Children's faces

Contributed by Philip Marazzi, a GP in East Horsley, Surrey

Facial weakness

This young man has neurofibromatosis and developed this facial weakness following surgery to remove one of his bilateral acoustic neuromas. The facial nerve had to be cut and reanastamosed, but his facial weakness persisted. He also has problems with hearing loss and now has only minimal hearing left.

Sunburn


In spite of all the advice and publicity about the dangers of sunburn, we still see cases regularly. At least this patient's dark hair and eyes mean the melanoma risk is lower than those with fairer complexions.

Trauma


This little girl fell flat on her face. It was clinically obvious that she had a broken nose. She was fortunate that when the swelling reduced, the septum was not significantly deviated and she had a good nasal airway. No action was therefore taken and the injury healed well.

Chicken pox


Chicken pox is an easy diagnosis that does not require a lengthy consultation. The presence of blisters with clear fluid is usually all that is needed to confirm the diagnosis. Use of simple analgesia and topical soothing creams is usually sufficient, though occasionally an oral antihistamine may help if the lesions are very itchy.

Measles


Measles is an increasingly common condition. Although usually relatively mild, it has potential for serious complications, including encephalitis. Parents need to be made aware of this small but significant risk. This boy has clear eye signs to go with his rash. He made a full recovery, but not before passing the infection onto other members of his family who had also not been given the MMR vaccination.

Eczema


This little girl has moderately severe atopic eczema. The area around her mouth is particularly affected due to being aggravated by saliva. Excoriations and chronic changes can already be seen in her skin. Management must include adequate use of emollients and topical corticosteroids as well as advice regarding environmental factors. Secondary staphylococcal infection is common, especially when the skin fails to settle down as expected.

Ectodermal dysplasia


This baby showed early signs of this unusual collection of conditions which are genetically transmitted, and affected his mother. A wide range of different tissues around the body may be affected, depending on which syndrome is present. The common feature is the development of the tissue from embryonic ectoderm. This baby has slightly abnormal almost transluscent skin and hair, both of which seem to be a little delicate. There is no specific treatment. Long-term management revolves around minimising the complications and treating symptoms as appropriate.

Mumps


This young woman presented with unilateral parotid swelling. Parotid swellings can be differentiated from cervical lymphadenopathy by the position of the swelling in relation to the ear. She had been vaccinated with MMR vaccine as per normal schedules. This infection was subsequently confirmed as mumps. Approximately 10 per cent of children remain susceptible to mumps following MMR vaccination, and of these, a second vaccine protects a further 90 per cent.

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