Emergencies in Pediatric Dermatology

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Emergencies in Emergencies in Pediatric Pediatric Dermatology Dermatology Ayelet Shani Adir, Ayelet Shani Adir, M.D M.D . . Pediatric Pediatric Dermatologist Dermatologist Haemek Medical Haemek Medical Center Center
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Emergencies in Pediatric Dermatology. Ayelet Shani Adir, M.D. Pediatric Dermatologist Haemek Medical Center. Dermatology in Emergency Medicine. Widespread skin involvement (massive trans-epidermal loss) Skin findings as clues for diagnosis. Case 1. 15 months old healthy infant - PowerPoint PPT Presentation

Transcript of Emergencies in Pediatric Dermatology

  • Emergencies in Pediatric DermatologyAyelet Shani Adir, M.D.Pediatric DermatologistHaemek Medical Center

  • Dermatology in Emergency MedicineWidespread skin involvement (massive trans-epidermal loss)

    Skin findings as clues for diagnosis

  • Case 115 months old healthy infantFever, malaise and skin tenderness for the past 3 days

  • SSSSStaphylococcal Scalded Skin SyndromeOccurs mainly in infants and young children (
  • SSSS: Clinical FindingsGeneralized erythema with flexural accentuationSkin tendernessFlaccid bulla in skin foldsPositive Nikolskys signDesquamation

  • SSSS: TherapyMaintain fluid statusIntravenous anti-staphylococcal antibioticsPrevent secondary infection

  • Case 211 year old healthy girlGeneralized skin eruption with bullaeTwo weeks before: UTI treated with Resprim for 8 days, later switched to Zinnat

  • Physical ExaminationFebrile, 390 CGeneralized maculo-papular rash on skin, erosions on oral mucosa and eyesLarge tense bulla on skin

  • Toxic Epidermal NecrolysisNikolskys Sign

  • SJS and TEN Incidence: 0.4-1.2 cases per million per yearSJS: detachment of 30% detachment

  • SJS and TENProdromal period of 1-14 days with fever, cough, coryza, sore throat, myalgiaExtensive erosions of mucous mebranes: oropharynx, eyes, genitalia, rectumVariable skin involvement

  • SJS-TEN TherapyPrompt discontinuation of suspected drugPICUWound care: nonstick dressings, debridementOphthalmologic interventionHydration, electrolyte balance, nutritional support, pain control

  • SJS-TEN TherapyUse of systemic corticosteroids is controversialHigh-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 reactionFever, rash, Lymphadenopathy and hepatitisAnticonvulsants, sulfa antibiotics1:10000 exposures

  • Dress SyndromeImmediate withdrawal of suspected drugClose monitoring of liver and kidney functionsCorticosteroids 1-2 mg/kg IVIG

  • Skin Findings as Clues for DiagnosisSystemic infectionsKawasakis DiseaseChild Abuse

    purpuric, necrotic lesions of MeningococcemiaCondyloma acuminata

  • (from nasal / perianal region)

    Fas receptor= CD95,