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Flashcards in Dermatology Deck (47)
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1

Erythema toxicum neonatorum

Transient, benign, polymorphous skin rash of infancy.

Erythematous macules followed by wheals, vesicles, and sometimes pustules.

Palms and soles spared

2

Incidence, risk factors and typical age for erythema toxicum neonatorum

Occurs in 50-60% of newborns
More common in full-term/post-term infants and those with >2500g birth weight
Usually appears 24-48 hours after birth and resolves in 5-7 days

3

Acne neonatorum: definition and management

A new vulgaris appearing in the first 2-6 weeks of life, presumably 2/2 maternal and neonatal androgens

Self-limiting, occurs in 20% of infants

"6-week rash"

4

Port wine stain

Possible complications and associated conditions

Lesions covering entire half of face or bilateral face may be associated with Sturge Weber syndrome (neuro-ocular manifestations)

Hypertrophy Of soft tissue and bone with extremity lesions

Lesions on back, particularly crossing midline, associated with spinal/vertebral malformations

5

Port wine stain management

Refer to dermatologist early. Pulsed dye laser treatment recommended early in infancy, definitely before 1 year

6

Growth pattern for capillary hemangioma

Rapid growth beginning at birth and peaking around 6 months.
Involution begins between 9-12 months
10% resolution per year (10% at 1 year, 50% at 5 years, etc)

7

Complications of hemangiomas

Depth rather than size determines risk
Very deep may cause cardiovascular compromise
Thrombocytopenia may occur from platelet sequestration
Visual disturbance with orbital/eyelid/periorbital
Occult hepatic hemangiomas possible
Head/face lessons carry risk if subglottic lesion with airway compromise (hoarseness and stridor rapidly worsening in first weeks of life)
Ulceration as involution occurs

8

Lesions concerning for neurofibromatosis or Albright syndrome

Cafe au lait spots that are > 1.5cm or 6 or more in number

9

Risk factors for malignant melanoma development

Sunburn and excessive exposure prior to 10yoa
Family history

10

Albinism management

Sun protection counseling
Derm referral for skin changes
Ophtho referral for vision assessment

11

Vitiligo
Definition

Acquired autoimmune destruction of melanocytes resulting in hypopigmented areas on skin, oral mucosa and genitalia

Segmental- unilateral, 2 dermatomes
Generalized- >2 dermatomes, often bilateral

12

Vitiligo management

Sun protection
Topical steroids
Topical tacrolimus (inhibits T-cels)
Derm referral for other therapies

13

Psoriasis definition

Acquired inflammatory disorder with chronic relapsing-remitting pattern of erythematous plaques With silver-grey-white scales

14

Psoriasis guttate

Small patches primarily on trunk, upper arms and thighs
Often follows strep infection

15

Psoriasis vulgaris

Large plaques primarily on elbows and knees
Often associated with constant rubbing and trauma, "Koebner's response"

16

Psoriasis management

Controlled and limited sunlight exposure
Topical corticosteroids
At least BID moisturizer or mineral oil

17

Atopic derm

Etiology/incidence

Disorder of skin barrier function, chronic forms often associated with filaggrin mutation and deficiency. Some associated with high IgE levels and altered immune function

10-15% incidence
Up to 50% develop other atopic disease
Up to 25% have symptoms that persist into adulthood

18

Dermatitis management

Topical steroids, oral antihistamine for pruritis, topical antibiotic for secondary infection

Diaper/atopic: emollients

Seborrheic: antiseborrheic shampoos, mineral oil, topical steroids, or topical salicylic acid. Some infants benefit from topical ketoconozole (melasezzia species may play too in etiology)

19

Burn classification

Superficial: epidermis only; erythema, edema, and dry tenderness
Partial-thickness: involve epidermis and part of dermis; includes moist areas and blisters
Full-thickness: Epidermis, dermis, and dermal appendage involvement; white, brown, black, swollen, dry areas with loss of sensation

20

Define minor burn

Less than 10% BSA for superficial burns
Less than 2% BSA for partial- or full-thickness

21

Define major burn

More than 10% BSA for superficial burns
More than 2% BSA for partial- or full-thickness burns
Any burns of hands, feet, face, eyes, ears, and perineum, regardless of BSA involved

22

Burn diagnostics

Electrolyte studies, especially if burn is extensive
Culture of secondary infections

23

Burn management - when to admit

Inpatient admission for all major burns, suspected abuse, esophageal or airway burns, or concomitant injuries (i.e. fractures)

24

Outpatient burn management

Cool compresses
Pain control - acetaminophen or ibuprofen
Prophylactic antibiotics on open blistered areas (mupirocin or silver sulfadiazine [don't use on face])
Push fluids for hydration
Topical emollients to repair and maintain barrier

25

Recommended SPF for children

greater than 30, apply 20 minutes before exposure

26

Cellulitis - common pathogens

Strep
H. influenzae
S. aureus
MRSA

27

Cellulitis management

Burrow's solution compresses
Topical antibiotics - mupirocin
Oral abx: Staph- cephalexin or dicloxacillin
Strep - amoxicillin, cehazolin, nafcillin
H. flu - augmentin
MRSA- Bactrim or clindamycin

28

impetigo - pathogens

Staphylococcus aureus (most common)
Streptococci

29

Impetigo management

Topical mupirocin for most cases
Oral abx for extensive disease, entire family affected, athletes, daycare: cephalexin or dicloxacillin
Use amoxicillin if strep suspected
Use bactrim or clinda if MRSA suspected

30

Staphylococcal Scalded Skin syndrome
Definition

Toxin-mediated systemic bacterial infection with skin manifestations.
Caused by toxin produced by S. aureus

31

Staphylococcal Scalded Skin syndrome
presentation

Abrupt onset fever and malaise
Generalized erythema and swelling, particularly perioral, periorbital, elbows, knees, groin, and axilla
Light pressure causes pain and desquamation
Vesicles and bullae

32

Staphylococcal Scalded Skin syndrome
Diagnostics

Blood culture or secretion culture to confirm S. aureus

33

Staphylococcal scalded skin syndrome
management

Hospitalize all neonates and sever cases for IV abx
Mild cases with stable environment: outpatient cefazolin or dicloxacillin, encourage fluids, fever and pain control

34

Acne vulgaris, mild - treatment

First line: Either BP or topical retinoid, or a combination of the two. May add topical antibiotic in fixed-ratio combination therapy
Alternate: topical dapsone

35

Acne vulgaris, moderate - treatment

First line: Combo therapy containing BP + retinoid and/or antibiotic -or- PO antibiotic + BP + retinoid +/- topical abx
Alternate: consider adding OCP or isotretenoin

36

Acne vulgaris, severe - treatment

Likely requires derm referral
First line: PO abx + combo therapy with BP + retinoid + topical abx -or- PO isotretenoin
Alternate: Consider OCP, spirinolactone in older teens

37

Topical abx in acne vulgaris

not recommended as monotherapy due to high resistence

38

PO abx in acne vulgaris

Extended release minocyline only FDA approved abx; use in kids >12yoa
Tetracycline and doxycycline also used

39

Viral warts - treatment

salicylic acid and occlusive tape

40

pyogenic granuloma
definition and management

lobular capillary hemangioma - bleed easily
treatment required, either shave excision and cautery or surgical removal

41

Tinea versicolor

Macules/patches that are hypo- or hyperpigmented, or erythematous; caused by Malassezia species
treat with topical ketoconozole or selenium sulfide
Repigmentation may take months

42

Tinea corporis - presentation/management

Pruritic, erythematous, annular patch with central clearing and scaly raised border.
Topical terbinafine or azole antifungals

43

Tinea capitis - management

Topicals ineffective, requires PO griseofulvin for 10-12 weeks and terbinafine for 6 weeks. Selenium sulfide shampoo may shorten length of fungal shedding and reduce familial infection

44

Telogen effluvium

Most common cause of diffuse hair loss
Mature hair follicles switch prematurely to telogen (resting) state then shed within 3 months
Typically occurs after major stress (pregnancy, surgery, major illness, severe weight loss)
Self-limited with regrowth over a few months

45

Transient Neonatal Pustular Melanosis

Self-limiting condition most common in full-term infants with darker skin pigment. Pustules erupt to leave an erythematous or hyperpigmented macule with collarette of scale. Macules fade over a few months

46

Pityriasis Alba - description

Acquired condition
Scaly, hypopigmented macules
Indistinct borders
Various shapes/sizes
Primarily on cheeks

47

Pityriasis alba - clinical course

May be pruritic or erythematous
Exacerbated by sunlight
Spontaneous resolution in 3-4 months
Moisturize and protect from sunlight