Pediatric emergency medicine trisk 315

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