FIGURE 65.8 Phytophotodermatitis in an infant (From Gru AA, Wick M Pediatric Dermatopathology and Dermatology 1st ed Philadelphia, PA: Wolters Kluwer; 2018.) FIGURE 65.9 Hyperpigmentation due to phytophotodermatitis from lime juice (Reprinted with permission from Craft N, Fox LP, Goldsmith LA, et al VisualDx: Essential Adult Dermatology Philadelphia, PA: Wolters Kluwer; 2010.) Treatment for phytophotodermatitis consists of supportive care Avoidance of direct contact with furocoumarins is preventative, such as wearing protective clothing, including face and eye protection, when cutting or handling suspected plants Skin that has touched a plant should be washed with soap and water to try to remove the photosensitizing compounds and prevent development of phytophotodermatitis Suggested Readings and Key References Admani S, Jacob SE Allergic contact dermatitis in children: review of the past decade Curr Allergy Asthma Rep 2014;14(4):421 Bains SN, Nash P, Fonacier L Irritant contact dermatitis Clin Rev Allergy Immunol 2019;56(1):99–109 Bieber T Atopic dermatitis N Engl J Med 2008;358(14):1483–1494 Chantorn R, Lim JW, Shwayder TA Photosensitivity disorders in children: part I J Am Acad Dermatol 2012;67(6):1093.e1–1093.e18 Eichenfield LF, Boguniewicz M, Simpson EL, et al Translating atopic dermatitis management guidelines into practice for primary care providers Pediatrics 2015;136(3):554–565 Gruber-Wackernagel A, Byrne SN, Wolf P Polymorphous light eruption: clinical aspects and pathogenesis Dermatol Clin 2014;32(3):315–334 Mehta AJ, Statham BN Phytophotodermatitis mimicking non-accidental injury or self-harm Eur J Pediatr 2007;166(7):751–752 Paller AS, Simpson EL, Eichenfield LF, et al Treatment strategies for atopic dermatitis: optimizing the available therapeutic options Semin Cutan Med Surg 2012;31(3 suppl):S10–S17 Yang EJ, Sekhon S, Sanchez JM, et al Recent developments in atopic dermatitis Pediatrics 2018;142(4):e20181102 CHAPTER 66 ■ RASH: BACTERIAL AND FUNGAL INFECTIONS/RASH: MACULOPAPULAR JAMES TREAT BACTERIAL INFECTIONS Pustular Eruptions Folliculitis Folliculitis presents with pustules and red papules that are centered around hair follicles due to bacterial invasion of the follicle ( Fig 66.1 ) The infection is sometimes itchy but can be painful When excoriated, the pustules may be unroofed and eroded, or crusted papules may predominate Folliculitis can be widespread but is often concentrated in hair-bearing areas Cultures of pustules prove the diagnosis, establish bacterial sensitivities, and guide therapy Folliculitis is most commonly caused by Staphylococcus aureus (SA) Group A Streptococcus (GAS) causes folliculitis as well but may present with intermixed pustules, vesicles, and erosions Pseudomonas aeruginosa can survive in recirculated water and causes “hot tub” folliculitis Pseudomonas infections from recirculating water often present under the clothing where the bacteria get trapped Therapy with antibacterial washes and topical antibiotics directed at P aeruginosa, such as silver sulfadiazine, bacitracin/polymyxin B, gentamicin, or neomycin, are often sufficient For more widespread or symptomatic infections or those in immunocompromised hosts, systemic therapy with ciprofloxacin should be considered Gram-negative folliculitis can be confused with acne; it can occur on the face and presents in adolescents with pustules, especially around the mouth The differential diagnosis of bacterial folliculitis includes miliaria (heat rash) in patients who are sweating, reactions, and other nonbacterial causes of folliculitis, such as pityrosporum yeast infections, especially on the upper ... primary care providers Pediatrics 2015;136(3):554–565 Gruber-Wackernagel A, Byrne SN, Wolf P Polymorphous light eruption: clinical aspects and pathogenesis Dermatol Clin 2014;32(3) :315? ??334 Mehta AJ,... 2012;31(3 suppl):S10–S17 Yang EJ, Sekhon S, Sanchez JM, et al Recent developments in atopic dermatitis Pediatrics 2018;142(4):e20181102 CHAPTER 66 ■ RASH: BACTERIAL AND FUNGAL INFECTIONS/RASH: MACULOPAPULAR