15. PAEDIATRIC DERMATOLOGICAL CONDITIONS(Psoriasis, pytriasis alba, eczema and albinism).pptx

Paediatric dermatology

1. PAEDIATRIC DERMATOLOGICAL CONDITIONS DR.SHABAN

2. OBJECTIVES Outline epidemiology of common dermatological conditions Explain aetiology /risk factors of common paediatric dermatological conditions Explain clinical features of common paediatric dermatological conditions Establish diagnosis/ provisional and differential diagnosis of common paediatric dermatological conditions Treat common paediatric dermatological conditions according to protocol Provide pre-referral treatment and refer common paediatric dermatological conditions Provide counselling and follow-up services of common paediatric dermatological conditions Provide preventive and control measures of common paediatric dermatological conditions

3. History : series of questions Wh at is the nature of lesions , itchy, painful ? When did the lesion first develop? & what has been the progression of rash Was there any prodrome to the lesions? What are the associated symptoms?

4. P h y si c al Diagnosis relies heavily on careful inspection of the skin. Examine in well-lit area where one can examine the entire skin surface Most important objective is to characterize the morphology of the primary lesion Description of rash should include morphology , color , configuration distribution

5. Morphology : primary & secondary lesions Primary lesions are uncomplicated abnormalities which represent initial pathologic change Secondary changes reflect progression of disease such as excoriation , infection or keratinization NOTE; Morphologic expression of dermatologic condition is basic entity on which all diagnosis are founded

6. Skin lesions Primary Lesions Macule patch Papule plaque Vesicle Bullae Pustule Bulla Plaque Nodule Tumor Petechiae purpura Purpura Secondary lesions Scale: Crust: Atrophy: Fibrosis: Lichenification

7. Primary lesions Macule : circumscribed flat discoloration < 1cm in diameter eg ash-leaf spots, flat nevi and freckle P a t ch : circumscribed flat discoloration > 1cm in diameter eg vitiligo, tinea versicolor. Often have fine scale (pityriasis alba) Papule : circumscribed superficial solid elevated lesion < 1cm ,eg warts, elevated nevi insect bites molluscum contagiosum.

8. Primary lesions Plaque : > 1cm elevated flat top superficial lesion eg psoriasis and pityriasis rosea. Vesicle : fluid filled lesion < 1cm in diameter eg herpes simplex and varicella Bulla : fluid filled lesion > 1cm in diameter eg ssss and bullous impetigo Pustule : vesicle with purulent exudates eg acne , folliculitis

9. Primary lesions Nodule : lesion < 1cm in diameter with depth eg secondary / tertiary syphilis Tumor : > 1cm solid lesion with depth Petechiae : pinpoint < 1cm flat red spots under the skin surface Purpura : > 1cm visible collection blood eg ITP

10. Macular and Patches . Hypopigmented patches Macular

11. Petechiae and Purpura .

12. Nodule and Tumor . Nodule Tumor

13. Papule and plaque .

14. Vesicle and Bullae (BLISTERS) . BULLAE VESICLE

15. Pustules .

16. Secondary lesions Scales : dry and greasy masses of keratin ranging from fine and delicate to coarse , implies pathologic process in epidermis Crust : dried exudates ( pus or blood) Excoriation : linear abrasion caused by scratching Fissure : linear crack or cleavage on skin with sharply defined margins

17. Secondary lesions Ulcer :depressed lesion with epidermal & dermal loss Scar : permanent lesion result from process of repair by replacing connective tissue Lichenification : area of increased epidermal thickness with accentuation of skin

18. . .

19. DERMATOLOGICAL CONDITIONS. Study conditions Common in Pediatrics; Eczema/ dermatitis Psoriasis Pytiaris Alba Albinism

20. ECZEMA/dermatitis .

21. ECZEMA/DERMATITIS Dermatitis , / eczema , is a group of diseases that result in inflammation of the skin  These diseases are characterized by itchiness, red skin and a rash. Acute  lesions  are papules and vesicles on a background of erythema . Subacute   lesions  may develop scales and lichenification .

22. EPIDEMIOLOGY Dermatitis was estimated to affect 245 million people globally in 2015.  Atopic dermatitis is the most common type and generally starts in childhood.Globally it affects about 10–30% of people.  Contact dermatitis is twice as common in females than males. Allergic contact dermatitis affects about 7% of people at some point in their lives.

23. ECZEMA ;CAUSE The cause of dermatitis is unknown but is presumed to be a combination of genetic and environmental factors. Environmental The hygiene hypothesis postulates that the cause of asthma, eczema, and other allergic diseases is an unusually clean environment in childhood which leads to an insufficient human microbiota . it has been suggested that eczema is commonly an allergic reaction to the excrement from house dust Genetic A number of genes have been associated with eczema Eczema occurs about frequently in individuals with familial history of disease and in triad of asthma and allergic rhinitis.

24. ECZEMA; COMMON TYPES 1.Atopic Atopic dermatitis is an allergic disease having a hereditary component and often runs in families whose members have asthma and allerigic rhinitis Itchy rash is particularly noticeable on head and scalp, neck, inside of elbows, behind knees, and buttocks. 2.Contact Contact dermatitis is c: allergic (resulting from a delayed reaction to Some substances which acts as allergen and irritant . 3. Seborrhoeic Seborrhoeic dermatitis or ("cradle cap" in infants) is a condition causes dry or greasy peeling of the scalp, eyebrows, and face, and sometimes trunk. In newborns, it causes a thick, yellow, crusty scalp rash called cradle cap

25. ECZEMA .

26. ECZEMA; CLINICAL FEATURES Although every type of dermatitis has different symptoms, there are certain signs that are common for all of them, which are itching Redness of the skin,  swelling On examination skin lesions Papules and vesicles are commonly present

27. Eczema ; diagnosis Diagnosis of eczema is based mostly on the history and physical examination. skin biopsy may be taken for a  histopathologic Patch tests  are used in the diagnosis of allergic contact dermatitis

28. TREATMENT There is no known cure for some types of dermatitis, with treatment aiming to control symptoms by reducing inflammation and relieving itching. Contact dermatitis is treated by avoiding what is causing it. 1.Moisturizers (emollients), oil–based formulations appear to be better 2.Medications Corticosteroids are effective in controlling and suppressing symptoms in most cases. [ For mild-moderate eczema a weak steroid may be used (e.g., hydrocortisone 3.Antihistamines Can be used for relieving in itching

29. PSORIASIS .

30. PSORIASIS Psoriasis is a chronic skin condition with typical appearance of red, thickened, scaly plaques These plaques can vary in size and distribution from person to person. In some people, it may affect small areas of skin while others may have large areas covering their body.

31. PSORIASIS; EPIDEMIOLOGY The Disease Affects 2% To 4% Of The Population.  Men And Women Are Affected With Equal Frequency. The Disease May Begin At Any Age, But Typically Starts In Adulthood .

32. PSORIASIS ; CAUSES Psoriasis is not contagious, therefore, affected children do not need to be isolated from other children The cause of psoriasis is not fully understood, but there are risk factors. 1.Genetics Around one-third of people with psoriasis report a family history of the disease, and researchers have identified genetic loci associated with the condition. Identical twin studies suggest a 70% chance of a twin developing psoriasis if the other twin has the disorder. 2. Lifestyle Conditions reported as worsening the disease include stress, Obesity and changes in season and climate.  3. Chronic infections psoriasis tends to be more severe in people infected with human immunodeficiency virus(HIV). 4. Microbes Psoriasis has been described as occurring after strep throat, and may be worsened by skin or gut colonization with  Staphylococcus aureus , and  Candida albicans 5. Medications Drug-induced psoriasis may occur with beta blockers,  antimalarial medications, non-steroidal anti-inflammatory drugs,  calcium channel blockers. etc

33. PSORIASIS ;DIAGNOSIS The diagnosis of psoriasis is usually made clinically from history and examination. The plaques tend to be distributed symmetrically. They favour certain sites such as scalp, elbows and knees; or; skin folds such as behind ears, armpits and groin. There is often a family history of psoriasis. Skin biopsy may be necessary to distinguish psoriasis from other skin conditions that may appear similar.

34. PSORIASIS; TREATMENT There is no cure for psoriasis; however, various treatments can help control the symptoms.  These treatments include  Steroid creams,  Vitamin D3 cream,  Immune system suppressing medications eg . Methotrexate

35. DIFFERENCES .

36. PYTRIASIS ALBA .

37. PITYRIASIS ALBA  Skin condition which appear as multiple, discrete, hypopigmented (whitish) macular or patches lesions. The lesion are usually dry, with or without the presence of scale. These lesions are seen most commonly on the face, neck and upper limbs. The condition is so named for the fine scaly appearance initially present ( pityriasis ), and alba (Latin for white) refers to the pallor of the patches that develop

38. PITYRIASIS ALBA EPIDEMIOLOGY It occurs in mainly children and adolescents of all races, particularly people with dark skin. The worldwide prevalence is 5% in children, with boys and girls affected equally. adults can also suffer from this disease

39. PITYRIASIS ALBA ;CAUSES The cause of pityriasis alba is not known but usually is associated with skin dermatitits Dry skin and atopic dermatitis may co-exist. Any dermatitis may heal leaving pale skin, Excessive use of corticosteroid creams used to treat episodes of eczema.

40. PITYRIASIS ALBA CLINICAL FEATURES Smooth flat pale macular or patches Lesions are round or oval raised or flat, The patches are dry with very fine scales. They most commonly occur on the face (cheeks) The patches may become more apparent after sun exposure, when the normal surrounding skin is tanned.

41. PITYRIASIS ALBA DIAGNOSIS Diagnosis is mainly done by clinical examination. Shining a Wood's light over the skin may reveal further lesions not obviously visible otherwise.

42. PITYRIASIS ALBA;DIFFERENTIAL DIAGNOSIS Pytriasis versicolor cutaneous leprosy.

43. PITYRIASIS ALBA TREATMENT No treatment is required and the patches in time will settle.  The redness, scale and itch if present may be managed with simple emollients and  corticosteroids,  Cosmetic camouflage may be required. As the patches of pityriasis alba do not darken normally in sunlight, effective sun protection helps minimise the discrepancy in colouration against the surrounding normal skin.

44. SAMPLE QUESTION Deo is a 8-year-old male, accompanied by his mother, during the visit to your health facility; he is noted to frequently scratch the flexural areas of his arms. • History: Deo has complained of dry, itchy skin on his arms for many years that worsened over the past 2 years. Symptoms are worse in the winter. – Mother had asthma and father has seasonal allergies – Deo has asthma since 4 years of age • on examination: – Dry skin – Erythema , dryness, lichenification noted in flexural areas of both arms - Hyperlinear palms and increased scaling on legs - Mom also shows hyperlinear palms/dry legs. Discuss the Management of Deo condition.

45. ALBINISM .

46. ALBINISM Definition: Is a congenital disorder characterized by the complete or partial absence of melanin pigment in the skin, hair and eyes. Due to absence or defect of tyrosinase enzyme involved in the production of melanin.

47. H i story A man in the 17th century named Balthazar Telez , who was an explorer, came up with the name "Albino" , which means white negro , after he saw an albino African tribe. Balthazar thought he was seeing two different races of people. This was the first discovery of albinism.

48. ALBINO: organism with complete absence of melanin. ALBINOID or ALBINIC: an organism with only a diminished amount of melanin.

49. Melan i n Also called pigment, melanin is a substance that gives the skin and hair its natural color. It also gives color to the iris of the eye , feathers , and scales . Melanin is synthesized from the amino acid tyrosine. In the skin, melanin is formed by cells called melanocytes.

50. Melanin have some benefits Melanin provides a natural protection against the harmful effects of ultraviolet rays of the sun. Melanin is also a mechanism for absorbing heat from the sun. Melanin, also important for sharpness of vision.

51. Types of Albinism 1) Oculocutaneous Albinism (OCA) Affecting the eyes , skin and hair . People with this type of albinism have white or pink hair, skin, and iris color, as well as vision problems . Most severe type. ‐ Have 4 types (1,2,3,4) Ocular Albinism (OA) Affecting the eyes only . Skin color is usually normal or slightly lighter than the skin of other family members. Eye color may be in the normal range but there is no pigment in the retina. ‐ Have 3 types.

52. Genetics of Albinism Most types of albinism are inherited as an Autosomal recessive but some types are X‐ linked Recessive. 1) Autosomal Recessive: Most types of albinism are inherited when an individual receives the albinism gene from both parents. If parents are carriers, the child has a 25% chance of being completely normal , a 50% chance of being a carrier , and a 25% chance of getting albinism .

53. 2) X‐linked Recessive: The exception: some types of ocular albinism, which is passed from mothers to their sons .

54. ALBINISMEPIDEMIOLOGY The international average for albinism is about 1 in 20,000 . Research indicates that the first type, Oculocutaneous Albinism (OCA) happen by 1 per 40,000 of the population. While the second type, Ocular Albinism (OA) happen by 1 per 15,000 of the population.

55. Symptoms Skin and Hair E y e s  Pale skin or  p a t c h y skin  White hair  Usually pale blue or light brown, but can sometimes appear pink‐ red  Extremely poor vision  Light sensitivity (Photophobia)  Rapid eye movements (Nystagmus)  Strabismus

56. P r ognos i s Growth, development and intellectual development in the albino child are normal . Vision is invariably severely impaired . Albinism does not affect the expected lifespan . People with albinism may be limited in their activities because they can't tolerate the sun.

57. Complications Lack of skin pigmentation making more susceptible to sunburn and skin cancer . Blindness . Albinism may cause social problems , because people with albinism look different from their families, peers and other members of their ethnic group.

58. Diagnosis Albinism can first appear at birth because it is a physical deformity that never changes. Detected at birth because of irregular pigmentation. Diagnosis is based on careful history of pigment development and an examination of the skin, hair and eyes. The most accurate way to determine albinism is genetic test , for example : Chorionic Villus Sampling Test(CVS) and Amniocentesis can identify albinism during the second trimester of pregnancy .

59. MANEGMENT and TREATMENT There is no cure for albinism, because albinism is a genetic disorder, treatment is limited . Treatments only reduce the symptoms . The skin and eyes must be protected from the sun. Skin The skin can be protected by using sunscreen creams . Always wear special UV protective clothing to reduce sunburn risk. Children should receive annual skin assessments to screen for skin cancer or lesions that could lead to cancer.

60. MANEGMENT and TREATMENT E yes Many children will need to wear prescription Glasses or lenses , which can provide improvements in their vision . Wear dark Sunglasses (UV protected) may relieve photophobia . Eye muscle surgery is sometimes recommended to correct abnormal eye movements ( Nystagmus ). Children should receive annual examinations by an ophthalmologist .

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