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chronic cases, ultraviolet light phototherapy can be an effective adjunct to therapy Seborrheic Dermatitis For more information about seborrheic dermatitis, see Chapter 69 Rash: Neonatal This is a red eruption with greasy scale that is seen in neonates and then in adolescence and adulthood Psoriasis Psoriasis occurs in three forms during childhood: guttate, erythrodermic, and pustular Any or all of these types may develop with silvery scales into the chronic, plaque-type psoriasis For a more detailed discussion please see Chapter 70 Rash: Papulosquamous Eruptions and Viral Exanthems VASCULAR LESIONS Pyogenic Granulomas Pyogenic granulomas ( Fig 88.8 ) are vascular nodules that develop rapidly at the site of an injury, such as a cut, scratch, insect bite, or burn Clinically, the lesions are bright red to reddish-brown or blue-black The vascular nodules are pedunculated, ranging from 0.5 to cm in size Their surfaces are glistening, or raspberry-like, often becoming eroded and crusted They bleed easily Removal by curettage, excision, or laser is advisable because few spontaneous resolve Acute bleeding may be managed by cautery, by constriction with a suture, or by excision Hemangioma Hemangiomas, including PHACE and LUMBAR syndromes, are detailed in Chapter 69 Rash: Neonatal URTICARIA/WHEALS Urticaria is often encountered in the pediatric population, occurring in 2% to 3% of all children In most cases, no cause is identified A small number of cases are caused by allergic reactions from the ingestion of drugs or foods (e.g., nuts, eggs, shellfish) Urticaria also follows viral (e.g., Epstein–Barr virus, hepatitis), bacterial (streptococcal), or parasitic infections Physical factors, including dermographism, cholinergic stimulation (induced by heat, exercise, and emotional tension), cold (acquired and familial), and solar exposure, can induce urticaria Finally, urticaria may be caused by factors producing a vasculitis or other autoimmune phenomena (particularly thyroid diseases) and substances causing degranulation of mast cells (e.g., radiocontrast material) Episodes of urticaria lasting less than weeks are termed transient or acute The most common causes of urticaria are infection, insect bites, drugs, and foods Chronic urticaria is defined as that which lasts for more than weeks No cause is found in 90% of children These cases include the physical urticarias or urticarial vasculitis The lesion itself follows vasodilation and leakage of fluid and red blood cells from involved vessels The vascular damage can be caused by mediators such as histamine complement and immune complexes IgE can attach to and cause degranulation of mast cells in sensitized individuals, with resulting histamine release Clinical Manifestations The typical urticarial lesions are familiar to all physicians They can be localized or generalized (involving the entire body) At times, the lesions are giant with serpiginous borders Individual wheals rarely last more than 12 to 24 hours Most commonly, the lesions appear in one area for 20 minutes to hours, disappear, and then reappear in another location The total duration of an episode is usually 24 to 48 hours; however, the course can last to weeks In young children, urticaria may have an annular or polycyclic (coalescent annular) or arcuate (partially annular) appearance and may be associated with edema of the hands or feet Because this is frequently confused with EM (which manifest with more fixed, targetoid lesions), this annular urticarial hypersensitivity has sometimes been referred to as urticaria multiforme Management Acute relief can be accomplished by oral diphenhydramine mg/kg (max 50 mg) Oral antihistamines are useful for maintenance therapy for transient urticaria H1 antihistamines for to weeks are usually effective for controlling urticaria Many recommend combinations of H1 and H2 antihistamines, but there is currently insufficient evidence to support this as a routine practice Shorter-acting agents like hydroxyzine can be used for breakthrough Suggested Readings and Key References General Eichenfield LF, Esterly NB, Frieden IJ Textbook of Neonatal Dermatology Philadelphia, PA: Elsevier Health Sciences, 2014 Goldsmith L, Papier A VisualDx: Essential Pediatric Dermatology Visual Dx: The Modern Library of Visual Medicine Philadelphia, PA: Lippincott Williams & Wilkins, 2009 Goldsmith LA, Katz SI, Gilchrest B, et al Fitzpatrick’s Dermatology in General Medicine 8th ed New York: McGraw-Hill; 2012 Harper J, Oranje A, Prose N Textbook of Pediatric Dermatology Oxford, England: Blackwell Science; 2012 James WD, Berger TG, Elston D Andrews’ Diseases of the Skin 11th ed Philadelphia, PA: WB Saunders; 2011 Paller AS, Mancini AJ Hurwitz Clinical Pediatric Dermatology 4th ed Philadelphia, PA: WB Saunders; 2011 Schachner LA, Hansen RC Pediatric Dermatology 4th ed New York: Churchill Livingstone; 2011 Treat JR Curbside Consultation in Pediatric Dermatology 1st ed Slack Inc.; 2012 Atopic Dermatitis Flohr C, Mann J New insights into the epidemiology of childhood atopic dermatitis Allergy 2014;69(1):3–16 Lio PA, Lee M, LeBovidge J, et al Clinical management of atopic dermatitis: practical highlight and updates from the atopic dermatitis practice parameter 2012 J Allergy Clin Immunol Pract 2014;2(4):361–369 Mathes EF, Oza V, Frieden IJ, et al “Eczema coxsackium” and unusual cutaneous findings in an enterovirus outbreak Pediatrics 2013;132(1):e149–e157 Sanders JE, Garcia SE Pediatric herpes simplex virus infections: an evidencebased approach to treatment Pediatr Emerg Med Pract 2014;11(1):1–19 Torti CR, Diaz L, Eichenfield LF 2014 update on atopic dermatitis in children Curr Opin Pediatr 2014;25(4):466–471 Allergic Contact Dermatitis Adami S, Jacob SE Allergic contact dermatitis in children: review of the past decade Curr Allergy Asthma Rep 2014;14(4):421 Epstein WL Topical prevention of poison ivy/oak dermatitis Arch Dermatol 1989;125:499–501 Diaper Dermatitis Berg RW, Buckingham KW, Stewart RL Etiologic factors in diaper dermatitis: the role of urine Pediatr Dermatol 1986;3:102–106 Blume-Peytavi U, Hauser M, Lünnemann L, et al Prevention of diaper dermatitis in infants—a literature review Pediatr Dermatol 2014;31(4):413–429 Honig PJ, Gribetz B, Leyden JL, et al Amoxicillin and diaper dermatitis J Am Acad Dermatol 1988;19:275–279 Shin HL Diagnosis and management of diaper dermatitis Pediatr Clin North Am 2014;61(2):367–382 Drug Reactions Dodiuk-Gad RP, Laws PM, Shear NH Epidemiology of severe drug hypersensitivity Semin Ctan Med Surg 2014;33(1):2–9 Kirchhof MG, Miliszewski MA, Sikora S, et al Retrospective review of StevensJohnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine J Am Acad Dermatol 2014;71(5):941–947 Mathur AN, Mathes EF Urticaria mimickers in children Dermatol Ther 2013;25(6):467–475 Mockenhaupt M Stevens-Johnson syndrome and toxic epidermal necrolysis: clinical patterns, diagnostic considerations, etiology and therapeutic management Semin Cutan Med Surg 2014;33(1):10–16 Schawartz RA, McDonough PH, Lee BW Toxic epidermal necrolysis: Part II Prognosis, sequelae, diagnosis, differential diagnosis, prevention and treatment J Am Acad Dermatol 2013;69(2):187.e1–16; quiz 203–204 Wong S, Koh M PD33—Drug Reaction and Eosinophilia with systemic symptoms (DRESS): a 10-year review in a pediatric population Clin Transl Allergy 2014;4(suppl 3rd Pediatric Allergy and Asthma Meeting):P33 Staphylococcal Scalded Skin Syndrome Braunstein I, Wanat KA, Abuabara K, et al Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome Pediatr Dermatol 2014;31(3):305–308 Stanley JR, Amagai M Pemphigus, bullous impetigo and the staphylococcal scaled skin syndrome N Engl J Med 2006;355:1800–1810 Bites and Infestations Fuller LC Epidemiology of scabies Curr Opin Infect Dis 2013;26(2):123–126 Howard R, Frieden IJ Papular urticaria in children Pediatr Dermatol 1996;13:246–249 Jucket G Arthropod bites Am Fam Physician 2013;88(12):841–847 Mounsey KE, McCarthy JS Treatment and control of scabies Curr Opin Infect Dis 2013;26(2):133–139 Paller AS Scabies in infants and small children Semin Dermatol 1993;12:3–8 Shmidt E, Levitt J Dermatologic infestations Int J Dermatol 2012;51(2):131  ... Pediatric Dermatology 4th ed Philadelphia, PA: WB Saunders; 2011 Schachner LA, Hansen RC Pediatric Dermatology 4th ed New York: Churchill Livingstone; 2011 Treat JR Curbside Consultation in Pediatric. .. Gilchrest B, et al Fitzpatrick’s Dermatology in General Medicine 8th ed New York: McGraw-Hill; 2012 Harper J, Oranje A, Prose N Textbook of Pediatric Dermatology Oxford, England: Blackwell Science;... Health Sciences, 2014 Goldsmith L, Papier A VisualDx: Essential Pediatric Dermatology Visual Dx: The Modern Library of Visual Medicine Philadelphia, PA: Lippincott Williams & Wilkins, 2009 Goldsmith