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Flashcards in Derm from Book ?s Deck (58):
1

What characterizes erythema toxicum neonatorum?

--transient, benign, self-limited skin rash with lesions of varied morphology
--erythematous macules; wheals, vesicles, and pustules in 50-60% of all newborns
--lesions usually arise from erythematous base, with macular erythema fading w/in 2-3 days
--occurs predominantly on the trunk, but may occur anywhere except soles and palms

2

In order to confirm dx of Erythema toxicum neonatorum, you order a Wright's stained smear. If your dx is correct, what are the suspected results?
a) Presence of eosinophils
b) Presence of neutrophils
c) Presence of keratinous material
d) Presence of Staphylococcus aureus

a) Presence of eosinophils

--Wright's stained smears of pustules identifies predominance of 90% eosinophils rather than neutrophils
--> rules out neonatal pustular melanosis

3

Best tx for Erythema toxicum neonatorum?

no tx necessary!
--condition will resolve spontaneously in 5-7 days

(is benign and self-limiting)

4

You examine a newborn and observe numerous white papular lesions on the cheeks, forehead, and nose. You suspect either milia or neonatal acne. Which physical findings helps to confirm a dx of milia?
a) papular lesions are intermixed w/pale yellow macules
b) papular lesions have an erythematous circular ring at the base
c) papular lesions are surrounded by lacy-blue area w/erythematous mottling
d) papular lesions, yellow in color, are observed on the hard palate

d) papular lesions, yellow in color, are observed on the hard palate

--in milia, there is an oral counterpart of yellow, papular lesions on the hard palate... aka Epstein's Pearls!
(these do not occur in neonatal acne)

5

What is a port-wine stain?

aka nevus flammeus
--irregular dark red or purple macular lesions occurring on any body surface, predominantly on face and head
--never fade and become thickened and raised in adulthood

6

Management/counseling for port-wine stain?

--referral for derm eval for consideration of pulsed dye laser tx
--> recommended to start as early as possible in infancy and definitely before 1 year of age
--area may be camouflaged later in childhood with water-resistant cosmetics
--using a steroid cream is not indicated

7

Which condition is thought to be more apparent in darker-skinned individuals or during the summer months?
a) Tinea corporis
b) Psoriasis
c) Pityriasis alba
d) Pityriasis rosea

c) Pityriasis alba

--is more apparent in darker-skinned individuals and occurs in warmer months

8

What characterizes pityriasis rosea?

--is an acquired common mild inflammatory condition characterized by scaly, hypopigmented, and hyperpigmented lesions
--predominantly on the trunk, upper arms, and upper thighs
--also has a "herald" patch (often "fir tree" distribution) of 1cm to 5cm on trunk or buttocks

9

What is most common symptom of pityriasis rosea?

pruritus, of varying degree of severity
--esp. at onset!

10

Management for pityriasis rosea?

--topical calamine lotion on lesions
--oral antipruritic agents for severe pruritus (such as diphenhydramine)
--cool bath or compresses on lesions
--low-potency steroid creams

(no antibiotics!)

11

Management for atopic dermatitis? How to treat secondary infection?

--topical steroids to affected areas
--wet compresses to affected skin areas
--eliminate all substances that dry the skin

--do NOT maintain a dry, warm environment
--> atopic derm worsens with sweating and temp extremes: warm, dry environment will make sx worse!

Secondary bacterial infection:
--oral antibiotics
--> Bactrim, cefadroxil, cephalexin (Keflex), clindamycin

12

What are capillary hemangiomas?

--bright red or blue-red nodular tumors of varying sizes and shapes with a rubbery and rough surface
--occur predominantly on the head and face
--often are not present at birth, but the area of the eventual lesion may be blanched or slightly colored
--grow quickly within 2 to 4 weeks to a red or blue-red, protuberant, rubbery nodule or plaque, with the most growth in the first 6 months
--there is a gradual reduction in proliferation usually beginning between 9 and 12 mos

13

How are cafe au lait spots characterized? What disease are they associated with?

light to medium brown pigmented macular lesions of varying sizes and shapes, found anywhere on the body
--the color of coffee with milk
--are usually present at birth but may develop at any age
--20% of darker-skinned populations have them

--if there are 6 or more lesions, may be assoc. w/neurofibromatosis or Albright syndrome

14

What is tx for pityriasis alba?

bland moisturizers to reduce overdrying

15

What can we teach patients about the progress and prognosis of pityriasis alba?

resolves spontaneously in 3-4 months

16

Malignant melanoma is more common in which populations?

--females from birth to 40 years of age
--light-skinned individuals

17

What is characteristic of a lesion seen in chronic psoriasis vulgaris? Etiology/incidences of psoriasis?

large scaly silver-white plaque 5-10cm in diameter

(chronic psoriasis = characterized by erythematous plaques with silver-gray-white scaly plaques)
--> occurring predominantly on the head and face

--seen in approx. 33% of children
--more common in light-skinned than dark-skinned populations
--occurs in those w/a positive family hx
--assoc. w/constant rubbing or trauma to exposed areas such as elbows; assoc. w/overproduction of epithelial cells and epithelial cells that migrate to the skin surface much more quickly than normal

18

Management of psoriasis?

--apply topical steroids
--apply mineral oil and moisturizers
--decrease exposure to direct sunlight

19

What symptom is most characteristic of contact dermatitis?

pruritus at site of affected areas

20

Characteristics of contact dermatitis?

--hypersensitivity to a substance within the environment when direct contact is made
--may be caused by direct contact with topical meds, soaps, cosmetics, fabrics, and plants
--caused by hypersensitivity to an allergen with reexposure
--> allergic response usually occurs w/in 24 hrs d/t prior sensitization
--typical response = redness and edema at the site of contact, which may progress to papules and vesicles

21

TX for contact dermatitis?

--cool compresses w/Burrow's solution
--oral antihistamines
--topical steroids to affected areas for 5 days

**skin testing during an acute episode is not recommended

22

In what age groups do you see seborrhea dermatitis? Characteristics?

--common in both infants and adolescents
--can cause irritating pigment changes to include hyperpigmentation and hypopigmentation
--is associated w/an overproduction of sebum in areas abundant with sebaceous glands

in newborns/infants:
--is known as "cradle cap," areas of underlying erythema with yellow crusts and greasy scaling on scalp and face
--in more severe cases, lesions may be present on trunk and in diaper area

in adolescent:
--will have white flakes and greasy scaling on scalp, forehead, eyebrows, and face

23

What is the best tx of seborrhea in the infant?

--shampoo and wash affected areas with a non perfumed baby shampoo or baby wash
--use mineral oil with brushing to loosen crusts prior to washing

24

Classify burns according to skin layers:

1) First-degree/superficial: epidermis only
2) Second-degree/partial thickness: epidermis and part of dermis, which may be superficial or deep dermis
3) Third-degree/full-thickness: epidermis, dermis, and dermal appendages

25

Classify burns according to extent of affected area:

1) Minor burns: hands, feet, eyes, ears, and perineal burns are always considered major burns, regardless of extent of body surface affected

26

First and second degree burn would appear:

moist with edema, erythema, and a few vesicles
(red, swollen, moist and blistered areas with tenderness)

27

Tx for 2nd degree burns?

evaluation at a tertiary care center is recommended

28

What is folliculitis? Most common cause? Where does it most commonly occur?

an inflammatory condition involving the pilosebaceous follicle
--most commonly caused by Staphylococcus aureus
(less commonly caused by Streptococcus bacteria)

--most commonly occurs on neck and scalp
--> on localized areas of erythema and edema with papular or pustular lesions on face, scalp, neck, buttocks, and other areas

29

Tx for folliculitis if caused by staph?

dicloxacillin

30

Which of the following antibiotics would you not consider for moderate chronic acne?
a) Topical clindamycin
b) Oral erythromycin
c) Oral minocycline
d) Oral tetracycline

b) Oral erythromycin

--in moderate chronic acne, oral antibiotics may be considered
--> antibiotics of choice = tetracycline, doxycycline, minocycline

31

What causes Molluscum contagiosum? What characterizes it?

a poxvirus

--a self-limiting skin condition characterized by waxy, firm papules that may occur on any skin surface, but predominantly on the face, axillae, abdomen, and arms

32

Which tx would you not recommend for Molluscum?
a) Curettage lesions
b) Oral antibiotics
c) Observation
d) Topical imiquimod

b) Oral antibiotics

--molluscum tx does not consist of antibiotics
--may use imiquimod (also treats genital warts & basal cell carcinoma)

33

What characterizes impetigo?

--is caused by a localized bacterial infection of skin often precipitated by insect bites (spider, mosquito, flea) or other trauma that breaks protective skin barrier
--predominantly involves the face and less commonly other body surfaces, including perineum
--vesicles that erupt result in honey-colored serous crusts with erosion of the epidermis

34

What characterizes lesions caused by tinea corporis?

--scaly plaques of varying sizes from 3cm with mild erythematous active borders
--lesions spread peripherally as they heal centrally and may be singular or several (numerous lesions are uncommon)

35

Would you use topical antibiotics after 8 weeks of use of topical antifungals with additional lesions appearing?

no! use of antibiotics is not indicated.
--tx consists of: topical antifungal meds, clotrimazole, miconazole, naftifine, ciclopirox, or ketoconazole

36

What characterizes spider bites? Where would you find common spiders?

--a dull burning or pain at the site of bite with two puncture marks surrounded by white area with bluish-red border

Black Widow: dry, warm, dark areas; grass, wood piles, gardens, sheds, basements, closets, trunks
Brown Recluse: trunks, carpets, old shoes, old clothes, closets, crates, shelves

37

What is scabies characterized by?

--intense pruritus, esp. at night in older children and adolescents
--red bumps, blisters, pustules, and small burrow marks that may be obliterated by scratch marks
--> burrows are superficial, 2-8mm long, linear, and curved with small papules at the proximal end
--> burrows may be obliterated by scratch and excoriation marks resulting from scratching

38

TX for scabies?

--topical antiparasites
--antihistamines or topical steroids
--store non-washables in a plastic bag for a week

39

Pediculosis us a highly communicable, common condition in children. Which of the following is not correct of Pediculus humanus?
a) An insect that does not fly or jump
b) Gravid females lay ova in seams of clothing
c) Likes hairy areas of the body better than the non-hairy body surfaces
d) Same medication used for scabies may be used to effectively eradicate this species

c) Likes hairy areas of the body better than the non-hairy body surfaces

--> Pediculus humanus prefers less-hairy body surfaces

(Pediculus capitis: affects scalp
Phthirus pubis: affects pubic and axilla areas, eyelashes, eyebrows)

40

What is Pediculus humanus?

lice!

41

Hypersensitivity may occur to a variety of substances, causing a variety of reactions. It is important to determine whether the body's hypersensitivity reaction will cause erythema multiforme condition. Which of the following is not typical of the erythema multiforme reaction?
a) Target "bulls-eye" lesion with a necrotic center surrounded by a pale macular middle area and then by an erythematous peripheral ring
b) Itching at site of affected area
c) Pain at site of affected areas, esp. in the oral cavity
d) Lesions that all have the same morphology on the trunk

d) Lesions that all have the same morphology on the trunk

--lesions are not all the same size and morphology

42

When do you see a target, "bulls-eye" lesion? What are its 3 distinct characteristics?

seen w/erythema multiforme

Lesion has:
1) a necrotic or vesicular center
2) a pale middle macular ring
3) an outer erythematous peripheral ring

43

What is the key distinction b/t erythema multiforme minor and erythema multiforme major?

w/major, occurrence of prodromal systemic sx of fever, malaise, sore throat, HA, n/v

44

Tx/management for erythema multiforme major?

need immediate attention at a hospital for a full medical evaluation

45

A 7yo African American female presents with several hyperkeratotic raised, periungual lesions on the two middle fingers of her left hand. She has a hx of nail biting. The most likely dx is:
a) Impetigo
b) Molluscum contagiosum
c) Verruca vulgaris
d) Herpetic whitlow

c) Verruca vulgaris

--common warts are found most usually on fingers, hands, and feet in children, and are often preceded by trauma such as nail biting or picking at cuticles

46

What skin changes are associated with atopic dermatitis?

--thickened (lichenification)
--pigment changes (hyperpigmented)
--crusted (excoriations)

47

In infants, the lesions associated with atopic dermatitis are most likely to be distributed on the:
a) cheeks and forehead
b) wrists and ankles
c) antecubital and popliteal fossae
d) flexural surfaces

a) cheeks and forehead

--the infantile phase of atopic dermatitis follows a different distribution than that associated with the childhood phase
--> may include the face, trunk, and extensor surfaces

48

During your newborn exam, you note a generalized lacy reticulated blue discoloration. This clinical presentation describes:
a) Harlequin color change
b) Mongolian spots
c) Blue nevus
d) Cutis marmorata

d) Cutis marmorata
--> transient mottling of the neonate's skin with a lacy, bluish appearance
--> physiologic response of uneven blood flow that results from constriction of small blood vessels while others dilate
--> more common in preemies, often precipitated by cold

--Harlequin color change isomer red than pale

49

What is a salmon patch?

salmon patch = nevus simplex
--a flat, light pink to light red mark seen on the eyelid, glabella, or nape of neck ("stork bite") that intensifies with crying
--benign! gradually fades and disappears with time
--seen in 40-50% of newborns, more common in girls

50

What would cause a beefy red macular-papular rash in the diaper area with satellite lesions on the abdomen? Tx?

Candida albicans
--treat w/an antifungal agent such as Clotrimazole

51

How do you confirm a suspected case of scabies? Tx of choice?

microscopic skin scraping
--will reveal the mite, eggs, or feces if scabies are present
--> are not routinely done, but are definitive if there is any doubt of the dx

--treat w/Permethrin 5%

52

Which of the following statements regarding tx of pediculosis capitis is true?
a) Carpeting and furniture must be shampooed and spray with a pediculicide.
b) Nonwashable items that have come into contact w/an infected person should be sealed in plastic bags for 2-4 weeks.
c) Hair must be trimmed close to the scalp to ensure elimination of nits.
d) Frequent shampooing with permethrin 1% will prevent reinfestation.

b) Nonwashable items that have come into contact w/an infected person should be sealed in plastic bags for 2-4 weeks.
--> since eggs mature in 7-10 days, 2-4 weeks should be sufficient to prevent reinfestation

--frequent shampooing and close haircuts are unnecessary and may contribute to a feeling of shame and embarrassment
--environmental cleaning includes vacuuming, although sprays are not recommended

53

A 6yo comes in bc of "hives" that the mother describes as a red, raised rash. Which finding would support a dx of erythema multiforme rather than urticaria?
a) Lesions that blanch with pressure
b) Eyelid edema
c) Lesions that are present for more than 24 hours.
d) Intense pruritus

c) Lesions that are present for more than 24 hours

Urticaria:
--tend to pruritic and blanch with pressure
--generally fade w/in a few hours
--edema is common d/t the large # of mast cells present in the eyelids

Multiforme lesions:
--are fixed and present for up to 2-3 weeks

54

Characterize mild, comedonal, moderate, and severe acne.

Mild:
--open and closed comedones and occasional pustules

Comedonal:
--open and closed comedones only

Moderate:
--open and closed comedones, papules, and pustules

Severe:
--open and closed comedones, papules, pustules, plus cysts

55

What medication is the appropriate choice for moderate acne?

--oral antibiotics (such as minocycline) is used to control moderate papulopustular acne
--> (in addition to topical keratolytics such as salicylic acid)

--antiandrogens are not recommended
--corticosteroids may be used for more severe forms or the flare-ups assoc. w/isotretinoin therapy

56

What type of rash is seen w/erythema toxicum?

--located all over body
--papule (not vesicle)
--redness w/ yellow-white "bumps"

57

DJ is a 4yo African American child w/a depigmented macular lesion on his forehead. The lesion has sharp borders. No scales are present. The most appropriate tx would be:
a) 1% hydrocortisone
b) Alpha hydroxy acid
c) Ketoconazole
d) Silver sulfadiazine

a) 1% hydrocortisone
--> most likely dx is vitiligo: responds to steroids 30-50% of the time

58

While examining 7yo SR's scalp, you note 3 small patches of hair loss. Broken hair is present, as is erythema and scaling. On the basis of this information, which of the following dx's is most likely?
a) Tinea captitis
b) Traction alopecia
c) Trichotillomania
d) Alopecia areata

a) Tinea captitis
--> characteristic findings are erythema, scaling, and broken hair

--traction alopecia may also have associated erythema, but no scaling
--only alopecia areata is noted for total hair loss