Accurate, timely diagnosis of dermatoses in children critical

April 1, 2005

New Orleans — Rare, life-threatening dermatoses are presenting in pediatric patients across the country, and some dermatologists are missing these critical diagnoses, according to Patricia Treadwell, M.D., professor of pediatrics, Riley Hospital for Children, Indianapolis.

New Orleans - Rare, life-threatening dermatoses are presenting in pediatric patients across the country, and some dermatologists are missing these critical diagnoses, according to Patricia Treadwell, M.D., professor of pediatrics, Riley Hospital for Children, Indianapolis.

"It is vital that we recognize and differentiate symptoms that can be fatal if not treated appropriately," Dr. Treadwell says. "There are telltale signs that may often be confused with other conditions, yet we should always rule out those that put the child at most risk."

Speaking at the 63rd Annual Meeting of the American Academy of Dermatology (AAD) here, Dr. Treadwell focused on two potentially lethal diseases, including meningococcemia and Henoch-Schonlein purpura, with an emphasis on how skin findings can aid the dermatologist in distinguishing the conditions.

"The lesions present with jagged edges, but can often be confused with gonococcemia, yet those patients with gonococcemia tend to be less toxic," Dr. Treadwell tells Dermatology Times. "Once diagnosed with meningococcemia, most children must be isolated and treated immediately."

Cases of meningococcal disease are sporadic, with the disease most often occurring in children younger than 5 years of age, yet approximately half of the cases occur in people 16 years of age or older, according to the American Academy of Pediatrics. Precipitated by the Neisseriameningitidis, a gram-negative diplococcus, the disease requires prompt care for effective treatment.

"The preferred drug for treatment (of meningococcemia) is penicillin and also minocycline, ceftriaxone, ciprofloxacin - unless there is an allergy to these, then chloramphenicol is preferred," Dr. Treadwell says.

A skin rash is often one of the first and most obvious symptoms of Henoch-Schonlein purpura, which occurs in children ages 2 through 10. Arising in the Northern Hemisphere commonly between November and February, the disease is often accompanied by symptoms including a low-grade fever, abdominal pain and blood in the urine.

"Petechiae are also present, but while the rash brought on by meningococcemia can be wide spread, Henoch-Schonlein purpura is notable for the rash appearing mostly on the buttocks and legs that can appear purple," Dr. Treadwell says.

While children rarely die from complications of Henoch-Schonlein purpura, prompt diagnosis and treatment is crucial to avoid long-term kidney involvement. Any therapy will be related to the source of the initiating trigger, or supportive, according to Dr. Treadwell.

"If the cause is thought to be a bacterial infection, prophylactic antibiotics are often given once the infection is eliminated to prevent recurrence," she says.

Unnatural causes A third and equally detrimental skin condition in children that is often seen, but surprisingly missed, is child abuse burns. Dr. Treadwell tells of a case in which a child first seen by a dermatologist for a skin condition that was ruled to be the result of an infectious cause. Dr. Treadwell and a pediatrician at Riley Hospital for Children conducted a second, separate evaluation and diagnosed the "condition" as an inflicted burn.

"The child was being abused, but because of the initial misdiagnosis it was very difficult for us to backtrack. The parents also had a different story at this point," Dr. Treadwell says. "Tragically, the child came back dead to the hospital a few months later."

Accuracy can save lives when diagnosing child abuse burns. According to Dr. Treadwell, non-accidental burns can be easily identified. For example, children who are forced into a liquid capable of burning the skin pull their legs up.

"If their bottom touches the bottom of the bath tub, which is colder than the water, the buttocks are often spared," Dr. Treadwell explains. "The knees are also often not burned."