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- Presentation
Treating the "Outsides" of the Inpatient: Pediatric Consults for the General Dermatologist
Description
This talk focuses on pediatric dermatology, particularly common cutaneous infections in children that may necessitate hospitalization. Key topics include recognizing various skin infections and their complications, especially in high-risk patients. Two detailed case studies illustrate the clinical presentation and management of pediatric infections. The first case involves a 5-year-old girl diagnosed with primary herpetic gingivostomatitis, revealing the challenges of treatment in patients with concurrent illnesses, like colitis and COVID-19. The importance of prompt IV acyclovir treatment and hydration is emphasized, alongside understanding complications such as dehydration and secondary infections.
The second case discusses a 3-year-old with severe atopic dermatitis who developed eczema herpeticum post-dupilumab treatment. This raises critical considerations regarding the risks of herpes virus infections in patients on immunomodulatory therapies. The discussion concludes by addressing various common pediatric infections caused by viruses like Coxsackievirus, focusing on atypical presentations of hand-foot-mouth disease and their management. Throughout, the significance of timely diagnosis and treatment is underscored to prevent complications, especially in immunocompromised children.
Conclusions
- Common childhood cutaneous infections like herpetic gingivostomatitis can lead to severe complications and hospitalization.
- History of underlying conditions such as colitis can predispose children to more severe infections.
- Concomitant infections, such as COVID-19, can exacerbate the severity of skin infections in children.
- Inability to tolerate oral medications can delay appropriate treatment for severe infections in children.
- Herpetic gingivostomatitis is the most common manifestation of primary HSV infection in children, often leading to dehydration and nutritional risks.
- Eczema herpeticum is common in children with severe atopic dermatitis and poses a risk for HSV infections when on treatments like dupilumab.
- There is a need for careful monitoring and management of HSV risks in children treated with immunomodulating therapies like dupilumab.
- Children with atopic dermatitis and prior HSV infection history are at increased risk for herpesvirus complications.
- Supportive care and hydration are critical for managing conditions like hand-foot-mouth disease, especially in young children.
- Vaccination against varicella is critical to prevent outbreaks and complications in at-risk populations, including the immunocompromised.
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- Krause PR, Klinman DM. Varicella vaccination: evidence for frequent reactivation of the vaccine strain in healthy children. Nat Med. 2000;6(4):451g4.
- Weinmann S, Chun C, Schmid DS, et al. Incidence and clinical characteristics of herpes zoster among children in the varicella vaccine era, 2005-2009. J Infect Dis. 2013;208(11):1859-1868.