Emergencies in Pediatric Dermatology Ayelet Shani Adir, M.D. Pediatric Dermatologist Haemek Medical...

Emergencies in Emergencies in Pediatric DermatologyPediatric Dermatology

Ayelet Shani Adir, M.DAyelet Shani Adir, M.D..

Pediatric DermatologistPediatric Dermatologist

Haemek Medical CenterHaemek Medical Center

• Widespread skin involvement (massive trans-epidermal loss)

• Skin findings as clues for diagnosis

Dermatology in Emergency Medicine

Case 1

• 15 months old healthy infant

• Fever, malaise and skin tenderness for the past 3 days

SSSSSSSSStaphylococcal Scalded Skin SyndromeStaphylococcal Scalded Skin Syndrome

• Occurs mainly in infants and young children (<5 years)

• Malaise, fever, generalized macular erythema with tenderness of skin

• Exfoliation with exudation and crusting around mouth, eyes and nose

• Diagnosis- Tzanck smear and bacterial cultures

SSSS: Clinical Findings• Generalized erythema with flexural

accentuation

• Skin tenderness

• Flaccid bulla in skin folds

• Positive Nikolsky’s sign

• Desquamation

SSSS: Therapy

• Maintain fluid status

• Intravenous anti-staphylococcal antibiotics

• Prevent secondary infection

Case 2

• 11 year old healthy girl

• Generalized skin eruption with bullae

• Two weeks before: UTI treated with Resprim for 8 days, later switched to Zinnat

Physical Examination

• Febrile, 390 C

• Generalized maculo-papular rash on skin, erosions on oral mucosa and eyes

• Large tense bulla on skin

Toxic Epidermal Necrolysis

Nikolsky’s Sign

SJS and TEN

• Incidence: 0.4-1.2 cases per million per

year

• SJS: detachment of <10% BSA with

widespread targetoid lesions

• SJS-TEN overlap: 10-30% detachment

• TEN: >30% detachment

SJS and TEN• Prodromal period of 1-14 days with

fever, cough, coryza, sore throat, myalgia

• Extensive erosions of mucous mebranes: oropharynx, eyes, genitalia, rectum

• Variable skin involvement

SJS-TEN Therapy• Prompt discontinuation of suspected drug

• PICU

• Wound care: nonstick dressings, debridement

• Ophthalmologic intervention

• Hydration, electrolyte balance, nutritional support, pain control

SJS-TEN Therapy• Use of systemic corticosteroids is

controversial

• High-dose IVIG (inhibit Fas-mediated apoptosis) 0.4-2 gr/kg/d for 2-5 days

Hypersensitivity SyndromeDrug Rash with Eosinophila and Systemic

Symptoms (DRESS Syndrome)

• Severe multi-organ reaction

• Fever, rash, Lymphadenopathy and

hepatitis

• Anticonvulsants, sulfa antibiotics

• 1:10000 exposures

Dress Syndrome• Immediate withdrawal of suspected

drug

• Close monitoring of liver and kidney functions

• Corticosteroids 1-2 mg/kg

• IVIG

Skin Findings as Clues for Diagnosis

• Systemic infections

• Kawasaki’s

Disease

• Child Abuse

purpuric, necrotic lesions

of Meningococcemia

Condyloma acuminata

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