Derm Flashcards
(361 cards)
1
Q
Clustered or grouped vesicles on an erythematous base in a neonate?
A
Neonatal herpes
2
Q
What is seen on Wright stain in neonatal herpes?
A
Multinucleated giant cell and eosinophilic intranuclear inclusions
3
Q
Where do lesions of neonatal herpes often appear?
A
Buttocks or scalp (Often presenting parts closest to maternal lesions)
4
Q
If you find a lesion on the scalp of neonate, what should you always consider?
A
If there was a scalp pH monitor
5
Q
If you suspect neonatal herpes, what do you do?
A
Start IV acyclovir (even before confirmation of the diagnosis)
6
Q
True or False: Most cases of neonatal herpes occur without a known history of maternal herpes?
A
True (Don’t be tricked just because they tell you the infants mother has a history of herpes)
7
Q
What can present as vesicles, but in a linear pattern without an erythematous base?
A
Incontinentia pigmenti
8
Q
Multiple pustules, brown macules, vesicles, and pustules on a non-erythematou base?
A
Transient neonatal pustular melanosis
9
Q
Leaving a collarette?
A
Transient neonatal pustular melanosis
10
Q
When does transient neonatal pustular melanosis present?
A
At birth
11
Q
Who is transient neonatal pustular melanosis more common in?
A
African American infants
12
Q
What is the treatment for transient neonatal pustular melanosis?
A
Nothing
13
Q
What is the natural course of the rash in transient neonatal pustular melanosis?
A
Starts as pustules, becomes hyperpigmented macules
14
Q
What does Gram stain or Wright stain show for transient neonatal pustular melanosis?
A
PMNs without organisms
15
Q
What does a staph infection (usually involving the hair follicles) usually show on a Gram stain or Wright stain?
A
Both PMNs and gram-positive cocci
16
Q
What is a very common rash that presents as yellow pustules on an erythematous base or generalized erythematous macules with solitary papules or vesicles in the center?
A
Erythema Toxicum Neonatorum
17
Q
When does E-Tox usually present?
A
Within a few days of birth (not at birth)
18
Q
What does Wright stain show for E-Tox?
A
Eosinophils
19
Q
What does a Tzanck smear show for E-Tox?
A
Eosinophils, maybe neutrophils, otherwise negative
20
Q
True or False: E-tox is present on the palms and soles?
A
False
21
Q
True or False: E-Tox is common in preterm newborns?
A
False
22
Q
One-day old infant with erythematous macules with an occasional vesicle in the center… Most likely diagnosis?
A
E-Tox (central vesicle in a macular lesion is consistent with E-Tox)
23
Q
What is the treatment for E-Tox?
A
Reassurance- Rash will fade within a week
24
Q
What presents as diffuse scaling and erythematous papules and pustules?
A
Cutaneous Candidiasis
25
Lichenification with scratching?
Atopic dermatitis
26
What is the distribution for atopic dermatitis?
Behind knees, antecubital areas, dry/chapped hands
27
What is a crucial component of atopic dermatitis?
Itching
28
True or False: Heredity plays a big role in atopic dermatitis?
True
29
What are 2 other conditions that commonly go with atopic dermatitis?
1. Allergic rhinitis
| 2. Asthma
30
What might be a lab finding in cord blood that would make you think atopic dermatitis?
High IgE
31
What are factors that can worsen atopic dermatitis?
1. Allergens (food)
2. Chemical irritants
3. Heat
4. Physical trauma
5. Drying elements
32
In an infant with eczema, what % chance is there that food allergy is a factor?
30%
33
What types of foods are often allergen triggers for atopic dermatitis?
Milk, eggs, soy, wheat, peanuts
34
True or False: Negative testing can rule out a food allergy?
True
35
True or False: Positive testing verifies a food allergy?
False- Verification will require either a food challenge or skin testing
36
True or False: Food elimination is recommended for atopic dermatitis?
False- Food allergy is not a factor in up to 70% of cases and food elimination can have negative impact on nutrition
37
How does tinea pedis present?
Itchy rash with scaling/peeling, involves plantar aspect and sometimes lateral aspect of foot (dorsal aspect spared), maceration
38
How does atopic dermaitis present on the foot?
Scaly, dry with lichenification, dorsal aspect of foot involved (in tinea pedis there is maceration and sparing of the dorsal aspect of the foot)
39
Child with eczema who has oozing/crusting of the skin that isn't responding to usual treatment modalities?
Superinfection
40
What bug should you direct treatment at for an eczema superinfection?
S. Aureus
41
What is eczema herpeticum?
Invasion of eczematous skin by herpes
42
Inflamed eczema which isn't responding to steroids and antibiotics?
Eczema herpeticum
43
Classic description for eczema herpeticum?
Vesicles, punched out lesions, crusted erosions
44
Where does eczema herpeticum usually occur?
Face (primary herpes infection)
45
What behavior might pre-dispose a child to getting eczema herpeticum?
Sucking thumb/finger
46
What is treatment for eczema herpeticum?
Acyclovir
47
If you have a child with eczema and concern for immunodeficiency, what are 2 things you should consider?
1. Wiskott-Aldrich Syndrome
| 2. Hyperimmunoglobulin E syndrome
48
Greasy yellow patches on the scalp, face, behind the ears, and in skin folds during the first few months of life?
Seborrheic Dermatitis
49
How is seborrheic dermaitis treated?
Regular antifungal washes
| Topical steroids
50
Child with Seborrheic Dermatitis, profuse ear discharge, profuse urine output...?
Histiocytosis X
51
What is another name for seborrheic dermatitis of the scalp?
Cradle Cap
52
What is a rash that involves erythema, edema, vesicle formation, exudate, and scaling?
Eczema
53
Are atopic dermatitis and eczema the same thing?
No... nummular eczema and contact dermatitis are forms of non-atopic eczema
54
What are the 2 types of contact dermatitis?
1. Allergic
| 2. Primary irritant
55
What causes allergic contact dermatitis?
Delayed hypersensitivity reaction (requires multiple exposures- don't be tricked if its something the child always wears)
56
Describe the rash of allergic contact dermatitis
Red, vesicular, can be crusting
57
What are 2 examples of things that can cause allergic contact dermatitis?
1. Jewelry
| 2. Poison ivy
58
What are things that can trigger primary irritant contact dermatitis?
Soaps and detergents
59
How long is the delay in primary irritant contact dermatitis?
No delay in reaction
60
How is poison ivy described?
Linear vesicles and papules
61
What type of hypersensitivity reaction is poison ivy?
Type 4
62
Does the rash of poison ivy spread?
No- It's just the slower appearance of lesions in areas with milder exposure
63
What can help limit the rash of poison ivy?
Washing with soap and water immediately after exposure
64
What can be given for severe cases of poison ivy?
Oral steroids (sometimes up to 21 days)
65
True or False: Exposure to poison ivy during the winter can cause rash?
True
66
True or False: Exposure to aerosolized poison ivy can cause rask (like if someone is raking it up a distance away)
True
67
True or False: Fluid from vesicles of poison ivy spreads the rash?
False
68
True or False: Poison Ivy rash is contagious?
False
69
True or False: Barrier preparations protect from poison ivy exposure?
True
70
True or False: There are no desensitization treatments available for poison ivy?
True
71
8 year old female with pruritic rash on soles of feet. Has minimal scaling, thickening of the skin, and hyperlinearity of distal soles. Interdigital skin normal... treatment?
Triamcinolone (this is juvenile plantar dermatosis)
*Not tinea pedis because of minimal scaling, interdigital skin being involved, and tinea pedis rarely happening before puberty
72
What type of dermatitis is juvenile plantar dermatosis?
Contact
73
What is juvenile plantar dermatosis a result of?
Occlusive shoes and synthetic sock
74
Silvery lesions on the elbows or knees?
Psoriasis
75
What happens when you pick off spots in psoriasis and what is this called?
Leave behind bleeding spots the size of pins- Auspitz sign
76
"Erythematous plaques surrounded by thick adherent scales", "Pinpoint areas of hemorrhage", "Thick scales on the scalp"
Psoriasis
77
What are 4 other conditions psoriasis might be confused with?
1. Non-bullous impetigo
2. Nummular eczema
3. Pityriasis rosea
4. Tinea corporis
78
How is non-bullous impetigo described?
Oozing and crusting
79
How is nummular eczema described?
Round, oozing, crusting erosions, dry macules with a fine scaly pattern
80
How is pityriasis rosea described?
Small oval, thick scaling plaques, long axis of the lesions parallel to the lines of skin stress
81
How is tinea corporis described?
Scaly lesions, but thin rather than thick, has central clearing
82
Small oval scaling patches of rash on the trunk and back. Herald patch in a Christmas tree pattern with the long axis of the lesions parallel to the lines of skin stress?
Pityriasis rosea
83
What is treatment for pityriasis rosea?
Not necessary- can try exposure to sun or other light (improves symptoms and can hasten resolution)
84
What are 4 rashes pityriasis rosea can be confused with?
1. Secondary syphilis
2. Nummular eczema
3. Tinea corporis
4. Tinea versicolor
85
How do you distinguish pityriasis from secondary syphilis?
Rash appears similar- Syphilis has fever/generalized lymphadenopathy. Syphilis often involves palms/soles, pityriasis doesn't.
86
How do you distinguish nummular eczema and tinea corporis from pityriasis?
Herald patch can look the same...
- Tinea corporis has elevated border with central clearing
- Nummular eczema has crusting erosions
87
How do you distinguish tinea versicolor from pityriasis?
Tinea will be described as hyper/hypo-pigmented scaling macules
88
Dry skin with thin scales that have a pasted-on appearance?
Ichthyosis Vulgaris
89
When does icththyosis present?
Pre-school years
90
What is the treatment for Ichthyosis
1. Keratolytic agents- Ammonium lactate creams
2. Alpha hydroxy acid
3. Urea-containing emollients
91
What % of patients with ichthyosis have atopic dermatitis too?
50%
92
What is a benign inflammatory condition that manifests as non-scaling annular lesions without epidermal involvement?
Granuloma annulare
93
What caues granuloma annulare?
Don't know
94
What is the key part to distinguish granuloma annulare from ringworm?
Granuloma annulare is NON-SCALING
95
What is a papule caused by atypical mycobacteria and found on the sole of a child who likes walking bearfoot?
Swimming pool granuloma
96
How do you distinguish between swimming pool granuloma and granuloma annulare?
Swimming pool has a break in the skin, granuloma annulare skin is intact
97
What causes impetigo?
Strep or staph
98
What is the most likely cause of bullous impetigo and crusted impetigo?
S. Aureus
99
What is treatment for impetigo?
Mupirocin
100
True or False: Treatment of strep skin infection prevents post-strep GN?
False
101
What are the 4 key elements for cellulitis?
1. Red
2. Hot
3. Tender
4. Swollen
102
What are the 2 most common causes of cellulitis?
1. Strep pyogenes
| 2. Staph aureus
103
If there is a low likelihood of MRSA, what is the treatment for cellulitis?
Cephalexin or amoxicillin0clavulanate
104
If cellulitis is more advanced or you are concerned about MRSA (more prevalent in community), what is the treatment?
Clindamycin, trimethoprim-sulfamethoxazole, or doxycycline (if child is older than 8)
105
What is due to an exotoxin produced by S. Aureus?
Staph Scalded Skin Syndrome
106
What causes toxic shock syndrome?
Toxin production by either S. Aureus or Strep
107
Which has a higher mortality... Strep TSS or Staph TSS?
Strep
108
What causes scarlet fever?
Erythrogenic exotoxin produced by group A strep
109
What does scarlet fever most commonly occur in association with?
Strep Pharyngitis
110
What are 3 dermatological conditions caused by toxin-producing bacteria?
1. SSS
2. TSS
3. Scarlet Fever
111
Rash in a preschooler that starts out very tender and red, and spreads to become a sheet-like loss of skin?
SSS
112
What causes SSS?
Exotoxin produced by S. Aureus (don't get tricked into thinking it's due to earlier treatment with an antibiotic...that would be erythema multiforme)
113
What is treatment for SSS?
Antibiotics
114
What is erythema multiforme?
Hypersensitivity reaction in response to a veriety of triggers
115
What are the two forms of erythema multiforme?
Major and minor
116
What is the "buzzword" for erythema multiforme?
Target lesion
117
True or False: Children under 3 are often the patients that get erythema multiforme minor?
False (children under 3 rarely present with this)
118
What is the most likely trigger for erythema multiforme minor?
Primary or recurrent infection with Herpes Simplex
| medications may also cause this
119
Where does the rash of erythema multiforme minor initially present then spread?
Appears abruptly on extremities then spreads to the trunk
120
What is treatment for erythema multiforme minor?
Treating the underlying infection or stopping the medication (AKA... geared towards triggering agent)
121
Child just completed antibiotic regimen, develops rash on distal extremities that's maculopapular with some lesions appearing dusky in the center. They also have 1-2 lesions on the mouth. Otherwise well appearing...Diagnosis?
Erythema multiforme minor (especially with child being well-appearing... vs. erythema multiforme major/SJS)
122
What comes before the rash in SJS?
Fever, muscle aches, and joint aches
123
Describe the rash in SJS
Initially similar to EM minor (bullous or target lesions which can coalesce), but it spreads more quickly, progresses from primarily cutaneous to mucous membrane involvement (conjunctiva, oral mucosa, anogenital mucosa)
124
What often happens to the lesions involving the mucosa in SJS?
They become encrusted
125
Name 3 typical medications that can trigger EM major
1. Sulfa drugs
2. Anticonvulsants
3. NSAIDs
126
How is EM major/SJS treated?
1. Prevent dehydration
2. Prevent superinfection
- Patients often managed in a burn unit
127
True or False: There is separation of the skin in sheets in SJS?
False- separation of skin in sheets is in SSS
128
What is the most severe form of erythema multiforme major?
TEN
129
Describe the skin in TEN
Sunburn-like erythema and sheet-like separation of skin, widespread bullae, denuded necrotic skin
130
How do you distinguish SSSS from TEN?
Biopsy
131
What is the difference in biopsy between TEN and SSSS?
- TEN involves dermis (like SJS)
| - SSSS usually does not involve dermis
132
What age groups typically get SSSS v. TEN?
SSSS usually affects infants and younger children
| TEN usually affects older children
133
Which has a higher mortality, TEN or SSSS?
TEN
134
What causes TEN?
Hypersensitivity reaction (NOT due to a toxin)
135
What are 2 forms of Erythema Multiforme Major?
1. SJS
| 2. TEN
136
Boggy and blue ulcers with a necrotic base?
Pyoderma gangrenosum
137
What is pyoderma gangrenosum usually associated with?
Systemic disease
138
What 3 things does toxic shock syndrome present with?
1. Fevers
2. Hypotension
3. Rash
139
Child comes in with sepsis-like picture and a rash...?
TSS
140
True or False: Tampons do not cause most cases of TSS anymore
True
141
What is treatment for TSS?
Antibiotics and aggressive supportive care
142
Erythema associated with SJS, oral lesions, mucous membrane involvement (anal/genital), foot involvement, starts with fever and other general symptoms?
Erythema multiforme
143
5th disease, slapped cheek fever, associated with Parvovirus B19?
Erythema infectiosum
144
Rash associated with Lyme disease (carditis, arthritis, neuritis), rash migrates?
Erythema chronicum migrans
145
What % of cases of Lyme have the classic bullseye rash?
70%
146
Rash that causes painful bluish lesions on the shin?
Erythema nodosum
147
What is erythema nodosum assocaited with?
1. TB
2. Birth control pills
3. IBD
4. Fungal infections
148
Rash associated with rheumatic fever (one of the major Jones criteria)?
Erythema marginatum
149
Describe erythema marginatum?
Erythematous macule on the trunk which clears centrally
150
Pruritic linear lesions that are papular or pustular, burrows, involvement between the digits?
Scabies
151
True or False: Scabies is high contangous and affects other family members?
True (if the say no other family members are affected, consider something else- papular urticaria)
152
What is classic/pathognomonic for scabies?
Burrows
153
How is scabies usually diagnosed?
Clinically... can be confirmed by identifying mites/eggs in skin scrapings
154
How is scabies treated?
Permethrin 5% cream (Elimite)
155
Do household contacts need to be treated for scabies?
Yes
156
In infants, what 2 unusual spots can you see scabies?
1. Scalp
| 2. Palms/soles
157
2 kids from same family with intense scalp itching and excoriation on the nape of the neck and/or behind the ears?
Head Lice
158
How are nits from lice described?
On the hair shafts, white dots that can't be removed
159
What is primary treatment for lice?
Permethrin cream rinse
160
How long does permethrin cream rinse need to be used for lice?
Initial treatment, then repeat a week after first application
161
Besides treating the patient, what 2 other things needs done for lice treatment?
1. House should be thoroughly cleaned
| 2. Close household contacts treated preventatively
162
In lice, do asymptomatic classmates need treated?
No
163
True or False: Many areas of the country have lice resistant to permethrin?
True (there are many more expensive alternatives to try, but make sure they used permethrin correctly before doing this)
164
True or False: Even after successful treatment of lice, itching can continue?
True
165
What causes continued itching after treatment for lice?
Inflammatory reaction
166
What can help with the continued itching after treatment for lice?
Steroid creams, diphenhydramine, hydroxyzine
167
True or False: Nits must be removed before kids with lice can return to school?
False
168
How long ca lice live without a blood meal?
36 hours
169
How long until fresh lice eggs on hair shafts can hatch?
10 days later
170
True or False: Public lice can live in other locations?
True (like facial hair)
171
True or False: Head lice are slower moving than pubic lice?
False
172
Which type of lice impacts all races equally?
Pubic lice
173
Who does head lice rarely infest?
African Americans
174
What are pubic lice strongly suggestive of in children?
Sexual abuse (head lice are common in children, but public crab lice aren't)
175
What are maculae caeruleae?
Blue-gray macules on the abdomen or inner thigh
176
What are maculae caeruleae consistent with?
Pubic lice
177
What is treatment for pubic lice?
Permethrin (same as head lice)
178
What is treatment for crabs (pubic lice) in the eyelashes?
Petroleum jelly applied TID for 10 days
179
Pearly papules with central dimpling?
Molluscum contagiosum
180
What is treatment for molluscum?
Nothing- it will clear in months to years
181
How is molluscum differentiated from warts and comedones?
By the central umbilication seen in molluscum
182
What is seen on wright staining in molluscum?
Viral inclusion bodies
183
Pink/excoriated pruritic lesions on the extensor surfaces of the arms and legs?
Papular urticaria
184
Clustered erythematous papules with a central punctum that recur episodically, often at night?
Papular urticaria
185
How long can the lesions with papular urticaria last?
Up to 10 days
186
How is papular urticaria differentiated from scabies?
No other family members are affected
187
What causes papular urticaria?
Delayed hypersensitivity reaction to an insect bite
188
What is the best management for papular urticaria?
ID the causative agent (so family can eliminate it)
189
Honey colored crusted lesions that are not recurrent of episodic?
Non-bullous impetigo
190
Translucent papules with central umbilication, no period with complete absence of lesions?
Molluscum contagiosum
191
What is one specific feature that differentiates molluscum from papular uritcaria?
Molluscum has no period with compelte absence of lesions
192
Small papules that appear in lines (not clusters)?
Scabies
193
How can the distribution of lesions with scabies versus papular urticaria distinguish between the two?
Scabies appears in lines, papular uritcaria in clusters
194
What are 3 rashes that might be confused with papular urticaria?
1. Non-bullous impetigo
2. Molluscum contagiosum
3. Scabies
195
Toddler who has a 2 month history of a recurrent pruritic rash of clustered erythematous papules. No body else in family is similarly affected.... diganosis?
Papular urticara (don't be tempted to pick scabies... no one else in family is affected)
196
What is produced in the skin in response to androgen production (in both girls and boys)?
Sebum
197
What does sebum form?
A plug which causes mature comedones
198
What is the bacteria most often associated with acne?
Propionibacterium acnes
199
What are the 2 major causes of acne vulgaris?
1. Inflammatory
| 2. Non-inflammatory
200
What 2 things does non-inflammatory acne consist of?
1. Closed Comedones
| 2. Open Comedones
201
What is a closed comedone?
Whitehead- follicles that are plugged, but covered with epithelium
202
What is an open comedone?
Blackheads- No epithelial covering
203
What causes the black color in a blackhead?
Melanin (not dirt)
204
What should the appearance of comedones prior to age 8 make you think of?
Precocious puberty
205
What 2 things in addition to acne warrant an endocrine workup?
1. Hirsutism
| 2. Menstrual irregularity
206
If you have a child with acne plus hirsutism or menstrual irregularly, what should they bet worked up for?
Polycystic ovary disease
207
What 3 things does inflammatory acne consist of?
1. Papules
2. Pustules
3. Nodules (cysts)
208
What are papules?
Small, red, solid lesions
209
What is something that can be mistaken for a papule due to acne?
Adenoma sebaceum
210
What is another name for ademona sebaceum?
Angiofibroma
211
What is a small papule that is firm and may appear pink, red, or brown in color?
Adenoma sebaceum/Angiofibroma
212
If you have inflammatory acne with lots of papules that is resistant to treatment (espiecally on nose/cheeks) what should you consider?
Angiofibroma/Adenoma sebaceum
213
What type of skin lesions are superficial and filled with pus?
Pustule
214
Describe a nodule (cyst)?
Deep, located in the dermis, red/painful
215
What type of skin lesions can lead to permanent scarring?
Nodule (cyst)
216
What 2 drugs can lead to acne?
1. Systemic steroids
| 2. Anticonvulsants (phenobarbital/phenytoin)
217
Where does acne from systemic steroids appear primarily?
Trunk
218
Kid with acne mostly on trunk... what should you consider?
If they have any other conditions that might result in them needed systemic steroids
219
What 3 things does acne treatment depend on?
1. Type of lesion
2. Age of patient
3. Distribution of lesion
220
True or False: Poor hygiene/improper bathing habits causes acne?
False
221
What must you do for psychological care of a teen with acne?
Reassure them that this is a normal part of growth/development
222
True or False: Chocolate doesn't cause or accelerate acne?
True
223
Why shouldn't teens vigorously scrub or squeeze pimples?
Can lead to permanent scarring
224
What is the treatment for neonatal acne?
None
225
How does benzoyl peroxide function?
Primarily bactericidal
226
How can the irritating effects of benzoyl peroxide be reduced?
If the right formulation is used
227
What effects to topical antibiotics have for acne?
1. Bactericidal
| 2. Anti-inflammatory
228
What is the most commonly used topical antibiotic for acne?
Topical clindamycin
229
What type of acne are topical antibiotics typically used for?
Inflammatory acne
230
What is tretinoin derived from?
Vitamin A
231
How does tretinoin help prevent acne?
Halts the process that plugs hair follicles
232
What can topical tretinoin result in with initiation of use?
An initial flare-up of acne
233
What effects to oral antibiotics have for acne?
Anti-inflammatory
234
When are oral antibiotics used for acne?
When it is severe inflammatory acne
235
What location of acne are oral antibiotics particularly effective against?
Trunk
236
What are the 3 most commonly used oral antibiotics for acne?
1. Tetracycline
2. Doxycycline
3. Minocycline
237
Why is continued use of oral antibiotics for acne not appropriate?
Because bacterial resistance is a problem (acne can be controlled, but oral antibiotics don't cure it)
238
Why are OCP's helpful in treating severe acne?
Because of the anti-androgenergic effects of estrogen
239
What 4 things does isotretinoin (Accutane) do?
1. Antibacterial
2. Reduces sebum production
3. Anti-inflammatory
4. Destroys comedones
240
What is isotretinoin often used in combination with?
Benzoyl peroxide
241
Who is isotretinoin often used in?
Patients with multiple inflammatory lesions (because it helps reduce the formation of new lesions)
242
What can worsen acne when taken at the same time as isotretinoin?
Steroids
243
What has to be ruled out before isotretinoin can be prescribed?
Pregnancy- This needs to be ruled out before, during, and after treatment
244
Name 5 side effects of isotretinoin
1. Dry lips
2. Dry skin
3. Dry eyes
4. Nosebleeds
5. Headaches
245
What should you think of with hair loss and black dots or broken hairs noted on exam?
Tinea capitis
246
What might you find on scalp exam for tinea capitis?
Kerions
247
What is a kerion?
Tender, boggy areas of induration
248
What is gold standard for diagnosis of tinea capitis?
Fungal culture
249
What is treatment for tinea capitis?
Oral griseofulvin for 6-12 weeks
250
True or False: Alternatives for griseofulvin like oral fluconazole or terbinafine are acceptable for tinea cpitis?
True
251
True or False: A set of routine labs must be obtained prior to starting griseofulvin?
False
252
What condition causes hair loss with NO inflammation?
Alopecia Areata
253
What causes alopecia areata?
Unknown
254
What other dermatological finding can be seen in alopecia areata?
Nail pitting
255
Child with areas of complete hair loss with no scalp lesions noted. Also has nail pitting. Remained of PE negative. Hair is tightly braided. Most likely diagnosis and treatment?
Alopecia areata- Reassurance (could do steroids)
-Nail pitting makes this alopecia areata v. traction alopecia
256
What describes the sudden loss of large amounts of hair during routine activities such as washing and brushing the hair?
Telogen Effluvium
257
What type of hair loss is often triggered by stressful events (febrile illness, surgery, emotional stress)?
Telogen Effluvium
258
Complete areas of hair loss that are well defined round patches?
Telogen Effluvium
259
What can be seen on microscopic exam of shedded hairs in telogen effluvium?
Telogen bulbs
260
How is telogen effluvium distinguished from other forms of hair loss?
No inflammatory reaction
261
What type of hair loss is caused by tight pulling (hair in braids or trichotillomania)?
Traction alopecia
262
What is trichotillomania?
Habit of pulling on one's own hair
263
What type of hair loss do you see irregular patches of hair loss or incomplete patches of hair loss?
Traction alopecia
264
What finding can help to distinguish traction alopecia from other forms of alopecia?
Hair shafts of different lengths
265
What refers to a group of non-inherited disorders with excess mast cell degranulation and mast cell accumulation in various tissues?
Mastocytosis
266
What is the most common form of mastocytosis?
Urticaria Pigmentosa
267
Pigmented lesions that turn into hives and develop blisters (particularly with rubbing)?
Urticaria Pigmentosa
268
What age group is urticaria pigmentosa typically described in?
Infant during first 6 months of life
269
What is the Darier sign?
Pigmented lesions that turn into hives and develop blisters (especially with rubbing)
270
What condition is the Darier Sign seen with?
Urticaria Pigmentosa
271
What is treatment for urticaria pigmentosa?
No treatment is needed
272
What 3 things should infants with urticaria pigmentosa avoid?
1. Narcotic pain relievers
2. Radiocontrast material
3. NSAIDs
273
Hypopigmented patches that get worse with sun exposure
Tinea versicolor
274
What causes tinea versicolor?
Fungus
275
What confirms diagnosis of tinea versicolor?
KOH prep
276
What is the treatment for tinea versicolor?
1. Astringents (strip superficial layers that are primarily involved)
2. Topical antifungal creams
277
What is important in management of tinea versicolor?
Sun deprivation- May take a few months to get rid of it
278
What oral medications may be considered appropriate in certain situations for tinea versicolor?
Oral ketoconazole, fluconazole, and itraconazole
279
Besides astringents and topical antifungal creams, what else can be used for tinea versicolor?
Topical selenium sulfide
280
What skin mark may appear similar to tinea versicolor?
Ash leaf spot (seen in tuberous sclerosis)
281
How is incontinentia pigmenti inherited?
X-linked dominant
282
Who is affected worse by incontinentia pigmenti, boys or girls?
Boys- this is lethal in males
283
What are 4 stages of skin lesions in incontinentia pigmenti?
1. Erythematous papules and vesicles in crops along the lines of Blaschko that last 1-2 weeks
2. Swirls of warty growths
3. Streaks of hyperpigmentation in marble cake pattern
4. Hypopigmentation
284
What is an acquired autoimmune destruction of melanocytes leading to depigmentation?
Vitiligo
285
What causes vitiligo?
Exact cause unknown, appears to be a genetic component
286
What is treatment for vitiligo?
1. Topical steroids
| 2. Tacrolimus/Pimecrolimus
287
What is the natural course of vitiligo?
Most cases slowly progressive, some exhibit spontaneous repigmentation
288
What is pityriasis alba?
Post-inflammatory hypopigmentation seen in atopic skin
289
What is the difference between pityriasis alba and vitiligo?
Pityriasis has hypopigmentation, vitiligo complete depigmentation
290
Name 5 characteristics of Sturge Weber
1. Port wine stain in trigeminal distribution
2. Developmental delay
3. Seizure
4. Hemiplegia
5. Vision problems/calcification/glaucoma
291
What is another name for a port wine stain?
Nevus flammeus
292
In Sturge Weber, does glaucoma occur on the same or contralateral side as the port wine stain?
Same side
293
In Sturge Weber, do the focal seizures occur on the same or contralateral side as the port wine stain?
Contralateral
294
What CNS finding is the port wine stain in Sturge Weber often associated with?
Venous leptomeningeal angiomatosis
295
How is a venous leptomeningeal angiomatosis (seen with port wine stain in Sturge Weber) identified?
By MRI
296
True or False: The size of the port wine stain correlates with the extent of CNS involvement with a venous leptomeningeal angiomatosis in Sturge Weber?
False (You can have a venous leptomeningeal angiomatosis even with no skin lesion)
297
How can a port wine stain with Sturge Weber be treated?
Tunable dye (pulsed dye) laser
298
Besides Sturge Weber, what other syndrome can present with a port wine stain?
Klippel Trenaunay Weber Syndrome
299
What % of children with a facial port wine stain have Sturge Weber?
8%
300
What increases the likelihood of a port wine stain being due to Sturge Weber syndrome
If it is distributed along branches of trigeminal nerve
301
If you have a port wine stain in the distribution of the trigeminal nerve concerning for Sturge Weber, what needs done?
Immediate referral to opthalmology
302
What are genodermatoses?
Inherited single-gene disorders with skin manifestations
303
What are 7 genodermatoses?
1. Neurofibromatosis
2. Ataxia telangiectasia
3. Incontinentia pigmenti
4. Garder syndrome
5. Peutz-Jeghers
6. Xeroderma pigmentosum
7. Epidermolysis bullosa
304
What 3 main categories does neurofibromatosis effect?
1. Skin
2. CNS
3. Orthopedic
305
Which type of neurofibromatosis is more peripheral and which is more central?
1- Peripheral
| 2- Central
306
What is another name for Von Recklinghausen Disease?
Neurofibromatosis Type 1
307
Name the 7 criteria that can involved with neurofibromatosis.
1. 6+ Café Au Lait spots (may appear after birth)
2. Lisch Nodules
3. Neurofibromas
4. Optic Nerve Glioma
5. Inguinal and axillary freckling
6. Bony defects
7. Family history of NF1 in a first degree relative
308
What size do Café Au Lait spots have to be in kids to fit criteria for neurofibromatosis type 1?
>5mm wide
309
What is a Lisch Nodule?
An iris hamartoma
310
When do Lisch Nodules develop in neurofibromatosis type 1?
May not develop until adulthood
311
What is required to see a Lisch Nodule?
Slit-lamp exam
312
When do neurofibromas typically show up in neurofibromatosis type 1?
After onset of puberty
313
Of the 7 criteria, how many are required to make the diagnosis of NF1?
2/7
314
If you have a patient with 1/7 criteria for neurofibromatosis, what can help to make the diagnosis?
```
Genetic test (can be confirmatory)
-Diagnosis is typically clinical)
```
315
Which type of neurofibromatosis is sometimes known as central neurofibromatosis and why?
NF-2, higher incidence of meningiomas and acoustic neuromas
316
How is neurofibromatosis type 1 inherited?
Autosomal dominant
317
Which chromosome is the gene for NF1 on?
17
318
What % chance does a parent with NF1 have to transmit this to any one child?
50%
319
What % of cases of NF1 are due to spontaneous mutation?
50%
320
What are neurofibromas?
Skin lesions that either appear on the surface or deep in the skin (found by palpation)
321
What vital sign abnormality needs to be monitored in kids with NF1?
BP- They can get pheochromocytoma and renal artery stenosis which can cause HTN
322
What are the classic features with neurofibromatosis type 2?
Acoustic neuroma- schwannoma
323
What chromosome is neurofibromatosis type associated with?
22
324
How do patient with neurofibromatosis type 2 usually present?
Hearing loss or tinnitus related to their acoustic neuromas
325
Other than hearing loss or tinnitus, how else can a child with neurofibromatosis type 2 present?
Ocular symptoms- due to cataracts or hamartomas of the retina
326
How is definitive diagnosis of neurofibromatosis type 2 made?
Bilateral cranial nerve VIII masses on CT or MRI
327
What can help support the diagnosis of neurofibromatosis type 2?
Presence of family history of NF2 along with schwannoma, neurofibroma, meningioma, glioma, or juvenile cataracts.
328
Name the 8 features of Tuberous Sclerosis.
1. Ash leaf spots (>3)
2. Periventricular/cortical tubers
3. Sebaceous gland hyperplasia
4. Shagreen patch
5. Sub/periungual fibroma
6. Cardiac rhabdomyoma
7. Retinal nodular hamartomas
8. Renal angiomyolipoma
329
What portion of cases of tuberous sclerosis develop cardiac rhabdomyoma?
Half (especially in infants)
330
What might adenoma sebaceum with tuberous sclerosis might be mistaken for?
Acne vulgaris
331
How many of the 8 criteria for tuberous sclerosis are needed for diagnosis?
2/8
332
What is another name for a hypomelanotic macule?
Ash leaf spot (Hypopigmented skin- ash colored)
333
What is often the earliest sign of Tuberous sclerosis?
Ash Leaf Spots
334
What is sometimes needed to visualize an ash leaf spot?
Wood's lamp
335
Where is sebaceous gland hyperplasia (or adenomas) usually described in Tuberous sclerosis?
On the face
336
What is the name for cobblestone appearing skin which can be seen in tuberous sclerosis?
Shagreen patch
337
What feature of tuberous sclerosis typically presents and manifests as seizures?
Periventricular/Cortical tubers
338
What is the name for the group of inherited disorders that involve developmental abnormalities of the skin as well as the teeth, nails, hair, and sweat glands?
Ectodermal dysplasia
339
What are the group of inherited disorders that manifest as epithelial fragility?
Epidermolysis bullosa
340
Who should you suspect epidermolysis bullosa in?
Infants and children presenting with recurrent blistering of the skin and mucosa after minor trauma as well as nail changes
341
What is the common feature between ectodermal dysplasia and epidermolysis bullosa?
Both involve skin and nails
342
How can you distinguish between ectodermal dysplasia and epidermolysis bullosa?
ED: Developmental- presents as bad skin, teeth, and nails and they stay bad
EB: Starts normal and blisters on and off until the skin, nails, and mucosa scar
343
What is a benign neoplasm made up of prolferative and hyperplastic vascular endothelium?
Hemangioma
344
What are the 3 categories of hemangiomas?
1. Superficial
2. Deep
3. Mixed
345
What is another name for a superficial or capillary hemangioma?
Strawberry hemangioma
346
Where are superficial or capillary hemoangiomas located?
Upper dermis
347
What is the time course for a superficial or capillary hemangioma?
Present at birth, gradually get larger, then resolve completely
348
When is treatment required for a superficial/capillary hemangioma?
When it interferes with vision, breathing, eating, hearing, or other normal functions
349
What is treatment for a superficial/capillary hemangioma?
Steroids and laser treatment
350
Where are deep/cavernous hemangiomas located?
Lower dermis, fat, muscle
351
What color are cavernous hemangiomas?
Often blue
352
What are treatment options for a cavernous hemangioma?
Steroids, laser, propranolol
353
What is the name for a hemangioma that enlarges rapidly?
Kasabach-Merritt Syndrome
354
What causes the hemangioma to enlarge rapidly in Kasabach-Merritt Syndrome?
Sequestration of platelets into the lesion
355
What are 2 problems with Kasabach-Merritt Syndrome?
1. Low platelet coutns
| 2. Vulnerability to bleeding
356
What type of lesions are at risk for transformation into melanoma?
Congenital melanocytic nevi
357
What type of nevi have the greatest risk for later transformation to melanoma?
Giant congenital nevi
358
What are 3 main risk factors for melanoma?
1. Sun exposure
2. Family history
3. Fair complexion
359
Describe how the risk for melanoma progresses.
Risk is cumulative- More sun exposure over time results in higher risk for malignant melanoma and other forms of skin cancer
360
True or False: Melanoma can appear in any part of the body (even those that have never seen the sun)
True
361
What are the ABCDs of melanoma?
Asymmetry
Borders (irregular, rough, notched)
Colors (unusual or change
Diameter (larger than 6mm)
