Staying A- Head in Pediatric Dermatology:

Transcription

1 Staying A- Head in Pediatric Dermatology: Common Scalp and Hair Diagnoses Matt Grisham, MD Greenville Health System Post-Graduate Seminar April 20, 2016

2 I have no financial disclosures or conflicts of interest.

3 Objectives Discuss common pediatric dermatologic diagnoses affecting the scalp and hair Identify key features on history and exam to help narrow the differential diagnosis Generate appropriate therapeutic plans for these conditions

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5 Born at term gestation by C/S without complication No maternal medications or infections Prenatal US and quad screening were both normal

6 Cutis Aplasia Congenita Born at term gestation by C/S without complication No maternal medications or infections Prenatal US and quad screening were both normal

7 Cutis Aplasia Congenita 80% occur at the vertex o Can occur on face, trunk, and extremities Majority are single lesions Healing over weeks to months, forming a hairless scar Larger lesions may warrant plastic surgery

8 Trisomy 13 (Patau Syndrome) Midline cleft palate/lip Holoprosencephaly Omphalocoele Polydactyly Cardiac anomalies Renal anomalies

9 Nevus Sebaceous Congenital lesion that grows with the child and eventually thickens in adolescence

10 Basal Cell Carcinoma

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12 Began on the scalp and is now spreading onto forehead Using baby shampoo daily without improvement

13 Seborrheic Dermatitis Began on the scalp and is now spreading onto forehead Using baby shampoo daily without improvement

14 Seborrheic Dermatitis Occurs in areas with highest concentration of sebaceous glands Controversial fungal etiology Self-limiting (8-12 mos) o o o o o Mineral/baby oil Selenium sulfide shampoo Zinc pyrithione shampoo Topical steroids Topical antifungal

15 6 Months Later Scalp issues have persisted despite antiseborrheic shampoo Cheeks and chin are now involved Loves to eat Beginning to teethe

16 Atopic Dermatitis Commonly affects the infant scalp Dry appearance vs. greasy scale Predictable involvement of other sites Positive family history of atopy

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18 Mom worried about a knot on the back of his head Recent haircut and noticed this spot as well She wants to know if she needs to get rid of the family pet.

19 Tinea Capitis Mom worried about a knot on the back of his head Recent haircut and noticed this spot as well She wants to know if she needs to get rid of the family pet.

20 Tinea Capitis Black Dots = Fractured Hair Dermatophyte infection o Trichophyton tonsurans o Microsporum canis Kerion

21 Tinea Capitis

22 Tinea Capitis Black Dots = Fractured Hair Dermatophyte infection o Trichophyton tonsurans o Microsporum canis Kerion

23 Tinea Capitis Drug Dosage Duration Griseofulvin microsize (liquid 125 mg/5 ml) Griseofulvin ultramicros ize (tablets of varying size) Terbinafine tablets (250 mg) Terbinafine granules (125 mg and mg) mg/kg/day 6 wk; continue until clinically clear mg/kg/day 6 wk; continue until clinically clear 4 6 mg/kg/day kg: 62.5 mg kg: 125 mg >40 kg: 250 mg <25 kg: 125 mg kg: mg >35 kg: 250 mg T tonsurans: 2 6 wk M canis: 8 12 wk FDA approved for children 4 y 6-wk duration for all species Fluconazole 6 mg/kg/day 3 6 wk FDA approved for children >2 y

24 Id Reaction Widespread papular rash Pruritic Treatment o Oral antihistamines o Topical corticosteroids

25 Traction Alopecia Hair loss along lines of tension Regional adenopathy is common Treatment o Discontinue hairstyling Complication o Traction folliculitis

26 Traction Folliculitis

27 Late Childhood/Early Adolescence

28 This middle school female is being teased o Now refusing to attend school Closer inspection of her scalp reveals

29 Trichotillomania This middle school female is being teased o Now refusing to attend school Closer inspection of her scalp reveals

30 Trichotillomania dsafsdf Association with OCD and anxiety Treatment o Address the underlying psychiatric disorder

31 Appendectomy 3 months ago

32 Telogen Effluvium Appendectomy 3 months ago

33 Telogen Effluvium Diffuse thinning of the hair seen 6-16 weeks after a stressful event o Thyroid disorders o SLE o Fe-deficiency anemia o Oral contraceptives Treatment: address any underlying cause + time

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35 Single patch of hair loss over the last few days No recent stressful events or prior tinea infections Never noted scaling, pustules Anxious because dad is bald

36 Single patch of hair loss over the last few days No recent stressful events or prior tinea infections Never noted scaling, pustules Anxious because dad is bald

37 Alopecia Areata Single patch of hair loss over the last few days No recent stressful events or prior tinea infections Never noted scaling, pustules Anxious because dad is bald

38 Alopecia Areata New patches of hair loss may appear for 4-6 weeks (or months) o Alopecia universalis Scotch-plaid nails Treatment o Topical steroids (Class I/II) o Intralesional steroid injections o Anthralin 1% cream o 2% minoxidil solution o Psychological support Complete resolution in 95% within one year if mildly affected o 30% experience relapse

39 Dandruff that is not improving with selenium sulfide or pyrithione zinc shampoo

40 Psoriasis Dandruff that is not improving with selenium sulfide or pyrithione zinc shampoo

41 Psoriasis Auspitz sign

42 Knees and elbows commonly affected Psoriasis Positive family history

43 Scalp Psoriasis: Management Topical corticosteroids o Fluocinolone 0.01% in peanut oil base Shampoo options o Coar-tar based o Zinc-based o Keratinolytic Look for an occult Streptococcus pyogenes infection Avoid vigorous brushing, combing, scratching of the scalp

44 Pediatric Dermatology Resources Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence by Paller and Mancini (~$185) Atlas of Pediatric Physical Diagnosis by Zitelli and Davis (~$90) Pediatric Dermatology: A Quick Reference Guide by Krowchuk and Mancini (~$90 new edition coming in May 2016) VisualDx (online and app format- ios and Android)

45 Thank you for your time and attention. Any Questions?