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V 2 year old / M

V What should you ask in Hx?

V 2 Ddx? defend!
V Viral? Bacterial?
V Pathogen?
V Future Complications?
V Treatment?
V Patient Education
V R    © early childhood, but
may occur in all ages
V     © Exposed body parts (face
hands, neck and extremities)
V esion start as 2mm erythematous macules
J thin walled vesicles or bullae J pustules,
which ruptured producing a this straw-
colored seropurulent discharge. This
discharge dries to form stratified Y 

V Can also spread to different parts of the body
by sharing of towels
V Gyrate patterns are produced as lesions
spread peripherally and the skin clears
V Differentials

½ Childhood atopic dermatitis

ë less exudative, drier, more papular
ë ocations Ȃ antecubital and popliteal fossa, flexor wrists,
eyelids, face and around the neck.
V 3ource of infection© pets, dirty fingernails, other
children with skin lesions, daycare, crowded housing.
V Complication© Acute GN (Group A beta- hemolytic
V Pathogen©
½ Group A 3treptococcus Ȃusual
Complication© Acute GN (Group A beta- hemolytic
Treatment© 3ystemic antibiotics Ȃ Clozacillin; 1st generation
cephalosporin (Cefalexin)
Topical© Mupirocin
Prophylaxis Ȃ Mupirocin ointment to anterios nares BID
Rifampicin 600mg OD x 5 days
25/M with a 6 mon Hx of itchy red lesions on both hands. He had a
Brake up with her GF a week before the onset of his complaint.
In order to win her GF back he worked in a mining company in w/c
He noted hypersensitivity to certain metals. PE e/n except for
Derma complaint



V Present with deep-seated tapioca-like vesicular
eruption of the palms and soles characterized by
eczematous weeping patches containing
intraepidermal vesicles
V Burning and itching
V Predeliction sites© fingers, toes, frequently
bilateral symmetrical
V Bullae may occasionally be found
V Contents are clear and colorless but may be
straw colored
V May become secondarily infected
V Condition may be chronic and relpsing
V Etiology Ȃ ideopathic
V Major triggers Ȃ stress, atopy, contactants
½ Contact dermatitis Ȃ lesions are more eczematous
and are prominent on the dorsal aspect of the hands
and feet, there is a history of contactant
½ Drug eruptions Ȃ there is a previous history of drug
intake, lesions are located predominantly on the
palms and less likely confined to the lateral aspect of
the digits
½ Pustular psoriasis Ȃ no fever with sudden appearance
of cutaenous lesions
V Treatment©
½ 3uperpotent and potent topical steroids Ȃ initial
½ 3ystemic corticosteroids
½ Others Ȃ phototherapy, radiation therapy, and
systemic immunosuppressive therapy
£ 13/M
Payatas, RC,
Right handed
Describe the lesions.
More questions?
As a GP in Payatas, what practical
Test can you do to confirm
your diagnosis ?

V Pruritic erythematous papules which may or
may not have a 0.5 Ȃ 1 cm linear wavy burrows,
distributed in areas that are soft, warm and
moist© interdigital area, wrist, armpit,
inframammary area, umbilical area, inner thigh,
scrotal, and buttocks area
V 3econdary pustules, nodules and excoriations
may appear due to chronic rubbing and
scratching. Children may be affected in face
palms and soles.
V Pruritus is worse at night
V Etiology Ȃ 3arcoptes scabie var hominis Ȃ
found in human skin
V Transmitted from person to person by skin
contact and is highly contagious. Family
might be affected.
V Course and prognosis© resolve after therapy
½ Pruritus Ȃ may persist for several weeks after
treatment since hypersensitivity to mite
segments that have remained in the skin.
V Treatment and management
½ 3ingle application of permithrin 5% lotion Ȃ neck
down Ȃ washed off after 8-12 hours
½ Alternatives Ȃ Crotamiton 10% lotion to entire body
neck down for 3-5 days
½ 3ulfur 2-10 in petrolatum OD washed off after 24
hours for 3-5 days\secondary bacterial infection
should be treated with oral antibiotics or mupirocin
½ Topical mild glucocorticosteriods
½ 3edating antihistamine at night to prevent trauma in