Pediatric – Week 7 Discussion 2nd REPLY

Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.  
JO Discussion:
A 7-month-old boy presents with an erythematous, confluent, slightly raised, and scaly rash on his cheeks; and his extremities are also covered with a fine papular rash. The infant has had some scaling behind the ears and on the scalp since early infancy, but the symptoms have recently increased. The mother applies baby oil to the scalp to relieve scaliness. Except for some intermittent rhinorrhea, the infant has otherwise been well. Immunizations are deficient; he received only the first set when he was two months old. The family history is positive for bronchitis. The infant’s weight is at the 75th percentile, and the height is at the 50th percentile. Vital signs are normal. The physical examination is normal, except for the presence of the rash.
What are the characteristics of papulosquamous eruptions? Be thorough and descriptive.
The hallmark of papulosquamous eruptions is the existence of thin scaling to thick adherence scaling, erythematous raised lesions that range in size from small papules (1-3 mm) to large discoid copper-colored plaques (>10 cm in diameter) (Bellet, 2021).
What are the common conditions associated with papulosquamous eruptions in children? List at least 3 common conditions and include the pathophysiology of each condition.
The three most common conditions associated with papulosquamous eruptions in pediatric patients include: Tinea, pityriasis rosea, nummular eczema.
Tinea are dermophytes responsible for causing superficial fungal infections within keratinized tissues and specifically rely on keratinized cells to reproduce (Sahoo & Mahajan, 2016). Dermophytes are categorized into three groups based on the area of the body the infection occurs. Microsporum, causes infections on the hair and skin; Trichophyton infects the skin, hair, and nails; Epidermophyton infects the nails and skin (Sahoo & Mahajan, 2016). Pityriasis rosea is a viral infection causing a papulosquamous disorder presenting with large erythematous scaly plaque called the “mother patch” on the trunk or neck, which is followed by the eruption of multiple secondary small erythematous scaly Christmas tree appearing lesions on the trunk and back (Mahajan et al., 2016). Eczema/atopic dermatitis is a disorder that results from a complex interaction between defects in environmental and infectious agents, immune dysregulation, and skin barrier function (Kapur et al., 2018).  Eczema presents with papulosquamous eruptions that are found to be erythematous, pruritic, scaly, crusty, dry-leathery patches on the face, scalp, neck, trunk, extensor surfaces of the extremities, and flexural surfaces (Kapur et al., 2018).
What are the appropriate treatments for common papulosquamous eruptions? Why?
The appropriate treatments for common papulosquamous eruptions depend on the triggering/offending agent. Tinea is best treated with the antifungal class Azoles, with the preferred method of administration being applied topically (Sahoo & Mahajan, 2016). Pityriasis rosea is typically a self-limiting disorder, however, patients may require the utilization of topical steroids, antihistamines, and emollients to reduce the severity of pruritis associated with the rash (Mahajan et al., 2016).  Treatment of eczema/atopic dermatitis is geared towards reestablishing the skin barrier by applying topical calcineurin inhibitors, or topical corticosteroids to reduce inflammation, itching, breakdown of skin, and restoring the overall dryness of the skin (Kapur et al., 2018).
When should children with papulosquamous eruptions be referred to a dermatologist?
Children suffering from unrelenting papulosquamous eruptions not responsive to treatment, should be referred to a dermatologist to assist in the identification process of the rash.  A dermatologist can perform a skin biopsy or scraping of the skin containing the rash, to identify the underlying etiology of the rash. Dermatologists have particular training allowing them to serve as exceedingly proficient medical detectives and natural collaborators with other healthcare specialists to better serve to dermatological needs of patients (Grimes, 2018).
Define the following: a) confluent, b) papular, c) papulosquamous, and d) rhinorrhea
 Confluent is the joining of skin lesions that become merged forming a patch/lesion that is not separate or distinct from one another (Farlex, 2021). Papular consists of or is characterized by papules (small solid conical elevation of the skin (Merriam-Webster, 2021). Papulosquamous is characterized by well-demarcated areas of papules and scale, classically on an erythematous background (Griffith, 2020). Rhinorrhea is defined as excessive mucous secretion from the nose (Merriam-Webster, 2021).
References
Bellet, J. (2021). Chapter 307: Papulosquamous diseases. Retrieved from https://pediatriccare.solutions.aap.org/chapter.aspx?sectionid=137947447&bookid=1626
Farlex Inc. (2021). Confluent. Retrieved from https://medical-dictionary.thefreedictionary.com/confluent
Griffiths, C. (2020). Papulosquamous disease. Retrieved from https://oxfordmedicine.com/view/10.1093/med/9780198746690.001.0001/med-9780198746690-chapter-554
Grimes P. E. (2018). A closer look at the role of the dermatologist in championing total women’s health through the dermatology gateway. International journal of women’s dermatology, 4(4), 189–192. https://doi.org/10.1016/j.ijwd.2018.09.006
Kapur, S., Watson, W., & Carr, S. (2018). Atopic dermatitis. Allergy, asthma, and clinical immunology: official journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2), 52. https://doi.org/10.1186/s13223-018-0281-6
Mahajan, K., Relhan, V., Relhan, A. K., & Garg, V. K. (2016). Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects. Indian journal of dermatology, 61(4), 375–384. https://doi.org/10.4103/0019-5154.185699
Merriam-Webster. (2021). Papular. Retrieved from https://www.merriam-webster.com/dictionary/papular
Merriam-Webster. (2021). Rhinorrhea. Retrieved from https://www.merriam-webster.com/medical/rhinorrhea
Sahoo, A. K., & Mahajan, R. (2016). Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian dermatology online journal, 7(2), 77–86. https://doi.org/10.4103/2229-5178.178099

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