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General Peds Boards > Derm > Flashcards

Derm Flashcards

1
Q

Natural course of infantile hemangiomas

A
  • Generally appear in first 2 weeks of life
  • Reach maximum size by 3-6 months
  • Spontaneously involution at 10% per year (50% by 5 years, 90% by 10 years)
  • 50% of kids with untreated hemangiomas have residual scarring or discoloration
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2
Q

Anatomic locations you have to worry about infantile hemangiomas

A
  • Eyes (strabismus, amblyopia)
  • Nares (airway compromise)
  • Auditory canals (deafness)
  • Pharynx/larynx (airway compromise)
  • Liver (congestive heart failure)
  • Segmental lumbosacral (tethered cord, GU anomalies)
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3
Q

Treatment of hemangiomas

A
  • Pulsed dye laser

- Beta blockers (oral propranolol or topical timolol

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4
Q

Erythematous plaques with thick scales and areas of hemorrhage where scales have been removed (Auspitz sign)

A

Psoriasis

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5
Q

5 types of psoriasis

A
  • Plaque psoriasis - extensor surfaces most commonly but can be anywhere, often in areas of trauma (the Koebner phenomenon)
  • Scalp psoriasis
  • Nail psoriasis - have pitting of nails
  • Guttate psoriasis - precipitated by strep pyogenes
  • Diaper area psoriasis
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6
Q

Psoriasis cause and treatment

A
  • Genetic predisposition and environmental trigger
  • 30-50% onset before age 20
  • Topical steroid (low potency for face or groin) is first line
  • Other agents: topical calcipotriene, calcineurin inhibitors, retinoids, phototherapy, systemic agents
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7
Q

Infantile hemangioma normal time course

A
  • First 5 months: proliferation (most in months 1-2)
  • 6-12 months: growth lows and lesions begin to involute
  • Most kids have persistent telangiectasisa, redundant skin, fibrofatty tissue, or scars
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8
Q

Infantile hemangiomas requirement treatment

A
  • Tx: oral propranolol
  • Periocular (vision issues), nasal tip (can damage cartilage), lip (feeding troubles), beard area (may be associated with hemangiomas involving the airway), midline lumbosacral (can be associated with spinal issues)
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9
Q

Pruritic, scaly eruption that involves the interdigital spaces with scaling and fissuring

A

Tinea pedis

Tx: clotrimazole

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10
Q

Superficial erosions on plantar surface of foot, excessive foot moisture, foot order

A
  • Pitted keratolysis
  • Infection with organisms that produce proteases and degrade keratin
  • Tx: topical aluminum chloride and topical antibiotic
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11
Q

Clustered or group vesicles on an erythematous base in a neonate

A
  • Neonatal herpes
  • Most common on buttocks or scalp
  • Look for lesions not present at birth, could have mention of scalp probe
  • Dx with PCR swab of lesions
  • Tx with IV acyclovir
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12
Q

Neonate with vesicles in a linear pattern without an erythematous base

A

Incontinentia pigmenti

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13
Q

Neonate with multiple pustules, brown macules, vesicles, and pustules on a non-erythematous base

A

Transient neonatel pustular melanosis

  • Present at birth
  • More common in African Americans
  • Gram stain will show neutrophils without organisms
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14
Q

Neonate with yellow pustules on an erythematous base or generalized erythematous macules with solitary papules or vesicles in the center

A

Erythema toxicum neonatorum

  • Appears within a few days of birth (not present at birth)
  • Wright stain with eosinophils
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15
Q

Diaper dermatitis vs candidasis

A
  • Contact dermatitis willl often spare the creases

- Candidasis will have satellite lesions and be worse in the creases

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16
Q

Workup for infantile acne

A
  • Usually starts around 2-4 months of age and resolves at 6-12 months of age but if severe deserves workup for excess androgen cause
  • Check 17-hydroxyprogesterone levels
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17
Q

Location of fixed drug eruption

A

Hand, trunk, genital, perioral areas

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18
Q

Neonate with clustered or grouped vesicles on an erythematous base on teh buttocks or scalp

A

Neonatal herpes - watch for lesions not present at birth, also think about this if scalp pH monitor

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19
Q

Diagnosis/treatment of neonatal herpes

A
  • Wright stain with multinucleated giant cells and eosinophilic intranuclear inclusions
  • Can do surface culture or PCR
  • Tx with IV acyclovir
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20
Q

Neonate with vesicles in a linear pattern without an erythematous base

A

Incontinentia pigmenti

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21
Q

Multiple pustules, brown macules, vesciles, pustules on a non-erythematous base that is present at birth

A

Transient neonatal pustular melanosis

  • More common in African Americans
  • No treatment needed
  • Gram stain will show PMNs with no organisms
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22
Q

Neonate with yellow pustules on an erythematous base, not present at birth but presents within a few days

A

Erythema toxicum neonatorum

  • Can also have occasional vesicles
  • Wright stain will show eosinophils
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23
Q

Diffuse scaling and erythematous papules/pustules

A

Cutaneous candidiasis

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24
Q

Lichenification with scratching, commonly behind the knees and in antecubital areas

A

Atopic dermatitis

  • Family hx asthma and allergic rhinitis are common triggers
  • Also have high blood level IgE
  • Food infections are a trigger in up to 30% of cases but need allergy testing before you would eliminate foods
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25
Q

Tinea pedis rash location

A

NOT on the dorsal aspect

- Will be pruritic with scaling and peeling on the plantar aspect and lateral aspect of the foot

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26
Q

Inflamed eczema not responding to steroids and antibiotics

A

Eczema herpeticum

  • Vesicles, punched out lesions, crusted erosions
  • Tx with acyclovir
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27
Q

Greasy yellow patches on the scalp, face, behind the ears, in skin folds in first few months of life

A

Seborrheic dermatitis

  • Tx with antifungal washes and topical steroids
  • If also have profuse ear discharge or urine output think of Langerhans cell histiocytosis
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28
Q

Delayed hypersensitivity reaction after multiple exposures causing red, vesicular, crusting rash

A

Allergic contact dermatitis

  • Jewelry and poison ivy are typical examples
  • Primary irritant contact dermatitis occurs with the first time (soap/detergents)
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29
Q

Rash on pre-pubertal child on the feet with minimal scaling, thickening of the skin, hyper-linearity of distal soles with normal interdigital skin

A

Juvenile plantar dermatosis

- Tx with triamcinolone

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30
Q

Linear vesicles and papules

A

Poison ivy

  • Type 4 reaction
  • Rash is not contagious, fluid from the vesicles will not spread the rash
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31
Q

Silvery lesions on the elbows or knees, Auspitz sign (bleeding spots if plaques come off), erythematous plaques surrounded by thicken adherent scales, pinpoint areas of hemorrhage, thick scales on the scalp

A

Psoriasis

32
Q

Small oval scaling patches on trunk and back

A

Pityriasis Rosea

  • Herald patch in christmas tree pattern
  • Long axis of lesions parallel to the lines of skin stresss
33
Q

Rash with elevated border with central clearing on trunk

A

Tinea corporis

34
Q

Dry skin with thin scales that have a pasted on appearance in preschool years

A

Ichthyosis vulgaris

- Tx with keratolytic agents like ammonium creams or urea containing emollients

35
Q

Non scaling annular lesions without epidermal involvement

A

Granuloma annularea

- Remember non-scaling, skin will be intact

36
Q

MCC impetigo

A

Staph aureus but can also be strep

- Tx with mupirocin

37
Q

Staph scalded skin syndrome

A

Diffusely erythematous rash that is tender and red and spreads to a sheet like loss of skin

  • Due to toxin from staph aureus
  • Need antibiotics
38
Q

Rash triggered by infection like herpes simplex or medication

A

Erythema multiforme

- Starts on extremities and then spreads to teh trunk

39
Q

Bullous/target lesions that spread rapidly to involve mucosal membranes

A

Stevens Johnson

  • Rash is preceded by fever, muscle aches, and joint aches
  • Lesions involving mucosa frequently become encrusted
  • Tx is preventing dehydration and superinfection
40
Q

Common triggers for Stevens Johnson

A

Sulfa drugs, anticonvulsants, NSAIDs

41
Q

Sunburn like erythema and sheet like separation of skin with widespread bullae and denuded necrotic skin

A

Toxic epidermal necrolysis

  • Need biopsy to distinguish from staph scalded skin syndrome (TEN involves the dermis, SSSS does not)
  • TEN often is in older children, SSSS in younger children
  • TEN is a hypersensitivity reaction, not due to toxins
42
Q

Painful bluish lesions on the shin

A

Erythema nodosum

- Associated with TB, birth control pills, inflammatory bowel disease, fungal infections

43
Q

Erythematous macule on the trunk with central clearing

A

Erythema marginatum

- Rheumatic fever

44
Q

Intensely pruritic linear lesions that are papular or pustular with burrows and involvement between the digits

A

Scabies

  • Extremely contagious, often involves family members
  • Treat with permethrin cream including all household members
  • In infants can be on scalp, palms, or soles
45
Q

Intense scalp itching with excoriation on neck or behind ears in family members

A

Head lice

  • Nits are white dots that can’t be removed on teh hair shaft
  • Tx is permethin cream rinse that is repeated in a week and need to treat all household contacts
  • If itching after treatment may need to use steroid creams
46
Q

Random facts about lice

A
  • Can last 36 hours without a blood meal

- Fresh eggs on hair shafts can hatch 10 days later

47
Q

Signs of public lice

A
  • Blue/gray macules on abdomen or inner thigh
  • Suggestive of sexual abuse, not common in children
  • Tx is permethrin
48
Q

Pearly papules with central dimpling/umbilication

A

Molluscum contagiosum

  • Will clear in months to years
  • Wright staining has viral inclusion bodies
49
Q

Pink and excoriated pruritic erythematous papules with central punctum on extensor surfaces of arms/legs

A

Papular urticaria

  • Often are recurrent at night and may last up to 10 days
  • Due to delayed hypersensitvity reaction to an insect bite
  • No one else in the family is affected
50
Q

Cause of acne

A
  • Sebum made by sebaceous glands in reponse to androgen production
  • Propionibacterium acnes is the bacteria –> WBC –> pustules/inflammation
51
Q

Two types of non-inflammatory acne

A
  • Closed comedones - whiteheads - covered with epithelium

- Open comedones - blackheads - no covering (black covering is due to oxidation of melanin)

52
Q

Description of inflammatory acne

A

Erythematous papules, pustules, and nodules

53
Q

Small papules that are firm and may be pink, red, or brown

A

Adenoma sebaceum or angiofibromas

54
Q

Medication causes of acne

A

Systemic steroids, anticonvulsants (phenobarbital, phenytoin)

55
Q

Treatment options of acne

A
  • Salicylic acid reduces formation of obstructive lesions and is good for comedonal acne, good for large areas (chest/back)
  • Benzoyl peroxide is bactericidal so is good for inflammatory acne but can’t use with tretinoin
  • Topical antibiotics for inflammatory acne
  • Tretinoin is best for comedonal acne
  • Oral antibiotics for moderate to severe inflammatory acne (need to use backup contraception if on OCPs)
  • OCPs due to anti-androgeric effects
  • Isotretinoin: antibacterial, reduces sebum production, anti-inflammatory, destroys comedones
56
Q

Black dots or broken hairs on scalp with tender boggy areas of induration

A

Tinea capitis

  • Fungal culture is gold standard
  • Tx with oral griseofulvin
57
Q

Association with alopecia areata

A

Nail pitting

- There is no inflammation with alopecia

58
Q

Sudden loss of large amounts of hair during stressful events

A

Telogen effluvium

- Round patches, well defined, complete areas of hair loss

59
Q

Irregular patches of hair loss, incomplete patches of hair loss, hair shafts of different length

A

Trichotillomania or traction alopecia

60
Q

Pigmented lesions that flush or turn into hives and develop blisters with rubbing or scratching

A

Urticaria pigmentosa

  • Common in first 6 months of life
  • Pathognomic for presence of mast cells within the lesion
  • Infant should avoid narcotic pain relievers, radiocontrast material, NSAIDs but there is otherwise no treatment
61
Q

Persistent scalp or diaper sebborheic rash, chronic ear drainage, lytic lesions in skull or vertebrae, excessive urination

A

Langerhans cell histiocytosis

- Dx with skin biopsy and electron microscopy

62
Q

Hypopigmented patches that get worse with exposure to sun

A

Pityriasis veriscolor

  • Caused by a fungus, can see on KOH prep
  • Tx with astringents or topical antifungals
  • Could also use oral azoles if needed or topical selenium
63
Q

Lesions in 4 stages:

  • Erythematous papules/vesicles along lines of Blaschko for 1-2 weeks
  • Swirls of warty growths
  • Streaks of hyperpigmentation
  • Hypopigmentation
A

Incontinentia pigmenti

- X linked dominant, generally lethal in males

64
Q

Cause/treatment of vitiligo

A
  • Autoimmune destruction of melanocytes leading to depigmentation
  • Tx topical steroids and tacrolimus
65
Q

Hypopigmentation following inflammation in atopic skin

A

Pityriasis alba

66
Q

5 main characteristics of Sturge Weber

A
  • Port wine stain in a trigeminal distribution (nevus flammeus) –> can be associated with venous leptomeningeal angiomatosis on MRI
  • Developmental delay
  • Seizures (usually focal)
  • Hemiplegia
  • Vision problems/calcification/glaucoma (on same side as port wine stain)
67
Q

Seven diagnostic criteria for neurofibromatosis type 1 (Von Recklinghausen disease) - need 2/7

A
  1. 6 or more cafe au lait spots (must be > 5 mm in kids or > 15mm post pubertal)
  2. 2 or more lisch nodules (iris hamartomas seen on slit lamp exam)
  3. Neurofibromas (usually not until after puberty)
  4. Optic nerve glioma
  5. Inguinal and axillary freckling
  6. Tibial pseudoarthrosis
  7. First degree relative with NF1
68
Q

Genetics of NF1

A
  • Autosomal dominant on chromosome 17 - 50% are due to spontaneous mutations
69
Q

Complications of NF1

A
  • Renal artery stenosis
  • Pheochromocyotoma
  • Hypertension
70
Q

Characteristics of NF2

A
  • Acoustic neuroma (schwannoma)
  • Chromosome 22
  • Hearing loss or tinnitus, cataracts or hamartomas of retina
  • Diagnosis made by bilateral cranial nerve VIII masses on CT or MRI
71
Q

Diagnostic criteria for tuberous sclerosis (need 2)

A
  • More than 3 ash leaf spots (hypomelanotic macules)
  • Periventricular/cortical tubers (seizures)
  • Sebaceous gland hyperplasia (common on the face)
  • Shagreen patch (cobblestone appearing skin)
  • sub/periungual fibroma
  • cardiac rhabdomyoma
  • retinal nodular hamartomas
  • renal angiomyolipoma
72
Q

Developmental abnormalities of skin, teeth, nails, hair, sweat glands

A

Etodermal dysplasia

73
Q

Recurrent blistering of skin and mucosa after minor trauma as well as nail changes

A

Epidermolysis bullosa

74
Q

Infantile hemangioma life cycle

A

Located in upper dermis

  • Present at birth or shortly after, get larger until maximum at 6-9 months of age and then slowly involute over the years
  • Tx only required when hemangioma interferes with vision, breathing, eating, hearing, or other normal functions
75
Q

Blue hemangiomas in lower dermis, fat, muscle treatment

A

Cavernous hemangiomas

- Tx with steroids, laser, or propranolol

76
Q

Hemangioma that enlarged rapidly and low platelets

A

Kasabach-Merritt syndrome

General Peds Boards (24 decks)

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