicle is clue to diagnosis

Omphalitis

Localized infection of the umbilical stump which

can progress to systemic illness
Most frequent complication is sepsis, followed
by necrotizing fasciitis
Mostly polymicrobial, most common organisms
are Staph aureus, group A Strep, E. coli and
Klebsiella
Can occasionally accompany LAD(leukocyte
adhesion deficiency or neutropenia syndromes
Rx should include gram positive and negative
coverage

Cold(Popsicle)
Panniculitis

Discrete indurated subcutaneous mass

Caused by cold injury

Should be differentiated from buccal

cellulitis by well appearance of the child,
lack of systemic manifestations and
tenderness

Henoch-Schonlein
Purpura

Vaculitis with palpable purpura, arthritis, arthralgia(75%), GI

(85%) and renal (50%) symptomatology

Occurs usually after viral illnesses but can occur after bacterial
infections, insect bites, immunizations and drugs

Renal disease can progress to nephritis, nephrotic syndrome and

rarely end stage disease

Can be a lead point in intussusception

Most patients are over the illness in 4 weeks

Rhus Dermatitis(Poison
Ivy)

Most common allergic contact

dermatitis in the U.S.

Caused by contact with the sap of the

plant whether the plant is alive or dead

Treatment is support and consider

steroid burst when rash is extensive or
involves the face

Cupping

In addition to coining practiced by

Asian cultures for healing purposes
A candle is lit inside a glass coated
with alcohol
The cup is applied to the forehead or
trunk and creates a vacuum as the cup
cools and consumes oxygen
Once removed, the imprint is left on
the skin

Varicella

Intense pruritis
Characteristic rash described as
dewdrop on a rose petal which are thin
walled vesicles surrounded by red halos
Hallmark is finding lesions of all stages
of evolution within a small geographic
area of skin
Incubation period ranges from 10-20
days

Fifth Disease

Caused by Parvovirus B19

transmitted by respiratory secretions
Characterized by rash and fever
Constitutional symptoms are unusual
Warm bright red patches over both
cheeks which are non-tender
Develops a lacy erythematous rash
over extremities
Resolution in 3-7 days

Candida Dermatitis

Bright red eruption with sharp borders

and pinpoint satellite papules and pustules

Occasionally associated with oral thrush

Does involve intertriginous spaces unlike

irritant or ammoniacal diaper dermatitis

Most cases respond to topical antifungal

therapy

Transient Neonatal
Pustular Melanosis

Self-limited dermatosis of unknown

etiology
Presents at birth with vesiculopustules
or ruptured pustules that disappear in
24 or 48 hours
After rupture leave pigmented macules
with a collarette of scale
Wrights stain reveals numerous
neutrophils but negative for bacteria

Cutis Marmorata

Marbled Skin
Transient lacy mottling of the skin of
newborns
Caused by variable vascular
constriction and dilation
Usually resolves within 6 months
Can be confused with poor perfusion
related to sepsis

Pyogenic Granuloma

Common benign vascular tumor that

resembles a hemangioma
Thought to be due to vascular
overgrowth of granulation tissue after
a trauma or foreign body reaction
Often pedunculated and friable
Treatment is simple with cautery of
blood vessels at the base
May recur

Cutis Aplasia Congenita

At birth, absence of or failure of

formation of localized area of scalp or
skin
Usually single lesion inherited as
autosomal dominant
May be associated with other anomalies
At birth may be open and crusting and
heals as a smooth atrophic and hairless
scar

Guttate Psoriasis

Erythematous well demarcated

plaques with dry thick silvery scales
Occurs in children and adolescents
following streptococcal pharyngitis
This form occurs variably in patients
with chronic psoriasis
Auspitz sign which is when small
bleeding points occur after removing
scale

Hydranencephaly

Severe anomaly of the brain characterized by absence

of cerebral hemispheres

Often appear normal at birth

Within first few weeks of like patients develop

irritability, hypertonia, hyperreflexia and
developmental arrest

Most do not live beyond 6 to 12 months

Severe hydrocephalus and bilateral subdural hygromas

may transilluminate as well, so CT is indicated

Patellar dislocation

Injury secondary to direct contact or

sudden change of direction
Most commonly dislocates laterally
The femur rotates on the stabilized tibia
and the patient will fee their knee give
out
Reduction is completed with pain meds
and/or conscious sedation by extending
the leg and rotating the patella medially
Xrays should be completed after reduction

Clavicle Fracture

Most commonly fractured bone in the body

due its location and lack of muscular
support

Rarely requires surgical stabilization

Treatment is pain control and sling

It is important to tell families that the bone

will heal with a bump or visible callous

Greenstick Fracture

Most common fracture pattern in

kids
The thick periosteum prevents
severe displacement and angulation
Treatment is closed reduction often
completing the fracture
Sugar tong splint or cast for 6 weeks

Femur Fracture

Often associated with abuse secondary to

twisting force required to cause the
fracture

Can occur in accidental situations as well

Treatment is closed reduction and SPICA

casting by orthopedics

Buckle (Torus) Fracture

Very common injury

Usual mechanism is falling on
outstretched upper extremity
Doesnt require orthopedic
intervention, just follow up
Can splint with a volar splint or
casted immediately if swelling is not
significant

Salter Harris II Fracture

Very common injury

Usual mechanism is shearing forces

Fracture is through physis and

metaphysis

Requires closed reduction by orthopedics

if significant angulation and displacement

Salter Harris III Fracture

Intra-articular shearing forces can produce

this fracture ( basketball and football
injuries)

Fracture runs through physis and epiphysis

Requires orthopedic consultation and

reduction if significant angulation and
displacement

Spiral tibia fracture

Called toddlers fracture in younger

children (aged 1-5)
Often from twisting motion applied to tibia
after a fall which is usually unwitnessed
Toddlers usually refuse to bear weight
and can have point tenderness over the
bone
May need oblique views to see fracture
Treatment with posterior splint or cast if
minimal swelling

Supracondylar Fracture

Account for 50% of elbow fractures

Usually result from fall backward onto
outstretched hyperextended arm
which results in posterior
displacement of the distal humerus
fracture
Significant risk of associated
neurovascular injury so orthopedic
consultation a must

Occult Supracondylar
Fracture

Same mechanism as obvious fracture

Not always visible on xray
Posterior fat pad visualization is key to
diagnosis
A line drawn from anterior humeral line
should intersect with anterior 1/3 of
capitulum which might also might be a clue
to an occult fracture
Posterior splinting with orthopedic follow up