PEDIATRIC HEALTH
A Guide to Common Pediatric Skin Conditions By Ashley Chakales, Ryan Wealther, Marie Vu and John Browning, MD, FAAD, FAAP, MBA
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kin conditions are commonly encountered in the primary care clinic. In this article, we highlight four common pediatric skin conditions often encountered by primary care physicians, including clinical pearls and when a referral to a dermatologist is warranted. Atopic Dermatitis Atopic Dermatitis (AD) affects 11-12% of children in the United States. Several mechanisms have been proposed for the pathophysiology of AD, including epidermal barrier dysfunction, immune dysregulation, genetic predisposition, as well as environmental triggers.6 The classic lesion is a pruritic, erythematous rash (Figure 1). The distribution differs with age, with the face and extensors primarily affected in children ages 0-2 years and flexural surfaces primarily affected in adolescents. Common treatments for AD include gentle skin care practices (mild cleansers and bland emollients), topical corticosteroids and non-steroidal topicals (topical calcineurin inhibitors, topical phosphodiesterase-4 inhibitors). Figure 1:
Clinical Pearls: A common mistake in the management of AD is undertreatment.5 “Topical steroid phobia” is prevalent among patients because misinformation regarding potential side effects is often Image: Procedural Pediatric Dermatology8 overemphasized 9 on the internet. Providers play an important role in debunking inaccurate information to increase treatment adherence. Additionally, the
diagnosis of AD in skin of color patients is challenging because erythema may be difficult to visualize.2 It is always important to ask about pruritus, as it is the hallmark symptom of AD. When to refer: A referral to a dermatologist is recommended when attempts at initial management have not been successful, the patient has frequent flare-ups or the condition is causing psychosocial disturbance. Allergic Contact Dermatitis Allergic contact dermatitis (ACD) is a type four hypersensitivity reaction consisting of two phases: sensitization followed by elicitation. During sensitization, a hapten penetrates the skin and forms an antigen complex, inducing an immune response. Upon re-exposure to the same culprit, immune cells recognize and process the allergen and induce a local inflammatory response. The classic lesion is a localized, pruritic, eczematous eruption (Figure 2). Common culprits include poison ivy, nickel, topical antibiotics (neomycin, bacitracin), fragrance and preservatives.10 Figure 2:
Image: Procedural Pediatric Dermatology8
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SAN ANTONIO MEDICINE • September 2021
