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Flashcards in Dermatology Deck (26):

What are the five most common organisms of red rash in paediatric patients?

Really Red Munchkins Scare Parents

R: Rubella -- fever + 3 day descending rash

R: Roseola -- macular rash starting at high fever resolution; starts on trunk

M: Measles -- 4Cs: cough, conjunctivitis, corzya and Koplik spots

S: Scarlet Fever -- S. pyogenes sandpaper-like rash with strawberry tongue within first 2 days; desquamation on palms and soles afterwards

P: Parvovirus B19 -- "slapped-cheek" lacy rash following fever


What are some common infections in paediatric patients associated with rashes?

Really Sick Children Must Take No Exercise

R: Rubella (D1)
S: Scarlet fever (D2)
C: Chickenpox (D3)
M: Measles (D4) + Koplik spots one day before rash
T: Typhus, Rickettsia (D5)
N: Nothing
E: Enteric fever/Salmonella/Typhoid (D7) >> Number of days after fever onset that a rash appears


What are 3 organisms that cause rash specific to palm and soles?

You drive CARS with your palms and soles.

CA: Coxsackie virus A
R: Rickettsia rickettsii
S: Syphilis (secondary)


What is this lesion? What disease is it related with? 

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Erythema marginatum

- Asosciated with rheumatic fever


What are the presenting features of measles?

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Prodrome of the three Cs:
- Cough
- Coryza
- Conjunctivitis


- ~4 days after start of symptoms
- Erythematous maculopapular rash
- Starts at the hairline and spreads down
- Sparing palms and soles
- Koplik spots in the mucosa ~1 day before rash

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What are the presenting features for roseola (6th disease) by HHV-6?

High-grade fever with irritabilty and lymphadenopathy

Rash once fever subsides
- Blanching, pink maculopapular
- Starts at the neck and the trunk
- Spreads to the face and extremities


What is this lesion? What is it associated with?

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Erythema multiforme
>> Fixed lesions for at least 7 days
>> Target lesions with damaged skin in the central zone
>> All lesions appear within 72 hours

- Infections: HSV, Orf virus, hisioplasmosis
- Drug reactions
- Non-Hodgkin lymphoma
- Connective tissue disorders
- Vasculitides

>> Severe major erythema multiforme: think toxic epidermal necrolysis


What are the possible causes of generalized itching?

- Anemia
- Iron deficiency
- Polycythemia rubra vera
- Lymphoma

- Hepatic failure
- Thyroid disease

- Drugs


>> Unbearable generalized itching: think malignancy


What is a bulla?

Vesicle (papule that contains clear fluid) >0.5cm


What is a macule?

Flat circumscribed discolouration (think cafe-au-lait spots)


What is a papule?

Elevated solid lesion <0.5cm


What is excoriation?

Linear erosion induced by scratching


What are the differences between erosion and ulcer?

Erosion: partial local loss of epidermis; heals without scar

- FULL thickness focal loss of epidermis and dermis
- Heals with scar


What is the difference between erythema and purpura?

Erythema: blanchable

Purpura: nonblanchable


How does one differentiate between diaper rash and Candida napkin dermatitis?

- Sharp margin with scaling
- Satellite lesions
- Involvement of intertriginous areas

>> Check oral cavity for oral flush

>> Treat with topical anti-fungal


What is this lesion?

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Infantile seborrhoeic dermatitis

- Mainly affects:
   >> Scalp
   >> Face
   >> Flexural areas
- Cradle cap: yellow or white greasy scales
- Starts from 2-3 weeks and clears in a few weeks

>> Can also occur in adults


What is this lesion? How would one describe it?

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Eczema/Atopic dermatitis

Some characteristics of eczema
- Erythema
- Oozing
- Excoriations
- Crusting
- Papulations
- Hyperlinearity due to thickened skin


What is the management for atopic dermatitis/eczema?

- Emollients
- Topical steroids
- Immunomodulating agents: topical VS. systemic
- Food/allergen avoideance

>> 90% onset before 5 years
>> Remission by age 15 in 90%


What is this lesion? 

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Eczema Herpeticum

>> PAINFUL!!!!

- Admit
- Consult ophthalmologist


What is this lesion? What are the possible treatments?

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Molluscum contagiosum

- Cryotherapy
- Laser ablation
- Topical antivirals


What is this lesion? What is the treatment?

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Scabies: highly contagious and pruritic

- Topical application of insecticides: lindane, sulphur
- Apply below the neck for older children
- Apply the whole body for infants and toddlers
- Treat all household members

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What is this condition? What are the possible causes?

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Stevens-Johnson syndrome
- Variable skin rash plus at least 2 mucosal lesions
   >> Purulent conjunctivitis
   >> Lip lesions
   >> Perianal/urethral lesions
   >> Look for blood in urine and stool
- Look for erythema multiforme
- Erythematous macules rapidly evolve into bullae, skin necrosis and denundation


- Drugs: NSAIDs, sulfonamides, anti-convulsants, penicillins, tetracyclines etc.
- Infections: HSV, mycoplasma etc.


What is this lesion?

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Toxic epidermal necrolysis
- Detachment of the epidermis from the dermis all over the body
- Usually related to drug reactions
- Life-threatening
- Associated with Stevens-Johnson Syndrome


What are fixed drug eruptions?

A type of drug reaction that recur at the same site with each exposure of one particular drug

Possible drugs include:
- Aspirin
- Antibiotics: penicillin, tetracyclines and sulfonamides
- Anti-convulsants


If a non-palpable rash erupts after varicella infection, what are the differential diagnoses?

- Immune thrombocytopenic purpura (ITP)
- Henoch-Schonlein purpura (HSP)

>> CBC to rule out ITP


What is this lesion? What is the management for this lesion?

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Natural history
- Onset at first week of life
- Growth fastest at 6 months of life
- Involution begins at 12 months of life
- Complete involution
    >> 50% by age 5 years
    >> 70% by age 7 years
    >> 100% by age 12 years

1. Conservative: usually fades in a few years
2. Propranolol: if it causes functional disability

Note: Hemangiomas VS. tufted angiomas
>> Tufted angiomas rarely self-involute

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