Flashcards in Peds - Derm Deck (66):
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first degree burn
dry, red, no blisters
epidermis only
2
second degree burn
moist, blisters
extends beyond epidermis
3
third degree burn
dry, leathery, pearly, waxy
extends from epidermis to dermis to underlying tissues (fat, muscle, bone)
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Of particular concern with significant burns?
HYPO thermia especially in young children
First 6 hours are critical, hospitalize immediately
5
Identifying factors in dermatology
MORPHOLOGY - character of lesion itself
CONFIGURATION - how the lesions present in relation to each other
DISTRIBUTION - where on the body the lesions appear
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(morphology)
MACULE
small, flat discoloration
freckle, petechiae, flat nevi
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(morphology)
PATCH
large, flat discoloration
may have surface changes
big macule
mongolian spots, cafe au lait spot
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(morphology)
PAPULE
small, elevated skin lesion
< 1 cm
ant bite, psoriasis
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(morphology)
NODULE
elevated, firm lesion
> 1 cm
(big papule)
fibroma
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(morphology)
TUMOR
"mass"
firm, elevated lump
(big nodule)
can be benign or malignant
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(morphology)
WHEAL
slightly raised and extending a bit below the epidermis
often allergic in origin
aka hive or PPD
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(morphology)
PLAQUE
scaly, elevated lesion
classic for psoriasis
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(morphology)
VESICLE
small lesion filled with serous fluid
< 1 cm
varicella, herpes simplex, herpes zoster
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(morphology)
BULLA
large lesion filled with serous fluid (big vesicle)
> 1 cm
blister
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(morphology)
PUSTULE
small lesion filled with pus
< 1 cm
acne, impetigo
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(morphology)
ABCESS
large lesion filled with pus
> 1 cm
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(morphology)
CYST
large, raised lesion filled with serous fluid, blood and pus
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primary lesion
first appearing
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secondary lesion
follow primary
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(configuration)
SOLITARY or DISCRETE
individual lesions that remain separate
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(configuration)
GROUPED
in a cluster
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(configuration)
CONFLUENT
lesions that run together
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(configuration)
LINEAR
scratch, streak, line, or stripe
poison ivy
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(configuration)
ANNULAR
circular
ring worm
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(configuration)
POLYCYCLIC
annular lesions that merge
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Distribution
examples
Where on the body the lesions appear
face
trunk
extremities
groin
dermatomal
feet
axilla
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Rash which typically is found in buccal cavity, palms, and soles
Rash of syphilis
ddx - pityriais rosea
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Rash which follows dermatomes
Zoster
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Rash which tends to be confluent
Tinea
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Medications which exacerbate acne. (2)
steroids
anticonvulsants
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NP management of acne
non-pharmacologic
avoid oil-based products
mild cleanser and moisturizer
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NP management of MILD acne
pharmacologic (5)
topical treatment, generally in this order:
benzoyl peroxide
retinoic acid
tretinoin
salicylic acid
topical ABT - erythromycin, clindamycin
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NP management of MODERATE acne
pharmacologic
add systemic ABT to topical treatment:
Doxycycline
Erythromycin
Minocycline
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NP management of SEVERE acne
refer to dermatology :-)
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Which acne medication should be used at night because it is inactivated by UV light and oxidized by benzoyl peroxide?
tretinoin (Retin-A)
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Why are erythromycin and clindamycin lotions or pads often effective in treating acne?
because the causative agent is often staph
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jock itch
tinea cruris
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scalp ringworm
tinea capitus
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body ringworm
tinea corporis
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athlete's foot
tinea pedis
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hypo- or hyperpigmented macules on the limbs
tinea versicolor
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fungal infection of the nail
tinea unguium
onychomycosis
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Which of the tineas tend to be pruritic?
tinea cruris
tinea pedis
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Appearance of fungal infection on microscopic slide treated with KOH?
hyphae = "spaghetti and meatballs"
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fungal infection of the hand(s)
tinea manuum
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tinea capitus rx
griseofulvin x 6 weeks
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tinea corporis rx
topical -azole
ketoconazole
micoconazole
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tinea cruris rx
topical -azole
terbinafine cream
griseofulvin if severe
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tinea pedis rx
tinea manuum
macerated stage - aluminum subacetate solution
dry, scaly stage - topical antifungals
oral therapy if severe
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tinea versicolor rx
selenium sulfide shampoo x 7 days
itraconazole (Sporanox) PO
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Chicken pox -
aka
caused by
varicella zoster - caused by the herpes virus
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How is varicella spread?
direct contact with lesions or airborne
48 hours prior until after lesions are crusted
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Varicella management
prevention - vaccine
for pruritis - topicals, antihistamine
for fever - acetominophen
acyclovir - if given in first 24 hours can reduce duration, severity; particularly important to immunocompromised
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If unimmunized are exposed, what is management?
isolate from day 7 - 21
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What are the likely causes of death from varicella?
pneumonia
hepatitis
56
What is a drug interaction concern with anti-fungals?
They are CYP 450 blockers
57
Management of molluscum (5 + 1 + 1)
trentinoin (Retin-A)
Salicylic acid
Liquid nitrogen
Trichloracetic acid
Silver nitrate
mechanical removal (NOT in 1* care)
OR wait for spontaneous resolution
58
Atopic dermatitis - diagnostics
Radio-allergosorbent test (RAST) or skin test --> dust mite allergy
Serum IgE
Eosinophilia
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Atopic dermatitis - management
Extensive moisturizing
Topical steroids: hydrocortisone, desonide, triamcinolone
Systemic steroids: in extreme cases only
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Acute or chronic
Results from direct skin contact with irritant
nickel is most common cause
Allergic contact dermatitis
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Allergic dermatitis - management
Remove offending agent
Topical steroids - high potency if needed
Oral steroid taper
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Irritant (Diaper) dermatitis - defined
Most common diaper rash
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Irritant (Diaper) dermatitis - peak age
9 - 12 months
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What happens if steroids are applied to fungal infection?
Condition worsens
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Irritant (Diaper) dermatitis - management (1 + 5)
consider possible causes...
keep clean and dry
mild = barrier emollients - butt paste
erythema, papules = hydrocortisone
severe erythema, vesicles = burrow's solution
secondary bacterial = mupirocin, bactroban
secondary fungal = nizoral, ketoconazole
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