Pediatric Dermatology Flashcards
(62 cards)
1
Q
Varicella (Chickenpox) dermatologic presentation
A
- Generalized pruritic vesicular rash beginning on face, neck, or
upper trunk & spreads outward - Mucous membranes may be involved
- Lesions are in different stages of healing (crops)
- Other symptoms may include fever & malaise
- Hx of contact with another infected person within
previous 10-21 days
2
Q
What is a superinfection?
A
infection occurring after or on top of an earlier infection, especially following treatment with broad-spectrum antibiotics.
3
Q
Varicella (Chickenpox) management
A
usually supportive
* Acyclovir may be useful in immunocompromised patients & pregnant
women
* Varicella Zoster Immune Globulin (VZIG) may be given to patients
exposed to varicella who are at risk for severe disease
* Vaccination does not prevent the disease 100% (more mild)
4
Q
When are patients non infectious for Varicella (chickenpox)
A
Contagious from 1-2 days prior to onset, until ALL the lesions have crusted
5
Q
How is Small Pox different than Chicken Pox?
A
- Highly contagious/fatal infection due to variola virus
- Abrupt onset of prodrome fever, malaise, & other symptoms about 10-14
days after respiratory exposure & lasting 1-4 days (patients often bedridden) - Rash follows prodrome ~1-4 days later, with lesions on mucous
membranes of mouth, tongue, & oropharynx (enanthem) appearing first
rash follows eruptive phase about 1-4 days later. - Skin lesions (exanthem) begin on face & appear on all parts of body within
24-48 hours (NO CROPS), lesion crusting complete in 2-3 wks
6
Q
Rubeola (Measles) pathophysiology and transmission
A
- Direct viral infection of the epidermis
- Highly contagious
- Person-to-person via respiratory droplets
7
Q
Rubeola (Measles) survives up to ____ hours on surfaces or in air spaces
A
2
8
Q
Incubation period of Rubeola (Measles) =
A
12 days to onset of fever, & 14 until rash
9
Q
Rubeola (Measles) presentation
A
- ↑fever, dry cough, rhinitis, conjunctivitis (clear discharge), distinctive rash
- Koplik spots are pathognomonic
- White dots on red base, buccal mucosa 1-2 days prior to onset of rash
- Rash is brick-red (dusky), raised macules & papules (morbilliform) & begins
at hairline & spreads to involve trunk, arms, legs, & eventually hands & feet
10
Q
Rubeola (Measles) management
A
- Supportive care
- No specific antiviral therapy available
- Vitamin A 200,000 units orally once daily for 2 days may ↓ mortality in
hospitalized children with measles (mechanism unknown)
11
Q
Erythema Infectiosum, Fifth Disease pathophysiology
A
- Multiple synonyms:
- Erythema infectiosum, “slapped cheek” disease
- Caused by Parvovirus B19 (endemic worldwide)
12
Q
Erythema Infectiosum, Fifth Disease presentation
A
- Illness usually mild & may include low-grade fever, URI symptoms, & mild malaise-or asymptomatic
- Rash is flat, lacy, reticular, often pruritic, located on cheeks, trunk, & extremities
- Children are NOT contagious once the rash appears
13
Q
Erythema Infectiosum, Fifth Disease management
A
- Supportive & symptomatic care
- In pregnancy, infection can lead to hydrops fetalis caused by severe fetal
anemia or fetal loss - Consider perinatology consult
14
Q
Roseola presentation
A
– Abrupt onset of high fever which lasts for 3-7 days (occasionally
respiratory or GI symptoms are present)
– Resolution of fever is followed by development of erythematous
maculopapular rash that spontaneously resolves
– May appear 1-2 days after fever breaks
15
Q
Roseola pathophysiology
A
- Typically results from HHV-6 (aka “6th disease”)
- Acute, benign infection
- Very common, especially in children <3 years old
- Seroprevalence in most countries approaches 100% in children over 2 years of age
16
Q
Roseola management
A
- Supportive & symptomatic care
- Antipyretics & hydration
- Antivirals are not recommended
for an immunocompetent patients
17
Q
Oral Candidiasis (Thrush)
A
- Most common fungal infection in
humans - Mainly affects infants or older
children in debilitated state - May occur in patients taking broad
spectrum antibiotics or steroids
(including patients taking inhaled
steroids)
18
Q
Oral Candidiasis (Thrush) presentation/exam
A
- Symptoms: mouth soreness, refusal of feedings
- Physical exam: white curd-like plaques predominantly on buccal mucosa
- Lesions easily bleed & CAN be scraped away
19
Q
Oral Candidiasis (Thrush) Management
A
- Treatment: Fluconazole or Nystatin oral suspension
- Remove plaques prior with moistened cotton-tipped applicator or piece
of gauze
20
Q
Diaper Rash types
A
– Irritant diaper dermatitis
– Candidal diaper dermatitis
21
Q
Candidiasis - Diaper dermatitis presentation
A
marginal scaling,
& “satellite pustules” in the area covered
by a diaper in an infant.
22
Q
Diaper Rash management + ABCDE
A
Air (allow diaper-free time)
Barrier (creams/pastes)
Cleansing (only after stools)
Diapering (frequent Δ’s)
Education
- Topical medications
- Irritant diaper dermatitis
complicated by secondary
bacterial infection - Fungal diaper dermatitis
suspected to be due to
Candida albicans
23
Q
Pityriasis Rosea
A
- Common, acute, self-limited papulosquamous skin rash of childhood
- First sign of disease is often a “herald patch” which may resemble
psoriasis or tinea corporis - Following the herald patch (1-2 weeks later) multiple, similar but
smaller scaling lesions distributed along cleavage (Langer) lines of
trunk, neck, & proximal limbs
24
Q
Pityriasis Rosea presentation
A
- Lesions are often oval with long axis paralleling the lines of skin stress
(results in “pine tree appearance”) - Lesions resolve in 6-10 weeks & may be pruritic
- “This rash appeared but it hasn’t gone away”
25
Verruca (Warts)
* HPV infection of epithelial tissues
* Causes benign cutaneous papilloma
* Different subtypes of HPV can affect different areas
* Most commonly occur in children & young adults
26
Verruca Vulgaris features & morphologies
* Spontaneous remission in ~2/3 of cases within 2 years
* Several different morphologies:
* Common (flesh-colored or grayish white with a papillate,
hyperkeratotic surface)
* Flat
* Mosaic (a confluent presentation)
* Filiform (threadlike)
27
Verruca Vulgaris presentation
* Can present as either a single lesion or coalesced together
* Paring down a wart will cause pinpoint bleeding
* Penetration to the dermis
28
Verruca treatment
* Observation
* Imiquimod (Aldara®)
* Occlusion
* Liquid Nitrogen
* Salicylic acid
* Cantharadin (black blister beetle)
29
If the lesion starts small & grows then it is likely _____
fungal
30
Most fungal infections DO NOT ____
fluoresce under Wood’s lamp
31
Superficial Fungal Infections
* Dermatophyte Infections
* Tinea Versicolor
* Intertriginous candida
32
Superficial Fungal Infections presentation
* Presentation
* scaly, erythematous lesions
with defined margins.
* Candidal infections tend to
occur in creases with satellite
lesions & may or may not be
scaly
33
Dermatophyte infections
* Tinea is the word to describe a
dermatophyte infection
– Tinea cruris (jock itch): groin &
inner thighs
– Tinea pedis (athlete’s foot): feet
– Tinea corporis (ringworm): body
– Tinea faciei: face
– Tinea capitus: on the scalp
(mostly affects children)
34
Dermatophyte infections characteristics
* Annular, scaly, erythematous
plaque(s) with central clearing,
may be itchy
35
Tinea capitis
with kerion
* Inflammatory, pus -filled sore that
sometimes oozes. Immune system
overreaction to a fungal infection
36
Dermatophyte infections management
– Antifungal medications
* Most topical agents work well
* Azoles [clotrimazole (Lotrimin®)] tend to have better activity against candidal infections than Allylamines (terbinafine)
* Polyenes (Nystatin®)
* Primarily anticandidal
* Azoles (E.g. Diflucan®)
* Better for systemic infections
* Allylamines (eg Lamisil AT®)
* Better against dermatophyte infections (tinea) than Azoles
37
Tinea Versicolor
* Common superficial infection caused by Malassezia species
(saprophytic yeast, part of the normal skin flora)
38
A number of factors may trigger Tinea Versicolor conversion to the hyphal form that is associated with clinical disease, including:
– Hot & humid weather
– Use of oils
– Hyperhidrosis
– Immunosuppression
39
Tinea Versicolor Presentation
* Brown, pink, red, or white scaly patches or slightly elevated plaques on the chest, back & shoulders
* Most patients do NOT have pruritus (some may have mild itching)
* During the summer, may present as areas of hypopigmentation
& be mistaken for vitiligo
40
The key with differentiating tinea versicolor from vitiligo
scratching the macular region will elicit scaling in tinea versicolor
41
Tinea Versicolor Diagnosis
* Fluorescence with Wood’s light
* Scraping a scaly lesion & performing KOH prep reveals short hyphae & spores
42
Tinea Versicolor Treatment
* 2.5% selenium sulfide (Selsun)
* Pyrithione zinc shampoo (Head & Shoulders)
* Apply treatment with rough washcloth, leave for 10 minutes & then rinse off, qd x 1 week
* Ketoconozole shampoo also very effective
* Depigmentation may persist until going back into the sun
* Often until the next season
43
Oral antifungals considered in patients who are immunocompromised
or who have very widespread disease with ____
Tinea Versicolor
44
Atopic Dermatitis (Eczema) - Pathophysiology
The “itch that rashes”
* Pathogenesis incompletely understood
* Genetic predisposition fillagrin gene (FLG ) mutation
* Environmental irritants
* Humidity, dress & hydration status of the child's skin, that is, too many baths, drying soaps, exposure to cold air
45
The “Atopic Triad”
Asthma
Hayfever
Eczema
45
Atopic Dermatitis (Eczema) presentation
– Intense itching → scratching, eczematous change, &
lichenification
– Children: commonly on the cheeks, but can be in neck, wrists,
behind the ears, & antecubital/popliteal flexure areas
45
A typical localization of atopic dermatitis in children is ___
the region around the mouth.
In this child, there is lichenification & fissuring & crusting.
45
Atopic Dermatitis (Eczema) Treatment
* Eliminate possible triggers or irritants
* Hydration, hydration, hydration!
* Emollients (moisturizers) should be an integral part of applied
soon after bathing to improve skin hydration in patients with atopic dermatitis
* Topical steroids: -Ointments > creams > lotions
46
Topical steroid side effects in treating Atopic Dermatitis (Eczema)
* Atrophy, telangiectasia, purpura, striae, & acneiform eruption
* ↑potency = ↑side effects
* Especially high potency steroids & prolonged use
47
Molluscum Contagiosum epidemiology
* Common
* Peak incidence in children
aged 2-5 years
* Sexually active young adults
* Immunocompromised
Transmitted by direct contact
48
Molluscum Contagiosum Clinical presentation
* Firm, flesh-colored or pearly skin
papules of 1 mm to 1 cm size
* Often umbilicated
* Occur over several weeks
* Average 11-20 lesions
49
Molluscum Contagiosum diagnosis
* Clinical
* Biopsy can confirm
50
Molluscum Contagiosum treatment
* Not always necessary
* Lesions generally resolve within 6-9 months
* Curettage
* Cryotherapy
* Cantharidin
* Podophyllotoxin 0.5% topical BID x 3 days
* Immiquimod cream 3x/week
51
Complications of Molluscum Contagiosum
* Bleeding
* Inflammation (sign the lesion is recognized by the immune
system)
* Eczematous dermatitis around lesions 10-30%
52
Hand-Foot-and-Mouth Disease
* Acute viral illness
* Coxsackievirus A
* Epidemics generally occur in the
summer to early fall
* Affects children < 10 years
53
Hand-Foot-and-Mouth Disease Presentation
* Incubation period is approx. 1 week
* Sore mouth and/or throat Malaise
* Skin lesions
* Fever may be present for 24-48 hours
54
Hand-Foot-and-Mouth Disease exam
* Macular lesions appear on the buccal mucosa, tongue, and/or hard palate
* Rapidly progress to vesicles that erode and become surrounded by an
erythematous halo
* Skin lesions develop in 75% of patients
* Hands, feet, buttocks, and genitalia
55
Hand-Foot-and-Mouth Disease Diagnosis
* Dx based on clinical findings
* Vesicle swabs, prn
56
Hand-Foot-and-Mouth Disease treatment
* Supportive
* Hydration
* Rest
* Antipyretics
* Magic mouthwash
57
Kawasaki Disease
acute, self-limited, systemic vasculitis of unknown etiology
* Likely infectious
* Consider Kawasaki disease in children with ≥ 5 days of high fever &
any of 5 typical findings:
58
Kawasaki Disease Presentation
1. Asymmetric anterior cervical adenopathy
2. Bulbar conjunctivitis
3. Changes in lips & oral cavity
* strawberry tongue, red cracked lips
4. Hand & foot redness & swelling, or periungual peeling
5. Morbilliform rash
59
Kawasaki Disease treatment
* Goal of treatment for Kawasaki disease is to
prevent coronary artery disease & relieve symptoms
