How is lyme dz spread and what is the most common age to get it?
-spread through ticks
-highest rates among children 5-10 y/o
what is the presentation of lyme dz?
-early dz (1-2 wks after bite): red papule expands to red border with area of central clearing (aka erythema migrans), may be painful or pruritic
-may also have fever, HA, malaise, myalgia and LAD
-Late dz: arthritis (50%), neurologic sequelae possible bu
What is the tx for rocky mountain spotted fever and lyme dz?
-doxycycline
-may choice to give tetracycline in lyme dz to avoid risk of staining teeth <8
what is the presentation of rocky mountain spotted fever?
-most do not remember hx of tick bite
-prodrome: HA, fever, malaise
-rash: pale, red maculopapular rash that
starts peripherally and spread to entire body
-evolves to petechial/purpuric eruption on feet/ankles ->wrists/hands -> trunk and head
-severe case
How are scabies transmitted and what is the tx?
-transmitted skin to skin and can only live for 48 hours without host
-tx: perthemthrin cream for patient and all in the household, wash all linens, towels, clothes and plush toys in hot water and dryer
What are the symptoms of scabes in infants vs children?
-infants will have papules, pustules, vesicles on scalp, wrists/palms, ankles/sole, axilla and groin, waistband
what is the big pt education with lice?
-Permetherin (nix) only gets the adults out, they need to brush the hair really well to make sure all of the eggs are getting out as well
What is the usual cause of erythema mutliforme minor and what are the symptoms?
-often precipitated by HSV
-1-3 cm oval deep target lesions with 3 rings (outer ring, middle ring and center white ring)
-if there are blister they are mild and involved
<10% of the body
-rarely involves mucosa and if it doesn't only one
what is the tx for erythema multiforme minor?
-NSAIDS and antihistamines
what are the common causes of erythema multiforme major (SJS) and what are the symptoms?
-drugs (NSAIDS) and mycoplasma pneumonia are MC
-often preceeded by febrile resp illness
-involves 2 or more mucous membranes (erosions of conjuntiva, genital/anal mucosa, oral mucosa, esophagus and trachea)
-lesions may have necrotic ulceration
what is the tx for erythema mutliforme major (SJS)
-antihistamines
-steroids
-antibiotics
what is kawasaki dz?
-multisystem vasculitis of the small-medium size arteries
-usually occurs in children <5
-presents with high fever last >5 days
-child will be
irritable
How is the diagnosis of kawasaki dz made?
fever 5+ days plus at least 4
:
-bilateral conjunctivitis
-mucus membrane change (dry, cracked lips, strawberry tongue, red pharynx)
-skin changes (one or more)
-polymorphous rash
-cervical LA >1.5cm
What are the characteristics of the subacute and convalescent phase of kawasaki dz?
-subacute: carditis and giant coronary artery aneurisms are possible: highest mortality from acute MI (thrombocytosis)
-convalescent: continuous until ESR is normal
What is the tx for kawosaki dz?
-IVIG single dose
-ASA in high doses fro 48 hrs followed by low dose ASA for additional 6-8 weeks
-repeat echocardiograms and cardiology care
What are the 3 stages of atopic dermaitits presentation?
-acute: erythema/scaling, erythematous vesicles that rupture and weep from scratching
-subacute: mild and lichenification
-chronic: prominant scaling and marked lichenification and minimal skin erythema
What is the difference in atopic dermatitis presentation in someone less than 2 vs over 2?
-in children < 2: acute and subacute present on cheecks, forehead and scalp with extensor surfaces>flexor surfaces
-in children >2 subacute and chronic lesions are MC in flexural area of neck, elbow, wrist, knees and ankles affected
what is the tx for atopic dermatitis?
-key is to control the symptoms bc there is no cure
-moisture replace and prevention of moisture loss (don't bath daily, pat dry)
-use cream/ointment bid
-relief of pruritus and inflammation: benadryl, hydroxyzine, zertec, topical steroids.
-topical stero
What are the types of contact dermatitis and what is the tx?
-irritant: exposure to irritating or drying substance
-allergic: cell mediated immune rxn
-tx: topical steroid, nystatin cream for candida, keep area clean, keep diaper dry, remove offending agent
What is the tx for seborrheic dermatitis?
-dandruff shampoo
-gently comb scales out with baby oil
-resolves by 12 months usually
What is cutis marmorata and is it concerning?
-mottled
-generally not concerning as long as it goes away by 2 months, isn't a new onset occurrence and gets better with warming the baby up
What is aplasia cutis congenita?
-congenital absence of skin generally on the top of head
-is concerning from presence of trisomies
What is the difference between milia and sebaceous hyperplasia?
-milia is more white appear
-sebaceous hyperplasia is more yellow/fleshy
What is erythema toxicum?
-benign rash with no known cause that moves around and generally only last 36 hrs