Clinical images: Paediatric presentations

Paediatric presentations. By Dr Philip Marazzi.

Periorbital cellulitis

What appeared to start as a normal case of conjunctivitis rapidly spread to produce this pattern with surrounding cellulitis. The patient was admitted to hospital and treated with IV antibiotics. This condition can potentially lead to complications including orbital cellulitis with the eye itself affected, and meningitis if not treated.


Slapped cheek disease

This little girl has a classical appearance of slapped cheek or Fifth disease. The erythematous rash on the face is a sign of this viral condition caused by the B19 strain of parvovirus. The infection is often fairly mild. Adults may also rarely become infected. If adults do get the infection, it is often more severe, with an initial flu-like illness and occasional secondary polyarthropathy. There is no specific treatment required or available, and the condition is self-limiting.


Port wine stain

This little girl has a large, flat port wine stain on her face. It was present at birth and is due to a capillary-based vascular anomaly. She is having laser therapy, which explains the appearance here. There is a clear improvement, with areas fading with successive treatments as the laser is used to seal the vessels. This treatment is performed on an outpatient basis, with relatively minimal stress to the patient and her parents.



This baby has clear signs of atopic dermatitis developing in his first few weeks. He came from a family with a strong history of atopy. The rash developed soon after birth. Many parents find it difficult to understand the condition, looking for a 'cure'. Education is a crucial aspect of the management of this condition. With care and appropriate use of emollients, steroids and antibiotics, good results can be obtained.



This little girl of nine years looked very pale. This is not always the most reliable of clinical signs, but she had a history of ulcerative colitis. Blood was taken and her FBC came back with an Hb of 6.6g/dL. She was admitted for control of her colitis and transfusion. She looked and felt much better after this.



This young boy has psoriasis. It is quite unusual to see this in children of this age, but he has a very strong family history. Both his mother and grandmother have severe psoriasis. The diagnosis was not difficult. Treatment has been challenging and required methotrexate with the associated frequent blood tests, making me somewhat unpopular with the child. He has been very tolerant and done very well on this treatment.



This 16-year-old was experimenting with his chemistry set. He decided to make his own fireworks and tried to ignite them. He was extremely lucky that the subsequent explosion only resulted in these mild superficial injuries.


Bat ears

This cosmetic problem can have a significant effect on a child's psychological wellbeing. This child's parents were keen for her to have corrective surgery. It is becoming increasingly difficult to get funding for this sort of problem in some areas, but it should not be regarded as a minor cosmetic procedure solely for the sake of vanity.

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