Pediatric Dermatology Flashcards Preview

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Flashcards in Pediatric Dermatology Deck (60):
1

distinguish between a macule and a patch 

  • macule: circumscribed area of change in skin color without elevation or depression (flat); < 1 cm
  • Patch: macule that is larger than 1 cm

2

circumscribed, solid superficial elevations < 1 cm

papule

3

papule > 1cm

plaques

4

distinguish between a vesicle and a bulla 

  • vesicle < 1 cm
  • bulla > 1 cm 

5

rounded or irregular shaped excavations into the dermis or deeper

ulcer 

6

thickened skin with accentuated skin markins 

lichenification 

7

shallow, hemorrhagic linear excavations 

excoriations

8

what are congenital melanocytic nevi?

proliferations of benign melanocytes 

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9

clinical presentation

  • macules, papules, or plaques at birth
  • hair may or may not be present
  • appearance may change with time
  • lesions grow in proportion to individual size 

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congenital melanocytic nevi

10

clinical presentation

  • patch of bluish-grey pigmentation with irregular border and normal skin texture
  • most commonly affects buttocks and lower back
  • increased incidence in darker skin types
    • asian >> black> hispanic
  • usually present at birth or becomes evident on the first weeks of life 

mongolian spot

11

management of mongolian spot

  • consider further work up in cases where extensive involvement with failure to thrive
  • affected areas tend to fase by age 2 and often disappear by age 10 

12

what is nevus sebaceous

hyperplasia of epidermis, sebaceous glands, hair follicles, apocrine glands 

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13

clinical presentation

  • occurs primarily on the scalp or face
  • waxy solitary, smooth, yellow-orange hairless patch, often oval or linear in shape
  • usually becomes more pronounced in adolescence
    • may become bumpy, warty, or scaly 

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nevus sebaceous

14

what is concerning about nevus sebaceous

BCC or other malignancy may arise from lesion 

15

treatment of nevus sebaceous

  1. intermittent interval f/u is recommended
  2. refer to derm if concerning changes are observed

16

what is aplasia cutis congenita

absence of skin present at birth that can be localized or widespread 

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17

clinical presentation

  • most commonly found midline posterior scalp
    • tuft of hair may surround defect which may indicate neural tube defect
  • may be associated fluid-filled bulla
  • lesions are well demarcated 

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aplasia cutis congenita

18

treatment of aplasia cutis congenita

  • gentle cleansing and ointment
  • referal to neurosx for surgical repair indicated for large or multiple scalp defects 

19

clinical presentation

  • discrete uniformly pigmented macules or patches
  • most commonly found in african american population
  • present at birth or appear in early childhood
  • may be associated with neurofibromatosis type 1 

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cafe-au-lait macules 

20

Neurofibromatosis type 1 is what type of disease 

autosomal dominant 

21

name some signs and symptoms of Neurofibromatosis 

  1. cafe-au-lait macules
  2. axillary or inguinal freckling
  3. neurofibromas
  4. lisch nodules (well-defined, dome-shaped elevations projecting from the surface of the iris )
  5. optic gliomas
  6. skeletal abnormalities 

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22

Name the two major types of vascular anomalies in pediatrics 

  1. vascular tumor: neoplasms proliferate and require tx to stop growth
  2. vascular malformation: abnormal blood vessels without rapid proliferation
    1. static or slow growing

23

what is a port-wine stain

cutaneous capillary malformation; vascular malformation

24

clinical presentation

  • presents at birth and does not regress
  • pink or dark red patches (may gradually darken or thicken)
  • may be associated with
    • soft tissue or bony overgrowth
    • sturge weber syndrome in the V1 distribution

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port-wine stain

25

management of port-wine stain

  • no treatment needed
  • pulse dye laser
  • if widespread or associated with overgrowth of the extremities, refer to a vascular specialist 

26

What are infantile hemangiomas 

common benign vascular tumor

27

what are the risk factors for infantile hemangiomas 

  • low birth rate
  • female
  • twin gestation
  • fair skin 

28

clinical presentation

  • may present superficial, deep, or mixed
    • superficial: bright red and minimally elevated
    • deep: larger with bluish color
  • rapid growth during 5-7 weeks of age

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infantile hemangiomas 

29

what is a common complication of infantile hemangiomas 

ulceration

30

clinical presentation

  • faint, transient capillary malformation
    • flat, pink/red patch
    • typically midline of forehead, scalp, upper eyelid, posterior neck and back

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nevus simplex (salmon patch) 

31

what is the most common pediatric vascular lesion

*present in 30-40% of newborns 

nevus simplex (salmon patch)

32

when do nevus simplex (salmon patch) typically fade 

1-2 years 

33

what is a pyogenic granuloma 

  • common acquired lobular vascular tumor
  • occurs at any age
  • develops rapidly (days to months) 

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34

pyogenic granuloma affects what areas of skin 

affects skin particularly prone to trauma

  • hands
  • fingers
  • face
  • mucous membrane 

35

how do you diagnose pyogenic granuloma

  • biopsy needed to confirm diagnosis 

36

treatment of pyogenic granuloma

  • curettage or shave removal
  • pulsed-dye laser 

**risk of recurrence is high

37

treatment for port-wine stains in a V1 distribution

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urgent ophthalmologic evaluation 

* need to rule out Sturge Weber syndrome

38

pathogenesis of diaper dermatitis 

  • excessive moisture, friction, increased pH causing localized skin to break down
    • may be caused by seborrheic derm; atopic derm
    • macerated sin increased susceptible for infection from urine and feces

39

if diaper dermatitis are persistant and have moved from areas of contact with diaper to inbetween skin folds or developed pustules, what do you expect happened?

secondary infection

  1. candidal superinfection
    1. beefy red plaques (involves skin folds) 
  2. impetigo: secondary infection Staph aureus 
    1. fragile pustules and honey crusted erosions

40

what signs/symptoms allows you to diagnose an Active lice infection 

  • visualize live lice (wet combing)
  • nits may persist for months and does not indicate active infection

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41

treatment of lice 

  • topical insecticides
    • pyrethroids
    • malathion
    • benzyl alcohol
    • spinosad
  • conditioner should not be used prior to application
  • prophylactic treatment for others in same household 

42

what is neonatal acne

*not true acne

  • inflammatory reaction possibly to malazzesia colonization

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43

when does neonatal acne typically resolve 

  • resolves by 6-12 months of age

44

clinical presentation

  • present in first 2-3 weeks of life
  • inflammatory papules and pustules
    • forehead, nose, cheeks
    • no true comedones 

neonatal acne

45

treatment of neonatal acne

  • mild: cleansing with soap and water
  • if persistant, may use ketoconazole or hydrocortisone 

46

what is infantile acne 

  • presents at 3-4 months of age
  • hyperplasia of sebaceous glands
    • androgenic stimulation
    • M > F
  • see inflammed pustules, comedones, pustules 

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47

when does infantile acne commonly resolve 

2-3 years of age 

48

management of infantile acne 

  • treatment often required to prevent scarring
  • benzoyl peroxide
  • topical abx
  • topical retinoids
  • oral treatment only needed in severe cases 

49

pathogenesis of acne vulgaris

  • chronic inflammatory disease of the pilosebaceous unit, self limited
  • factors
    • increased sebum production by sebaceous glands 
    • hyperkeratinization of the follicle
    • colonization of follicle
    • inflammatory reaction

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50

when trying a new acne treatment regimen, how long do you need try it for?

minimum of 8 weeks 

51

role of topical retinoids in the treatment of acne vulgaris

  • prevent formation and reduce number of comedones
  • anti-inflammatory properities 

52

What are these medications:

  • Adapalene (Differin)
  • Tazarotene (Tazorac)
  • Tretinoin (Retin-A) 

topical retinoids 

53

what are the two most commonly used topical abx to treat acne vulgaris

  • clindamycin
  • erythromycin 

54

topical abx are commonly used in combo with what medications in the treatment of acne vulgaris

  • benzoyl peroxide to prevent resistance
  • topical retinoids 

55

function of dapsone in the treatment of acne vulgaris

  • abx
  • MOA: inhibiting inflammation 

56

what are the most commonly used oral abx to treat acne vulgaris

  1. doxycycline
  2. minocycline
  3. erythromycin
  4. tetracycline 

57

indications of oral abx to treat acne vulgaris

moderate to severe acne 

58

what oral contraceptive pills are commonly used a 2nd line therapy for acne vulgaris 

  • ortho Tri-Cyclen
  • Yaz
  • Estrostep 

59

indication to use oral isotretinoin to treat acne vulgaris

severe recalcitrant acne or less severe treatment resistance 

60

what required monitoring is associated with oral isotretinoin 

  • CBC, lipids, liver enzymes
  • side effects
    • depression
    • HA, dry skin, GI upset
  • iPLEDGE program to prevent pregnancy