Pediatric dermatological vital emergencies

Abstract

Pediatric patients in the emergency unit often present with muco-cutaneous symptoms. Most muco-cutaneous findings are not life-threatening, but it is crucial to identify those dermatoses with urgent need of treatment. In this review, we present infectious and non-infectious pediatric disorders with muco-cutaneous red-flag signs for a potential severe course and complications associated with significant mortality. By recognizing these dermatological symptoms, early confirmation of diagnosis and initiation of appropriate treatment outcome can be optimized.

Zusammenfassung

Pädiatrische Patienten in der Notaufnahme zeigen nicht selten mukokutane Symptome. Die Mehrheit dieser dermatologischen Befunde ist nicht lebensbedrohlich. Es ist aber von entscheidender Bedeutung jene Dermatosen zu identifizieren, die einer dringlichen Behandlung bedürfen. In dieser Übersicht werden infektiöse und nicht-infektiöse Erkrankungen des Kindesalters mit den Warnzeichen eines potenziell schweren Verlaufes und von Komplikationen mit signifikanter Mortalität vorgestellt. Durch Erkennung der Symptome, frühzeitige Diagnosesicherung und Einleitung einer adäquaten Behandlung kann die Prognose optimiert werden.

Keywords

children - pediatric emergencies - dermatoses - mortality - treatment

Schlüsselwörter

Kinder - pädiatrische Notfälle - Hauterkrankungen - Mortalität - Behandlung

Publication History

Article published online:
21 June 2024

• References

• 1 Aljohani AG, Abduljabbar MH, Hariri J. et al. Assessing the ability of non-dermatology physicians to recognize urgent skin diseases. Cureus 2023; 15: e37823
• 2 Chalmers E, Cooper P, Forman K. et al. Purpura fulminans: recognition, diagnosis and management. Arch Dis Child 2011; 96: 1066-1071
• 3 Theron A, Ayadi S, Boissier E. et al. Post-viral idiopathic purpura fulminans is associated with inherited thrombophilia and anti-cardiolipin antibodies. Front Pediatr 2023; 11: 1197795
• 4 Perera TB, Murphy-Lavoie HM. Purpura Fulminans. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
• 5 Büttner LC, Schroth M. Infektiologische Kindernotfälle – vom Fieberkrampf bis zur Purpura fulminans. Med Klin Intensivmed Notfmed 2023; 118: 646-655
• 6 Kizilocak H, Ozdemir N, Dikme G. et al. Homozygous protein C deficiency presenting as neonatal purpura fulminans: management with fresh frozen plasma, low molecular weight heparin and protein C concentrate. J Thromb Thrombolysis 2018; 45: 315-318
• 7 Gossack-Keenan KL, Kam AJ. Toxic shock syndrome: still a timely diagnosis. Pediatr Emerg Care 2020; 36: e163-e165
• 8 Atlanta Center for Disease Control. http://www.cdc.gov
• 9 Cone LA, Woodard DR, Schlievert PM. et al. Clinical and bacteriologic observations of a toxic shock-like syndrome due to Streptococcus pyogenes. N Engl J Med 1987; 317: 146-149
• 10 Walker MJ, Barnett TC, McArthur JD. et al. Disease manifestations and pathogenic mechanisms of Group A Streptococcus. Clin Microbiol Rev 2014; 27: 264-301
• 11 Stevens DL. Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment. Emerg Infect Dis 1995; 1: 69-78
• 12 Carapetis JR, Jacoby P, Carville K. et al. Effectiveness of clindamycin and intravenous immunoglobulin, and risk of disease in contacts, in invasive group A streptococcal infections. Clin Infect Dis 2014; 59: 358-365
• 13 Salati SA. Necrotizing fasciitis a review. Pol Przegl Chir 2022; 95: 1-8
• 14 Auquier-Dunant A, Mockenhaupt M, Naldi L. et al. Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study. Arch Dermatol 2002; 138: 1019-1024
• 15 Gibson A, Deshpande P, Campbell CN. et al. Updates on the immunopathology and genomics of severe cutaneous adverse drug reactions. J Allergy Clin Immunol 2023; 151: 289-300
• 16 McPherson T, Exton LS, Biswas S. et al. British Association of Dermatologistsʼ guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in children and young people, 2018. Br J Dermatol 2019; 181: 37-54
• 17 Liotti L, Pecoraro L, Mastrorilli C. et al. Pediatric angioedema without wheals: how to guide the diagnosis. Life (Basel) 2023; 13: 1021
• 18 Weerasubpong P, Jiamton S, Phumariyapong P. et al. Prevalence of concomitant angioedema in chronic spontaneous urticaria: A systematic review and meta-analysis. Asian Pac J Allergy Immunol 2023; 41: 12-19
• 19 Özçeker D, Can PK, Terzi Ö. et al. Differences between adult and pediatric chronic spontaneous urticaria from a cohort of 751 patients: Clinical features, associated conditions and indicators of treatment response. Pediatr Allergy Immunol 2023; 34: e13925
• 20 Orphanet. https://www.orpha.net/data/patho/Pro/en/Emergency_NonHistamineInducedAngioedema.pdf
• 21 Sinnathamby ES, Issa PP, Roberts L. et al. Hereditary angioedema: diagnosis, clinical implications, and pathophysiology. Adv Ther 2023; 40: 814-827
• 22 Zhao Y, Cheng J. Medical and interventional therapy of Kasabach-Merritt phenomenon associated with kaposiform hemangioendothelioma: A case report. J Interv Med 2023; 6: 130-133
• 23 Drolet BA, Trenor 3rd CC, Brandão LR. et al. Consensus-derived practice standards plan for complicated kaposiform hemangioendothelioma. J Pediatr 2013; 163: 285-291
• 24 Kelly M. Kasabach-Merritt phenomenon. Pediatr Clin North Am 2010; 57: 1085-1089
• 25 McCrindle BW, Rowley AH, Newburger JW. et al. Diagnosis, treatment, and long-term management of Kawasaki disease: A scientific statement for health professionals from the American Heart Association. Circulation 2017; 135: e927-e999
• 26 Ayusawa M, Sonobe T, Uemura S. et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int 2005; 47: 232-234
• 27 Lin KH, Chang SS, Yu CW. et al. Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease: a systematic review and meta-analysis. BMJ Open 2015; 5: e006703
• 28 Rife E, Gedalia A. Kawasaki disease: an update. Curr Rheumatol Rep 2020; 22: 75
• 29 Zhong X, Wang H, Jia X. et al. Association of noncoding RNAs with Kawasaki disease: A meta-analysis based on the current evidences. Medicine (Baltimore) 2023; 102: e35736
• 30 Pan Y, Fan Q, Hu L. Treatment of immunoglobulin-resistant Kawasaki disease: a Bayesian network meta-analysis of different regimens. Front Pediatr 2023; 11: 1149519
• 31 Hoste L, Van Paemel R, Haerynck F. Multisystem inflammatory syndrome in children related to COVID-19: a systematic review. Eur J Pediatr 2021; 180: 2019-2034
• 32 WHO. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. [Aug; 2023]. https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19
• 33 Mehrban S, Tahghighi F, Aghaei Moghadam E. et al. Multisystem inflammatory syndrome in children and Kawasaki disease; comparison of their clinical findings and one-year follow-up-a cross-sectional study. Ital J Pediatr 2023; 49: 90
• 34 Mahmoud S, El-Kalliny M, Kotby A. et al. Treatment of MIS-C in children and adolescents. Curr Pediatr Rep 2022; 10: 1-10
• 35 Albanji MH, Baghafar AA, Alghanmi YA. et al. Clinical presentation and management of multisystem inflammatory syndrome in children with COVID-19: A systematic review. Cureus 2023; 15: e46918