Pediatric emergency medicine trisk 1301 1301
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FIGURE 67.8 Frostbite. Child played in the snow for a prolonged period on a cold day wearing
sneakers.
Friction Blisters
Blisters usually occur in areas predisposed to trauma or friction such as on the
heels after walking or playing sports or due to new, possibly poorly fitted, shoes.
However, a persistent history may suggest EB, which may not always present in
infancy in milder subtypes such as EB simplex as discussed above. See Table
67.2 for differentiation of the various types.
Occasionally, accidental burns or burns secondary to child abuse are seen.
Abused children may have cigarette burns or have had their feet dipped in
scalding water.
Frostbite
Fingers, toes, feet, nose, cheeks, and ears are affected by extreme cold. After
exposed areas are damaged by the cold temperature, symptoms occur on
rewarming. Erythema, swelling, and burning pain occur at first, followed by
vesicles and bullae (at times hemorrhagic ( Fig. 67.8 )) within 24 to 48 hours.
Prevention is most important with appropriate protection of these sites from
extreme cold.
