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INTRODUCTION

Pediatric dermatology has emerged over the years as an important subspecialty of dermatology. Infants and children cannot be treated as “small adults” as they are dynamic beings with constant developmental changes. New skin diseases appear at different stages of development. Similarly, clinical features of a skin condition may change as the child grows older. Some skin diseases are unique to the pediatric population. Conditions covered in this chapter include the vascular tumors and malformations, nevi, pigmentary disorders, acute exanthems, infections, and conditions occurring primarily in the neonatal period and infancy.

VASCULAR TUMORS AND MALFORMATIONS

Vascular tumors and malformations are a heterogeneous group of distinct clinicopathological entities (Figures 7–1, 7–2, 7–3, 7–4, 7–4a, 7–5, 7–6, 7–7, 7–8, 7–9, 7–10, 7–11, 7–12, 7–13, 7–14, 7–15). The accurate diagnosis of a vascular birthmark is essential as prognosis and management strategies differ.

Figure 7-1

Infantile hemangioma

Infantile hemangioma is the most common benign tumor in childhood. It exhibits a characteristic clinical course of an early rapid proliferative phase, followed by slow involution. This photo shows a bright red plaque above the right eyebrow. Full involution may take up to 10 years.

Figure 7-2

Infantile hemangioma

The majority of infantile hemangiomas do not require any intervention. Treatment of a hemangioma is individualized, based upon the size, location, presence or possibility of complications, risk of disfigurement, and age. This child was treated with oral propranolol and pulsed dye laser, after having a poor response to oral corticosteroids.

Figure 7-3

Congenital hemangioma

Congenital hemangiomas are vascular lesions that are present and at maximal size at birth. There are two major recognized subgroups, rapidly involuting congenital hemangiomas (RICH) and non-involuting congenital hemangiomas (NICH). The typical appearance is that of a solitary vascular tumor with peripheral pallor and overlying telangiectasias.

Figure 7-4

Pyogenic granuloma

This red fleshy nodule on the lower lip is a classical example of a pyogenic granuloma. This relatively common, benign, vascular lesion presents clinically as a bright red friable papule or nodule which often bleeds after minor trauma.

Figure 7-4a

Pyogenic granuloma—histology

Pyogenic granuloma (lobular capillary hemangioma) has a polypoidal silhouette which is commonly ulcerated and covered by an inflamed crust. In the dermis, lobular proliferations of small capillaries are seen within an edematous, fibromyxoid stroma.

Figure 7-5

Port wine stain

There are two types of capillary malformations, namely port wine stain (nevus flammeus) and salmon patch (nevus simplex). This child presented at birth ...

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