COMMON SKIN

DISEASES IN
CHILDHOOD
Dr ‘Yemi Osi.
OSINAIKE
Wednesday, May 21, 2025
Consultant Paediatrician
GLORY… GLORY… MANUNITED !!!!!
Wednesday, May 21, 2025
OUTLINE

 Anatomy of the skin

 Descriptive dermatology
 Common skin disorders
 Q/A

Wednesday, May 21, 2025

FUNCTIONS AND ANATOMY:

 The skin is the body's largest organ, covering the entire body.

 It is about 2 mm thick and weighs about 1/6th of the body weight.

 Throughout the body, the skin's characteristics vary (i.e., thickness,

color, texture).
For instance, the head contains more hair follicles than
anywhere else, while the soles of the feet contain none. In
addition, the soles of the feet and the palms of the hands are much
thicker.

FUNCTIONS:
 Protective shield against heat, light, injury, and infection.
 Regulates body temperature.
 Stores water and fat.
 Is a sensory organ.
 Has esthetic and beauty qualities.

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 the skin is basically made up of 3 layers :
EPIDERMIS
DERMIS
SUBCUTANEOUS (SUBCUTIS/HYPODERMIS)

EPIDERMIS:
Outermost layer. Thickness averages 0.1 mm. On the face it is only 0.02
mm, while on the soles of the feet between 1 and 5 mm.

The epidermis is differentiated into five layers:

- Basal layer (stratum basale)
- Prickle-cell layer (stratum spinosum)
- Granular layer (stratum granulosum)
- Clear layer (stratum lucidum)
- Horny layer (stratum corneum)

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Basal layer (stratum basale)
The lowest layer of the epidermis. The basal cells lie directly on the
basal membrane that forms a definite border between the dermis
and epidermis.
The basal cells acting as mother-cells, by cell division, provide for
the continuous regeneration of the skin. In the basal layer are also
found the melanocytes, which are the pigment producing cells.

The basal cell layer is comprised mostly of keratinocytes, which

contain keratin tonofibrils and are secured by hemidesmosomes
to the basement membrane.

Prickle-cell layer (stratum spinosum)

The basal layer. Composed of keratinosomes. They contain the
precursors of the epidermal lipids in the form of disk-like (lamellar)
lipid bilayer membranes.

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Granular layer (stratum granulosum)
the cornification (keratinization) of the keratinocytes begins here. It
gets its name from its appearance, which is due to the presence of
what are known as keratohyaline granules, a mixture of several
smaller protein units. (Note: Besides keratohyaline, which is a
precursor of keratin, the granules contain filaggrins - the intercellular
cement of the skin structure.)

Clear layer (stratum lucidium)

The stratum lucidium is also called the clear layer as it is highly
refractive. The cells have been extremely flattened and are closely
packed. The cell boundaries are no longer recognizable.

Also, the translucent or transitional layer, this is a translucent, thin

layer of cells. This layer is sometimes visible in thick skin; however,
nuclei and other organelles are not visible. The cytoplasm (the
amorphous area between the nucleus and the outer membrane of the
cell) is mostly made of keratin filaments.

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Horny layer (stratum corneum)
- is the uppermost layer of the epidermis.
- The horny layer - especially the bottom third - forms the
permeability barrier, which is the skin's true barrier against
exogeneous factors.

This layer is made of flattened epithelial cells in multiple layers.

These layers are called keratinized layers because of the build-up
of the protein keratin in those cells. Keratin is a strong protein that
is specific to the skin, hair and nails. This layer of skin is, for the
most part, dead--it is composed of cells that are almost pure
protein.

Differentiation and skin regeneration

Through differentiation, the living, cylindrical basal cells lose their
nuclei and become flattened cornified cells, changing their shape
and composition in the process. The cells pass through the barrier
zone, the border zone between the living epidermal layers and the
horny layer, where the epidermal lipids are released.

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Did you know that 90% of
household dust is dead skin cells?
Keratinocytes become progressively flattened as they
advance upward from the basal layer to the corneal layer.

The epidermis renews itself every 28 days through

continual reproduction, differentiation / cornification and
desquamation (mechanical sloughing-off of the
uppermost horny cell layer).

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DERMIS:
The dermis, or the "true skin," is composed of gel-like and elastic
materials, water, and, primarily, collagen.

Embedded in this layer are systems and structures common to other

organs such as lymph channels, blood vessels, nerve fibers, and
muscle cells.
unique to the dermis are hair follicles, sebaceous glands, and sweat
glands.

Dermis consists of two main layers –

- Stratum papillare
- Stratum reticulare

The stratum papillare (papillae = protuberance/Lat.) is the upper layer

which is clearly demarcated from the epidermis by an undulated
border.

The stratum reticulare (reticular = net-like/Lat.) makes up the lower

part of the dermis and shows a continuous transition to subcutis.

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The connective tissue of the dermis
The main constituent of the dermis is the proteinous connective
tissue made up of arc-shaped, elastic fibres and undulated, nearly
inelastic collagen fibres. These are responsible for the high elasticity
and tensile strength of the dermis.

Young collagen fibre - glycosaminoglycan - can bind large amounts

of water and so determine the high intrinsic tension of young skin.

Other constituents of the dermis are various types of cells such as

fibroblasts, mast cells and other tissue cells, as well as a multitude
of blood and lymph vessels, nerve endings, hot and cold receptors
as well as tactile sensory organs.

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Epidermal Appendages
The epidermal appendages include the nails, hair and glands
(glandulae cutis). They arise from invaginations of the epidermis into
the dermis.
The hair follicle and sebaceous gland form a structural and
functional unit.

Nails
The nails are horny plates firmly attached to the nail bed. They are
about 0.5 mm thick and consist of the front free edge - the body of
the nail - and the nail matrix, which is embedded in the proximal nail
fold.

Hair
The hair is divided into the protruding hair shaft and the hair root.
The latter thickens at the end to become a bulb (bulbus), which
together with the underlying dermal hair papillae are responsible for
the nourishment, development and growth of hair. A dermal sheath
of connective tissue surrounds the whole hair root and together
these form a hair follicle. The sebaceous glands open into the
infundibular part of the hair follicles.

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Glandulae cutis
The glands of the skin (glandulae cutis) include the sweat, scent,
sebaceous and milk glands.

The sebaceous glands are attached to the hair follicles and through
the follicles excrete an oily substance called sebum, which both
lubricates and protects the skin. On most of the skin surface sebum
appears constantly and imperceptibly, but in areas with a higher
concentration of sebaceous glands, such as the face and back, there
are wide variations in the amount of sebum produced.

**Except on the palms of the hands and the soles of the feet,
sebaceous glands are found everywhere on the skin.

* The size of the sebaceous gland and therefore the amount of

sebum itself differ according to body region.

* An important influencing factor in sebaceous gland activity is the

androgens.

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Sebaceous and sweat glands are exocrine glands (exo = outer,
external/Gk.), which means they deliver their secretion directly to a
surface such as the skin.

In the case of the sebaceous glands this occurs with complete

disintegration of lipid-rich cells. They are continually replaced through
division of the basal cells (holocrine glands).

In the case of apocrine glands, like the mammary glands or the sweat
glands of the axilla (underarm), only the outer parts of the cell body are
lost with the secretion. (Note: The secretion of the sebaceous and sweat
glands contain important substances that help form the hydrolipid film.)

The cells of the eccrine glands like the small sweat glands of the skin,
show no loss of cytoplasm after the secretion process.

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There are two distinctive sweat-producing glands, the apocrine and
the eccrine.

The apocrine gland is best known for producing body odor but
otherwise has no known physiological function. In the ear it forms a
portion of what we see as earwax. It is also present under the arms,
around the nipples and navel, and in the anal-genital area.

The eccrine glands are an advanced and extensive system of

temperature control. The highest concentration in the palms, soles,
forehead, and underarms.

Sweat, a dilute salt solution, evaporates from the skin's surface to

cool the body. Eccrine glands sweat in response to physical activity
and hot environments, but emotional stress and eating spicy foods
can also cause perspiring.

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DESCRIPTION OF SKIN LESION:
PRIMARY LESIONS:
1. MACULE: Flat. Non plapable lesion. < 1cm
2. PATCH: large macule > 1cm e.g vitiligo, FDE
3. PAPULE: solid, raised lesion with distinct borders <1cm in diameter
e.g Molluscum contangiosum
4. PLAQUE: solid, raised flat topped lesion with distinct borders >1cm
5. NODULE: raised solid lesion with indistinct borders and deep
palpable portion.
6. WHEAL: area of tense edema in upper dermis
7. VESICLE: raised lesion filled with clear fluid <1cm in diameter e.g
herpes simplex, varicella
8. BULLA: larger vesicle > 1cm
9. PUSTULE: raised lesion filled with exudate e.g folliculitis, acne

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patch
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Wednesday, May 21, 2025 Vesicles/blister
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SECONDARY LESIONS:
A. SCALE: Accumulation of stratum corneum cells seperated from the
rest of the epidermis.
B. CRUST: composed of dried secretions
C. SCAR: healed dermal lesion.
D. EROSION: superficial loss of epidermis. Usually appears as moist
circumscribed area.
E. EXCORIATION: loss of epidermis and upper dermis due to
scratching
F. FISSURE: crack or split in the epidermis and dermis.
G. ULCER: deep defect in the epidermis and dermis.
H. ATROPHY: thinning
I. HYPERTROPHY: thickening of the skin. (LICHENIFICATION – type of
hypertrophy where chronic rubbing produces numerous papules.

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Lichenification

Crusting

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excoriation
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fissures
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SKIN DISORDERS:
INFECTIOUS
NON-INFECTIOUS

INFECTIOUS:
BACTERIAL INFECTIONS

A. IMPETIGO:
- usually secondary to staph/strep.
- described as pustular lesions that rapidly burst and
spread with crusting. (“alefo” amongst the yorubas).
- Bullous/non bullous
- tx: topical /systemic antibiotics

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impetigo
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B. FURUNCLE/BOIL:
- deeper painful staph. infection of the hair follicle.
- furunculosis refers to recurrent mulitiple boils.
- most commonly affected areas include the face,
neck, axillae, buttocks and upper thigh
- risk of CVT in middle third of face if forcefully
compressed
* Periporitis:
Furuncle-like lesions around sweat gland.
Usually found in moist climates.
TX:
topical/systemic antibiotics
Analgesia
Cooling the patient

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C. FUNGAL/DERMATOPHYTE INFECTION:
3 common types of superficial fungus infection:
- dermatophytoses (tinea)
- pityriasis versicolor
- candidiasis

 TINEA
 [Link] (scalp)
 [Link] (face)
 [Link] (hand)
 [Link] (body)
 [Link] (foot)
 [Link]
 [Link] (oncychomycosis)

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DIAGNOSIS OF FUNGAL INFECTIONS:
[Link]
[Link]’s light examination
[Link] wet mount preparation
[Link] culture

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TINEA CAPITIS:
• Most common dermatophytosis of childhood.
• Caused only by microsporium/trichophyton spp.
• Disease of pre-pubertal children (2-10yr).
• Rare in infancy.
• Boys > girls.

Clinical features:
scaly patches. Single/multiple
round/irregular.
alopecia
Kerion/favus

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TX:
Griseofulvin
Ketoconazole- oral/topical
+/-antibiotics

TINEA
COPORIS:
 Circumscribed scaly patch with clear center and scaly papular or
pustular edges (satellite lesions)
 Commonest in children
 M. canis, [Link], [Link] usual suspects.
TX:
- Griseofulvin
- Itraconazole
Wednesday,-May
Clotrimazole
21, 2025
TINEA PEDIS (”athlete foot”):
 Very rare in children.
 [Link], mentagrophytes
 Usually xterised by interdigital vesiculopustular eruptions or scaly
lesions +/- hperkeratosis.

“id” reaction ?
TX:
Similar to others
+/- astrigents : potassium permangernate
+/- antibiotics

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TINEA MANUM:
 Uncommon in children.
 Usually in post-pubertal. Unilateral in most cases.
 [Link], mentagrophytes and Epidemophyton floccosum

TINEA UNGUIUM (onychomycosis):

Chronic fungal infection of the nail matrix (cp: paronychia)
[Link], mentagrophytes and Epidemophyton floccosum +
[Link]
Rare in children.
+/- [Link] or pedis.

TX:
- As above
- Nystatin
- Topical agents ?
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C. VIRAL:
- varicella (chicken pox)
- Herpes zoster
 Varicella:
 Caused by human herpes virus 3

 Xterised by abrupt onset of crops of skin lesions.

 Faint erythematous macules progress to edematous papules
and then vesicles within 24 – 48hr.
 Crusting of ruptured vesicles occur, as new lesion develops.
*polymorphic nature of the lesions differentiates
varicella from small pox.
 Disease highly contagious 1-2days before rash appears and up
to 6days afterwards.

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 Herpes zoster:
Same causative virus as varicella.
Usually seen in those with previous varicella.
Lesions consists of crops of vesicles along dermatomes.
Very itchy.
Pain may occur, especially after lesion heal (post-zoster neuralgia)

TX:
Varicella:
Mostly supportive.
- Calamine lotion
- Antihistamine
- +/-antibiotics
**AVOID SALICYLATES.

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- ZIG , if within 72hrs of exposure
- Antiviral: iv/oral acyclovir/foscanet

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NON-INFECTIOUS:

 ATOPIC DERMATITIS
 SEBORRHEIC DERMATITIS
 PAPULAR URTICARIA
 FDE
 CONTACT DERMATITIS
 VITILIGO

Wednesday, May 21, 2025

ATOPIC DERMATITS:
“ATOPIC ECZEMA, INFANTILE ECZEMA”
- First postulated by Coca in 1925
- Raising prevalence in last 3 decades
- Familial tendency
-25% of offspring of atopic mothers in first 3mo
will develop allergic symptoms, 50% by 2yrs
- 79% if both parents.
- higher risk of inheritance from mother

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Classification:
Infantile: 2mo-2yr (60%). Role of cow milk in
60%
Childhood: 2-10yr
Adolescent/adult: > 10yr

* pruritus is Hallmark of all

types.

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DIAGNOSTIC CRITERIA (OF HANIFIN AND RAJKA)

MAJOR:
1. Pruritus
2. Typical morphology/distribution
- flexural in adults
- facial/extensor in children
3. Chronic/chronically relapsing
4. Family hx

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MINOR CRITERIA:

Xerosis
Hyperlinear palms
Keratosis pilaris
Elevated Ig E
Recurrent conjuctivitis
Food sensitivity
Dennie morgan folds
Dermographism
Post auricular fissure in infants

** DIAGNOSIS BASED ON 3 MAJOR + MINOR CRITERIA.

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ASSOCIATED FEATURES/COMPLICATIONS:
- Cataracts 10%
- Secondary infections (90% staph. Herpes simplex also
high)
- Clinical features in diagnostic criteria.

MGX:
GENERAL:
1. AVOID EXTREMES OF COLD/HEAT
2. SOAPS?
3. DIET

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SPECIFIC:
TOPICAL:
- Steroids
- 10% urea in xerosis/scaly skin

SYSTEMIC:
ANTIHISTAMINES
CYCLOSPORINE

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Wednesday, May 21, 2025 Atopic dermatitis
‘Head- lamp’ sign in Atopic dermatitis
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PAPULAR URTICARIA:

- Characterized by chronic/recurrent papular eruptions.

- Secondary to exaggerated reactions to bites by insects.
- Rare in infants (usually 2-7yrs)
- Usually in exposed areas.
- High risk of secondary bacterial infections.
- TX:
- PROTECT FROM INSECT BITES
- ANTIHIISTAMINES
- TOPICAL STEROIDS/EMOLIENTS
+/- Antibiotics

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Papular urticaria
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CONTACT DERMATITS:

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 IRRITANT CONTACT DERMATITIS: Local exposure to irritating,
non- allergic origin

 ALLERGIC CONTACT DERMATITIS:

•Role of patch test.

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FDE:

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COMMON DRUGS IMPLICATED IN FDE :
 TRIMETHOPRIM/SULFATHOXAZOLE
 ACETAMINOPHEN
 BARBITURATES
 CBZ
 TCN
 CIPROFLOXACIN
 OCP

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Vitiligo
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Thank you for
not sleeping
on me…
Wednesday, May 21, 2025