Pediatric emergency medicine trisk 311

FIGURE 65.1 Infant with atopic dermatitis on the cheeks. (Reprinted with permission
from Goodheart HP. Goodheart’s Photoguide to Common Skin Disorders . Philadelphia,
PA: Lippincott Williams & Wilkins; 2009:52.)


FIGURE 65.2 Nummular dermatitis. (Reprinted with permission from Lugo-Somolinos
A, McKinley-Grant L, Goldsmith LA, et al. VisualDx: Essential Dermatology in
Pigmented Skin . Philadelphia, PA: Lippincott Williams and Wilkins; 2011.)

Asteatotic Eczema


Asteatotic eczema, also called winter eczema, xerotic eczema, and eczema
craquele, is a pruritic condition in which the skin is dry and cracked with
red fissures and scale ( Fig. 65.3 ). The skin has the appearance of cracked
porcelain and patients may complain of burning and redness upon
application of lotions or creams. The most common sites are the
extremities. It tends to occur in adolescents during the winter and is
associated with overbathing with drying soaps (often strongly scented body
washes). Use of a gentle soap and petrolatum-based ointment or thick
emollient applied twice daily is effective treatment in most cases. If needed,
mid- to high-potency topical corticosteroid ointments can be used for flares.

Dyshidrotic Eczema
Dyshidrotic eczema, also called pompholyx, involves the hands and feet.
There is sudden onset of pruritic, tiny, clustered, deep-seated vesicles that
look like tapioca pearls ( Fig. 65.4 ). With time, scaling, lichenification, and
painful fissures occur. Lesions appear on the palms, soles, and lateral digits.
The process may be acute, chronic, or recurrent. It may be associated with
hyperhidrosis and may also occur as a form of an Id reaction
(autoeczematization) in the setting of a remote contact dermatitis or tinea

capitis. Approximately 50% of patients have an atopic background. Acute
presentations may be treated with thick emollients and potent topical
corticosteroids, which can be applied under white cotton gloves nightly, if
needed, to increase efficacy.


FIGURE 65.3 Asteatotic eczema. (Reprinted with permission from Goodheart HP.
Goodheart’s Photoguide of Common Skin Disorders . 2nd ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2003.)

Lichen Simplex Chronicus
Lichen simplex chronicus refers to a chronic, localized lesion resulting from
repeated rubbing and scratching. It has a predilection for the sites that are
easily reached, such as the arms, legs, ankles, neck, and the anogenital area.
It is rare in young children but fairly common in adolescents and adults. It
may occur in a pre-existing area affected by dermatitis. Typical lesions are
single or multiple oval plaques from 5 to 15 cm in size. The skin is
reddened and slightly edematous. Chronic lesions consist of welldemarcated areas of dry, thickened, scaly, hyperpigmented, or
hypopigmented plaques, often with lichenification (accentuated skin
markings). Intense pruritus is a hallmark. While topical corticosteroids can
be effective, some lesions may respond best to occlusion with a
corticosteroid-impregnated tape or intralesional corticosteroid. Monitoring