Derm Topics

Patient Buzz: Rare Pediatric Skin Conditions | The Expert Weighs In

Parade and other media outlets recently covered the story of actress Mandy Moore’s son, who was diagnosed with Gianotti-Crosti syndrome. What should dermatology clinicians know about Gianotti-Crosti syndrome and other rare pediatric skin conditions? What should dermatology clinicians do when they are unsure of how to diagnose a pediatric skin condition? 

For expert advice, I reached out to Kalyani Marathe, MD, director of the dermatology division at Cincinnati Children’s Hospital.

What should dermatology clinicians know about Gianotti-Crosti syndrome and how to diagnose it?

Gianotti-Crosti, also known as papular acrodermatitis of childhood, is a diffuse eruption triggered by a virus or vaccine. It presents as juicy pink papules on acral surfaces, including cheeks, extensor aspects of arms and legs, and buttocks. It can be very impressive in appearance and parents are often very worried. It can be itchy or asymptomatic and is self-resolving. I use topical steroids like triamcinolone 0.1% ointment if symptomatic, but if not I do supportive therapies like moisturizers and provide reassurance. It may take several weeks or up to a few months to fully resolve. Triggers historically are Epstein-Barr virus and Hepatitis B but we see many other triggers, including COVID-19 and vaccinations.

What are some other pediatric skin conditions that may be challenging to diagnose?

Eczema herpeticum and eczema coxsackieum can be difficult to tell apart as they both have punched out ulcerations and can be very diffusely distributed. Some differences are that Herpes simplex virus lesions tend to be more monomorphic and coxsackie may be more variable in size and shape. Also, children with diffuse eczema herpeticum tend to have high fevers and look unwell, unlike coxsackieum. I would suggest swabs for Herpes simplex virus PCR and enteroviral PCR if considering these diagnoses.

Urticaria multiforme and erythema multiforme are two other conditions that are often confused. Urticaria multiforme presents with transient juicy and urticarial papules and plaques that can be serpiginous or circinate in appearance. They may have dusky appearing centers but they are not fixed. Erythema multiforme lesions are fixed and present as “true targets” with a dusky center, ring of pallor and a red rim. 

According to media reports, Mandy Moore’s son was diagnosed after bouncing from urgent care to a pediatrician to a dermatologist and then to a pediatric dermatologist. What are some challenges dermatology clinicians face in diagnosing rare pediatric skin conditions, and what are some ways dermatology clinicians can overcome those challenges?

The biggest limitation is that we have too few pediatric dermatologists and general dermatologists have limited time to learn about pediatric skin conditions. Many residency programs do not have a pediatric dermatologist on faculty as well so many dermatologists have not had a lot of exposure to pediatric dermatology. However, general dermatologists can become more comfortable treating children with some practice. A good triage process for acuity can help get patients in more quickly but it means training your office staff thoroughly. Getting as much exposure to pediatric conditions via conferences and journals is another way we can continue to expand our comfort with treating all ages.

What are your top tips in diagnosing pediatric skin conditions?

Look at the whole child and think about children in terms of development. Some conditions look different in different age groups. For example, eczema in infancy presents on the cheeks and extensor surfaces of the body, whereas childhood eczema is more common in flexural sites. Children are also not able to report on their symptoms, so sometimes it takes a bit of detective work to determine if something is itchy or painful. Finally, remember that we have to do weight-based dosing for medications and we need to ask whether the child can swallow pills or prefers a liquid.

What should dermatology clinicians do when they are unsure of how to diagnose a pediatric skin condition? 

Reach out for help! Your pediatric dermatology colleagues are happy to give guidance when you have a challenging pediatric case. Biopsies can be helpful but bear in mind that procedures can be extremely traumatizing for children, so I recommend topical anesthetic, buzzy/vibration and ethyl chloride spray during the lidocaine injection. If you don’t feel comfortable doing biopsies in children please refer to a pediatric dermatologist.

What else should dermatology clinicians know about diagnosing rare pediatric skin conditions?

Conditions such as impetigo, staph scalded skin and tinea capitis are much more common in children than adults so become familiar with how to diagnose these. Viral rashes are extremely common in kids and are typically self-limited. If they aren’t resolving in a few weeks, consider other diagnoses.

Keywords: dermatology clinician, dermatology, Gianotti-Crosti syndrome, pediatric skin condition

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