Colour Atlas of Paediatric Dermatology

151 Pages·1982·34.667 MB·English

by  Julian Verbov MD, Neil Morley MB (auth.)

COLOUR ATLAS
OF PAEDIA TRIC
DERMATOLOGY
COLOUR ATLAS
OF PAEDIATRIC
DERMATOLOGY
JuHan Verbov
MO (Liverpool), FRCP (London), MIBiol (London)
Consultant Oermatologist
Royal Liverpool Children's Hospital
England
Neil Morley
MB (Edinburgh), FRCP (Edinburgh), FRCP(Glasgow)
Consultant Oermatologist
Royal Hospital for Sick Children
Glasgow, Scotiand
M.TP PRESS LIM.ITED
~~
~~ , membc, of the KLUWER ACADEMIC PUBLlSHERS GROUP
LANCASTER / BOSTON / THE HAGUE / DORDRECHT
Published in the UK and Europe by
MTP Press Lill1itcd
Falcon House
Lancaster, England
13ritish Libr:.ny Cataloguing in Publication Dara
Verbov,Julian
Colour atlas of paediatric dermatology.
1. Pediarric dermatology
I. Title II. Morley, Neil
618.92'5 R)511
ISBN-13,978-94-009-7339-8 e-ISBN-13: 978-94-009-7337-4
DOI, 10.1007/978-94-009-7337-4
First published 1983
Reprinted 1986
©
Copyright 1983 Julian Verbov and Neil Morley
Softeover reprint of the hardeover 1st edition 1983
All rights reservcd. No part of this pubhcation may be reproduced,
stored in a retricva! system, or transmitred in ally form or by any
mcallS, eleetronic, meehalllcal, photoeopyillg, recording or othcrwise,
without prior pennission from the publishers.
Redwood Burn Li1l1ited, Trowbridge, Wiltshire
Contents
Acknowledgements 7
Prefaec 9
Chapter 1 Dcvelopmental abnormalities 10
Chapter 2 Gcnodcrmatoscs 26
Chapter 3 The newborn 40
Chapter 4 Atopic and other types of dermatitis 56
Chapter 5 [nfeetions and infestations 70
Chapter 6 Psoriasis and other erythemato-squamous disorders 88
Chapter 7 Vaseular disorders 98
Chapter 8 Conneetive tissue disorders 110
Chapter 9 Bullous derrnatoses 118
Chapter 10 Hair and nails 126
Chapter 11 Trauma, drug cruptions, and miscellaneous 138
Index 154
5
Acknowledgements
Wc are indcbted to Mrs A. F. Pearcey of the Royal Livetpoo! Hospital
Depaument of Medical Illustratian, MT I. McKie of the Department of
Dermatology, Wesrern Inftrmary, Glasgow, MT J. Deviin of the Department
of Medical Illustration, Royal Hospita! for Sick Childrcn, Glasgow, and
MT G. Hotchkiss of the Department of Patholügy, Noble's Is1e of Man
Hospital, for providing and allowing reproduction of some of the photo
graphs in this book, copyright of which remains with the afoTementioned
institutions.
Wc should like to thank the many colleagues who havc allowcd us to use
photographs of their patients.
Finally wc should like to thank Mrs Hazel Verboy for her painstaking c/forts
in typing and retyping the manuseript.
7
Preface
Wc have felt for some years that an atlas of paediatrie dermatology merired a
place in the world dcrmatologicallitcrature. Non-dermatologists find skin
conditiom difficult to describe and diagnose and this may bc cvcn mare
difficult in children. Wc usually rely on the paTents for a history in childrcn,
although many conclitions can bc spür dtagnoses.
In this atlas wc have med to illustrare cOllditions seen regularly 111 our dinics
as weIl as some seen mare rarely but which arc nevercheless important to
recognize. Wc have limired the number of illustrations tn order to producc a
realistically-priced book and thus it has not always becn easy to decide what
to indude and whae to omü. Howevee, wc hope that wc havc produced a
reasonably comprehensive work.
We hope that this atlas will have a wide appeal both at home and abroad. It is
a book either to read or to browse through. It is intended for senior medical
students, family practitioners, and for trainees both 111 dermatology and in
paediatrics. We would like it acttlally taken to skin clinics to be avatlablc for
instant pcrusal, and to bc on hand in the paediatric ward. Wc have said
comparatively little about treatment because this alters regularly and often
varies in different centres and bccause we do not think that an atlas is the place
for this.
Julian Verbov
Neil Morley
9
1
Developmental abnormalities
SUPERNUMERARY NIPPLE (Figmc 1.1)
Supernumerary nipples usually develop along the course of the embryological mi lk
!ines, which run from the anterior lxillary faIds to the inner thighs. They accur in bach
sexes. They ean bc confused with pigmented naevi Of vira1 warts if not considered as a
possibility.
AURICULAR APPENDAGE (Figme 1.2)
An auriculaf appendage Of tag arises as aresult of the development of accessory annular
hillaeks during the development of the extemal ear. They appear as fleshy nodules
ameriOT to the ear.
CONGENITAL LYMPHOEDEMA (Figme 1.3)
Lymphoedema indicates diffuse sofc-tissue swellillg caused by accurnulatian ofJymph
due to inadequate lymphaeic drainage. In congenital1ymphoedema the area involved is
swollen at birth. The swelling is firm and pits on pressure. When occurring in females
and ifhypoplastic roenails are present Turner's syndrome should be suspected.
PIGMENTED NAEVI
Freckles (ephelides) (Figure 1.4) are light brown, weU-defined macules which appear in
early childhood rather than in infancy. There is no increase in the number of mel
anoeytes in the pigmented macules but their melanosomes are long and rod-shaped.
They oeeur espeeialIy on sun-exposed areas of skin in fair- or red-haired children and
tend to fade in wintcr.
Cafe-au-lait patches (Figure 1.5) are hyperpigmcnted maeules with welJ-defmed borders
and are usuaUy of no pathological signifieance. However, six or mare greater than
1·5 cm in diameter are pf('sumptive evidenee of neurofibromatosis. There IS an inereased
incidenee of these patches in tuberous selerosis.
Mongolian patches (Figures 1.6, 1.7) are eongenital macular slate-grey or black patehes
generalJy found over lumbosaeral areas and butrocks but they can oeeur anywhere on
10
Dtvelopmentll! Ilbllormlllitiu 11
Figure 1.1 Supernumerary nipple inferior to right breast. Figure 1.2 Auricular appendage anterior to
pinna.
/
~-~,-
Figurc 1.3 Congenitallymphoedema affcct Egurc 1.4 Freckles.
ing lower legs in a 3-weck-old male. He has
gradually improved and was wearing norma!
shoes by the age of 32 years. (Counesy of Dr
D. N. Williamson)
12 Developnlental abnormoljries
ehe skin including the faec. Most ncgro and orietltal babics show thcm but ehey are also
present in lcss than 10% of caucasaids. Thcy usually disappcar by the end of the first
decadc. They represcnt colleeriom of spindle-shaped melanocytcs loeared deep in the
dermis. It is important to distillguish thelll from bruiscs so as not to confme them with
non-accidcntal injury.
Blue naevus (Figures 1.8, 1.9) prescnts as a roundcd area of blue Of blue-black dermai
plgmcmation usually slightly raised and smooch-surf.1ccd, produced by aherrant co 1-
leetions offunetianing melanoeyces. Common sitcs arc dorsa ofhands and feet, hunoeks
and (aec. Lesions may appear at birth or at any age. There arc twO types: the ordinary,
and the less frequently seen eellular bluc naevus whieh tends to be larger than 1 cm in
diameter and which shows islands oflarge eells on histology not present in the ordinary
blue mevus.
Melanocytic naevus (naevus-cell naevus) (Figure 1.10)
These lesions, often referred to as moles, are composed of naevus eelis. They are divided
U1(O mtradermal, juncrional and compound, depending on the loeation of the celis.
Thus, nests of naevus eelis are situated solely in the dermiS in mtradermal !laev!, at the
Junction of epidermis and dermis in junctional naevi, and boch at the junetion and 111
the dermis in eompound nacvi. Moles are very common, the majority appearing 1Il
ehildhood and adoleseence. Face, neek and baek are the usua! siees and a very small
fraction of the tOtal become malignam, usually 111 adult life.
Irltrader",alnaelli (Figure 1.1 1) are dome-shaped, sessile or peduneulated and may be non
plgmemed or brown to black in eolour. Coarse h:llrs are often present. They may oeeur
anywhere on the skin surfaee and although usually small they ean bc greater than 1 cm in
diameter.
JunetiGllal "aell; (Figure 1.12) are generally brown to black, hairless macules less than 1 cm in
diameter. They often become eompound naevi as the child ages.
CompOlIIId naev; (Figure 1.13) are seen in older ehildren and tend to be more raised than
junetional naevi. Thcy may bc hairy, particubrly over the faee. Clinieally they may bc
indistinguishablc from intradennal naevi.
Special Jonus oJ melarlOcytie "aelliIS
Halo IWelllIS (SUt1011'S "aevus) (Figure 1.14) is a COmmon Icsion wluch prcscnts usually over
the trunk with a pateh of dcpigmentation around a central, commonly mclanoeytie,
nacvus. Halo Ilaevi may be single of multiple. The cause of the spontaneous depig
mentation is unknown but there is an increased incidenee ofvitiligo in those with halo
naev). Lesions (halo and ecntral lesion) have a tendeney to spontaneous resolutioll.
NaerIUS spilus (Figure 1.15) is a solitary brown maeule dotted with small brownish-blaek
areas ofpigmentation. It may vary from 1 tO 20em in diamcter and the histology is that
of a dermai or junetioml melanocytie naevus.
Gia/ll piglllented flaevus (Figure 1.16) presents at birth as an extensive pigmented hairy area
oftel1 oeetlpying the lower abdomcn and buttoeks to cover the bathing crunks area.
Del/eiopmenl<ll abllormalities 13
\
\
Figure 1.5 Caf'"e-au-Iait patches (three an' Figurc 1.6 Mongolian p atehes in a Pakistani infanl. Note the slaty
visiblc) over abdomen in a 6-wcek-old blby. grcy appearancc of !esions.
Figure 1.7 Mongolian patehes iil a Nig("rinn Figure 1.8 Blue naevus This shows thc
infant. Lesions have a blackt'r appearann' in this ordinary or common type.
dnrkcr-skinllcd chiid.