Focal Red Bumps




Approach to the Problem


Focal red bumps are common in pediatric patients. Etiologies include self-limited, benign diagnoses such as insect bites and erythema toxicum neonatorum; more serious infectious causes like furuncles, carbuncles, abscesses, and cat-scratch disease; and tumors including hemangiomas, pyogenic granulomas, and Spitz nevi.



Key Points in the History


Erythema toxicum neonatorum is a common, self-resolving rash seen in newborns with onset in the first 24 to 48 hours of life.


Insect bites may not have a known exposure. Household members may be affected differently, with younger patients experiencing more pronounced local reactions.


Furuncles, carbuncles, and abscesses are more common in patients and families with a history of recurrent skin infections and/or methicillin-resistant Staphylococcus aureus (MRSA) colonization.


Hemangiomas typically arise between 2 and 4 weeks of age, but may have a precursor lesion that is sometimes detected at birth.


Hemangiomas have a phase of rapid growth beginning at 4 to 8 weeks of age and continued expansion through 6 to 9 months of age. This is followed by slowed growth and eventual involution beginning in the second year of life. Hemangiomas typically completely involute by age 7 to 9.


Pyogenic granulomas tend to grow rapidly and bleed easily. They typically arise later in childhood than hemangiomas.



Key Points in the Physical Examination


Erythema toxicum neonatorum may appear as isolated lesions that resemble flea bites or as coalescent lesions.


Insect bites, particularly mosquito bites, tend to have induration that is particularly apparent the day after the insect bite. A central punctum can help to distinguish an insect bite from other swelling.


A furuncle is a deep bacterial folliculitis. Confluence of several adjacent furuncles can create a carbuncle, which can become further organized into a walled-off abscess. These lesions are all typically tender and warm.


Although pyogenic granulomas can resemble hemangiomas, only the former exhibit a hypopigmented collarette.


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Jun 15, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Focal Red Bumps

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