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Flashcards in Peds - Derm Deck (66):
1

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)

4

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

6

(morphology)

MACULE

small, flat discoloration

freckle, petechiae, flat nevi

7

(morphology)

PATCH

large, flat discoloration
may have surface changes

big macule

mongolian spots, cafe au lait spot

8

(morphology)

PAPULE


small, elevated skin lesion
< 1 cm

ant bite, psoriasis

9

(morphology)

NODULE

elevated, firm lesion

> 1 cm

(big papule)

fibroma

10

(morphology)

TUMOR

"mass"

firm, elevated lump

(big nodule)

can be benign or malignant

11

(morphology)

WHEAL

slightly raised and extending a bit below the epidermis

often allergic in origin

aka hive or PPD

12

(morphology)

PLAQUE

scaly, elevated lesion

classic for psoriasis

13

(morphology)

VESICLE

small lesion filled with serous fluid

< 1 cm

varicella, herpes simplex, herpes zoster

14

(morphology)

BULLA

large lesion filled with serous fluid (big vesicle)

> 1 cm

blister

15

(morphology)

PUSTULE

small lesion filled with pus

< 1 cm

acne, impetigo

16

(morphology)

ABCESS

large lesion filled with pus

> 1 cm

17

(morphology)

CYST

large, raised lesion filled with serous fluid, blood and pus

18

primary lesion

first appearing

19

secondary lesion

follow primary

20

(configuration)

SOLITARY or DISCRETE

individual lesions that remain separate

21

(configuration)

GROUPED

in a cluster

22

(configuration)

CONFLUENT

lesions that run together

23

(configuration)

LINEAR

scratch, streak, line, or stripe

poison ivy

24

(configuration)

ANNULAR

circular

ring worm

25

(configuration)

POLYCYCLIC

annular lesions that merge

26

Distribution

examples

Where on the body the lesions appear

face
trunk
extremities
groin
dermatomal
feet
axilla

27

Rash which typically is found in buccal cavity, palms, and soles

Rash of syphilis

ddx - pityriais rosea

28

Rash which follows dermatomes

Zoster

29

Rash which tends to be confluent

Tinea

30

Medications which exacerbate acne. (2)

steroids
anticonvulsants

31

NP management of acne
non-pharmacologic

avoid oil-based products
mild cleanser and moisturizer

32

NP management of MILD acne
pharmacologic (5)

topical treatment, generally in this order:
benzoyl peroxide
retinoic acid
tretinoin
salicylic acid
topical ABT - erythromycin, clindamycin

33

NP management of MODERATE acne
pharmacologic

add systemic ABT to topical treatment:
Doxycycline
Erythromycin
Minocycline

34

NP management of SEVERE acne

refer to dermatology :-)

35

Which acne medication should be used at night because it is inactivated by UV light and oxidized by benzoyl peroxide?

tretinoin (Retin-A)

36

Why are erythromycin and clindamycin lotions or pads often effective in treating acne?

because the causative agent is often staph

37

jock itch

tinea cruris

38

scalp ringworm

tinea capitus

39

body ringworm

tinea corporis

40

athlete's foot

tinea pedis

41

hypo- or hyperpigmented macules on the limbs

tinea versicolor

42

fungal infection of the nail

tinea unguium
onychomycosis

43

Which of the tineas tend to be pruritic?

tinea cruris
tinea pedis

44

Appearance of fungal infection on microscopic slide treated with KOH?

hyphae = "spaghetti and meatballs"

45

fungal infection of the hand(s)

tinea manuum

46

tinea capitus rx

griseofulvin x 6 weeks

47

tinea corporis rx

topical -azole

ketoconazole
micoconazole

48

tinea cruris rx

topical -azole
terbinafine cream
griseofulvin if severe

49

tinea pedis rx
tinea manuum

macerated stage - aluminum subacetate solution
dry, scaly stage - topical antifungals
oral therapy if severe

50

tinea versicolor rx

selenium sulfide shampoo x 7 days
itraconazole (Sporanox) PO

51

Chicken pox -
aka
caused by

varicella zoster - caused by the herpes virus

52

How is varicella spread?

direct contact with lesions or airborne
48 hours prior until after lesions are crusted

53

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

54

If unimmunized are exposed, what is management?

isolate from day 7 - 21

55

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

59

Atopic dermatitis - management

Extensive moisturizing
Topical steroids: hydrocortisone, desonide, triamcinolone
Systemic steroids: in extreme cases only

60

Acute or chronic
Results from direct skin contact with irritant

nickel is most common cause

Allergic contact dermatitis

61

Allergic dermatitis - management

Remove offending agent
Topical steroids - high potency if needed
Oral steroid taper

62

Irritant (Diaper) dermatitis - defined

Most common diaper rash

63

Irritant (Diaper) dermatitis - peak age

9 - 12 months

64

What happens if steroids are applied to fungal infection?

Condition worsens

65

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

66

A common, benign, hyperproliferative inflammatory skin disorder

Psoriasis