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Pediatrics BRS > Chapter 19 - Derm > Flashcards

Chapter 19 - Derm Flashcards

1
Q

What term is used to describe a large macule, large papule, and large vesicle.

A
  • a large macule is a patch
  • a large papule is a plaque
  • a large vesicle is a bulla
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2
Q

What is the difference between a crusting and a scaling skin lesion?

A
  • scaling is a desquamation of the stratum corneum

- crusting is dried exudate and debris

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3
Q

How are most fungal skin infections diagnosed?

A

with a KOH prep to identify fungal hyphae

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4
Q

Under what circumstances would a shave biopsy be preferred to a punch biopsy? What about the reverse?

A
  • a shave biopsy is appropriate for an epidermal or superficial dermal lesion
  • a punch biopsy is needed for a deeper lesion
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5
Q

In what way do premature infants differ in their response to topical agents?

A

they have a thinner stratum corneum and thus absorb topical agents to a greater degree

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6
Q

What is the difference between an ointment, cream, or lotion?

A
  • ointments contain little or no water and have maximal water-retaining properties, great for very dry skin
  • creams contain 20-50% water and are better for average dryness
  • lotions contain more water than creams are are only useful for minimally dry skin
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7
Q

How is thickened skin (hyperkeratosis) treated?

A

with keratolytics like salicylic acid, urea, alpha-hydroxy acids, and retinoic acid

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8
Q

Which areas of the skin are most susceptible to the side effects of topical corticosteroids and why?

A

the face and groin are most susceptible because the epidermis in these areas is thinner; this is why you should only use low-potency corticosteroids in these areas

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9
Q

What are the local side effects of topical corticosteroids?

A
  • acne
  • hirsutism
  • folliculitis
  • striae
  • pigmentation changes
  • atrophy
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10
Q

Allergic Contact Dermatitis

A
  • an inflammation of the epidermis and superficial dermis secondary to direct contact with a sensitizing substance
  • it constitutes a direct T-cell mediated response and requires an earlier exposure for sensitization
  • common causes include poison ivy, oak, or sumac; topical lotions, creams, soaps, and perfumes; and nickel
  • presents as an erythematous papular/vesicular rash
  • treated with topical corticosteroids and avoidance of the agent
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11
Q

Primary Irritant Contact Dermatitis

A
  • an inflammation of the epidermis and superficial dermis secondary to direct contact with a sensitizing substance
  • caused by a caustic substance that irritates the skin in a dose-depdent manner and does not require a prior sensitization
  • the classic example is diaper dermatitis, often with secondary C. albicans infection
  • presents with erythematous papules without involvement of the inguinal creases; involvement of the inguinal creases, intense confluent erythema, or satellite lesions suggests candidal superinfection
  • treated with moisturizers, barrier creams, and ointments containing zinc oxide in addition to frequent diaper changes
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12
Q

Seborrheic Dermatitis

A
  • believed to be a hypersensitivity to Pityrosporum ovale yeast
  • an eruption of greasy, red scales and crusts in areas with high numbers of sebaceous glands, such as the scalp, face, chest, or groin
  • infants are often affect by “cradle cap” in which it is limited to the scalp
  • should be treated with topical low-dose corticosteroids; sulfur, zinc, or salicylic acid-based shampoos; and a topical anti fungal to eradicate P. ovale
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13
Q

Pityriasis Rosea

A
  • a hypersensitivity reaction to a virus
  • it begins with a solitary, 2- to 5-cm scaly, erythematous lesion on the trunk of extremities, which is present for up to one month
  • approximately 1-2 weeks later, there is an eruption of oval erythematous macules and papules in a Christmas tree distribution on the trunk, which can be pruritic
  • treatment involves antihistamines
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14
Q

Psoriasis

A
  • an autosomal dominant disease caused by immune dysregulation and epidermal proliferation
  • characterized by well-circumscribed, salmon-colored plaques with a silvery scale, classically on extensor surfaces and the scalp; may also present with pitting of nails and often arise at sites of recent trauma
  • histology reveals acanthosis, parakeratosis, collections of neutrophils in the stratum corneum called Munro micro abscesses, and a thinning of epidermis above elongated dermal papillae
  • because of this epidermal thinning, bleeding occurs when the scale is picked off, known as the Auspitz sign
  • treat with corticosteroids, UV light + psoralen, or immune modulating therapy
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15
Q

Miliaria Rubra (Heat Rash)

A
  • caused by disrupted sweat ducts near the upper dermis, often secondary to occlusion or friction
  • sweat on the skin then produces an inflammatory response and small, erythematous, pruritic papules and vesicles erupt, most often where the skin has been rubbed
  • treat with avoidance of occlusive clothing
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16
Q

What is erythema multiforme?

A

a collection of hypersensitivity reactions which all have a classic skin lesion described as a target lesion, which is fixed, dull red, and oval in shape with a dusky center

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17
Q

Erythema Multiforme Minor

A
  • a hypersensitivity reaction to HSV
  • presents with symmetric target lesions, which are fixed, dull red, and oval in shape with a dusky center, in an acral distribution
  • it often follows a prodrome and generally involves only one mucosal surface, most commonly the mouth
  • treated with supportive care and acyclovir
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18
Q

Erythema Multiforme Major

A
  • a hypersensitivity reaction to M. pneumoniae or a drug
  • presents with symmetric target lesions, which are fixed, dull red, and oval in shape with a dusky center, in an acral and truncal distribution
  • it often follows a prodrome and involves at least two mucosal surfaces, usually the mouth and eyes
  • treated with supportive care and a macrolide if M. pneumoniae is suspected
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19
Q

Stevens-Johnson Syndrome

A
  • a drug hypersensitivity with widespread, atypical, asymmetric target lesions, blisters, and necrosis
  • often preceded by a prodrome and affects at least two mucosal surfaces
  • treatment involves supportive care, ophthalmology consultation, and steroids, IVIG, or burn unit admission
20
Q

Toxic Epidermal Necrolysis

A
  • a severe drug hypersensitivity with widespread epidermal necrosis and sloughing of the epidermis; Nikolsky sign is usually positive
  • there is severe mucous membrane involvement and target lesions are usually absent
  • mortality is high due to sepsis, dehydration, and electrolyte abnormalities
21
Q

Tinea Capitus

A
  • a fungal infection of the hair
  • most often by Trichophyton tonsurans, acquired via human interaction, or Microsporum canis from cats/dogs
  • presents with areas with scales and pustules, patchy hair loss, kerions (large, red, boggy nodules), and occipital or posterior cervical lymphadenopathy
  • diagnosed with KOH prep or woods light
  • treated with 6 weeks of griseofulvin to treat the infection and selenium sulfide shampoo to reduce infectivity
22
Q

Tinea of the Skin

A
  • includes tinea corporis, tinea pedis, and tinea curries
  • caused by Trichophyton species and Microsporium canis
  • presents with oval or circular scaly erythematous patches with partial central clearing
  • diagnosed with KOH prep of skin scrapings
  • treated with topical anti fungal medications
23
Q

What is tinea unguium?

A

also known as onychomycosis, it is a fungal infection of the nails, causing thickening and yellow discoloration, which requires systemic anti-fungals for treatment

24
Q

Tinea Versicolor

A
  • a superficial fungal infection
  • caused by Pityrosporum orbiculare, which invades the stratum corneum
  • presents with fine, scaly oval macules which may be hypo- or hyper-pigmented and come more prominent with sun exposure
  • diagnosed with KOH prep or Woods light examination
  • treated with selenium sulfide or systemic antifungal medications
25
Q

What is the difference between an exanthema and an enanthem?

A
  • exanthems are skin rashes

- enanthems are rashes of the oral mucosa

26
Q

Erythema Infectiosum (Fifth Disease)

A
  • caused by parvovirus B19, transmitted via respiratory secretions
  • presents with a slapped-cheek, erythematous macular rash that gives way to a lacy, reticular rash on the trunk and extremities
  • may cause asymptomatic anemia, aplastic crisis, or fetal hydrops
  • treatment is supportive
27
Q

Roseola Infantum

A
  • caused by HHV-6 or HHV-7
  • presents in children younger than 2 with 3-5 days of high fever, which resolves and gives way to a pink papular eruption on the trunk that fads in 1-2 days
28
Q

Varicella

A
  • an intensely pruritic erythematous macular rash that develops after a 7- to 21-day incubation period
  • a central vesicle often develops on the macules, given them the appearance of “dew drops on rose petals”
  • lesions crust over and are found to be of different ages
  • treated with antipyretics, antibacterial soaps to prevent superinfection, antihistamines, and acyclovir for patients with severe complications or in a topical form for those with ophthalmic involvement
  • may be complicated by superinfection, necrotizing fasciitis, scarring, Reye syndrome, pneumonia, encephalitis, acute cerebellar ataxia, hepatitis, or zoster
  • congenital varicella is a syndrome of zigzag scarring of the skin, shortened or malformed extremities, CNS damage, and eye abnormalities
29
Q

HSV Gingivostomatitis

A
  • an HSV-1 infection that typically presents in young infants
  • appears as grouped vesicles and ulcers on the lips and tongue (anterior oral cavity), often causing pain with swallowing; drooling and fever are common
  • diagnosis is made by finding epidermal gian cells on Tzanck prep, DFA, or PCR
  • the infection usually resolves after 1-2 weeks but can be treated with oral acyclovir
30
Q

Neonatal HSV

A
  • more often due to HSV-2 than HSV-1 and generally acquired during passage through the birth canal
  • it presents in the first week of life and is a medical emergency
  • may only have a few vesicles or may presents with sepsis, meningoencephalitis, hepatitis, shock, or death
  • diagnosis is made by finding epidermal gian cells on Tzanck prep, DFA, or PCR
  • requires treatment with acyclovir
31
Q

Hand-Foot-Mouth Disease

A
  • caused by coxsackievirus, usually A16
  • presents with vesicles, papules, or pustules on the palms, soles, or fingertips and shallow erosions on the soft palate or tongue
  • known as herpangina if only oral lesions are present
  • treatment is supportive
32
Q

Molluscum Contagiosum

A
  • caused by poxvirus and often associated with HIV
  • presents as small, asymptomatic, flesh-colored papules with central umbilication that may be present anywhere on skin with hair follicles
  • lesions are contagious
  • treatment requires only observation
33
Q

Louse Infestation

A
  • Pediculus humans causes head and body lice whereas Phthirus pubis causes pubic lice
  • infection is associated with crowded living conditions and sharing hats, clothes, combs, or hairbrushes
  • presents with itching and white, ovoid bodies attached to the hair shaft, which are eggs
  • treat head lice with permethrin shampoo and a comb to remove the nits; treat body or pubic lice with gamma-benzene hexachloride lotion
34
Q

Scabies

A
  • caused by Sarcoptes scabiei
  • presents as pruritic papules or vesicles, particularly in the interdigital spaces
  • burrows may be visible on the skin and diagnosis should be confirmed with examination of a scraping
  • treat with permethrin lotion or lindane; highly contagious so treat all household contacts
  • itching may persist up to 30 days after treatment
35
Q

Pityriasis Alba

A
  • presents as dry, scaly, hypopigmented patches, usually on the cheeks
  • treated with moisturizers and mild corticosteroids
36
Q

What is vitiligo?

A

a complete loss of skin pigment in patchy areas due to autoimmune destruction of melanocytes

37
Q

Oculocutaneous Albinism

A
  • a genetic defect in melanin synthesis

- patients present with white skin and hair, blue eyes, and often photophobia or nystagmus

38
Q

Tuberous Sclerosis

A
  • a neurocutaneous disorder due to a TSC1 mutation on chromosome 9 or TSC2 mutation on chromosome 16
  • features follow the HAMARTOMASS acronym: Hamartomas in CNS/skin, Angiofibromas, Mitral regurgitation, Ash-leaf spots (hypo pigmented macules), cardiac Rhabdomyoma, (Tuberous sclerosis), autosomal dOminant, Mental retardation, renal Angiomyolipoma, Seizures or infantile spasms, and Shagreen patches (thickened skin with an orange-peel appearance)
  • the number one cause of neonatal cardiac tumors
  • also have an increased incidence of subependymal astrocytomas and ungal fibromas
39
Q

Neurofibromatosis Type I

A
  • an autosomal dominant neurocutaneous disorder arising from a mutation of the NF1 tumor suppressor gene on chromosome 17, which encodes a negative regulator of RAS called neurofibromin
  • presents with cafe-au-lait spots, Lisch nodules (pigmented iris hamartomas), cutaneous neurofibromas, optic gliomas, and pheochromocytomas
  • the neurofibromas are derived from neural crest cells
40
Q

How do congenital and acquired nevi compare?

A
  • congenital are detected in the first six months of life and carry a risk for malignancy
  • acquired increase in size and number during puberty and after sunburn; most are junctional and have much lower risk of malignant transformation than congenital nevi
41
Q

Alopecia Areata

A
  • an autoimmune, lymphocyte-mediate injury to hair follicles
  • presents acutely with complete hair loss in one to three sharply demarcated areas of the scalp without any inflammation
  • alopecia totalis is the subsequent loss of all scalp hair whereas alopecia universalis is the loss of all body and scalp hair
  • most patients have regrowth within 1 year without any intervention
42
Q

Trichotillomania

A
  • an obsessive-compulsive-related disorder with hair loss that occurs due to conscious or unconscious pulling or twisting of hair
  • area of hair loss typically has irregular borders and hairs are broken off at different lengths, sometimes with perifollicular petechiae and involvement of the eyelashes or eyebrows
  • may also be associated with trichophagia, formation of trichobezoars, and abdominal pain with obstruction
  • treatment is with habit reversal training, a form of CBT
43
Q

Traction Alopecia

A
  • a form of traumatic alopecia caused by constant traction or friction as in tight hair braids, curlers, vigorous scalp massage, or constant rubbing
  • presents as patchy areas of alopecia with thinned, small hairs, but few broken hairs as in trichotillomania
44
Q

Telogen Effluvium

A
  • a form of alopecia caused by an acutely stressful event
  • the event converts hairs from a growing phase known as anagen to a resting phase known as telogen
  • presents with generalized hair loss 2-3 months after the inciting event, which continues for 3-4 months and then spontaneous regrows
45
Q

Acne Vulgaris

A
  • a skin condition characterized by a progression or collection of comedones, pustules, and nodules
  • comedones are colloquially referred to as white and black heads; they arise from androgen-induced upregulation of sebum production by sebaceous glands, which causes an excess of keratin, blocking follicles
  • Propionibacterium acnes infection produces lipases, which break down the sebum and release pro-inflammatory fatty acids, resulting in pustule formation
  • acne then becomes inflammatory and characterized by erythematous papules, pustules, nodules, and cysts
  • treat with benzoylperoxide (an antimicrobial) and vitamin A derivatives, which reduce keratin production; antibiotics may be required for inflammatory acne
  • systemic isotretinoin is highly effective but requires pregnancy testing and use of birth control due to the associated teratogenic risk

Pediatrics BRS (20 decks)

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