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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