In this video blog, Jennifer Huang, MD, discusses highlights from her lecture, Don’t Miss It! Important Skin Conditions in Children, on July 27, 2024, during the inaugural Elevate-Derm Alliance Summer Conference at the Westin Copley Place in Boston, Massachusetts.

In this video

Interviewed by dermatology PA and Elevate-Derm advisory board member Buchi Nida, Dr. Huang focuses on the conditions she hopes clinicians never see but definitely don't want to miss. For blistering disorders in a neonate, she stresses "infection, infection, infection" first, then the two genetic categories to keep in mind — incontinentia pigmenti and epidermolysis bullosa. Skin biopsy still offers a rapid diagnosis (apoptosis of keratinocytes, eosinophils, and intraepidermal vesicles in IP; blister induction with H&E and direct immunofluorescence in EB), while germline genetic testing pinpoints the affected gene or protein for prognosis, anticipatory guidance, and family counseling.

She lays out four red flags for a solitary nodule in an infant — rock-hard on palpation, present at birth, growth past six to nine months of age, and rapid growth — none of which fit an infantile hemangioma. For diaper rash, she flags zinc deficiency (a recalcitrant rash that often appears upon weaning and paradoxically improves with a zinc-containing diaper cream) and Langerhans cell histiocytosis, where non-blanching petechiae seen with a dermatoscope are essentially diagnostic. She closes on pediatric mucositis, distinguishing RIME (reactive infectious mucocutaneous eruption, most often triggered by mycoplasma but also chlamydia pneumoniae, adenovirus, and COVID) from paraneoplastic pemphigus, which warrants a thorough oncologic workup for Castleman disease and other malignancies.

  • When you see blisters in a neonate, think "infection, infection, infection" first, then the genetic causes — incontinentia pigmenti and epidermolysis bullosa; biopsy gives a fast answer, while genetic testing identifies the affected protein for prognosis and family counseling.
  • Four red flags for a solitary infant nodule: rock-hard consistency, presence at birth, growth past six to nine months, and rapid growth — don't reflexively assume it's a hemangioma.
  • In a recalcitrant diaper rash, consider zinc deficiency, which often begins upon weaning breastfeeding, may involve the wrists, ankles, or perioral skin, and responds to topical zinc.
  • Look closely at diaper-area rashes for non-blanching petechiae — using a dermatoscope helps — because petechiae point to Langerhans cell histiocytosis, and nothing else in the diaper area looks like that.
  • In pediatric mucositis, distinguish RIME (infection-triggered, prominent mucosal involvement with limited skin) from paraneoplastic pemphigus, which is life-threatening, recalcitrant to therapy, and requires an oncologic workup.