An infant with papules and pustules on feet. What is your diagnosis? Dr. Crutchfield’s Case of the Month

Foot sores

11-month-old infant presents with pruritic crusted papules and pustules on feet, as seen in the picture. Also hand and axilla involvement. A teen cousin visiting for the summer has a similar rash, and both are very pruritic.

Here is a picture of a mineral oil scraping I took through the microscope ocular with my cell phone.

Microscopic photo

What is your diagnosis?

Continue reading An infant with papules and pustules on feet. What is your diagnosis? Dr. Crutchfield’s Case of the Month

Pediatric News Atopic Dermatitis

pediatric dermatologistPediatricians can play an essential role in diagnosis, counseling, and management of atopic eczema. Your decision to treat these children and adolescents in your practice largely depends on your comfort level and the progression of their condition over time. In general, referral to a dermatology colleague is not warranted unless you are unsure about some aspect of the condition, or the eczema fails to improve.

To diagnose atopic eczema, look for the telltale signs, especially the cracking and fissuring of the skin on the flexural folds of the arms and legs. Besides the flexural areas of arms and legs, atopic eczema often presents on the cheeks, but can manifest anywhere on the body.

Counseling is paramount because eczema is not an individual patient disease; it affects the entire family. Parents must spend an inordinate amount of time taking care of the affected child, thereby reducing time with siblings. In addition, the condition is very, very itchy. The extreme pruritus that characterizes atopic eczema often keeps the child and parent awake at night, which can, in turn, negatively affect the next day for children at school and parents at work.

Provide information on eczema to educate everyone in the family, extended family, and anyone who participates in the child’s care. From the outset, they need to understand that optimal outcome will require a long-term commitment. Atopic eczema needs to be managed and controlled for years because there is no magic bullet or cure. Continue reading Pediatric News Atopic Dermatitis