Eczema coxsackie – on face
Eczema herpetic – deeper lesions, located anywhere

Shingles – *can occur in children*. PAINFUL, causes neuralgia
Herpes – no neuralgia

-*single lesions*
-asymmetrical distribution (if multiple)
-*annular, circular or oval lesions* (usually oval on face)
-*erythematous lesion WITH SCALE*

-*viral illness* – EBV, Hep A,C, CMV, coxsackievirus, rotavirus, parvovirus
-*generalized lymphadenopathy* may be seen
-papular lesions, urticarial lesions
-concentrated on *arms* and *legs*
-*koebner phenomenon*

*Topical corticosteroids*
-oral antihistamines (if pruritic)

-Topical anti-fungals for x2 weeks
-oral anti-fungal (if infection persists)

-*fever*
-*coxsackie virus* (human enterovirus 71 too)
EXANTHEM
-vesicular eruption
-lateral fingers and toes
-*elliptical shape with surrounding erythema*
ENANTHEM – vesicle in oral cavity rupture and become ulcers. *lateral aspects of tongue*

-fluid intake
-fever control
-analgesics

-seen in children that take *inhaled corticosteroids*
-erythematous papules in the *perioral/perinatal/periorbital* areas
-*similar to Rosales and acne* – no comodones
-may have *some scale* (none in acne – which has oiliness associated)

-avoid topical steroids
-*topical metronidazole*

-*patchy alopecia with scale*
-diffuse scale
-crusting or postures
-*occipital lymphadenopathy*
-*trichophyton tonsurans* is MC etiology
*Wood’s light examination* – negative doesn’t help, but if positive can

-Griseofulvin
-*good safety profile*
-side effects: HA, GI disturbances, urticarial, “ID” reaction (start treating then will get fine bumps)

-*Fluconazole* (if griseofulvin doesn’t work)
-side effects: GI disturbances

*terbinafine*
Side effects: GI disturbances, taste loss (causes weight loss)

Treatment option for tinea cavities
Side effects: *hepatotoxicity*

-dyshidrotic eczema: on *side of hands*, pruritic

-*pruritus* (especially at night)
-*eczematous* (scaly) patches and papules
-*finger web spaces*, axilla, wrists, belt-line, and groin area
-*burrows*

-permethrin
-apply under nails and every where

*frostnip* is the first stage
-fingers, toes, nose, ears, cheeks, and chin common areas affected
-*first cold* – *reddened* – *numb* – *hard* – *pale*

-get out of cold
-gently re-warm with *warm water* – not hot
-avoid trauma while numb

-*painful rash*
-*one side of body*
-*concern around the eye*

-story does not match with physical findings
-stories inconsistent
-unusual pattern of injury (LE ecchymosis on children that can’t walk yet)
-injuries at different stages
-check previous records

*NOT CHILD ABUSE*
-heat exposure insufficient to cause a burn
-heaters, heating pads, hot water bottle
-reticulated erythema
-*hyperpigmentation*

*NOT CHILD ABUSE*
-associated with *furocoumarins* and *sun exposure*
-can be found in *citrus fruits*
-more severe cases may *develop bullae*
*looks similar to ecchymosis* – hyperpigmentation in an unusual pattern

apthalous ulcer – no fever associated
becht’s disease – complex of apthalous ulcers
Herpes simplex – anterior mouth
herpangina – posterior mouth