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Continuity Clinic Notebook:

Chapter II. The Evaluation of the Sick Child

Chapter 2 Index

A. Evaluation by system:

1. General

2. HEENT

3. Cardiopulmonary

4. GI

5. GU

6. Orthopedics

7. Neurological

8. Skin
--The Evaluation of a Rash: Is it Allergic?

--Common Viral Rashes of Childhood
--Parvovirus B19
--Diagnosis and Treatment of Diaper Rash

 

Common Dermatologic Conditions

Name of Problem Organism Assoc.             Therapy Alternative Therapy
1.  Warts 1.  Papillomavirus 16: hands and feet
2.  PM virus 2: anogenital region (different subgroups for different locations of warts)
1.  Benign neglect
2.  Tape occlusion
3.  Hyperthermia
4.  Salicylic acid
5.  Cantharidin
6.  Cryotherapy
7.  Surgery: laser
1.  Hypnotherapy
2.  Cimetidine
3.  Interferons
4.  Imiquimod
5.  Cidofovir
6. Bleomycin injection
2.  Tinea Capitis **1.  Trichophyton tonsurans
2.  Microsporum audouinii
3.  Microsporum canis
1.  Griseofulvin: best a.  15-25 mg/kg/day if T. Tonsurans: give for up to 12 weeks
b.  10/kg/day for Microsporum org.
2.  Shampoo: 2.5% selenium sulfide: dec contagiousness
1.  Ketoconazole: 5 mg/kg/day; get lfts!
2.  Terbinafine (no suspension yet)
3. Itraconazole (a lot of diarrhea)
4. Fluconazole
----Kerions -Staph aureus in pus about half of time
-gm negs 20% time
If symptomatic add prednisone 1 mg/k/d for 5-10 days No evidence steroids help except with symptoms.
3.  Atopic Dermatitis

-precipitated by: stress, heat, infection, irritants, dry skin

Staph Aureus often complicates: 90% present 1.  Topical lubricants
-petrolatum, mineral oil, cetaphil, moisturel, eucerin
2.  Topical steroids
3.  Antibiotics often: keflex, emycin, dicloxacillin
1.  Bathe with cetaphil lotion
2.  Topical steroid right after bath
3.  Sedating antihistamine: benadryl or atarax

_____
Phototherapy and UV or immunosuppression

4.  Hemangiomas None 1.  Prednisone: 1-2/k check every 2 weeks
2.  Interferon alpha daily subQ injections for many months
3.  Lasers: vascular specific dye lasers
Bad side effects:
1.  Radiation therapy
2.  Cryotherapy
3.  Nonspecific laser rx
5. Scabies Sarcoptes scabiei Permethrin 5% is better than lindane. Apply for 8-12 hours, then remove
6. Erythema Multif. Herpes simplex None: not steroids Not acyclovir

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D., 
jbenj@mcg.edu

February 27, 2004