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2020_PC
PEDIATRIC
DERMATOLOGY
PEDIATRIC
DERMATOLOGY
FIFTH EDITION
Bernard A. Cohen, MD
Professor of Pediatrics and Dermatology
Johns Hopkins Children’s Center
Johns Hopkins University School of Medicine
Baltimore, Maryland
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PEDIATRIC DERMATOLOGY, FIFTH EDITION ISBN: 978-0-7020-7963-4
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Previous editions copyrighted 2013, 2005, 1999, and 1993
Internation Standard Book Number: 978-0-7020-7963-4
Content Strategist: Charlotta Kryhl
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Design Direction: Brian Salisbury
Printed in India
Last digit is the print number: 9 8 7 6 5 4 3 2 1
P R E FAC E
Since I began taking clinical photographs during my residency Although the focus of this chapter is on primary lesions of the oral
training over 30 years ago, I have been impressed by the virtu- mucosa, a discussion of clues of systemic disease is included. I am
ally unlimited variation in the expression of skin disease. How- also excited to introduce the new Chapter 10 that focuses on uro-
ever, with careful observation, clinical patterns that permit the logic, gynecologic, and anogenital findings in children. Chapter 2,
development of a reasonable differential diagnosis emerge. In which is devoted to dermatologic disorders of newborns and
collaboration with my colleagues in the fifth edition, we have infants, remains the longest chapter in the book as a result of the
been able to use over 600 images, a third of which are new, to continued blossoming of neonatology as a respected pediatric
demonstrate the diverse variations and common patterns that discipline. I never cease to be amazed by how human beings ma-
are fundamental to an understanding of skin eruptions in chil- nipulate their skin accidentally, deliberately, secretly, and/or thera-
dren. The algorithm at the end of each chapter is designed as a peutically. With this in mind, Chapter 11, Psychodermatology,
practical approach to evaluating pediatric patients. focuses on psychodermatoses and concludes with disorders that are
Pediatric Dermatology is designed for the pediatric and pri- triggered, exacerbated, or caused primarily by external factors.
mary care provider with an interest in dermatology and the Finally, the format of the text should be user friendly. The
dermatology practitioner who cares for children. The text is pages and legends have been numbered in a standard textbook
organized around practical clinical problems. This book should fashion, and the index was again revised to include all of the
not be considered an encyclopedic text of pediatric dermatol- disorders listed in the text and legends. The text and images
ogy; it should be used in conjunction with the further reading incorporate advances made in diagnosis, evaluation, and
list suggested at the end of Chapter 1. Classic papers and more treatment during the last eight years, since the publication of
recent literature are included in the further reading lists at the the fourth edition. I only hope that students of pediatric der-
end of each chapter. matology will enjoy reading the book as much as I enjoyed
I have been fortunate to work with oral pathologists on the der- working with my colleagues in pediatric dermatology com-
matology faculty in the roles of teacher and consultant. With their pleting this new edition.
help, the importance of recognizing oral lesions in the care of chil- Bernard A. Cohen
dren is reflected in Chapter 9, which is devoted to oral pathology. 2021
v
AC K N OW L E D G M E N T S
This book would not have been possible without the help of I will be forever indebted to the coauthors of the chapters
the children and parents who allowed me to photograph their in the fifth edition including Katherine Brown Püttgen for
skin eruptions and the practitioners who referred them to me. Chapter 2 Neonatal Dermatology, Jessica L. Feig for Chapter 3
I am particularly indebted to the faculty, especially my colleague Papulosquamous Eruptions, A. Yasmine Kirkorian and Nidhi Shah
Annie Grossberg; residents, nurse practitioners; nurses; physi- for Chapter 4 Vesiculopustular Eruptions, Kaiane Anoush
cians assistants; and students at the Johns Hopkins Children’s Habeshian for Chapter 5 Nodules and Tumors, Daren J. Simkin for
Center and the Departments of Pediatrics and Dermatology Chapter 6 Pigmentary Disorders, George O. Denny for Chapter 7
at the Johns Hopkins University School of Medicine for their Reactive Erythema, Saleh Rachidi for Chapter 8 Disorders of the
inspiration and support. I would again like to thank my friends Hair and Nails, Nikhil Shyam for Chapter 9 Oral Cavity, and Sherry
at the Children’s Hospital of Pittsburgh where this book was Guralnick Cohen for Chapter 11 Psychodermatology.
first conceived. I would like to thank the residents in dermatology and pedi-
Although we have been involved with online dermatology atrics, who by their questions and consultations, have helped
for over a decade, the craziness associated with the COVID me prioritize topics for inclusion in this book.
pandemic has allowed for a dramatic expansion of virtual visits Finally, I would like to again acknowledge Dr. Nancy Esterly
and high-quality clinical imaging. Many primary care providers, who contributed the foreword to the second edition (reprinted
patients, and parents have learned how to organize online con- in the subsequent editions). I think of her often and would like
sultation, which will undoubtedly revolutionize the acquisition to honor her by using her foreword in this edition as well.
of data for clinical evaluation and teaching. This is all reflected Dr. Esterly taught me that pediatric dermatology could be excit-
in the fifth edition. ing and academically challenging. As a role model and one of
I am also indebted to the oral pathology faculty who call the mothers of pediatric dermatology, her memory continues
dermatology their home. They have taught me to seek clues to guide all of us in pediatric dermatology. I would also like to
for dermatologic and systemic disease from evaluation of the acknowledge Dr. Frank Oski who brought me home to Balti-
mucous membranes, and to respect oral pathology in its own more, where he incorporated pediatric dermatology into the
right. Without them, the conception of Chapter 9 and the most pediatric training program. Hopefully, we can continue to live
recent updates would not have been possible. up to the high standards that he demanded.
I am also excited to thank Drs. Tina Ho and Kalyani S.
Marathe who encouraged us to include a new chapter focused
FIGURE CREDITS
on urologic and anogenital lesions, which are often misdiag-
nosed in this age group. The following figures have been reprinted from Zitelli BJ, Davis
I continue to be grateful for the persistent prodding and sensi- HW (eds). Atlas of pediatric physical diagnosis, 3rd edn. Mosby,
tive guidance of the editors at Elsevier who are responsible for St Louis, 1997:
completion of this book in a timely fashion. I would also like to 4.10, 7.8, 7.9, 8.1, 8.15, 8.49, 11.7, 11.9, 11.10, 11.13, 11.15.
thank Tracy Shuford for keeping the lines of communication open I am grateful for the use of images contributed by Dr. Russ
between the publisher and my office, despite the 6-hour time Corio and Dr. Gary Warnock for contributing additional
difference. images to the chapter on the Oral Cavity (Chapter 9).
vi
To Sherry for her continued patience, love, understanding, and
contributions to this edition, which took longer than I thought!
To Michael, Jared, and Jennie for keeping me young and laughing.
It has been exciting to see them mature into young adults who now
contribute to the care of children and adults in their own ways.
To Zeke and Thea who keep me honest!
To all of the children who made this project possible.
F O R E WO R D
NOTE FROM DR. COHEN
liberally illustrated with photographs depicting a wide range of
I have asked the managing editor to reprint the Foreword from the skin problems in infants and children.
second edition (also reprinted in subsequent editions) written by In this fourth edition of Pediatric Dermatology, the text has
Dr. Nancy Esterly to honor her for her contributions to pediatric been expanded to include a 20-page chapter devoted entirely
dermatology, the training of many practitioners of the specialty, and to mucosal lesions and accompanied by more than 50 new
my own career. In the spring of 1983 when I was desperately search- photographs of patients with problems ranging from the
ing for a mentor in pediatric dermatology, Nan adopted me during common herpes simplex infection to the uncommon ectoder-
my elective month at Children’s Memorial Hospital in Chicago. mal dysplasias. In keeping with the very successful style of
Dr. Esterly has been the quintessential practitioner of pedi- previous editions, the requisite algorithm, diagrams of the
atric dermatology since her pediatric and dermatology training oral cavity and up-to-date references are included in this
in Baltimore over 40 years ago. She was one of the founders of chapter. In addition, new photographs have been added and
the Society for Pediatric Dermatology and embodies the tripar- some old ones replaced throughout the book.
tite mission of pediatric dermatology of patient care, resident For beginners in this discipline, Dr. Cohen’s text is an excel-
teaching, and clinical research. lent place to start. For those of us who practice pediatric derma-
tology, there is still much to be learned from a well-put-together
text such as this one.
FOREWORD TO THE SECOND EDITION
Nancy B. Esterly, MD
It is not often that one encounters a single-author textbook that is Professor Emeritus
outstanding in both text and illustrations. But, once again, Bernard Medical College of Wisconsin
Cohen has crafted an exceptional basic pediatric dermatology text Milwaukee, Wisconsin
viii
