DDx Dermatite das Fraldas
Causas mais frequentes | Causas menos frequentes | Causas raras |
Dermatite de contacto irritativa • Pregas preservadas, pior nas superfícies convexas que roçam | Infeções bacterianas • Impetigo bolhoso • Intertrigo perianal streptocócico (faringite?) | Acrodermatitis enteropathica e outras formas de dermatite nutricional |
Candidíase • Favorece as pregas | Psoríase | Histiocitose de células de Langerhans |
Dermatite seborreica • Favorece as pregas | Dermatite de contacto alérgica Nas pregas as lesões de DCA são foliculares porque o alergéneo penetra mais facilmente nos folículos e poupa a prega que é mais húmida e mais propícia para os fungos | Sífilis congénita, dermatofitose |
ㅤ | Dermatite atópica | Paraqueratose granular |
ㅤ | ㅤ | Doença de Kawasaki inicial |
ㅤ | ㅤ | ㅤ |
Irritant contact diaper dermatitis
- Most common
- poupa as pregas
- Consider allergic contact dermatitis to diaper (blue dye, elastic band), wipes (MCI/MCMI)
- Rx absobent disposable diapers, avoid wipes (water wipes), barrier creams
- Mudar fralda mais vezes
- Advantan misturado com dermofix 10 dias
Diaper Seborrheic Dermatitis
- subsides by 2-3 months
- May have overlap with atopic dermatitis (that should not affect the diaper area)
- procurar envolvimento do couro cabeludo, eyebrows e outras áreas intertriginosas
Langerhans Cell Histiocytosis
Langerhans Cell Histiocytosis (LCH)- Clinical presentation in children
- Skin
- Polymorphic
- Classic: recalcitrant seborrheic dermatitis with petechiae
- Elementary lesion: micropapule, sometimes purpuric, covered with a scaly crust or eroded
- “Erosive intertrigo with crusty edges” (Saurat)
- Crusted papules, vesiculopustules, erosions, nodules, petechiae or purpura
- Nails: oniycholysis, subungueal hyperkeratosis
- Extra-cutaneous
- Bone
- Areas of osteolysis → “punch-out” lesions
- Mainly cephalic and axial regions
- Pituitary
- Diabetes insipidus, bitemporal hemianopia, growth retardation
- Liver, spleen
- Hepatomegaly, hepatocellular insufficiency, portal hypertension
- Sclerosing cholangitis and biliary cirrhosis
- Hematopoietic, lymph nodes
- Anemia, thombocytopenia, leukopenia, macrophage activation syndrome
- Lung
- Reticulonodular infiltrate → cysts and nodules
- Dyspnea, cough, pneumothorax, pulmonary fibrosis → chronic respiratory failure and pulmonary arterial hypertension
- Gastrointestinal
- Polyps, extensive granulomatous lesions
Neonatal Diaper Candidiasis
- Acquired during delivery (≠congenital candidiasis - in utero)
- juicy red sattelite papules
- Oral thrush may be present
- Rx ketoconazol cream + barrier cream (irritant context)
Jacquet´s dermatitis | Granuloma gluteale infantum
Granuloma gluteale infantum | Jacques erosive dermatitis- severe erosive diaper dermatitis with ulcerated papules or nodules
- rx/ like irritant dermatitis
- granulomatous reaction seen in severe irritant contact dermatitis
- Unique response to local inflammation, maceration, and possibly secondary infection (usually candida)
- In older child more likely to be scabies
Pseudoverrucous papules and nodules
- Do not confuse with condyloma lata
- Underlying neurologic or anatomic anomaly that makes kids stools or urinate abnormally with chronic irritation of skin
- Spina bifida
- VACTERL
Diaper psoriasis
- Sharply demarcated, outlines the diaper (probably due to Koebner phenomenon)
- DO NOT spare folds
- Moist environment may disguise the scale
- Very recalcitrant
- Often the penis is involved (males)
- Psoríase inversa mais frequente na criança
- Comobilidade com artrite psoriática: em 80% das crianças precede a psoríase cutânea
Acrodermatitis enteropathica
Zinc deficiency
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