Chapter 44: Alterations of the Integument in Children

Vascular anomalies represent a significant category of pediatric skin findings, with hemangiomas characterized as benign proliferative lesions demonstrating rapid growth during infancy followed by spontaneous regression, while port-wine stains manifest as persistent capillary malformations with potential association to neurocutaneous syndromes such as Sturge-Weber syndrome, and salmon patches present as transient vascular markings that typically resolve without intervention. Infectious dermatoses comprise both bacterial and fungal etiologies, including impetigo contagiosa caused by Staphylococcus aureus or Streptococcus pyogenes with characteristic honey-colored crusting, staphylococcal scalded skin syndrome resulting from exfoliative toxin production leading to widespread blistering, dermatophytic infections affecting various anatomical regions from scalp to nails, and candidal superinfections particularly in intertriginous areas and mucous membranes. Viral infections including varicella demonstrate significant morbidity risk with potential for serious complications such as secondary bacterial infection, pneumonia, or encephalitis, while herpes simplex virus establishes latency with recurrent manifestations. Inflammatory conditions such as atopic dermatitis reflect underlying barrier dysfunction and immune dysregulation manifesting as chronic pruritic lesions, seborrheic dermatitis presenting with lipophilic yeast colonization of sebaceous areas, contact and irritant dermatitis from environmental exposure, and acne vulgaris driven by sebaceous gland maturation, follicular keratinization, bacterial colonization, and inflammatory cascades. Pigmentary disorders including albinism represent inherited defects in melanin biosynthesis with systemic implications including ocular and photosensitivity complications, while vitiligo reflects acquired melanocyte destruction. Additional benign neonatal conditions such as erythema toxicum neonatorum and miliaria demonstrate self-limited courses, whereas dermatological neoplasms range from common benign lesions to rare but aggressive malignancies requiring careful differential diagnosis and appropriate management strategies.