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Flashcards in Derm from Book ?s Deck (58)
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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