SKIN

The skin - the outer covering of the human body that serves as a barrier between the
internal environment of an organism and its environment and involved in metabolism,
thermoregulation, etc.

The anatomic and physiological features of skin in

children
FEATURES structure of the skin and appendages SKIN Skin

The total surface area of the skin in infants is about 0,25 m 8 to year, it increased to 0.43
m 2. With age comes a further increase in surface area of the skin, using the formula:

2-9 years - S = 0,43 +0,06 x (n - 1), 10-17 years - S = (n-1) +10,

where: S - surface of the skin (m 2) n - age (years).

The thickness of different layers of the skin in children under 3 years in 1,5-3 times less
than in adults, and only to 7 years it reaches the performance of an adult.

The thickness of the epidermis in neonates varies from 0,15 to 0,25 mm, and an adult - in
the limits of 0,25-0,36 mm. Cells of the epidermis in children relatively far apart, contain a
lot of water. The structure of the epidermis is loose, which creates the impression of a
greater thickness of this layer. The horny layer of the newborn is thin and consists of 2-3
layers easily sloughed-contracting cells. Granular layer is poorly developed, which defines
a large transparent skin and her newborn pink color. The basal layer is well developed, but
due to insufficient production melanokorti-on in the first few months (sometimes years) of
life function of melanocytes is reduced, and they produce relatively little melanin, which
determines the lighter skin color.

Actually the skin of newborns and infants has a number of features. From 4 months of age
in the skin of the child appear first elements of the elastic fibers. They are particularly
active grow between 8 and 16 years. Only to 6 years of histological structure of the dermis
close to that of adults, although the collagen fibers are still thin, and elastic are relatively
weak. Distinctive feature of the skin of children, especially infants - the weak link of the
epidermis from the dermis, which primarily caused by insufficient quantity and poor
development of anchoring fibers. Border between the epidermis and derma rough,
tortuous. At various diseases epidermis is easily detached from the dermis, which leads to
the formation of bubbles.

The surface of the skin is covered with baby a secret, close to neutral, which determines its
weak bactericidal activity, but by the end of the first month of life significantly reduced
pH. The skin of infants contains up to 80-82% water. With age, the amount of water in the
skin gradually decreases, primarily due to extracellular fluid. In adult skin contains only
62% of water.

Nerve endings of the skin at the time of birth are not sufficiently developed, but
functionally are and rise to pain, touch and temperature sensitivity. Leather newborns and
children the first year of life has a well developed network of capillaries. After a year of
extensive network of capillaries gradually decreases, and the number of long narrow - is
increasing. The development of capillary structures ends in 14-16 years.

The skin of the child the first year of life due to the peculiarities of morphological structure,
biochemical composition, rich vascularization differs tenderness, velvety, elastic. In
general, it is thin, smooth, its surface is drier than in adults, there is a tendency to
flaking. The entire surface of the skin and hair covered with a water-lipid layer, or mantle,
consisting of aqueous and fatty substances. Mantle protects the skin from the influence of
environmental factors, excessive wetting and drying, sudden changes in temperature,
slows down and prevents the absorption and exposure to chemicals, serves as a carrier
provitamin D. In addition, it has antibacterial activity, increases the strength of the
epithelium. Water-lipid layer of the child contains 3 times less lipids.

Sebaceous glands

The sebaceous glands begin to function in utero. Their secret, containing fragments of
epithelial cells, forms a cheesy grease covering the entire skin of the fruit. It protects the
skin from the effects of amniotic fluid and facilitates the passage of the fetus through the
birth canal. The sebaceous glands continue to actively operate and in the first year of life,
and then their secretion decreases and increases again in puberty. In adolescents, the
sebaceous glands often sealing horny plugs, which contributes to the development of acne.
The number of sebaceous glands per unit surface area of the body decreases with age.

Sweat glands

The absolute number of sweat glands in the newborn is the same as that of an adult. As
your child grows, their number per unit of body surface decreases in 6-7 times.

Formation ekkrinnyh sweat glands in the birth does not end there. Their excretory ducts
are underdeveloped and closed with epithelial cells. During the first 3-4 months gland
function is not enough. The structure of the glands reaches full development for 5.7 years
of life. Sweating begins with the age of 3-4 weeks. In infants it appears at a higher
temperature than in older children. As the maturation of sweat glands, autonomic nervous
system and the heat-regulating center in the brain of the process of sweating is improving,
its threshold is reduced. Adequate sweating occurs in 7-8 years.
 Apocrine sweat glands begin to function only with the onset of puberty.

Hair

Primary hair before birth or shortly after birth Pushkova replaced, except in the area of
eyebrows, eyelashes and scalp.

Hair in term infants do not have a core, and the hair follicle are underdeveloped, resulting
in a slight loss of the hair shaft and does not allow to form blotches with purulent core.The
skin, especially on the shoulders and back, covered Pushkova hair (lanugo), which is more
noticeable in premature babies. Eyebrows and eyelashes are poorly developed, further
increasing their growth. During puberty hair reach its final development.

Nails

Nails in term infants are well developed and reaching fingertips. In the first days of life
observed time delay of nail growth, and therefore on the nail plate is formed so-called
"physiological trait. At the 3 rd month of life, it reaches the free edge of the nail.

FEATURES MAIN FUNCTIONS skin

Children, especially young children, the protective function of skin is low due to the fact
that the epidermis is the thin stratum corneum, keratinization is weak, the connection of
the epidermis with derma is not strong enough in the dermis is poorly developed
connective tissue, due to the insufficient development of the glands of the skin surface is
more dry, but its reaction is neutral, the local immunity immature. Status of water-lipid
mantle is different from its condition in adults.

Pigmentoobrazuyuschaya function of the skin is reduced, despite the large number of

melanocytes, because of their weak stimulation.

Rezorbtsionnaya function of the skin in children is increased thanks to the subtleties of

the stratum corneum, and, possibly, due to the lack of shiny layer, and abundant
vascularization. Therefore, the local treatment of toxic or hormonal creams may have
pronounced systemic effects.

Excretory function of the skin associated with sweating, is imperfect.

Thermostatic function of the skin of children is reduced. During the first months of life,
the heat transfer dominates the heat production due to the relatively large surface of the
body, rich vascularization, a significant direct evaporation, the imperfection of the center of
the temperature regulation. As a consequence, is easy to overheating or overcooling of the
child, which leads to the need to create for him the optimal temperature regime.
 Respiratory function of the skin of children is expressed in 8 times more than adults, due
to a thin layer of the epidermis and a rich blood capillary network. Contamination of skin
and lubrication of large portions of it by various ointments and creams interferes with the
cutaneous respiration, which affects the state of health of the child.

Synthetic function of the skin in childhood have a fully developed since the age of 3-4
weeks. Under the influence of natural or artificial UVR in the skin synthesize vitamin
D 3, the lack of which leads to the development of rickets.

The skin as a sensory organ functioned well since birth. With skin irritation due to
identify nearly all the reflexes of the newborn. Due to the lack of differentiation of eye and
hearing in the first month of life a child learns his mother through tactile perception. At the
same time, the excessive skin irritation (eg, wet and dirty diapers) can be alarming to the
newborn, a violation of his sleep and appetite.

In general, the skin of children, especially during the first year of life, are very susceptible
to infection, chemical and physical stimuli, the effect of weather conditions, overheating
and overcooling, less protected against the ingress of chemical substances, it is easy
matseriruetsya. The anatomic and physiological features of skin dictate the need for careful
hygiene, a scaled temperature, prohibiting the use of irritating and toxic substances, etc.

Method study skin

Condition of the skin reflects the course of many pathological processes in the body, so the
correct interpretation of changes in the skin is of great importance for the diagnosis of
various diseases. For the assessment of skin conduct inquiries, inspection, palpation and
special tests.

Inquiries and INSPECTION

In identifying the pathological elements of the skin necessary to clarify the time of their
appearance, communication with any factors (food, medications, infectious, chemical, etc.),
the existence of such symptoms in the past, their evolution (change in color of skin, rash
nature).

Observation of the child, if possible, should be carried out under natural daylight.
Integuments inspected sequentially from top to bottom: the scalp, neck, and natural folds,
inguinal and gluteal region, palms, soles, interdigital spaces. Infants and young children
immediately stripped completely, and older, especially pre-and pubertal age, exempt from
clothing gradually. On examination, evaluate the color and its uniformity, moisture content,
purity [no rash or other pathological elements (peeling, scratching, hemorrhage, etc.)], the
state of the vascular system of the skin, in particular, the localization and severity of venous
pattern; integrity, condition of skin appendages ( hair and nails).
Complexion

Skin color depends on its thickness and transparency, the amount contained in her normal
and pathological pigments, degree of development, depth and plethora of dermal blood
vessels, the content of hemoglobin per unit volume of blood and the degree of saturation of
hemoglobin with oxygen.

Depending on race and ethnicity, skin color is normal, a child may be pale-pink or various
shades of yellow, red, brown and black colors. From the pathological changes of color in
children most frequently noted pallor, flushing, cyanosis, jaundice and pigmentation.

Humidity skin

On the skin moisture is judged by its brilliance. In normal skin surface moderately shining,
with very high humidity skin glistens, often covered with sweat. Overly dry skin - matt,
rough.

Clean skin

Rash in children identify with many diseases. They often play a major role in the diagnosis
of the disease. If you find elements of the rash should be set:

time of appearance;

morphological type (see below);

size (in millimeters or centimeters);

number of items (single items, slim rash, quickly counted during the inspection, abundant
- multiple elements, unable to count);

shape (round, oval, irregular, stellar, ring-shaped, etc.);

color (for example, when inflammation occurs hyperemia);

localization and prevalence (show all parts of the body, having a rash, preferential
localization - the head, torso, flexor or extensor surface of limbs, folds of skin, etc.);

background in the field of skin rashes (eg, congested);

stages and the dynamics of the elements of the rash;

especially the secondary elements remaining after the fading of the rash (peeling, hyper-
or hypopigmentation, peels, etc.).
Skin rashes (morphological elements) can affect different layers of the skin: the epidermis,
dermis, subcutaneous tissues, and in some cases, skin appendages - sweat and sebaceous
glands, hair follicles. They may differ from each other by morphological characteristics, the
nature of the inflammatory response and other characteristics.

Pathological morphological elements of the skin conventionally divided into primary and
secondary. To the primary attribute rash appearing on the skin unchanged. They are
divided into bespolostnye (spot, pimple, node, blister, bump), and bladder, filled with
serous, hemorrhagic, or purulent contents (bubble, bubble, abscess). Secondary elements
appear in the evolution of primary (scale, hyperpigmentation, depigmentation, crust, ulcer,
erosion, scar, lihenifikatsiya, atrophy, excoriation).

Primary morphological elements

Spot - to change the color on a limited area, not rising above the surface of the skin and
do not differ in density from the healthy portions of it.

- The spots associated with inflammation of the epidermis and dermis, accompanied by
expansion of blood vessels of the latter. These spots disappear when pressing on the skin of
a finger, and reappear after the cessation of pressure.

About roseola - a spot the size of the point to 5 mm in diameter, pale pink, red or
purple. Multiple roseola up to 1-2 mm in diameter, is described as Punctulata rash.

On macula - a spot diameter of 6 to 20 mm. Numerous spot size from 5 to 10 mm form

melkopyatnistuyu rashes, spots larger than 10 mm - krupnopyatnistuyu rash.

0 Erythema - a large tract of homogeneous reddening of the skin for more than 20 mm in
diameter, with clearly defined boundaries. - Noninflammatory spots do not disappear with
pressure. These include:

0 nevi (naevus, birthmark") - pigment formation in the skin, consisting of nevusnyh cells
containing melanin;

0 vascular spots, due to expansion or proliferation of blood vessels of the skin;

0 pigment spots caused by increased or reduced content of melanin in the skin;

0 hemorrhagic spots, including petechiae (pinpoint hemorrhages), purpura (multiple

hemorrhages round shape size from 2 to 5 mm), zkhimozy (hemorrhage irregular larger
than 5 mm).

Papula - small (2-10 mm) limited, slightly above the level of skin formation with a flat or
domed surface, caused by inflammatory growth of the upper layers of the dermis. Papula
eventually disappears or suppurate, turning into pustules, leave a scar.
 Tubercle - a limited solid element, towering above the surface of the skin and reaches a
diameter of 5-10 mm. He appears in the result of the formation of inflammatory
granulomas in the dermis. Tubercle denser papules, often ulcerate and leave behind a scar.

Knot - a limited dense, oval or round-shaped formation of few millimeters in diameter,

located in the deep layers of skin or subcutaneous tissue.

Node - a dense, towering above the level of the skin, or who is in her column formation
measuring 10 mm or more. Arises during the formation of cellular infiltrate in the
subcutaneous tissue and deep layers of the dermis. In the process of evolution may ulcerate
and scar. Large purplish-red or purple nodes, painful when feeling, called erythema
nodosum.

Blister - clearly delineated bespolostnoy element, towering above the surface of the skin,
varying in shape, the size of 3-4 mm and more (hives). Excoriated elements appear in acute
inflammation of the superficial papillary dermis, accompanied by a significant expansion of
capillaries and usually cause severe itching.

Bubble - the surface, somewhat above the level of the skin filled with serous or bloody
fluid formation of 1-5 mm in size, originating from the epidermis. In the process of
evolution of the bubble can dry out to form a transparent or brown crust and opened,
revealing a limited weeping erosion. After a temporary permit leaves hyperpigmentation /
depigmentation or disappear without a trace. When the cluster in a bubble of white blood
cells, it becomes a pimple.

Bubble - element, like a bubble, but much higher than it in size (3-15 mm and more).
Located in the upper layers of the epidermis and under the epidermis. Filled with serous,
bloody or purulent contents. It may subside, forming a crust. Leave behind unstable
pigmentation.

Abscess - ostrovospalitelnoe rounded education in size from 1-2 to 10 mm with purulent

content, usually located in the hair follicles. In these cases, the element is called the
follicular pustules.

Secondary morphological elements

Scale - Cluster rejected horny plates of the epidermis. Depending on the size scales are
distinguished leaf (size scales greater than 5 mm), plate (1-5 mm) and defurfuration (less
than 1 mm). Color scales are usually yellowish or grayish.

Cork - morphological element, formed as a result of drying fluid vesicles, pustules,

discharge oozing surfaces. Crusts can be serous (clear or grayish), purulent (yellow),
bloody (brown). Corky on the cheeks in children with ekssuda-wise-catarrhal diathesis are
known as milk scab.
 Erosion - superficial skin defect within the epidermis.

Excoriation - linear skin defect within the epidermis and dermis.

4Lihenifikatsiya - pronounced thickening of the skin, accompanied by the growth of its

pattern and pigmentation disorders.

Ulcer - a profound defect in the skin, sometimes reaching to be bodies. Resulting from the
breakdown of the primary elements of the rash, in disorders of lymph and blood
circulation, trauma, wounds, burns, trophic disorders. Large ulcerative defects observed in
infections, the decay of the tumor and violations trophics.

Tripe - the expansion of coarse-fibered connective tissue in place of integrity of the

skin. Fresh scars are reddish in color, eventually fade. Localization and shape of the scar
can judge the character endured injury or surgical intervention and its possible
complications. Peculiar cicatricial skin changes in the form of close-lying parallel to the
longitudinal white stripes coming called striae. They are usually caused by hyperextension
of the skin and anguish in her connective tissue fibers.

Condition of skin appendages

In the study of hair drawn attention to the uniformity of their growth, define the
appropriate degree of development of hair on the body and its distribution, age and sex of
the child. Measured by the outside appearance of hair (they should be shiny, with smooth
ends) and skin condition of the scalp. On examination, nail draw attention to their shape,
color, transparency, thickness and integrity of the nail plate. Healthy nails are smooth
surface and smooth edge, pink, lying close to the nail bed. Okolonogtevoy roller should not
be congested, painful.

Palpation

Palpation of the skin are carried out consecutively from top to bottom with extreme
caution in areas of damage. Palpation of the skin evaluate humidity, temperature, elasticity.

Humidity determine stroking of the skin symmetric parts of the body including the skin of
the palms, feet, axillary and inguinal regions.

The body temperature can be determined by feel, putting the brush back to the surface of
the skin of the back of the patient. Measure the temperature of the body usually in the
armpit. In infants, debilitated patients and patients who are in a semiconscious state, body
temperature can be measured in the rectum, oral cavity, groin crease. Normally, the
temperature in the armpit of 0,5-1 "C lower than in the oral cavity and rectum, where it
usually does not exceed 37,5 C. The temperature of the skin reflects the internal
environment. With symmetrical palpation can determine the local variation of
temperature, often associated with local inflammation.

Determine the elasticity of the skin surface collecting in the fold between thumb and
index fingers into the ground with the least pronounced subcutaneous fat layer - on the
front surface of the chest over the ribs on the back of the hand in the elbow. The elasticity
of the skin feel normal, if the formation of a large number of small folds, ferocity
immediately after weaning fingers and leaving no white stripes. Slow smoothing large
coarse folds or the emergence in its place the white stripe indicates a decrease of skin
elasticity.

Special tests

Assessment of the blood vessel walls

Status of the blood vessels can be determined on the basis of symptoms tourniquet, an
emergency hammer and symptom.

Symptom bundle: the middle third of the shoulder impose a rubber band in such a way as
to stop the venous outflow, without disrupting the flow of blood (pulse at the radial artery
should be preserved). After 3-5 minutes at high fragility of blood vessels in the area of the
elbow and forearm appears petechial rash. Pathological consider the appearance of more
than 4-5 petechial elements in the elbow.

The symptom of an emergency: it is necessary to capture the skin folds on the front or
side of the chest with thumb and forefinger of both hands (the distance between the fingers
of both hands should be 2-3 mm) and remove it across the length of the folds in opposite
directions. With increased fragility of blood vessels on the spot pinch appear hemorrhage.

Hammer symptom: not causing pain, rapping his gavel on the sternum. Symptom is
positive in the case of hemorrhage in the skin of the child.

Dermographism

To assess the state of the blood vessels of the skin tone investigate local
dermographism. To do this, the tip of a finger nail with a little pressure, spend a few
strokes on the skin of the chest or abdomen. Normally after 5-20 with a white stripe
appears (white dermographism, which characterizes the sympathetic influence), replaced
after 1-10 min a red stripe (red dermographism characterizing parasympathetic influence),
continued to 2 h. At the recent rejection or retention of a otherwise dermographism say
sympathicotonia or vagoto Research Institute, respectively.

Other studies
If necessary, apply a number of special techniques, such as skin biopsy or pathologic
entities. To clarify the etiology of infection in making smears, fingerprints, and
scrapes.Immunological reactivity assessed by severity of skin reactions to the introduction
of tuberculin and other antigens (Ag), during skin al-lergologicheskih samples.

Skin changes occurring in the neonatal period

Physiological erythema: immediately after birth, there is pallor, rapidly changing
hyperemia of the skin with a slight cyanotic tinge. Physiological erythema is more
pronounced in preterm infants, reaching a maximum within 1-2 days, and then decreases,
leaving a small peeling.

Toxic erythema - polymorphic eruptions in the form of papules, fewer pustules

surrounded by a pink corolla, arising at 3-5-th day after birth. 2-3 days after the rash
disappears.

Marbling skin often occurs in newborns due to imperfections in the regulation of vascular
tone.

Harlequin syndrome observed in neonates-term morphofunctional immaturity. It

manifests a sharp difference in the color of both halves of the body in the position of the
newborn at her side. The lower half looks congested, and the top - the pale, but dividing
line is exactly in the middle of the body. Syndrome persists for several days or weeks.

Mongoloid spots (spots of light gray or bluish color) observed in newborn Negroid,
Mongoloid, and Caucasoid races occasionally on the skin of the sacrum, the back of the
thighs, legs, back and shoulders. They arise from the accumulation of pigment cells in the
deeper layers of skin.

In the first months of life on the skin of the nose and adjacent parts of the faces of
children show small white-yellow of Education (milia), representing the atheroma.

Physiological neonatal hyperbilirubinemia. The majority of infants at 2-3rd day of life

there is jaundice, which disappears by 7-10-th day. It is associated with increased
destruction of red blood cells and immature liver enzyme systems (lack glyukuroniltran-
sferazy), transforming the unbound (free) bilirubin in the blood associated (soluble).

Sudamen - dermatosis caused by slow evaporation of sweat in children, in particular,

with overheating. Thus there is a blockage of ducts of sweat glands, and on the trunk
appear multiple translucent vesicles without a peripheral halo.
 Diaper dermatitis is caused by exposure to physical, chemical, enzymatic and microbial
factors in the misuse of diapers or diapers. Places most frequent localization - the skin of
the perineum and thighs.

Semiotics lesions
Pale skin

Diffuse pallor of the skin and visible mucous membranes and conjunctivas most frequently
observed in anemia. In addition, it can be caused by disorders of peripheral blood: a
tendency to spasm of the peripheral arterioles in patients with aortic heart diseases,
hypertensive crisis, renal diseases, as well as redistribution of blood in the body in acute
circulatory failure (syncope, collapse) and the deposition of blood in the vessels of the
internal bodies.

In some diseases, accompanied by anemia, skin gets kind of tint: green and pale (alabaster),
with chlorosis, pale with an earthy tint in malignant tumors, dirty-yellow ( "coffee with
milk") in subacute infective endocarditis.

The skin may be pale in healthy children asthenic constitution with a deep location of
subcutaneous blood vessels or the weak of their development, as well as the propensity to
vasospasm.

Dermahemia

Dermahemia may be due to two main reasons:

expansion of peripheral blood vessels, that are watching with feverish conditions,
overheating, after receiving vasodilators, with inflammation of the skin, burns, nervous and
mental excitement, physical overexertion;

increase the content of hemoglobin and red blood cells per unit volume of blood (eri
trotsitoz, polycythemia), with a peculiar purple color is combined with mild cyanosis.

Redness of the skin also noted in cases of poisoning by carbon monoxide, methanol,
antifreeze, atropine, opium preparations. Reduced skin hyperemia cheeks (face matrons ")
is characteristic of exo-and endogenous Itsenko-Cushing's syndrome. The local congestion
occurs in the inflammation of the skin and underlying tissue.

Infringement of skin pigmentation

Hyperpigmentation of the skin can result from excessive accumulation of natural pigments
or coloring agents of pathological deposits.
 A bronze coloration of the skin, caused by increased melanin deposition in it, watching in
chronic adrenal insufficiency, chronic malaria and deficiency of vitamin PP (pellagra). It
appears primarily on the exposed parts of the body and in places exposed to friction (eg,
natural folds).

Hyperpigmentation occurs when metabolic iron (gemohroma-Tose) porphyrin heme

(cutaneous porphyria), tyrosine (homogentisuria), arsenic, silver or gold.

Brown spots remain for some time after infectious ekzantem (eg, measles).

In childhood, sometimes develops urticaria pigmentosa. Mechanical stimulation of the

skin area leads to blister, leaving behind a brown spot.

Since the birth of a child may be pigmented ( "birthmarks") spots. Please keep in mind
the propensity of cell carriers melanin cancerism.

The emergence of foci of hyper-and hypopigmentation is characteristic of scleroderma.

Total lack of pigment is observed in congenital anomalies - albinism. For vitiligo is

characterized by focal hyperpigmentation in the form of white spots of various shapes and
sizes.

Foci hypopigmentation may occur during intoxication with manganese and mercury, in
the field of burns and enable the rash.

Yellowness Integuments

Jaundice is caused by impregnating the skin and mucous membranes of bilirubin by

increasing its concentration in the blood. Ki-perbilirubinemiya occurs with lesions of
hepatic parenchyma obtu-tion, or external compression of the common bile duct, as well as
enhanced hemolysis of red blood cells. In the first place appears ikterichnost sclera, soft
palate and the lower surface of the tongue.

Physiological neonatal jaundice usually occurs at 2-3rd day of life and disappears by 7-10-
th day. Earlier appearance of jaundice (for 1 - 2 nd day of life) or slow its disappearance
indicates pathology.

The increase in blood content of conjugated bilirubin occurs in sepsis, VUI, neonatal
hepatitis, biliary atresia and hypoplasia of moves (in this ikterichnost acquires a greenish
tint).

Higher concentrations of unconjugated bilirubin in the blood occurs in HDN (in this case
ikterichnost is moderate and is combined with the pale skin that gives it a lemon-yellow
tint), violation of transport of bilirubin in the background of severe hypoxia and acidosis
and hypoalbuminemia in preterm infants. Conjugation of bilirubin can be violated with
hypoglycemia, hypothyroidism, intestinal obstruction.

Jaundice may also occur in certain metabolic disturbances - galactosemia, fructose

intolerance, tirozinemii, cystic fibrosis, the lack of a,-antitrypsin, glycogen storage disease,
Gaucher disease. In older children jaundice usually causes viral hepatitis, much less -
inborn errors of metabolism of bilirubin (syndromes Krieg-Teller-Nayar, Gilbert), Dubin-
Johnson syndrome, etc.

False jaundice may occur when metabolic carotene delayed its conversion into vitamin A or
excess flow in the body of carotenoids from foods (carrots, citrus fruits, pumpkin, egg
yolks). It never stained sclera and mucous membranes, and only yellow palms and soles.

Cyanosis

Cyanosis - cyanotic color of the skin and visible mucous membranes, arising either diffusely
or in a limited area of the body by increasing the number of reduced hemoglobin in the
peripheral blood, which has a darker color. This symptom is especially noticeable in those
parts of the skin where the epidermis is thin and contains little pigment, and a well-
developed capillary network (nail bed, lips, earlobes and the tip of the nose, oral
mucosa). There are three types of cyanosis: central, peripheral and local.

Central cyanosis

Central cyanosis occurs as a result of insufficient oxygenation of blood in the lungs during
various respiratory diseases, accompanied by respiratory failure. In the early stages of the
disease quasi-notichnuyu coloring acquire lips, tongue, hard palate and the peripheral
areas of the body, and then cyanosis becomes diffuse and warm to the touch limbs.Diffuse
(total) cyanosis developed while reducing the respiratory surface of lungs (pneumonia,
atelectasis, malformations of the lungs), impaired patency of the upper airway (choking)
and bronchi (bronchial asthma, obstructive bronchitis), difficulty Alva-olyarno-capillary
diffusion of oxygen (pneumosclerosis, sarcoidosis, al-Veolia), accumulation of fluid in the
pleural cavity or air, the weakness of the respiratory muscles.

In children the first year of life total asphyxia often occurs when damage to the CNS
[cerebrovascular accident, convulsions, asphyxia, respiratory disorder syndrome (WBS)]
and violations of the respiratory (atelectasis, croup, aspiration, pneumothorax).

The most pronounced cyanosis dark blue or violet color occurs when some of the UPU with
arteriovenous shunting of blood ( "blue-vices"), when the systemic circulation enters the
venous blood.

Cyanosis dark cherry or magenta color may be a sign of increased blood content of the child
but pathological forms, such as methemoglobin, in the use of food and water with high
content of nitrates and nitrites, aniline poisoning, congenital metgemo-globinemii,
receiving sulfonamides, sulfopiridinov.

Overall cyanosis may occur as a result of capillary stasis. The latter watched with shock and
sudden dehydration (profuse diarrhea, uncontrollable vomiting), bleeding in the adrenal
glands, acute infectious diseases, accompanied by collaptoid state.

Overall cyanosis can be observed in an epileptic fit. Even if the seizures were not observed,
cyanosis with loss of consciousness may be the only diagnostic feature of epilepsy.

Peripheral cyanosis

Peripheral cyanosis (acrocyanosis) appears at a deceleration of blood flow in the

periphery, resulting in a unit volume of blood gives the tissues more oxygen than usual, so
the flowing venous blood content of the recovered but improved. First get a bluish color
lips, tongue, hard palate, nails, and then the cheeks, tip of the nose, ears, chin, the terminal
phalanx of fingers and toes (of course this cold to the touch). Acrocyanosis lesion develops
in the myocardium (myocarditis, cardiomyopathy), pericardial effusion, and heart disease.

Local cyanosis

Restricted (local) cyanosis may result from disturbances of venous outflow due to
thrombosis or compression of major venous trunk from the outside (tumor, enlarged
lymph nodes, etc.). With superior vena cava syndrome appears cyanosis of the upper body,
face, neck and upper extremities, while infringement patency of the inferior vena cava - the
lower half of the trunk and lower extremities. Cyanosis of hands and feet occurs when
vegetative dystonia syndrome (IRS) and Raynaud's syndrome.

Violation of skin integrity

Large ulcerated skin defects observed in certain infections (tuberculosis, actinomycosis)

and violations of trophics. Trophic ulcers occur in chronic circulatory failure, diseases of
the spinal cord and peripheral nerves, obliterating or Troma-boticheskom lesion main
arteries, vasculitis, and vasculopathy. The deep ulcers (bedsores) appear on the buttocks,
sacrum, shoulder blades and heels in patients who are forced for a long time and still lie on
his back.

Scars on the skin can help in the retrospective diagnosis of varicella, tuberculous lesions
(deep sunken scar), syphiloma (star-shaped scar). Common fibro-APRO diffraction foci
characteristic of scleroderma. Most reveal posleranevye and postoperative scars,
sometimes transformed into a keloid.

During puberty, especially girls, on the skin of the lower half of the abdomen, hips,
buttocks, breasts appear white stripes on the background of stretching the skin
(striae). When illness or syndrome Itsenko-Kushina-ha, long-term treatment with
glucocorticoids in patients formed similar scars, wider and deeper, with a distinctive
purple color.

CHANGES IN BLOOD VESSELS SKIN

When hydrocephalus is expanding venous network on the scalp, with an increase in

bronchopulmonary lymph nodes - in the upper back. Pronounced venous pattern on the
chest in the form of "Medusa's head" may appear in chronic bronchopulmonary diseases,
stagnation in the portal vein, hepatic cirrhosis.

Sometimes the skin capillaries form the so-called vascular stars. They appear in chronic
liver disease, cirrhosis, often combined with red ( "liver") with his hands and feet.

Facial telangiectases may be formed on the skin and mucous membranes of early
childhood and combined with some other congenital anomalies (eg, Rand-Osler disease).

Often children are vascular education - hemangioma - a pale or bright red color
polymorphic spots formed by dilated capillaries, sometimes protrude above the surface of
the skin.

Some patients the skin of the trunk and extremities can be observed a kind of mesh or
tree-like pattern bluish-red or purple - livedo. Its appearance is associated with thrombosis
of small veins of the skin.

Desquamation

Nature peeling of the skin has a definite diagnostic value.

Lamellar desquamation of fingers, palms and soles occurs when scarlet fever 2 weeks
after onset.

Leaf epidermis peeling on the palms and soles developed in patients after
pseudotuberculosis and Kawasaki disease.

Lamellar desquamation occurs when cheiropompholyx due to increased

sweating. Formed in this disease finest, filled with serous contents of vesicles on the fingers
and hands are broken, causing a rough scaling of the skin.

Lamellar exfoliation of the soles can be observed in severely ill children, located on the
long-term bedrest. This skin is covered with cracks and rough sluschivaetsya.

Melkocheshuychatoe peeling occurs in hypothyroidism, some infectious diseases (eg,

measles).
 In combination with the dryness of the skin peeling observed in hypovitaminosis A and
Group B, dystrophy, ichthyosis.

Desquamation may occur when some effects on the skin for therapeutic purposes, for
example after applying mustard plasters, turpentine wraps, various ointments, pastes, after
smearing the skin with an alcoholic solution of iodine.

Violation of keratinization until the formation of horny shields, it is difficult for scraping
removed, say when ichthyosis.

VIOLATION skin moisture

Excessive moisture of skin develops in overheating of the child (especially young children),
high fever, physical and emotional overexertion, strong pains, episodes of hypoglycemia,
thyrotoxicosis. Hyperhidrosis armpits and palms violation occurs when the autonomic
regulation (this is more applicable to children and pre-pubertal age).

Dry skin may be a consequence of reduced sweating (hypo-idrosis) or reduce the

production of sebum (xerosis). Gipogidroz occurs during dehydration, and xerosis - in
chronic intoxication, malnutrition, hypovitaminosis A and PP, ichthyosis, hypothyroidism.

SKIN TEMPERATURE CHANGES

The total increase in temperature (hyperthermia) occurs when a fever, the local increase -
in acute inflammatory lesions of the skin, subcutaneous tissue, muscles, joints.

Total decrease in temperature (hypothermia) occurs when colds, circulatory failure, acute
coronary insufficiency, hypothyroidism, and local depressions - when spasm of blood
vessels (SVD, Raynaud's syndrome).

Elasticity of skin

Reduced elasticity of the skin occurs when rapidly coming dehydration (uncontrollable
vomiting, diarrhea, etc.), deep degrees of malnutrition, long-term ongoing severe infections,
skin diseases (scleroderma), hypothyroidism.

MAJOR SKIN DISEASE IN CHILDHOOD

In newborns and children the first year of life in relation to anatomical and physiological-
cal features of various skin diseases are often accompanied by the formation of vesicular
and bullous elements.

The anatomic and physiologic features of the body 55 Degenerative diseases of the skin
 Hereditary degenerative diseases of the skin primarily include various forms of
congenital bullosa epidermoliza. When the disease at any, even minor ones, trauma formed
extensive blisters on the skin due to exfoliation of the epidermis from the dermis, followed
by a secondary infection to the contents of the bubbles. The reason is simple congenital
form epidermoliza - mutations in the genes of collagen type VII, in particular cytokeratins 5
and 14. In this defective collagen is not capable of effectively fasten the epidermis from the
papillary layer of the dermis.

Acquired form bullosa epidermoliza - an autoimmune disease with the appearance of

autoantibodies to collagen type VII.

The group of inherited dystrophies include acrodermatitis, is based on the severe

disturbance of utilization of zinc. The disease manifests itself in the first year of life in the
form aula, bubbles and blisters on hands, feet, buttocks, in the perineum, around all the
orifices. At the same time disturbed the growth of hair and nails, there are intestinal
disorders, fever and exhaustion.

Bacterial skin

Bacterial purulent skin diseases (pyoderma) in children are more likely to staphylococcus
and streptococcus, rarely - treponema pallidum.

Stafilodermii newborns occur as vezikulopustulez (inflammation of the mouth of canals

ekkrinovyh glands), psevdofurunkulez (education subcutaneous sites, followed by their
opening and the release of the yellow-green pus slivkoobraznogo) and epidemic
pemphigus (formation of surface bubbles, revealing the formation of erosions). The most
severe form of stafilodermii - exfoliative dermatitis with the formation of large, flabby,
easily revealing the bubbles. Epidermis with sloughs and in areas outside the boundaries of
bubbles, often covering a large area. Exfoliation of epidermis in the form of tapes is
particularly easy to occur in oblique pressing (symptom Nicholas).

Streptoderma manifested in the form of impetigo (the appearance of soft bubbles - flikten
- followed erozirovaniem and the formation of crusts), erysipelas, papules-erosive
streptococcal impetigo, pemphigus, localized in the folds of the skin.

Syphilitic pemphigus develops not only on the skin of the body and face, but also on
palms and soles, where staphylococcal pyoderma develops rarely. Contents bubbles special
methods reveal pale treponema.

Newborn first days of life in some cases there omfalit - inflammation of the umbilical ring
with its redness, infiltration and edema, often with the release of serous fluid, blood or pus.

Viral diseases of the skin

 Among the viral diseases of the skin in children most commonly develop herpetic
infection (see "Infection caused by herpes simplex virus types 1 and 2, chapter 18, herpetic
infection). In newborns, it often runs hard and makes generalized form.

In children of preschool age may molluscum contagiosum virus infection. In this case the
skin appears pale pink papules measuring 5-7 mm with depression in the center and
release him from this mass of white.

Fungal diseases of the skin and dermatozoonozy

Of the fungal infections in children most often reveal trichophytosis, microsporia, crusted
ringworm and candidiasis. Rather common in children dermatozoonozy:

with scabies, the skin appear microvesicles, which depart from the curved mangy moves,
there is a strong itching, especially in the evening and at night, traces of scratching;

biting lice are also accompanied by strong itching and lead to the appearance of scratches
on the skin of the scalp.

Allergic skin

Already in the neonatal period in children with a genetic predisposition may be allergic
manifestations.

At 1-2-nd week of life in newborns may appear seborrheic dermatitis - a hyperemia and
infiltration of the skin of the scalp, buttocks and natural folds with individual
maculopapular elements cover the "crust" of the scaly flakes.

During the first months of life in children often observed ekssudatov-WIDE changes of
skin in the form of erythema, swelling, dryness and peeling of the cheeks. Later they may
become more pronounced and form atopic dermatitis or eczema in children's appearance
on the skin of the face (with the exception of nasolabial triangle), body and limbs
erythematous itchy pockets with microvesicles, exposure of the formation of wet, erosions
and crusts. On the exposed parts of the body may appear Uzelkov itchy rash - strofulyus.A
few years eczema can be transformed into atopic dermatitis.

Often occurs in the form of hives urtication, often merging into vast areas of infiltration
with uneven edges.

Angioedema - a limited fast-paced allergic swelling of skin, nasal mucosa, or oropharynx,

rarely genitals.

FEATURES Eruptions Under certain infectious and noninfectious diseases

 When scarlet fever (see Chapter 25, "Scarlet fever") usually occurs Punctulata rash on
congested background preferentially localized

in skin folds, elbow, groin, behind the knees. At the 2-3rd week of illness followed by a rash
lamellar desquamation of palms and soles.

For measles (see Chapter 20, Measles, rubella, mumps) is characterized by

maculopapular rash on the skin with an unmodified background landmark (for 3 days)
spread from top to bottom and outcome in light-brown pigmentation and defurfuration.

When rubella rash consists of pale red spots round or oval in shape, appearing
simultaneously and located on the face, neck, extensor surfaces of the limbs, buttocks and
back.

In varicella (see "Diseases caused by human herpes virus type 3" in Chapter 18, herpetic
infection) eruptions occur on mucous membranes, scalp, face, torso and extremities, and
are makulo-papular elements, becoming a several hours in the vesicles. After a while
vesicles opened and dry up, forming a brown crust.

When meningococcal disease (see Chapter 28 "Meningococcal infection") before

hemorrhagic rash elements of irregular (stellate) forms ranging in size from 1-2 mm to 5-6
cm in different colors (from pink-red to dark cherry). The first elements of the rash
appears on the back of the thighs and buttocks.

When enterovirus infection (see Chapter 21 "of enterovirus infections") has a spotty rash
or maculopapular in nature, lasts from several hours to several days and disappears
without a trace.

Important diagnostic value has a rash in a number of non-communicable diseases. Thus,

hemorrhagic rash monitored for thrombocytopenia purpura-ters (Idiopathic
thrombocytopenic purpura, see "thrombocytopenic purpura" in Chapter 14, "Diseases of
the blood"), hemorrhagic vasculitis (disease Shen-lyayna-Schnlein, see "systemic
vasculitis" in Chapter 13 "Rheumatic Diseases"), hypovitaminosis C (scurvy), aplastic and
hypoplastic anemia, leukemia (see "Acute leukemia" in Chapter 14, "Diseases of the
blood"), diseases associated with disturbances in blood coagulation.

Changes in skin appendages

Defeat nails

The defeat of the nails can be with fungal lesions, as well as many internal diseases,
metabolic and neuro-trophic disorders.
 Celonychia (lozhkoobraznye impressions nails, combined with their ischer-reliance)
occur in iron deficiency or chromium in the body.

Symptom thimble (point indentations on the surface of the nail plate) occurs in patients
with psoriasis. Fingernails grow turbid gradually acquire a transverse or longitudinal
striations, thin and atrophy (oniholizis).

The symptom of "time windows" - pronounced (more than usual) convex nails. Occurs
when prolonged purulent processes in the lungs, subacute bacterial endocarditis, UPU,
biliary cirrhosis of the liver.

Leykonihiya (the appearance of the nail inside the white spots or lines) may be the result
of injury or degeneration, with severe chronic medical diseases.

Syndrome "yellow nail" develops in children after an illness of the respiratory tract: Nail
growth is slowing, there are their total or partial yellow or yellow-green coloration and
transverse striations.

Onihogrifoz ( "clawed" nails) - the result of a congenital dystrophy.

Point hemorrhages under the nails, the nail bed occur when Troma-bovaskulite, such as
SLE.

In congenital ectodermal dysplasia of the nails may be absent or deformed,

underdeveloped.

Inflammatory swelling and redness of the skin around okolonogtevogo roller typical
paronychia.

Damaged nails as a result of their permanent obkusyvaniya watched with nervousness,

mental tension.

When fungal lesions observed deformation of nails, the appearance of these small holes
and cracks. They become dull, yellow, thickened, sometimes separated from the nail bed.

Loss of the nail occurs during the formation of hematoma nail bed (traumatic origin),
porphyria (nails take on a reddish tint), erythredema, dystrophic form epidermoliza.

Defeat hair

Common baldness (alopecia) may be congenital or occur in eating disorders, anemia,

chronic intoxication, hypovitaminosis, poisoning (eg, arsenic), some infections (scarlet
fever, typhus), and non-communicable diseases (SLE, SOM), hypothyroidism.
 Patchy hair loss occurs in syphilis, poisoning by thallium-containing zhaschimi products,
disease of hair, etc. Hair Loss neck in children the first six months of life observed in
rickets, perinatal encephalopathy.

Excessive hair growth can be total or regional. Hypertrichosis (excessive body hair body
and limbs) may be due to genetic or associated with some chronic diseases (tuberculosis,
Jura, ulcerative colitis, etc.). Excessive growth of body hair growth in girls with facial hair
(hirsutism) occurs when the disease and Cushing's syndrome Itsenko-, long-term
treatment with glucocorticoids, hyperandrogenism.

Rare, hard, brittle hair - diagnostically important symptom of hypothyroidism. Dim hair
color, their dryness and splitting at the ends may be a manifestation of malnutrition,
vitamin deficiency, iron and other micronutrients and metabolic disorders.

Disease of the hair (in particular, fungi genus Microsporum) characterized by the
appearance of the skin of the scalp rounded reddish foci, delineated from healthy skin. Hair
over them break very close to the root, thus formed, as it were clipped plots.

When lice from the hair roots can be found multiple dog-chinkoobraznye firmly seated
parasite eggs (nits).