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Paediatric Dermatology - Coggle Diagram

- - - - Bright red patches ith putules and satallite papules
      - +/- Intertriginous involvement (including scrotum
      - Painful
    - - Midl topical steroid and antifungal
  - - - Poorly demarcated erythematous plaques
      - Spares inguinal folds
    - - Hygeine
      - Barrier creams
  - - - Sharply demarcated bright pink / red plaques involving inguinal creases
      - Minimal scale
      - Most common psoriatic presentation in infants
  - - - Groin spared
      - Buttocks
  - - - Erythematous crusted patches / plaques with faccid bullae in perineal, periorificial and distal extremities
    - - Low zinc level
  - - - Yellow-brown crusted papules with purpura in seborrhoeic distribution
      - +/- systemic involvement
- - - - Infants:
        
        Face
        
        Scalp
        
        Extensors
      - Children
        
        Antecubital / popliteal fossae
        
        Neck
        
        Wrists
        
        Ankles
      - Adults
        
        Typicall hands
  - - - Impetigo
      - Eczema herpeticum
      - Molluscum contagiosum
      - Tinea
- - - - Single lesions in 10-20% of population
      - Multiple lesinos associated with genodermatoses
    - - Light to dark brow macule or patch
    - - NF - Neurofibram??
      - McCune-Albright syndrome
  - - - Onset at birth or 1st yr
    - - 1-2% of population
      - Slight increased risk of melanoma
    - - Large nevus over scalp - rule out neurocutaneous melanosis with MRI
        
        ↑ ICP
        
        Leptomeningeal melanoma
        
        Spinal cord compression
  - - - Common in infants with pigmental skin
      - Blue-gray macules or patches typically over lumbrosacral skin or buttocks
    - - If extensive - consider phakomatosis pigmetovascularis
    - - Dendritic melanocytes situated in lower half of dermis
      - Cells arranged parallel to epidermis
  - - - Dome-shaped red-brown or tan-pink smooth surfaced papule
      - Typically on face
      - Occurs within first 2 decades
    - - Kamino bodies (PAS+ globules
  - - - Congeital or acquired in early childhoos
      - Multiple blue nevi associated with Carney complex - risk of tumours
    - - Normal epidermis
      - Many elongated dendritic melanocytes within dermis
      - Large amounts of melain often seen within melanocytes
  - - - 0.3-0.4% in prepupertal children
    - - Fair skin
      - Blue eyes
      - Blonde / red hair
      - CDKN2A or p16 mutation
    - - Xeroderma pigmentosum
      - Dysplastic nevus syndrome
      - Large congenital nevus
      - Neurocutaneous melanosis
- - - - Hamartoma of epidemis and papillary dermis
      - Onsent at brith ( +/- adolscence, rare in childhood)
      - Hyperpigmented papillomatous papules and plaques along lines of Blaschko
  - - - Solitary yellow-orange slightly raised plaque
      - Typically on scalp or face
      - Plaque thickens and becomes more verrucous or pebbly during childhood
      - Associated alopoecia
    - - Benign tumours
        
        Trichoblastoma
        
        Syringocystadenoma papilliferum
      - Malignant tumours
        
        BCC
  - - - Skin-coloured firm papule on face
      - Nasolabial folds and chin
      - Progess in size and number
    - - Multiple lesions - tuberous sclerosis
        Onsent in early to mid chilhood
        
        Genetics
        
        AD
        
        TSC1 gene mutation (hamartin)
        
        TSC2 gene mutation (tuberin)
        
        Cutaneous manifestations
        
        Ash-lead macules
        
        Facial angiofibromas
        
        Connective tissue naevi (shagreen patch)
        
        Fibromas (gingival and subungual
        
        CALM
        
        Dental enamel pits
        
        Associated begning lesinos
        
        Renal angiomyolipomas
        
        Retinal hamartomas
        
        Seizures
        
        Pulmonary lymphangioleiomyomatosis
        
        Cortical tubers
        
        Cardiac rhabdomyoma
  - - - Skin-coloured, soft or rubbery paulonodule with positive buttonhole sign (easily invaginated)
      - Multiple lesions associated with neurofibromatosis
      - Plexiform NF considered pathognomonic for NF1 - malignant transformation in 2-13%
    - - Genetics
        
        AD
        
        NF-1 gene encodes neurofibromin (tumour suppressor protein)
      - Criteria
        
        Two or more of the following 6
        
        Six of more CALMs or two or more neurofibromas or one plexiform neurofibroma
        
        Axillary or inguinal freckling (Crowe's sign)
        
        Optic glioma
        
        Lisch nodules
        
        Sphenoid wing dysplasia or thinning cortex of long bone
        
        First degree realtive with NF
      - Risk Factors for Tumours
        
        Optic glioma
        
        Malignant peripheral nerve sheath tumour
        
        Neurosarcoma
        
        JMML
        
        Rhabdomyosarcoma
      - Associations
        
        HTN
        
        Learning disability
        
        Seizures
        
        Kyphoscoliosis
        
        Endocrine disorder
        
        Precocious puberty
        
        Acromegaly
        
        Thryoid/ parathyroid abnormalities
        
        Breast cancer
  - - - Onset before puberty
      - c-kit alteration
      - Solitary mastocytoma
      - Urticaia pigmentosa
      - Diffuse cutaneous mastocytosis
      - Positive Darier signs
- - - - Infantile haemangioma
    - - Capillary malformation
        Venous malformation
        Lymphatic malformation
      - AVF
        AVM
  - - - Most common benign tumour of infancy
      - 4%-1% of children
      - More common in premies, twins, girls
    - - Superficial
        
        Red discolouration of skin
        
        Superficial dermis and bright red in colour during proliferative phase
      - Deep
        
        Blueish hue
        
        Blue-purple mass with normal overlying skin
      - Precursor lesions
        
        Pink or bruised macule or patch with surrounding telangiectasia
    - - GLUT1 positive (endothelial marker - differentiates from malformation)
    - - Ulceration most common
      - Anatomic distortion with interference of normal function
      - High-output congestive heart failure (greater risk if in liver)
    - - Periocular
      - Beard region
        Clue for laryngeal haemangiomatosis with airway obstruction
      - Segemental haemangioma over lumbosacral are
        MRI spine to rule out GU/GI/spinal/skeletal abnormalities
      - Nasal tip
      - Segmental on face (PHACES)
    - - Propanalol
        
        Most effective when starting during growth phase of IG
        
        S/E
        
        Cold extremities
        
        Sleep disturbance
        
        Hypoglycaemia
        
        Bradycardia
        
        Hypotension
        
        MOA not completely elucidated
  - - - Well demarcated erythematous patch or plaque that grows in proportion to generel growth of the body
      - Does not spntaneously receed (unlike naevus simplex)
      - Facial - Skin changes from pink to deep purple andthickens with increased nodularity and pyogenic granulomas
    - - Sturge Weber-syndrome
        
        Sporadic neurological disorder associated with ipsilateral ocular and leptomeningeal abnormalities
        
        Clinical features
        
        Facial port wine stain - forghead and hemifacial phenotype
        
        Congeital or aquired ocular abnormalities (glaucoma)
        
        Neurological:
        
        Seizures
        
        Motor dysfx
        
        Learning disability
      - Overgrowth syndromes
  - - - Common aquired lesion in children and adults
    - - Central arteriole with radiating thin walled vessels
      - Temporary obliteration seen with compression
      - Brigh red papule with central papule surrounded by distinct radiating vessles
    - - Liver disease
      - Pregnancy
    - - Laser