Skin

The examination of the skin is the same for children as for adults.

Careful descriptions of the numerous rashes seen in this age group are paramount for diagnosis. There are many exanthematous diseases of childhood. These rashes may consist of macules, papules, vesicles, pustules, or petechiae. (A summary of important viral and bacterial exanthems is given in Table 24-6 at the end of the chapter.)

Impetigo is one of the most common skin conditions of children in this age group. It is a highly contagious, superficial skin infection caused by a group A beta-hemolytic streptococcus, Staphylococcus aureus, or both, and is more common in summer. The primary lesion is a vesi-copustule; once it has ruptured, it produces a honey-colored crust surrounded by a rim of erythema. The lesions may be seen on any part of the body, but the face is a common location. The child pictured in Figure 24-39 has the classic weeping, encrusted lesions of impetigo. Figure 24-40 shows the lesions of impetigo in another child.

Examine the spine. Tufts of hair along the spine, especially over the sacrum, may mark the location of a spina bifida occulta or other spinal dysraphism (see Fig. 24-17).

Is there evidence of trauma or child abuse? The signs of physical child abuse are discussed in the previous section.

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