Pediatric Dermatology in Skin of Color

A Practical Guide

Manish K Shah, Preeti K Sheth

• Verlag: CRC Press
• Jahr: 2021
• ISBN:
  9781351046572
• Auflage: 1
• Thema: Medicine
• Thema: Medical Theory, Practice & Reference

This book focusses on the clinical aspects and management of pediatric skin disorders, especially seen in darker skin types. It includes unique conditions that the authors have encountered in their lifetime with their independent observations and approach to management. Original high-quality images are used to illustrate most dermatoses described in the book enabling a strong visual impression of the discussed diseases. It hopes to provide readers with a blend of evidence and experience based pediatric dermatology. This book aims to be a hands-on manual that can be referred to during a busy practice as it discusses the practical approach to dermatoses.

Key Features

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• Focusses on darker skin types.

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• Examines unusual presentations with detailed clinical features.

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• Discusses the ways to differentiate between similar-appearing diseases.

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• Explores approaches to therapy, especially in resource-poor settings.

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• Covers topics with high quality illustrations.

1

PRINCIPLES OF DIAGNOSIS

Lesionology

Lesions can be classified as primary (appear de novo) and secondary (develop due to a change in an already existing lesion).

Primary lesions

1. Macule: A circumscribed alteration in the color or texture of the skin that is not elevated or depressed below the surface of the skin.

It may be

1. Hypopigmented, e.g., pityriasis alba, pityriasis versicolor
2. Hyperpigmented, e.g., lentigines, freckles
3. Depigmented, e.g., vitiligo (Figure 1.1a)

   

   FIGURE 1.1(a) Depigmented macule of vitiligo. (b) Flesh-colored papule of molluscum contagiosum.(c) Clear fluid-filled vesicles of varicella. (d) Blue vascular nodule on the penis.

4. Erythematous, e.g., exanthems, drug rash
5. Purpuric, e.g., thrombocytopenic purpura

2. Papule: A circumscribed palpable elevation of the skin less than 0.5 cm in diameter.

It may be

1. White, e.g., milium
2. Flesh-colored, e.g., molluscum contagiosum (Figure 1.1b)
3. Red, e.g., eczema
4. Yellowish, e.g., xanthoma
5. Yellowish brown, e.g., lupus vulgaris
6. Black, e.g., melanoma

3. Nodule: A solid mass in the skin that is either seen as an elevation or can be palpated. It is more than 0.5 cm but less than 2 cm in size (Figure 1.1d).

• E.g.: lupus vulgaris, erythema nodosum
• They may be soft, e.g., neurofibroma.
• They may be hard, e.g., calcinosis cutis.

4. Tumors: Soft or firm masses more than 2 cm in size, which can be inflammatory or noninflammatory, malignant or nonmalignant.
5. Vesicle: Visible accumulation of fluid beneath the skin, less than 0.5 cm in size. The fluid may be
   1. Clear, e.g., chicken pox, herpes simplex (Figure 1.1c)
   2. Hemorrhagic, e.g., herpes zoster
   3. Cloudy, e.g., impetigo
6. Pustule: Visible accumulation of free pus beneath the skin, measuring less than 0.5 cm in diameter. This may be
   1. Follicular, e.g., folliculitis (Figure 1.2a)

      

      FIGURE 1.2(a) Pustules on the scalp. (b) Single bulla. (c) Urticarial wheal. (d) Plaque of psoriasis.

   2. Nonfollicular, e.g., impetigo, candidiasis
7. Bulla: Visible accumulation of fluid beneath the skin, more than 0.5 cm in size. The fluid may be clear, hemorrhagic, or purulent.

Bullae may be tense, e.g., bullous pemphigoid (Figure 1.2b), or they may be flaccid, e.g., pemphigus.

8. Wheal: Evanescent, edematous, erythematous or pale, flat elevation of various sizes, e.g., urticaria, urticarial vasculitis (Figure 1.2c).
9. Patch: Alteration in skin color or texture measuring more than 0.5 cm, that is not elevated or depressed. One can argue that a patch is a large macule and need not be classified separately. Examples of patches include:
   1. Hypopigmented, e.g., leprosy
   2. Hyperpigmented, e.g., fixed drug eruption
10. Plaque: Circumscribed elevated area of the skin more than 1 cm in size such that the horizontal dimensions are more than the vertical dimension of the lesion.

Plaques can be formed by coalescence of papules, e.g., psoriasis, or nodules, e.g., granuloma annulare. These are elevated plaques (Figure 1.2d).

Plaques of morphea are depressed.

Secondary lesions

1. Scale: Abnormal accumulation or disordered shedding of the stratum corneum, which appears as visible flakes on the skin.

Types of scales are seen:

1. Collarette scales: fine, peripherally attached and centrally detached scale at the edges of inflammatory lesions, i.e., pityriasis rosea (Figure 1.3a).

   

   FIGURE 1.3(a) Collarette scaling in pityriasis rosea. (b) Thick fish-like scales in X-linkedichthyosis. (c) Honey-colored crusts in impetigo. (d) Excoriations in a case of atopicdermatitis.

2. Branny scales, e.g., pityriasis versicolor, pityriasis alba.
3. Ichthyotic scales: large brown polygonal scales (like on the body of a fish), e.g., ichthyosis vulgaris (Figure 1.3b).
4. Silvery, micaceous (mica-like that looks sparkling), thick scales, e.g., psoriasis.

2. Crust: Dried up exudates consisting of pus, serum, or dead inflammatory cells or just dried serous fluid. Sometimes dried blood.

Types:

1. Dry, golden-yellow, soft, friable, and superficial crust: impetigo contagiosa (Figure 1.3c)
2. Yellow, greasy crust: favus
3. Thick, hard, and tough crust: third-degree burns
4. Lamellated, elevated, brown crust: syphilis

3. Erosion: Loss of epidermis, mostly after rupture of vesicles. There is no dermal damage. Healing occurs without or with minimal scarring.
4. Excoriation: Abrasion by mechanical means, which usually involves only the epidermis. This is usually linear and is a sign of scratching. Excoriations are seen in scabies, dermatitis herpetiformis, and eczemas (Figure 1.3d).
5. Ulcer: Breach in the continuity of skin or mucous membrane resulting from loss of dermis as well as epidermis, with slow molecular death. Ulcers always heal with scarring. Examples are traumatic ulcers and neuropathic(trophic) ulcers (Figure 1.4a).

   

   FIGURE 1.4(a) Ulcer of pyoderma gangrenosum. (b) Atrophy of right mandibular region in morphea.(c) Lichenification in a patch of alopecia areata.

6. Atrophy: Secondary change in the skin characterized by loss of normal ...