Posted in Patient Information

Penile Adhesions in Male Children

Adapted from: Penile Adhesions Parent Information CHOP Website

What are penile adhesions

Penile adhesions in circumcised boys occur when the penile shaft skin adheres to the glans of the penis. There are three types of penile adhesions: glanular adhesions, penile skin bridges and cicatrix.

Causes

Some adhesions may develop due to an excess of residual foreskin following a newborn circumcision. Adhesions can also form as an infant develops more fat in his pubic area (the area around the penis and scrotum).

Symptoms

The penis may appear that it is “buried” in the prominent pubic fat pad. Because the penis remains hidden there is a tendency for the shaft skin to adhere to the glans.

With all adhesions you may notice a white discharge coming from the area of the adhesions. This is called smegma. Sometimes smegma can be mistaken for a cyst or pus under the skin, but it is not an infection and does not require antibiotics. Smegma consists of dead skin cells that accumulate underneath the adhesions and help to break them apart.

Diagnosis and treatment

Penile adhesions are generally benign and cause no pain or discomfort to your son. You or your pediatrician may notice them during a physical exam.

Treatment is generally performed by a urologist. They will determine by physical exam the type of penile adhesion and what treatment approach is recommended.

Glanular adhesions

On exam you may not be able to see the complete coronal margin. This is the purple line that separates the glans from the shaft of the penis. This is because the shaft skin has adhered to the glans, covering the coronal margin. Glanular adhesions are benign and when left alone tend to resolve on their own. To help the adhesions separate more quickly, we may suggest applying Vaseline® directly to the adhesions. The Vaseline will soften the adhesions, and with spontaneous erections, the adhesions will begin to break apart on their own.

Penile skin bridge

In some instance, the penile shaft skin will become attached to the coronal margin and develop a thicker permanent attachment that cannot be separated and will not separate on its own. You may notice a band of skin from the shaft adhering to the glans with a small tunnel underneath. In many situations the skin bridge can be divided during an outpatient procedure. Treatment may also involve division of the skin bridge and circumcision revision.

Cicatrix

Following a circumcision, the penis may drop back into the pubic fat pad and the surgical area may contract, trapping the penis. In this situation, you will not be able to expose the glans of the penis at all. We have found that cicatrix can be safely and effectively treated with a topical steroid cream. Your child’s doctor will give you instructions on the proper use of the cream. If the steroid cream fails and the penis remains trapped, a circumcision revision and correction of a concealed penis may be necessary.

Posted in Patient Information

Allergy Medication Dosing for Children

Quick reference of allergy med dosing for children.

Zyrtec (cetirizine) dosing:

  • 6-12 months: 2.5 mg once daily
  • 1-2 years: 2.5 mg once to twice daily
  • 2-5 years: 2.5 – 5 mg once daily
  • 6 years and up: 5 – 10mg once daily

Claritin (loratadine) dosing:

  • 2 – 5 years: 5 mg once daily
  • 6 years and up: 5 – 10 mg once daily

Allegra (fexofenadine) dosing:

  • 6 months and < 10.5kg: 15mg twice daily
  • < 2 years or < 10.5kg : 15 – 30 mg twice daily
  • 2 – 11 years: 30 mg twice daily
  • 12 years and up: 180 mg ER once daily

Flonase (fluticasone) dosing:

  • 4 years and up: 1 spray per nostril once daily. If not working, ok to increase to 2 sprays each nostril, but reduce to once daily as soon as possible
  • 12 years and up: 2 sprays each nostril once daily

Reference

Posted in Clinician Information

Tuberculosis Screening and Latent TB Treatment for Primary Care

Screening Recommendations for Tuberculosis in Healthcare Workers

In the May 17, 2019 MMWR, the CDC changed their recommendation on how to screen healthcare workers for TB. Here’s the short version of their recommendations:

  1. TB screening with an individual risk assessment and symptom evaluation at baseline (preplacement);
  2. TB testing with an interferon-gamma release assay (IGRA) or a tuberculin skin test (TST) for persons without documented prior TB disease or latent TB infection (LTBI);
  3. No routine serial TB testing at any interval after baseline in the absence of a known exposure or ongoing transmission;
  4. Encouragement of treatment for all health care personnel with untreated LTBI, unless treatment is contraindicated;
  5. Annual symptom screening for health care personnel with untreated LTBI;
  6. Annual TB education of all health care personnel.

Diagnosing Latent TB

If a person has a positive IGRA or TST, but has no symptoms of disease they meet criteria for Latent TB.

Treatment of Latent TB

Want to keep it simple? Treat latent tuberculosis with 4 months (120 doses) of once daily Rifampin. Dose is weight based. Adults are 10 mg/kg. Children must be age 2 years or older, their dose is 15-20 mg/kg. Rifampin (rifampicin; RIF) is formulated as 150 mg and 300 mg capsules. Max dose is 600 mg.

You can use these logs from the CDC to help the patient track their medications. CDC says that patients should be seen monthly to check for treatment-associated adverse events (systemic drug reactions, loss of appetite, vomiting, yellow eyes, tenderness of the liver, easy bruising, rash). Sounds like a good idea at least to have a telephone call with the patient each month. Don’t panic if the patient reports urine or saliva turning a reddish-orange color – it is not uncommon (although you should make sure that’s the only symptom they are experiencing).

There are great handouts and more information on the CDC website for Latent TB.

Reference:

  1. Health System Costs of Treating Latent Tuberculosis Infection With Four Months of Rifampin Versus Nine Months of Isoniazid in Different Settings, Annals of Internal Medicine
Posted in Fun

Normal Vitals Wall Decor

Have trouble remembering normal vitals for children of various ages? Try decorating with these wall photos and you’ll never forget again!

A day without demographics is like a day without sunshine
A day without demographics is like a day without sunshine
Fever = 100.4 F
Fever = 100.4 F
Minimum wet diapers in 24 hours: 3
Minimum wet diapers in 24 hours: 3
Newborn to 6 months: 120-150 bpm
Newborn to 6 months: 120-150 bpm
6 to 12 months: 110-140 bpm
6 to 12 months: 110-140 bpm
1-2 years: 90-130 bpm
1-2 years: 90-130 bpm
3-5 years: 80-120 bpm
3-5 years: 80-120 bpm
6-12 years: 70-110 bpm
6-12 years: 70-110 bpm
13+: 60-100 bpm
13+: 60-100 bpm
0-12 months: 30-50 breaths per minute
0-12 months: 30-50 breaths per minute
1-2 years: 25-40 breaths per minute
1-2 years: 25-40 breaths per minute
3-5 years: 20-30 breaths per minute
3-5 years: 20-30 breaths per minute
6 to 12 years: 16-25 breaths per minute
6 to 12 years: 16-25 breaths per minute
13 years and older: 12-20 breaths per minute
13 years and older: 12-20 breaths per minute