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My Peds Prep > Derm > Flashcards

Derm Flashcards

1
Q

Clustered or grouped vesicles on an erythematous base in a neonate?

A

Neonatal herpes

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2
Q

What is seen on Wright stain in neonatal herpes?

A

Multinucleated giant cell and eosinophilic intranuclear inclusions

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3
Q

Where do lesions of neonatal herpes often appear?

A

Buttocks or scalp (Often presenting parts closest to maternal lesions)

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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

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5
Q

If you suspect neonatal herpes, what do you do?

A

Start IV acyclovir (even before confirmation of the diagnosis)

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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)

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7
Q

What can present as vesicles, but in a linear pattern without an erythematous base?

A

Incontinentia pigmenti

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8
Q

Multiple pustules, brown macules, vesicles, and pustules on a non-erythematou base?

A

Transient neonatal pustular melanosis

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9
Q

Leaving a collarette?

A

Transient neonatal pustular melanosis

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10
Q

When does transient neonatal pustular melanosis present?

A

At birth

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11
Q

Who is transient neonatal pustular melanosis more common in?

A

African American infants

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12
Q

What is the treatment for transient neonatal pustular melanosis?

A

Nothing

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13
Q

What is the natural course of the rash in transient neonatal pustular melanosis?

A

Starts as pustules, becomes hyperpigmented macules

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14
Q

What does Gram stain or Wright stain show for transient neonatal pustular melanosis?

A

PMNs without organisms

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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

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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

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17
Q

When does E-Tox usually present?

A

Within a few days of birth (not at birth)

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18
Q

What does Wright stain show for E-Tox?

A

Eosinophils

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19
Q

What does a Tzanck smear show for E-Tox?

A

Eosinophils, maybe neutrophils, otherwise negative

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20
Q

True or False: E-tox is present on the palms and soles?

A

False

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21
Q

True or False: E-Tox is common in preterm newborns?

A

False

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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)

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23
Q

What is the treatment for E-Tox?

A

Reassurance- Rash will fade within a week

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24
Q

What presents as diffuse scaling and erythematous papules and pustules?

A

Cutaneous Candidiasis

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25
Q

Lichenification with scratching?

A

Atopic dermatitis

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26
Q

What is the distribution for atopic dermatitis?

A

Behind knees, antecubital areas, dry/chapped hands

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27
Q

What is a crucial component of atopic dermatitis?

A

Itching

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28
Q

True or False: Heredity plays a big role in atopic dermatitis?

A

True

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29
Q

What are 2 other conditions that commonly go with atopic dermatitis?

A
  1. Allergic rhinitis

2. Asthma

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30
Q

What might be a lab finding in cord blood that would make you think atopic dermatitis?

A

High IgE

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31
Q

What are factors that can worsen atopic dermatitis?

A
  1. Allergens (food)
  2. Chemical irritants
  3. Heat
  4. Physical trauma
  5. Drying elements
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32
Q

In an infant with eczema, what % chance is there that food allergy is a factor?

A

30%

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33
Q

What types of foods are often allergen triggers for atopic dermatitis?

A

Milk, eggs, soy, wheat, peanuts

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34
Q

True or False: Negative testing can rule out a food allergy?

A

True

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35
Q

True or False: Positive testing verifies a food allergy?

A

False- Verification will require either a food challenge or skin testing

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36
Q

True or False: Food elimination is recommended for atopic dermatitis?

A

False- Food allergy is not a factor in up to 70% of cases and food elimination can have negative impact on nutrition

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37
Q

How does tinea pedis present?

A

Itchy rash with scaling/peeling, involves plantar aspect and sometimes lateral aspect of foot (dorsal aspect spared), maceration

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38
Q

How does atopic dermaitis present on the foot?

A

Scaly, dry with lichenification, dorsal aspect of foot involved (in tinea pedis there is maceration and sparing of the dorsal aspect of the foot)

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39
Q

Child with eczema who has oozing/crusting of the skin that isn’t responding to usual treatment modalities?

A

Superinfection

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40
Q

What bug should you direct treatment at for an eczema superinfection?

A

S. Aureus

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41
Q

What is eczema herpeticum?

A

Invasion of eczematous skin by herpes

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42
Q

Inflamed eczema which isn’t responding to steroids and antibiotics?

A

Eczema herpeticum

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43
Q

Classic description for eczema herpeticum?

A

Vesicles, punched out lesions, crusted erosions

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44
Q

Where does eczema herpeticum usually occur?

A

Face (primary herpes infection)

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45
Q

What behavior might pre-dispose a child to getting eczema herpeticum?

A

Sucking thumb/finger

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46
Q

What is treatment for eczema herpeticum?

A

Acyclovir

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47
Q

If you have a child with eczema and concern for immunodeficiency, what are 2 things you should consider?

A
  1. Wiskott-Aldrich Syndrome

2. Hyperimmunoglobulin E syndrome

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48
Q

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

A

Seborrheic Dermatitis

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49
Q

How is seborrheic dermaitis treated?

A

Regular antifungal washes

Topical steroids

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50
Q

Child with Seborrheic Dermatitis, profuse ear discharge, profuse urine output…?

A

Histiocytosis X

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51
Q

What is another name for seborrheic dermatitis of the scalp?

A

Cradle Cap

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52
Q

What is a rash that involves erythema, edema, vesicle formation, exudate, and scaling?

A

Eczema

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53
Q

Are atopic dermatitis and eczema the same thing?

A

No… nummular eczema and contact dermatitis are forms of non-atopic eczema

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54
Q

What are the 2 types of contact dermatitis?

A
  1. Allergic

2. Primary irritant

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55
Q

What causes allergic contact dermatitis?

A

Delayed hypersensitivity reaction (requires multiple exposures- don’t be tricked if its something the child always wears)

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56
Q

Describe the rash of allergic contact dermatitis

A

Red, vesicular, can be crusting

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57
Q

What are 2 examples of things that can cause allergic contact dermatitis?

A
  1. Jewelry

2. Poison ivy

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58
Q

What are things that can trigger primary irritant contact dermatitis?

A

Soaps and detergents

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59
Q

How long is the delay in primary irritant contact dermatitis?

A

No delay in reaction

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60
Q

How is poison ivy described?

A

Linear vesicles and papules

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61
Q

What type of hypersensitivity reaction is poison ivy?

A

Type 4

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62
Q

Does the rash of poison ivy spread?

A

No- It’s just the slower appearance of lesions in areas with milder exposure

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63
Q

What can help limit the rash of poison ivy?

A

Washing with soap and water immediately after exposure

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64
Q

What can be given for severe cases of poison ivy?

A

Oral steroids (sometimes up to 21 days)

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65
Q

True or False: Exposure to poison ivy during the winter can cause rash?

A

True

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66
Q

True or False: Exposure to aerosolized poison ivy can cause rask (like if someone is raking it up a distance away)

A

True

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67
Q

True or False: Fluid from vesicles of poison ivy spreads the rash?

A

False

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68
Q

True or False: Poison Ivy rash is contagious?

A

False

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69
Q

True or False: Barrier preparations protect from poison ivy exposure?

A

True

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70
Q

True or False: There are no desensitization treatments available for poison ivy?

A

True

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71
Q

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?

A

Triamcinolone (this is juvenile plantar dermatosis)

*Not tinea pedis because of minimal scaling, interdigital skin being involved, and tinea pedis rarely happening before puberty

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72
Q

What type of dermatitis is juvenile plantar dermatosis?

A

Contact

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73
Q

What is juvenile plantar dermatosis a result of?

A

Occlusive shoes and synthetic sock

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74
Q

Silvery lesions on the elbows or knees?

A

Psoriasis

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75
Q

What happens when you pick off spots in psoriasis and what is this called?

A

Leave behind bleeding spots the size of pins- Auspitz sign

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76
Q

“Erythematous plaques surrounded by thick adherent scales”, “Pinpoint areas of hemorrhage”, “Thick scales on the scalp”

A

Psoriasis

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77
Q

What are 4 other conditions psoriasis might be confused with?

A
  1. Non-bullous impetigo
  2. Nummular eczema
  3. Pityriasis rosea
  4. Tinea corporis
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78
Q

How is non-bullous impetigo described?

A

Oozing and crusting

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79
Q

How is nummular eczema described?

A

Round, oozing, crusting erosions, dry macules with a fine scaly pattern

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80
Q

How is pityriasis rosea described?

A

Small oval, thick scaling plaques, long axis of the lesions parallel to the lines of skin stress

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81
Q

How is tinea corporis described?

A

Scaly lesions, but thin rather than thick, has central clearing

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82
Q

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?

A

Pityriasis rosea

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83
Q

What is treatment for pityriasis rosea?

A

Not necessary- can try exposure to sun or other light (improves symptoms and can hasten resolution)

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84
Q

What are 4 rashes pityriasis rosea can be confused with?

A
  1. Secondary syphilis
  2. Nummular eczema
  3. Tinea corporis
  4. Tinea versicolor
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85
Q

How do you distinguish pityriasis from secondary syphilis?

A

Rash appears similar- Syphilis has fever/generalized lymphadenopathy. Syphilis often involves palms/soles, pityriasis doesn’t.

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86
Q

How do you distinguish nummular eczema and tinea corporis from pityriasis?

A

Herald patch can look the same…

  • Tinea corporis has elevated border with central clearing
  • Nummular eczema has crusting erosions
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87
Q

How do you distinguish tinea versicolor from pityriasis?

A

Tinea will be described as hyper/hypo-pigmented scaling macules

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88
Q

Dry skin with thin scales that have a pasted-on appearance?

A

Ichthyosis Vulgaris

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89
Q

When does icththyosis present?

A

Pre-school years

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90
Q

What is the treatment for Ichthyosis

A
  1. Keratolytic agents- Ammonium lactate creams
  2. Alpha hydroxy acid
  3. Urea-containing emollients
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91
Q

What % of patients with ichthyosis have atopic dermatitis too?

A

50%

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92
Q

What is a benign inflammatory condition that manifests as non-scaling annular lesions without epidermal involvement?

A

Granuloma annulare

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93
Q

What caues granuloma annulare?

A

Don’t know

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94
Q

What is the key part to distinguish granuloma annulare from ringworm?

A

Granuloma annulare is NON-SCALING

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95
Q

What is a papule caused by atypical mycobacteria and found on the sole of a child who likes walking bearfoot?

A

Swimming pool granuloma

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96
Q

How do you distinguish between swimming pool granuloma and granuloma annulare?

A

Swimming pool has a break in the skin, granuloma annulare skin is intact

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97
Q

What causes impetigo?

A

Strep or staph

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98
Q

What is the most likely cause of bullous impetigo and crusted impetigo?

A

S. Aureus

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99
Q

What is treatment for impetigo?

A

Mupirocin

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100
Q

True or False: Treatment of strep skin infection prevents post-strep GN?

A

False

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101
Q

What are the 4 key elements for cellulitis?

A
  1. Red
  2. Hot
  3. Tender
  4. Swollen
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102
Q

What are the 2 most common causes of cellulitis?

A
  1. Strep pyogenes

2. Staph aureus

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103
Q

If there is a low likelihood of MRSA, what is the treatment for cellulitis?

A

Cephalexin or amoxicillin0clavulanate

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104
Q

If cellulitis is more advanced or you are concerned about MRSA (more prevalent in community), what is the treatment?

A

Clindamycin, trimethoprim-sulfamethoxazole, or doxycycline (if child is older than 8)

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105
Q

What is due to an exotoxin produced by S. Aureus?

A

Staph Scalded Skin Syndrome

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106
Q

What causes toxic shock syndrome?

A

Toxin production by either S. Aureus or Strep

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107
Q

Which has a higher mortality… Strep TSS or Staph TSS?

A

Strep

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108
Q

What causes scarlet fever?

A

Erythrogenic exotoxin produced by group A strep

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109
Q

What does scarlet fever most commonly occur in association with?

A

Strep Pharyngitis

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110
Q

What are 3 dermatological conditions caused by toxin-producing bacteria?

A
  1. SSS
  2. TSS
  3. Scarlet Fever
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111
Q

Rash in a preschooler that starts out very tender and red, and spreads to become a sheet-like loss of skin?

A

SSS

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112
Q

What causes SSS?

A

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)

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113
Q

What is treatment for SSS?

A

Antibiotics

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114
Q

What is erythema multiforme?

A

Hypersensitivity reaction in response to a veriety of triggers

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115
Q

What are the two forms of erythema multiforme?

A

Major and minor

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116
Q

What is the “buzzword” for erythema multiforme?

A

Target lesion

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117
Q

True or False: Children under 3 are often the patients that get erythema multiforme minor?

A

False (children under 3 rarely present with this)

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118
Q

What is the most likely trigger for erythema multiforme minor?

A

Primary or recurrent infection with Herpes Simplex

medications may also cause this

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119
Q

Where does the rash of erythema multiforme minor initially present then spread?

A

Appears abruptly on extremities then spreads to the trunk

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120
Q

What is treatment for erythema multiforme minor?

A

Treating the underlying infection or stopping the medication (AKA… geared towards triggering agent)

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121
Q

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?

A

Erythema multiforme minor (especially with child being well-appearing… vs. erythema multiforme major/SJS)

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122
Q

What comes before the rash in SJS?

A

Fever, muscle aches, and joint aches

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123
Q

Describe the rash in SJS

A

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)

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124
Q

What often happens to the lesions involving the mucosa in SJS?

A

They become encrusted

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125
Q

Name 3 typical medications that can trigger EM major

A
  1. Sulfa drugs
  2. Anticonvulsants
  3. NSAIDs
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126
Q

How is EM major/SJS treated?

A
  1. Prevent dehydration
  2. Prevent superinfection
    - Patients often managed in a burn unit
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127
Q

True or False: There is separation of the skin in sheets in SJS?

A

False- separation of skin in sheets is in SSS

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128
Q

What is the most severe form of erythema multiforme major?

A

TEN

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129
Q

Describe the skin in TEN

A

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

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130
Q

How do you distinguish SSSS from TEN?

A

Biopsy

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131
Q

What is the difference in biopsy between TEN and SSSS?

A
  • TEN involves dermis (like SJS)

- SSSS usually does not involve dermis

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132
Q

What age groups typically get SSSS v. TEN?

A

SSSS usually affects infants and younger children

TEN usually affects older children

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133
Q

Which has a higher mortality, TEN or SSSS?

A

TEN

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134
Q

What causes TEN?

A

Hypersensitivity reaction (NOT due to a toxin)

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135
Q

What are 2 forms of Erythema Multiforme Major?

A
  1. SJS

2. TEN

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136
Q

Boggy and blue ulcers with a necrotic base?

A

Pyoderma gangrenosum

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137
Q

What is pyoderma gangrenosum usually associated with?

A

Systemic disease

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138
Q

What 3 things does toxic shock syndrome present with?

A
  1. Fevers
  2. Hypotension
  3. Rash
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139
Q

Child comes in with sepsis-like picture and a rash…?

A

TSS

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140
Q

True or False: Tampons do not cause most cases of TSS anymore

A

True

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141
Q

What is treatment for TSS?

A

Antibiotics and aggressive supportive care

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142
Q

Erythema associated with SJS, oral lesions, mucous membrane involvement (anal/genital), foot involvement, starts with fever and other general symptoms?

A

Erythema multiforme

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143
Q

5th disease, slapped cheek fever, associated with Parvovirus B19?

A

Erythema infectiosum

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144
Q

Rash associated with Lyme disease (carditis, arthritis, neuritis), rash migrates?

A

Erythema chronicum migrans

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145
Q

What % of cases of Lyme have the classic bullseye rash?

A

70%

146
Q

Rash that causes painful bluish lesions on the shin?

A

Erythema nodosum

147
Q

What is erythema nodosum assocaited with?

A
  1. TB
  2. Birth control pills
  3. IBD
  4. Fungal infections
148
Q

Rash associated with rheumatic fever (one of the major Jones criteria)?

A

Erythema marginatum

149
Q

Describe erythema marginatum?

A

Erythematous macule on the trunk which clears centrally

150
Q

Pruritic linear lesions that are papular or pustular, burrows, involvement between the digits?

A

Scabies

151
Q

True or False: Scabies is high contangous and affects other family members?

A

True (if the say no other family members are affected, consider something else- papular urticaria)

152
Q

What is classic/pathognomonic for scabies?

A

Burrows

153
Q

How is scabies usually diagnosed?

A

Clinically… can be confirmed by identifying mites/eggs in skin scrapings

154
Q

How is scabies treated?

A

Permethrin 5% cream (Elimite)

155
Q

Do household contacts need to be treated for scabies?

A

Yes

156
Q

In infants, what 2 unusual spots can you see scabies?

A
  1. Scalp

2. Palms/soles

157
Q

2 kids from same family with intense scalp itching and excoriation on the nape of the neck and/or behind the ears?

A

Head Lice

158
Q

How are nits from lice described?

A

On the hair shafts, white dots that can’t be removed

159
Q

What is primary treatment for lice?

A

Permethrin cream rinse

160
Q

How long does permethrin cream rinse need to be used for lice?

A

Initial treatment, then repeat a week after first application

161
Q

Besides treating the patient, what 2 other things needs done for lice treatment?

A
  1. House should be thoroughly cleaned

2. Close household contacts treated preventatively

162
Q

In lice, do asymptomatic classmates need treated?

A

No

163
Q

True or False: Many areas of the country have lice resistant to permethrin?

A

True (there are many more expensive alternatives to try, but make sure they used permethrin correctly before doing this)

164
Q

True or False: Even after successful treatment of lice, itching can continue?

A

True

165
Q

What causes continued itching after treatment for lice?

A

Inflammatory reaction

166
Q

What can help with the continued itching after treatment for lice?

A

Steroid creams, diphenhydramine, hydroxyzine

167
Q

True or False: Nits must be removed before kids with lice can return to school?

A

False

168
Q

How long ca lice live without a blood meal?

A

36 hours

169
Q

How long until fresh lice eggs on hair shafts can hatch?

A

10 days later

170
Q

True or False: Public lice can live in other locations?

A

True (like facial hair)

171
Q

True or False: Head lice are slower moving than pubic lice?

A

False

172
Q

Which type of lice impacts all races equally?

A

Pubic lice

173
Q

Who does head lice rarely infest?

A

African Americans

174
Q

What are pubic lice strongly suggestive of in children?

A

Sexual abuse (head lice are common in children, but public crab lice aren’t)

175
Q

What are maculae caeruleae?

A

Blue-gray macules on the abdomen or inner thigh

176
Q

What are maculae caeruleae consistent with?

A

Pubic lice

177
Q

What is treatment for pubic lice?

A

Permethrin (same as head lice)

178
Q

What is treatment for crabs (pubic lice) in the eyelashes?

A

Petroleum jelly applied TID for 10 days

179
Q

Pearly papules with central dimpling?

A

Molluscum contagiosum

180
Q

What is treatment for molluscum?

A

Nothing- it will clear in months to years

181
Q

How is molluscum differentiated from warts and comedones?

A

By the central umbilication seen in molluscum

182
Q

What is seen on wright staining in molluscum?

A

Viral inclusion bodies

183
Q

Pink/excoriated pruritic lesions on the extensor surfaces of the arms and legs?

A

Papular urticaria

184
Q

Clustered erythematous papules with a central punctum that recur episodically, often at night?

A

Papular urticaria

185
Q

How long can the lesions with papular urticaria last?

A

Up to 10 days

186
Q

How is papular urticaria differentiated from scabies?

A

No other family members are affected

187
Q

What causes papular urticaria?

A

Delayed hypersensitivity reaction to an insect bite

188
Q

What is the best management for papular urticaria?

A

ID the causative agent (so family can eliminate it)

189
Q

Honey colored crusted lesions that are not recurrent of episodic?

A

Non-bullous impetigo

190
Q

Translucent papules with central umbilication, no period with complete absence of lesions?

A

Molluscum contagiosum

191
Q

What is one specific feature that differentiates molluscum from papular uritcaria?

A

Molluscum has no period with compelte absence of lesions

192
Q

Small papules that appear in lines (not clusters)?

A

Scabies

193
Q

How can the distribution of lesions with scabies versus papular urticaria distinguish between the two?

A

Scabies appears in lines, papular uritcaria in clusters

194
Q

What are 3 rashes that might be confused with papular urticaria?

A
  1. Non-bullous impetigo
  2. Molluscum contagiosum
  3. Scabies
195
Q

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?

A

Papular urticara (don’t be tempted to pick scabies… no one else in family is affected)

196
Q

What is produced in the skin in response to androgen production (in both girls and boys)?

A

Sebum

197
Q

What does sebum form?

A

A plug which causes mature comedones

198
Q

What is the bacteria most often associated with acne?

A

Propionibacterium acnes

199
Q

What are the 2 major causes of acne vulgaris?

A
  1. Inflammatory

2. Non-inflammatory

200
Q

What 2 things does non-inflammatory acne consist of?

A
  1. Closed Comedones

2. Open Comedones

201
Q

What is a closed comedone?

A

Whitehead- follicles that are plugged, but covered with epithelium

202
Q

What is an open comedone?

A

Blackheads- No epithelial covering

203
Q

What causes the black color in a blackhead?

A

Melanin (not dirt)

204
Q

What should the appearance of comedones prior to age 8 make you think of?

A

Precocious puberty

205
Q

What 2 things in addition to acne warrant an endocrine workup?

A
  1. Hirsutism

2. Menstrual irregularity

206
Q

If you have a child with acne plus hirsutism or menstrual irregularly, what should they bet worked up for?

A

Polycystic ovary disease

207
Q

What 3 things does inflammatory acne consist of?

A
  1. Papules
  2. Pustules
  3. Nodules (cysts)
208
Q

What are papules?

A

Small, red, solid lesions

209
Q

What is something that can be mistaken for a papule due to acne?

A

Adenoma sebaceum

210
Q

What is another name for ademona sebaceum?

A

Angiofibroma

211
Q

What is a small papule that is firm and may appear pink, red, or brown in color?

A

Adenoma sebaceum/Angiofibroma

212
Q

If you have inflammatory acne with lots of papules that is resistant to treatment (espiecally on nose/cheeks) what should you consider?

A

Angiofibroma/Adenoma sebaceum

213
Q

What type of skin lesions are superficial and filled with pus?

A

Pustule

214
Q

Describe a nodule (cyst)?

A

Deep, located in the dermis, red/painful

215
Q

What type of skin lesions can lead to permanent scarring?

A

Nodule (cyst)

216
Q

What 2 drugs can lead to acne?

A
  1. Systemic steroids

2. Anticonvulsants (phenobarbital/phenytoin)

217
Q

Where does acne from systemic steroids appear primarily?

A

Trunk

218
Q

Kid with acne mostly on trunk… what should you consider?

A

If they have any other conditions that might result in them needed systemic steroids

219
Q

What 3 things does acne treatment depend on?

A
  1. Type of lesion
  2. Age of patient
  3. Distribution of lesion
220
Q

True or False: Poor hygiene/improper bathing habits causes acne?

A

False

221
Q

What must you do for psychological care of a teen with acne?

A

Reassure them that this is a normal part of growth/development

222
Q

True or False: Chocolate doesn’t cause or accelerate acne?

A

True

223
Q

Why shouldn’t teens vigorously scrub or squeeze pimples?

A

Can lead to permanent scarring

224
Q

What is the treatment for neonatal acne?

A

None

225
Q

How does benzoyl peroxide function?

A

Primarily bactericidal

226
Q

How can the irritating effects of benzoyl peroxide be reduced?

A

If the right formulation is used

227
Q

What effects to topical antibiotics have for acne?

A
  1. Bactericidal

2. Anti-inflammatory

228
Q

What is the most commonly used topical antibiotic for acne?

A

Topical clindamycin

229
Q

What type of acne are topical antibiotics typically used for?

A

Inflammatory acne

230
Q

What is tretinoin derived from?

A

Vitamin A

231
Q

How does tretinoin help prevent acne?

A

Halts the process that plugs hair follicles

232
Q

What can topical tretinoin result in with initiation of use?

A

An initial flare-up of acne

233
Q

What effects to oral antibiotics have for acne?

A

Anti-inflammatory

234
Q

When are oral antibiotics used for acne?

A

When it is severe inflammatory acne

235
Q

What location of acne are oral antibiotics particularly effective against?

A

Trunk

236
Q

What are the 3 most commonly used oral antibiotics for acne?

A
  1. Tetracycline
  2. Doxycycline
  3. Minocycline
237
Q

Why is continued use of oral antibiotics for acne not appropriate?

A

Because bacterial resistance is a problem (acne can be controlled, but oral antibiotics don’t cure it)

238
Q

Why are OCP’s helpful in treating severe acne?

A

Because of the anti-androgenergic effects of estrogen

239
Q

What 4 things does isotretinoin (Accutane) do?

A
  1. Antibacterial
  2. Reduces sebum production
  3. Anti-inflammatory
  4. Destroys comedones
240
Q

What is isotretinoin often used in combination with?

A

Benzoyl peroxide

241
Q

Who is isotretinoin often used in?

A

Patients with multiple inflammatory lesions (because it helps reduce the formation of new lesions)

242
Q

What can worsen acne when taken at the same time as isotretinoin?

A

Steroids

243
Q

What has to be ruled out before isotretinoin can be prescribed?

A

Pregnancy- This needs to be ruled out before, during, and after treatment

244
Q

Name 5 side effects of isotretinoin

A
  1. Dry lips
  2. Dry skin
  3. Dry eyes
  4. Nosebleeds
  5. Headaches
245
Q

What should you think of with hair loss and black dots or broken hairs noted on exam?

A

Tinea capitis

246
Q

What might you find on scalp exam for tinea capitis?

A

Kerions

247
Q

What is a kerion?

A

Tender, boggy areas of induration

248
Q

What is gold standard for diagnosis of tinea capitis?

A

Fungal culture

249
Q

What is treatment for tinea capitis?

A

Oral griseofulvin for 6-12 weeks

250
Q

True or False: Alternatives for griseofulvin like oral fluconazole or terbinafine are acceptable for tinea cpitis?

A

True

251
Q

True or False: A set of routine labs must be obtained prior to starting griseofulvin?

A

False

252
Q

What condition causes hair loss with NO inflammation?

A

Alopecia Areata

253
Q

What causes alopecia areata?

A

Unknown

254
Q

What other dermatological finding can be seen in alopecia areata?

A

Nail pitting

255
Q

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?

A

Alopecia areata- Reassurance (could do steroids)

-Nail pitting makes this alopecia areata v. traction alopecia

256
Q

What describes the sudden loss of large amounts of hair during routine activities such as washing and brushing the hair?

A

Telogen Effluvium

257
Q

What type of hair loss is often triggered by stressful events (febrile illness, surgery, emotional stress)?

A

Telogen Effluvium

258
Q

Complete areas of hair loss that are well defined round patches?

A

Telogen Effluvium

259
Q

What can be seen on microscopic exam of shedded hairs in telogen effluvium?

A

Telogen bulbs

260
Q

How is telogen effluvium distinguished from other forms of hair loss?

A

No inflammatory reaction

261
Q

What type of hair loss is caused by tight pulling (hair in braids or trichotillomania)?

A

Traction alopecia

262
Q

What is trichotillomania?

A

Habit of pulling on one’s own hair

263
Q

What type of hair loss do you see irregular patches of hair loss or incomplete patches of hair loss?

A

Traction alopecia

264
Q

What finding can help to distinguish traction alopecia from other forms of alopecia?

A

Hair shafts of different lengths

265
Q

What refers to a group of non-inherited disorders with excess mast cell degranulation and mast cell accumulation in various tissues?

A

Mastocytosis

266
Q

What is the most common form of mastocytosis?

A

Urticaria Pigmentosa

267
Q

Pigmented lesions that turn into hives and develop blisters (particularly with rubbing)?

A

Urticaria Pigmentosa

268
Q

What age group is urticaria pigmentosa typically described in?

A

Infant during first 6 months of life

269
Q

What is the Darier sign?

A

Pigmented lesions that turn into hives and develop blisters (especially with rubbing)

270
Q

What condition is the Darier Sign seen with?

A

Urticaria Pigmentosa

271
Q

What is treatment for urticaria pigmentosa?

A

No treatment is needed

272
Q

What 3 things should infants with urticaria pigmentosa avoid?

A
  1. Narcotic pain relievers
  2. Radiocontrast material
  3. NSAIDs
273
Q

Hypopigmented patches that get worse with sun exposure

A

Tinea versicolor

274
Q

What causes tinea versicolor?

A

Fungus

275
Q

What confirms diagnosis of tinea versicolor?

A

KOH prep

276
Q

What is the treatment for tinea versicolor?

A
  1. Astringents (strip superficial layers that are primarily involved)
  2. Topical antifungal creams
277
Q

What is important in management of tinea versicolor?

A

Sun deprivation- May take a few months to get rid of it

278
Q

What oral medications may be considered appropriate in certain situations for tinea versicolor?

A

Oral ketoconazole, fluconazole, and itraconazole

279
Q

Besides astringents and topical antifungal creams, what else can be used for tinea versicolor?

A

Topical selenium sulfide

280
Q

What skin mark may appear similar to tinea versicolor?

A

Ash leaf spot (seen in tuberous sclerosis)

281
Q

How is incontinentia pigmenti inherited?

A

X-linked dominant

282
Q

Who is affected worse by incontinentia pigmenti, boys or girls?

A

Boys- this is lethal in males

283
Q

What are 4 stages of skin lesions in incontinentia pigmenti?

A
  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
Q

What is an acquired autoimmune destruction of melanocytes leading to depigmentation?

A

Vitiligo

285
Q

What causes vitiligo?

A

Exact cause unknown, appears to be a genetic component

286
Q

What is treatment for vitiligo?

A
  1. Topical steroids

2. Tacrolimus/Pimecrolimus

287
Q

What is the natural course of vitiligo?

A

Most cases slowly progressive, some exhibit spontaneous repigmentation

288
Q

What is pityriasis alba?

A

Post-inflammatory hypopigmentation seen in atopic skin

289
Q

What is the difference between pityriasis alba and vitiligo?

A

Pityriasis has hypopigmentation, vitiligo complete depigmentation

290
Q

Name 5 characteristics of Sturge Weber

A
  1. Port wine stain in trigeminal distribution
  2. Developmental delay
  3. Seizure
  4. Hemiplegia
  5. Vision problems/calcification/glaucoma
291
Q

What is another name for a port wine stain?

A

Nevus flammeus

292
Q

In Sturge Weber, does glaucoma occur on the same or contralateral side as the port wine stain?

A

Same side

293
Q

In Sturge Weber, do the focal seizures occur on the same or contralateral side as the port wine stain?

A

Contralateral

294
Q

What CNS finding is the port wine stain in Sturge Weber often associated with?

A

Venous leptomeningeal angiomatosis

295
Q

How is a venous leptomeningeal angiomatosis (seen with port wine stain in Sturge Weber) identified?

A

By MRI

296
Q

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?

A

False (You can have a venous leptomeningeal angiomatosis even with no skin lesion)

297
Q

How can a port wine stain with Sturge Weber be treated?

A

Tunable dye (pulsed dye) laser

298
Q

Besides Sturge Weber, what other syndrome can present with a port wine stain?

A

Klippel Trenaunay Weber Syndrome

299
Q

What % of children with a facial port wine stain have Sturge Weber?

A

8%

300
Q

What increases the likelihood of a port wine stain being due to Sturge Weber syndrome

A

If it is distributed along branches of trigeminal nerve

301
Q

If you have a port wine stain in the distribution of the trigeminal nerve concerning for Sturge Weber, what needs done?

A

Immediate referral to opthalmology

302
Q

What are genodermatoses?

A

Inherited single-gene disorders with skin manifestations

303
Q

What are 7 genodermatoses?

A
  1. Neurofibromatosis
  2. Ataxia telangiectasia
  3. Incontinentia pigmenti
  4. Garder syndrome
  5. Peutz-Jeghers
  6. Xeroderma pigmentosum
  7. Epidermolysis bullosa
304
Q

What 3 main categories does neurofibromatosis effect?

A
  1. Skin
  2. CNS
  3. Orthopedic
305
Q

Which type of neurofibromatosis is more peripheral and which is more central?

A

1- Peripheral

2- Central

306
Q

What is another name for Von Recklinghausen Disease?

A

Neurofibromatosis Type 1

307
Q

Name the 7 criteria that can involved with neurofibromatosis.

A
  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
Q

What size do Café Au Lait spots have to be in kids to fit criteria for neurofibromatosis type 1?

A

> 5mm wide

309
Q

What is a Lisch Nodule?

A

An iris hamartoma

310
Q

When do Lisch Nodules develop in neurofibromatosis type 1?

A

May not develop until adulthood

311
Q

What is required to see a Lisch Nodule?

A

Slit-lamp exam

312
Q

When do neurofibromas typically show up in neurofibromatosis type 1?

A

After onset of puberty

313
Q

Of the 7 criteria, how many are required to make the diagnosis of NF1?

A

2/7

314
Q

If you have a patient with 1/7 criteria for neurofibromatosis, what can help to make the diagnosis?

A 
Genetic test (can be confirmatory)
-Diagnosis is typically clinical)
315
Q

Which type of neurofibromatosis is sometimes known as central neurofibromatosis and why?

A

NF-2, higher incidence of meningiomas and acoustic neuromas

316
Q

How is neurofibromatosis type 1 inherited?

A

Autosomal dominant

317
Q

Which chromosome is the gene for NF1 on?

A

17

318
Q

What % chance does a parent with NF1 have to transmit this to any one child?

A

50%

319
Q

What % of cases of NF1 are due to spontaneous mutation?

A

50%

320
Q

What are neurofibromas?

A

Skin lesions that either appear on the surface or deep in the skin (found by palpation)

321
Q

What vital sign abnormality needs to be monitored in kids with NF1?

A

BP- They can get pheochromocytoma and renal artery stenosis which can cause HTN

322
Q

What are the classic features with neurofibromatosis type 2?

A

Acoustic neuroma- schwannoma

323
Q

What chromosome is neurofibromatosis type associated with?

A

22

324
Q

How do patient with neurofibromatosis type 2 usually present?

A

Hearing loss or tinnitus related to their acoustic neuromas

325
Q

Other than hearing loss or tinnitus, how else can a child with neurofibromatosis type 2 present?

A

Ocular symptoms- due to cataracts or hamartomas of the retina

326
Q

How is definitive diagnosis of neurofibromatosis type 2 made?

A

Bilateral cranial nerve VIII masses on CT or MRI

327
Q

What can help support the diagnosis of neurofibromatosis type 2?

A

Presence of family history of NF2 along with schwannoma, neurofibroma, meningioma, glioma, or juvenile cataracts.

328
Q

Name the 8 features of Tuberous Sclerosis.

A
  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
Q

What portion of cases of tuberous sclerosis develop cardiac rhabdomyoma?

A

Half (especially in infants)

330
Q

What might adenoma sebaceum with tuberous sclerosis might be mistaken for?

A

Acne vulgaris

331
Q

How many of the 8 criteria for tuberous sclerosis are needed for diagnosis?

A

2/8

332
Q

What is another name for a hypomelanotic macule?

A

Ash leaf spot (Hypopigmented skin- ash colored)

333
Q

What is often the earliest sign of Tuberous sclerosis?

A

Ash Leaf Spots

334
Q

What is sometimes needed to visualize an ash leaf spot?

A

Wood’s lamp

335
Q

Where is sebaceous gland hyperplasia (or adenomas) usually described in Tuberous sclerosis?

A

On the face

336
Q

What is the name for cobblestone appearing skin which can be seen in tuberous sclerosis?

A

Shagreen patch

337
Q

What feature of tuberous sclerosis typically presents and manifests as seizures?

A

Periventricular/Cortical tubers

338
Q

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?

A

Ectodermal dysplasia

339
Q

What are the group of inherited disorders that manifest as epithelial fragility?

A

Epidermolysis bullosa

340
Q

Who should you suspect epidermolysis bullosa in?

A

Infants and children presenting with recurrent blistering of the skin and mucosa after minor trauma as well as nail changes

341
Q

What is the common feature between ectodermal dysplasia and epidermolysis bullosa?

A

Both involve skin and nails

342
Q

How can you distinguish between ectodermal dysplasia and epidermolysis bullosa?

A

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
Q

What is a benign neoplasm made up of prolferative and hyperplastic vascular endothelium?

A

Hemangioma

344
Q

What are the 3 categories of hemangiomas?

A
  1. Superficial
  2. Deep
  3. Mixed
345
Q

What is another name for a superficial or capillary hemangioma?

A

Strawberry hemangioma

346
Q

Where are superficial or capillary hemoangiomas located?

A

Upper dermis

347
Q

What is the time course for a superficial or capillary hemangioma?

A

Present at birth, gradually get larger, then resolve completely

348
Q

When is treatment required for a superficial/capillary hemangioma?

A

When it interferes with vision, breathing, eating, hearing, or other normal functions

349
Q

What is treatment for a superficial/capillary hemangioma?

A

Steroids and laser treatment

350
Q

Where are deep/cavernous hemangiomas located?

A

Lower dermis, fat, muscle

351
Q

What color are cavernous hemangiomas?

A

Often blue

352
Q

What are treatment options for a cavernous hemangioma?

A

Steroids, laser, propranolol

353
Q

What is the name for a hemangioma that enlarges rapidly?

A

Kasabach-Merritt Syndrome

354
Q

What causes the hemangioma to enlarge rapidly in Kasabach-Merritt Syndrome?

A

Sequestration of platelets into the lesion

355
Q

What are 2 problems with Kasabach-Merritt Syndrome?

A
  1. Low platelet coutns

2. Vulnerability to bleeding

356
Q

What type of lesions are at risk for transformation into melanoma?

A

Congenital melanocytic nevi

357
Q

What type of nevi have the greatest risk for later transformation to melanoma?

A

Giant congenital nevi

358
Q

What are 3 main risk factors for melanoma?

A
  1. Sun exposure
  2. Family history
  3. Fair complexion
359
Q

Describe how the risk for melanoma progresses.

A

Risk is cumulative- More sun exposure over time results in higher risk for malignant melanoma and other forms of skin cancer

360
Q

True or False: Melanoma can appear in any part of the body (even those that have never seen the sun)

A

True

361
Q

What are the ABCDs of melanoma?

A

Asymmetry
Borders (irregular, rough, notched)
Colors (unusual or change
Diameter (larger than 6mm)

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