1	Pedsderm Top 10 Basic science Clinical presentation Special considerations Treatment In or out
2	Pediatric Red Book Report of the Committee on Infectious Diseases 26^th Edition 2003 American Academy of Pediatrics
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5	#1 Molluscum (Contagiosum) Pearly papules anywhere Poxvirus-sole member of the Molluscipoxvirus Humans-only known source Incubation period 2-7 weeks but up to 6 months Dx-clinical findings, crush prep, EM Rx: mechanical removal NO CONTROL MEASURES FOR ISOLATED CASES Restricting body, fomite contact ? value
6	#1 Molluscum Psychosocial issue Except in compromised host Molluscum neurosis They will drive you crazy!
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9	#2 Head Lice Crawlers and nits Itching, scratching, scale Pediculus humanus capitis-blood feeder Visible to naked eye Treatment-Don’t forget Ovide Nit picking? Incidence from < 1% to > 50%
10	#2 Head Lice “Head lice are not a health hazard because they are not responsible for spread of any disease.” “Removal of nits after treatment with a pediculicide is not necessary to prevent spread.” “No-nit policies…have not been effective in controlling lice transmission and are not recommended.” Treatment of clothing and other fomites is usually unnecessary.
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13	#3 Impetigo Strep induced ds assoc with acute glomerulonephritis, not rheumatic fever Staph usually implicated-dictates antibiotic Do not return to school for 24 hours p Rx Check, Rx close contacts Rx all contacts with active disease
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15	#4 Herpes Simplex Another psychosocial disaster Enveloped, double-stranded DNA virus Incubation period 2-14 days Skin to skin transmission from symptomatic and asymptomatic carriers Dx by culture, EM, fluorescent antibody, PCR Serologic studies not helpful for acute infection Rx-topical and oral antivirals does not eradicate carriage
16	#4 Herpes Simplex Most cases not symptomatic Exclude children with gingivostomatitis who cannot control secretions “Exclusion of children with cold sores from child care or school is not indicated.” Exclude wrestlers until active lesions dry Clean mats with bleach between matches
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18	#5 Herpes Zoster Member of herpesvirus family Patient’s latent virus Risk of skin to skin transmission not resp Rx: oral agents esp compromised hosts Exclude when cannot be covered until crusted Hand washing for affected staff
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20	#6 Tinea Capitis Often subtle diagnosis 15-20% of Afro-American school age children Transmission scalp to scalp and fomites Carriers-children and adults Clinical ds needs oral Rx Examine close contacts esp family No sharing of hair grooming tools Children on Rx can attend school
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22	#7 Tinea Corporis Dermatophytes (Trichophyton, Microsporum, Epidermophyton) Tinea=ringworm-not always ring Altered by therapy-topical steroids, antibiotics, antifungals Dx by clinical, scraping, culture, biopsy Transmission by skin to skin contact, fomites?
23	#7 Tinea Corporis Common in families with tinea capitis Check contacts Special considerations Special needs kids Wrestlers (tinea gladiatorum) Rx-topical, oral antifungal Avoid topical steroids
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26	#8 Fifth Disease Parvovirus B19 (erythema infectiosum) Transmission primarily by respiratory secretions Mild(but occasionally severe) Sx followed 7-10d Slapped cheeks Lacy erythema 6-8 weeks, worse in sun Arthralgias (age related)
27	#8 Fifth Disease Immunodeficiency-bone marrow failure SS patients-aplastic crisis Pregnancy-fetal hydrops, death in 2-6% Minimal risk to pregnant teachers Greater risk to certain pregnant nurse Seroconversion increases with age Transmission before rash in normal host Transmission risk prolonged in immunocompromised host
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29	#9 Scabies Sarcoptes scabei mite Transmitted from person to person-”But where did the first person get it?” Equal opportunity infestor Incubation period-weeks to months Characteristic rash often hidden by dermatitis Dx-consider it, scrape burrow Rx-permethrin 5% cream
30	#10 Dermatitis Contact-linear rash Atopic-age related patterns Seborrheic dermatitis-seborrheic areas Pityriasis rosea-fir tree pattern, post viral
31	#10 Dermatitis Outside job-look for clues Linear rash History of exposure Not contagious-no risk to classmates or staff Don’t confuse with scabies, ringworm, other infections/infestations
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