Dermatology Flashcards
(43 cards)
What are 5 functions of the skin?
1) Regulate body temperature
2) Protect from dehydration and infection
3) Respond to temp, pressure and pain
4) Excrete water, salts, urea
5) Vit. D synthesis
How is the neonatal skin different from an adults?
1) Thinner, less hairy, weaker intercellular attachment
2) Fewer eccrine and sebaceous gland secretions
3) ↑susceptibility to external irritants, micrococcal infection
4) ↓contact allergen reactivity
5) Percutaneous permeability increased in premature/ damaged/ scrotal skin
What are the important features of a rash history?
1) Age of the patient
2) Onset
3) Nature of the rash
– D – distribution
– A - a/w pain, itch, fever or constitutional symptoms
– M – morphology (primary/secondary)
4) Recent exposure
– sick contacts, contact with animals/insects, travel, sexual history
5) Previous treatment that worked/failed
6) New medications in the past 1 month
7) Vaccination status, family history, obstetric history (if neonate)
8) Systemic review e.g. immunosuppressed
What are the important findings for a rash?
1) Distribution
- generalised vs localised
2) Morphology
a) primary:
- macule, patch, plaque, wheal
- papule, pustule, abscess, cyst, nodule, tumour
- vesicle, bulla
- petechia, purpura, ecchymosis
b) secondary:
- atrophy, crusting, oozing, scaling, fissuring, excoriation, erosion, ulcer, lichenification
3) Systemic exam
What is erythema toxicum neonatorum?
1) erythematous macules with
central papule/pustule
2) occurs in the 1st 1-2 weeks
of life
3) Over face, trunk, limbs (spares palms, soles)
4) Self-limiting (<1wk) with no residual pigmentation
5) Eosinophil predominance on Wright’s stain
What form of HSV causes neonatal herpes?
HSV2
What is the chance of vertical transmission of neonatal herpes simplex?
10% of infants of parents with active HSV2
How does neonatal herpes simples manifest?
1) Grouped vesicles on erythematous base
2) presents up to a week after birth
3) Mild or progress to encephalitis, jaundice, progressive HSM, dyspnea (~21 days)
How is neonatal herpes simplex treated?
IV acyclovir 20mg/kg 8hrly for 14 days
What is miliaria rubra (prickly heat)?
1) Erythematous papules and papulovesicles (1-4mm D) on b/g of macular erythema
2) Usually begin after 2nd week of life and predominate in trunk and intertriginous areas where occlusion by clothing is accentuated
3) Lesions can be itchy or sore (restless/ distressed child)
4) Miliaria profunda usually result of repeated miliaria rubra (more common in adults
What are milia?
Benign, keratinous cysts
- manifest as tiny white pearly papules on the face of the newborn (esp nose, cheeks and chin)
- Resolves spontaneously in
weeks
What is transient neonatal pustular melanosis?
Idiopathic pustular eruptions (1-3mm flaccid, superficial, fragile with no surrounding erythema) that heal with brown pigmented macules/ scale
- predominantly chin, forehead, axilla, nape
- usually present at birth
What are 5 types of birth marks?
1) Vascular birthmarks
2) Lymph vessel
3) Pigment cell
4) Hypopigmentation
5) Epidermal
What are mongolian spots?
Dermal melanocytosis (Gray or blue-black flat poorly circumscribed lesions)
- usually on Lumbo-sacral, buttocks, limbs
- More common in darker skin infants
- Fades in 1-2 years
What are naevus simples and naevus flammeus?
Naevus simplex (salmon patch):
- glabella, eyelids, upper lip, nuchal area, symmetric
- Eventually fade in a few months except nuchal
Naevus flammeus (port wine stain):
- larger, unilateral, sharply
circumscribed
- Permanent
- possible association with Sturge Weber
syndrome when appearing around
trigeminal area
What are the 2 forms of hemangiomas?
1) Superficial (strawberry)
2) Deep hemangioma (cavernous)
What should be suspected in recurrent, treatment resistant seborrhoeric dermatitis?
Langerhan cell histiocytosis
What is seborrhoeic dermatitis?
Chronic inflammatory dermatosis with periods of remission and exacerbation
- presents as greasy yellow scales and plaques in typical distribution in areas rich in sebaceous glands
- Starts in 1st 2 weeks of life, peaks
around 3rd month, resolves around 1yr
How is seborrhoeic dermatitis treated?
1) Selenium sulphide shampoo (for overlying 2° fungal infection)
2) Weak topical steroid
How does candidiasis present in children?
Vivid red, sharp borders
- **Satellite papules and vesicles on
the outer limits
- involved skin folds (vs contact derm)
- oral thrush
- Hx of antibiotics
What is intertrigo?
Red macerated patches of
skin in moist body folds
- satellite lesions → candida
- Foul smell → GABH
How is intertrigo treated?
1) Topical antifungal cream
2) Topical antibacterial cream
3) Topical steroid cream
4) Oral penicillin/cephalexin
How does irritant contact dermatitis present in children?
1) Spares the folds, affects the convex areas (W-shaped)
2) Triggered by contact with
urine, faeces, occlusion and friction from diaper, preservatives in baby wipes
How is irritant contact dermatitis treated?
1) Keeping the area clean and dry by rinsing gently with warm water
2) Zinc oxide creams as barrier
3) Antifungal cream if secondarily infected
