PITYRIASIS ALBA. This is very common in children and consists of hypopigmented, poorly defined, scaly macules and plaques found on the face and upper outer arms. It is believed to be a mild form of atopic eczema. Lesions are first noticed after exposure to sunshine, where the surrounding sun-affected skin appears quite tan. Treatment consists of topical 1% hydrocortisone cream at night and sunscreens during the day.
PAPULAR URTICARIA. (Fig 35-22; see Fig 35-10). This term defines an exuberant reaction to arthropod bites. Initially there is an irritated weal and, later, an intensely pruritic papule develops at the site of the bite. There may be a central hemorrhagic puncture, a vesicle, or even a blister, especially in children. The number and localization of the lesions depend on the type of exposure and feeding habits of the arthropod. New bites may exacerbate quiescent old bites. Because of scratching, lesions can become infected and crusted. Localization of the affected areas help reveal the causative arthropod: Involvement of the legs suggests fleas, of the waist and thighs suggests chiggers, of the abdomen and arms suggests sarcoptic mange of dogs, and a generalized eruption suggests bird mites. Treatment consists of oral antihistamines, topical corticosteroids, and fumigation of the dwelling.
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