Paediatric dermatological disorders often manifest as various cutaneous symptoms, often triggered by infections, inflammatory reactions, and external factors.1 Children are more susceptible to skin problems, as their immune systems are growing, and they are frequently exposed to environmental stimuli.2 Among them, bacterial infections like impetigo, fungal infections, and viral exanthems are often seen in clinical settings. For an early diagnosis and successful treatment, it is essential to recognise the patterns of various dermatological manifestations. Furthermore, it has been

established that passive smoking exposure contributes to a higher risk of respiratory and dermatological issues in children.3

A key component of evaluating systemic involvement in paediatric dermatology is radiological imaging.4 Radiological abnormalities such as chest X-ray changes, skeletal abnormalities, and cranial MRI alterations might be useful for diagnosing infections, inflammatory skin conditions and immune mediated skin disorders. Such findings highlight the necessity of a multidisciplinary strategy incorporating radiographic and dermatological evaluations to detect underlying systemic connections and direct the right therapies.5

The underlying cause, severity, and related systemic characteristics of paediatric dermatological disorders determine treatment approaches.6 Supportive care is still the mainstay of care, although targeted therapies such as systemic and topical antibiotics, antifungal medicines, and corticosteroid and antihistamine drugs are essential for symptom alleviation and disease resolution. In paediatric dermatology, a comprehensive understanding of disease patterns and an integrated diagnostic and therapeutic strategy are crucial for enhancing patient outcomes

And minimising complications.7

This study highlights the need of a comprehensive assessment in diagnosis and treatment by emphasising the clinical and radiological correlations in paediatric dermatological disorders. The results highlight the necessity of a multidisciplinary strategy that combines radiographic investigations and dermatological evaluation in paediatric patients.

Study Design and Setting

The study was carried out at RVM Institute of Medical Sciences in Laxmakkapally, Telangana, India, using a retrospective examination of case sheets from January 2023 to December 2024. The study aimed to assess clinical and radiological correlations in paediatric dermatological conditions, focusing on demographic patterns, cutaneous manifestations, radiological findings, and treatment approaches for improved diagnostic accuracy and patient management.

Study Population

The study included 240 paediatric patients with dermatological disorders who were admitted in the paediatric ward. The diagnosis was determined through a clinical evaluation, and any necessary radiological investigations were conducted.

Inclusion Criteria

Paediatric patients with dermatological conditions are admitted to the paediatric ward.

Cases diagnosed based on clinical evaluation and radiological findings.

Patients with complete medical records.

Exclusion Criteria

Patients with dermatological disorders unrelated to the focus of this study.

Cases with incomplete clinical or radiological data.

Patients who have previously had therapy for the same skin condition.

Data Collection

Patient demographics, Radiological results and dermatological symptoms were documented. Chest X-rays, skeletal imaging, and cranial MRI were among the radiological evaluations used to determine systemic involvement. Clinical features were recorded, including lesion type, distribution, and related symptoms.

Outcome Measures

• Radiological Findings: Skeletal imaging, cerebral MRI, and chest X-ray abnormalities were categorized.
• Dermatological Conditions: Clinical presentation was used to classify cases, which included bacterial, fungal, and viral infections.
• Treatment Modalities: Analysis was done on the efficacy of supportive care, topical and systemic antibiotics, antifungal treatment, and adjuvant drugs.

Data Analysis

SPSS version 25.0 was used to conduct the statistical analysis. The patient's demographics, clinical presentations, and radiological findings were summarized using descriptive statistics. Associations between dermatological conditions and radiological abnormalities were evaluated using descriptive statistics and the chi-square test for categorical data.

Ethical Considerations

All data were anonymised, ensuring that no personal identifiers were used throughout the data collecting or analysis process, in order to protect participant privacy and confidentiality.

This retrospective cross-sectional study examined the records of 240 children who were hospitalised between January 2023 and December 2024 to the paediatric ward at RVM Institute of Medical Sciences. The study evaluated dermatological conditions, their cutaneous presentations, radiological findings, and treatment approaches, with key findings provided below.

Demographic Data:

Among the 240 cases, 113 (47%) were female and 127 (53%) were male. Children ages 6 to 10 account for most cases (36%) followed by those ages 0 to 5 (26%) and 11 to 15 (22%). Additionally, there was a statistically significant correlation between pulmonary involvement and 158 (66%) children's history of passive smoking exposure (p < 0.05). (Table 1).

Table 1: Demographic Characteristics of the Study Population

Dermatological Conditions:

Viral exanthems were the most prevalent dermatological issue, affecting 94 (39%) of children. Impetigo and pustular lesions were detected in 67 (28%) individuals, while fungal infections were seen in 53 (22%) cases. (Table 2).

Table 2: Distribution of Dermatological Conditions

Cutaneous Presentations:

The most common cutaneous symptom, occurring in 87 (36%) of the patients, was maculopapular rashes. 49 (20%) patients had vesiculobullous eruptions, while 36 (15%) children had petechiae or purpura. Additional manifestations were scaling and erythema (12%), crusted lesions (10%), and non-specific lesions (7%). Purpura and petechiae were significantly associated with underlying systemic diseases (p < 0.05) (Figure 1).

Radiological Findings:

Radiological abnormalities were found in 121 (51%) of the patients. The most frequently observed findings were abnormalities on chest X-rays (23%), followed by skeletal abnormalities (12%), cranial MRI alterations (8%), and abnormalities on soft tissue ultrasounds (7%) (Table 3).

Table 3: Radiological Findings in Paediatric Dermatological Conditions

Treatment Approaches:

Most cases, 110 (46%), were treated with supportive care. 53 children (22%) received prescriptions for topical antibiotics, whilst 46 patients (19%) received systemic antibiotics. Antifungal therapy was prescribed in 31 (13%) patients while adjuvant medications such corticosteroids and antihistamines were utilised in 22 (9%). The study found a significant difference in therapy selection between bacterial and viral illnesses (p < 0.05). (Table 4).

Table 4: Treatment

Approaches

A multidisciplinary approach is necessary for an accurate diagnosis and the best possible treatment of Paediatric dermatological disorders, which frequently present a variety of clinical and radiological symptoms. ^8,9 This study highlights the impact of demographic characteristics, cutaneous manifestations, radiological results, and

therapeutic approaches on patient outcomes in Paediatric dermatology. The analysis of these indicators emphasizes the need for multidisciplinary treatment and provides a comprehensive understanding of their clinical relevance.

Paediatric dermatological diseases are influenced by various demographic variables such as environmental exposures, age, and gender. Passive smoking exposure has been associated with a higher risk of skin diseases because it may affect inflammatory responses and immunological function. According to our study, which aligns with previous research, exposure to passive smoking increases the risk of developing skin conditions due to its potential effects on immune function and inflammatory responses.¹⁰ For Paediatric populations, identifying these risk factors is essential for early intervention and preventative measures.

Our study examined a range of dermatological conditions, including viral exanthems, impetigo/pustular lesions, and fungal infections, with diverse cutaneous presentations. Erythematous rashes, vesiculobullous eruptions, scaling, ulcerations, and pigmentary changes, were common findings that frequently needed careful distinction via clinical evaluation. Patient care can be enhanced, and diagnostic procedures are streamlined by identifying similar patterns in cutaneous symptoms.

Radiological findings are crucial in assessing paediatric dermatological conditions, especially when systemic involvement is suspected. Imaging techniques like chest X-rays, skeletal scans, and soft tissue ultrasounds offer crucial insights into the underlying pathology. Imaging tools play a crucial role in paediatric dermatology care, enabling the differentiation of benign conditions from those requiring medical intervention.

The treatment for paediatric skin conditions is influenced by the underlying cause. Our study found that while supportive care and topical antibiotics are commonly used, systemic antibiotics and antifungal therapy are used in severe cases. The integration of adjunctive therapies like antihistamines and corticosteroids can enhance symptom control and improve patient outcomes.

Comparison with Previous Studies:

Similar patterns in the demographic distribution and prevalent dermatological disorders among paediatric patients have been noted when comparing these findings with those of previous studies. These demographic findings are consistent with previous studies linking environmental exposures to a worsening of childhood dermatological disorders.¹¹ Furthermore treatment patterns align with established guidelines, prioritising a patient-centred approach that focuses on non-invasive and targeted therapies.¹²

Clinical Implications

In Paediatric dermatology, the integration of radiological and clinical findings greatly improves patient care and diagnostic accuracy. Dermatologists can lower the risk of complications and enable early intervention by identifying important imaging signals linked to dermatological disorders. Antibiotic usage and some dermatological disorders are not directly linked, which emphasizes the need for individualized care to cut down on unnecessary prescriptions and encourage antimicrobial stewardship.

Limitations and Future Directions

Although this study offers insightful information, it should be noted that it has certain drawbacks. Results are restricted to available clinical and radiological data, and selection bias may be introduced by the retrospective nature of the study. In addition, there was no long-term follow-up, which limited our ability to evaluate treatment results over time. Future prospective studies with larger cohorts and longer follow-up periods may confirm these findings and assess the impact of early imaging on clinical judgement.

The study emphasizes the significance of clinical and radiological correlations in paediatric dermatology. Our findings highlight the necessity of multidisciplinary collaboration, structured clinical evaluations, and early imaging for the best possible patient management. These results highlight the importance of comprehensive assessments for improved paediatric dermatological outcomes and the need for a personalized, evidence-based approach to diagnosis and treatment.

1. Sladden MJ, Johnston GA. Common skin infections in children. BMJ. 2004 Jul 10;329(7457):95-9. doi: 10.1136/bmj.329.7457.95. PMID: 15242915; PMCID: PMC449820.
2. Kong F, Galzote C, Duan Y. Change in skin properties over the first 10 years of life: a cross-sectional study. Arch Dermatol Res. 2017 Oct;309(8):653-8. doi: 10.1007/s00403-017-1764-x. Epub 2017 Jul 19. PMID: 28726004; PMCID: PMC5606948.
3. Wang Y, Yeh K, Huang J, Su K, Tsai M, Hua M, et al. Longitudinal analysis of the impact of smoking exposure on atopic indices and allergies in early childhood. World Allergy Organ J. 2023;16(7):100802. doi: 10.1016/j.waojou.2023.100802.
4. Fink AZ, Gittler JK, Nakrani RN, Alis J, Blumfield E, Levin TL. Imaging findings in systemic childhood diseases presenting with dermatologic manifestations. Clin Imaging. 2018 May-Jun; 49:17-36. doi: 10.1016/j.clinimag.2017.10.015. Epub 2017 Oct 31. PMID: 29120812.
5. Shafiei M, Shomal Zadeh F, Mansoori B, Pyle H, Agim N, Hinojosa J, et al. Imaging more than skin-deep: Radiologic and dermatologic presentations of systemic disorders. Diagnostics (Basel). 2022 Aug 19;12(8):2011. doi: 10.3390/diagnostics12082011. PMID: 36010360; PMCID: PMC9407377.
6. Gür Çetinkaya P, Şahiner ÜM. Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turk J Med Sci. 2019 Aug 8;49(4):963-84. doi: 10.3906/sag-1810-105. PMID: 31408293; PMCID: PMC7018348.
7. Quddusi FI, Youssef MJ, Davis DMR. Dermatologic manifestations of systemic diseases in childhood. Pediatr Rev. 2021;42(12):655-71. doi: 10.1542/pir.2020-000679.
8. Taberna M, Gil Moncayo F, Jané-Salas E, Antonio M, Arribas L, Vilajosana E, et al. The multidisciplinary team (MDT) approach and quality of care. Front Oncol. 2020 Mar 20; 10:85. doi: 10.3389/fonc.2020.00085. PMID: 32266126; PMCID: PMC7100151.
9. Chen K, Guo M, Chen J, Zheng S, Deng Q. Multidisciplinary approach to diagnosis and management of fever of unknown origin: A case report. Medicine (Baltimore). 2023 Dec 15;102(50):e36628. doi: 10.1097/MD.0000000000036628.
10. Lee CH, Chuang HY, Hong CH, Huang SK, Chang YC, Ko YC, Yu HS. Lifetime exposure to cigarette smoking and the development of adult-onset atopic dermatitis. Br J Dermatol. 2011 Mar;164(3):483-9. doi: 10.1111/j.1365-2133.2010.10116.x. PMID: 21054333; PMCID: PMC3062947.
11. Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev Clin Immunol. 2017 Jan;13(1):15-26. doi: 10.1080/1744666X.2016.1212660. Epub 2016 Jul 28. PMID: 27417220; PMCID: PMC5216178.
12. Janerka C, Leslie GD, Gill FJ. Development of patient-centred care in acute hospital settings: A meta-narrative review. Int J Nurs Stud. 2023;140:104465. doi:10.1016/j.ijnurstu.2023.104465.