Pediatric emergency medicine trisk 338

Albright syndrome should be suspected when large, unilateral café-au-lait spots
with irregular borders occur in a segmental/Blaschkoid distribution.
Characteristics of this syndrome are bony abnormalities and precocious puberty.
Children who have large, swirling areas of pigmentation following lines of
Blaschko (lines representing planes of cutaneous embryogenesis) may have forms
of cutaneous mosaicism as can be seen in linear and whorled nevoid
hypermelanosis.
Melanocytic lesions are also important in the neonatal period. True malignant
melanoma is rare in children but can occur. Melanoma can arise de novo or within
a congenital melanocytic nevus. Giant congenital melanocytic nevi have a high
risk of malignant transformation, whereas small and medium have a much lower
risk of transformation. Patients with giant congenital melanocytic nevi are also at
an increased risk of neurocutaneous melanosis ( Fig. 69.18 ).

FIGURE 69.18 Congenital melanocytic nevus. Giant congenital melanocytic nevus on the
thigh of a neonate.


Suggested Readings and Key References
Pustules and Vesicles
Ehrenreich M, Tarlow MM, Godlewska-Janusz E, et al. Incontinentia pigmenti
(Bloch-Sulzberger syndrome): a systemic disorder. Cutis 2007;79(5):355–362.
Eichenfield LF, Krakowski AC, Piggott C, et al; American Acne and Rosacea
Society. Evidence-based recommendations for the diagnosis and treatment of
pediatric acne. Pediatrics 2013;131(Suppl 3):S163–S186.
Ferrazzini G, Kaiser RR, Hirsig Cheng SK, et al. Microbiological aspects of
diaper dermatitis. Dermatology 2003;206(2):136–141.
Fortunov RM, Hulten KG, Hammerman WA, et al. Evaluation and treatment of
community-acquired Staphylococcus aureus infections in term and late-preterm
previously healthy neonates. Pediatrics 2007;120(5):937–945.
Hundalani S, Pammi M. Invasive fungal infections in newborns and current

management strategies. Expert Rev Anti Infect Ther 2013;11(7):709–721.
Kimberlin DW. Neonatal herpes simplex infection. Clin Microbiol Rev
2004;17(1):1–13.
Paloni G, Berti I, Cutrone M. Acropustulosis of infancy. Arch Dis Child Fetal
Neonatal Ed 2013;98(4):F340.
Pinninti SG, Kimberlin DW. Management of neonatal herpes simplex virus
infection and exposure. Arch Dis Child Fetal Neontal Ed 2014;99(3):F240–
F244.
Patches and Plaques
Colon-Fontanez F, Fallon Friedlander S, Newbury R, et al. Bullous aplasia cutis
congenital. J Am Acad Dermatol 2003;48(5 suppl):S95–S98.
Izmirly PM, Buyon JP, Saxena A. Neonatal lupus: advances in understanding
pathogenesis and identifying treatments of cardiac disease. Curr Opin
Rheumatol 2012;24(5):466–472.
Klunk C, Domigues E, Wiss K. An update on diaper dermatitis. Clin Dermatol
2014;32(4):477–487.
Mitra S, Dove J, Somisetty SK. Subcutaneous fat necrosis in newborn—an
unusual case and review of the literature. Eur J Pediatr 2011;170(9):1107–
1110.
Poindexter GB, Burkhart CN, Morrell DS. Therapies for pediatric seborrheic
dermatitis. Pediatr Ann 2009;38(6):333–338.
Totri CR, Diaz L, Eichenfield LF. 2014 update on atopic dermatitis is children.
Curr Opin Pediatr 2014;26(4):466–471.


Hamartomas
Harter N, Mancini AJ. Diagnosis and management of infantile hemangiomas in
the neonate. Pediatr Clin North Am 2019;66(2):437–459.
Püttgen KB. Diagnosis and management of infantile hemangiomas. Pediatr Clin
North Am 2014;61(2):383–402.

Disorders of Pigmentation
Castells M, Metcalfe DD, Escribano L. Diagnosis and treatment of cutaneous
mastocytosis in children: practical recommendations. Am J Clin Dermatol
2011;12(4):259–270.
Frieri M, Quershi M. Pediatric mastocytosis: a review of the literature. Pediatr
Allergy Immunol Pulmonol 2013;26(4):175–180.
Heinze A, Kuemmet TJ, Chiu YE, et al. Longitudinal study of pediatric urticaria
pigmentosa. Pediatr Dermatol 2017;34(2):144–149.


CHAPTER 70 ■ RASH: PAPULOSQUAMOUS
ERUPTIONS AND VIRAL EXANTHEMS
PETER A. LIO

PAPULOSQUAMOUS ERUPTIONS
The papulosquamous eruptions describe a set of skin conditions
characterized by solid, elevated skin lesions (papules and plaques) that are
associated with scaling. The prototypical disease is psoriasis, but a variety of
skin conditions can resemble psoriasis and fall into this large category. These
disorders can often be differentiated on the basis of their morphology,
configuration, distribution, and associated symptoms and signs, but
occasionally may prove difficult to diagnose and thus may require further
serologic or histologic testing.
The size of the lesions may be helpful for diagnosis. Tiny (generally 1 to 2
mm) clustered papules may indicate lichen nitidus. Small scattered papules
resembling spattered paint could suggest guttate (from the Latin word for
“drops”) psoriasis. Larger, oval, coin-sized plaques with peripheral scaling
might point to pityriasis rosea (PR), secondary syphilis, lichen planus, or
nummular eczema. Larger, confluent plaques would be more compatible
with plaque-type psoriasis, the morphologically similar pityriasis rubra

pilaris (PRP), or lichen planus.
The color of the lesions is often helpful in differentiating papulosquamous
diseases. Salmon-colored erythema is typical of seborrheic dermatitis, while
psoriasis is often a beefy red color. An orange-red color is characteristic of
PRP, while a more purplish color with white striations is unique to lichen
planus.
Arrangement or configuration characterizes the local grouping of skin
lesions. Koebnerization refers to the eruption of skin disease findings
produced by scratching or incidental trauma, often in a linear pattern ( Fig.
70.1 ). When present, the clinician can focus on a more limited differential
diagnosis because only certain skin conditions commonly produce the
Koebner phenomenon: psoriasis, lichen planus, and lichen nitidus being