Pediatric Dermatology and Dermatologic Therapy: Age-Specific Decisions
Pediatric Dermatology and Dermatologic Therapy tests age-specific diagnosis and safe prescribing: neonatal rashes, atopic dermatitis, vascular lesions, genodermatoses and drug doses that differ from adult practice.
Core rules
- Neonatal rashes: erythema toxicum neonatorum is blotchy erythema with sterile pustules on day 1–3; transient neonatal pustular melanosis has pustules with collarette scale; seborrheic dermatitis favours scalp, eyebrows and flexures; atopic dermatitis spares the nappy area in infants. Fever or systemic illness changes the differential to infection.
- Infantile haemangioma: appears in the first weeks, proliferates for 3–6 months, then involutes. Propranolol is first-line for problematic lesions (ulceration, vision, airway, large facial); start under specialist supervision with baseline heart rate and blood pressure.
- Atopic dermatitis: emollients plus topical corticosteroids; use the lowest effective potency, but do not undertreat inflamed skin. In infants, 1% hydrocortisone is appropriate for face and flexures; potency escalation is acceptable for short courses on the trunk. Calcineurin inhibitors are steroid-sparing for sensitive sites.
- Pediatric dosing: calculate by weight, not age. Oral prednisolone 1–2 mg/kg/day; antihistamines are often sedating and not first-line for eczema; methotrexate and ciclosporin require monitoring.
- Phototherapy: narrowband UVB is used for severe eczema and psoriasis in children old enough to cooperate; protect eyes and genitals and document cumulative dose.
- Genodermatoses: neurofibromatosis type 1 (café-au-lait, axillary freckling, neurofibromas), tuberous sclerosis (ash-leaf macules, facial angiofibromas), incontinentia pigmenti (Blaschko-linear stages).
Worked example
A 4-month-old has a rapidly growing 2 cm facial haemangioma near the eye. This is not a port-wine stain. Refer urgently for propranolol because of amblyopia risk; topical timolol may be used for superficial small lesions. Do not wait for spontaneous involution when vision is threatened.
Traps
Do not use potent topical steroids on the face or nappy area for long periods. Do not miss fever with a neonatal pustular rash. Do not prescribe tetracyclines or fluoroquinolones to children. Do not assume all vascular lesions are haemangiomas.