104: Pediatric Ascolescent Dermatology Flashcards
What is crucial when working with pediatric patients and their families?
Working with parents/caregivers and understanding the home situation is crucial.
What should be considered when examining infants and children?
Examinations should be thorough, including checking all creases and valleys of body folds, and addressing underlying problems such as food intolerances or allergies.
What are some common cutaneous findings in infants that may indicate underlying conditions?
Common findings include vascular stains, which may indicate hemangiomas, and midline lesions that may have CNS connections and should not be biopsied without proper evaluation.
What is the typical resolution pattern for telogen effluvium in infants?
Telogen effluvium may be gradual or sudden, typically occurring in the first few days after birth, with spontaneous resolution being the rule.
What distinguishes triangular temporal alopecia from alopecia areata?
Triangular temporal alopecia is characterized by its typical location, presence of vellus hairs, absence of exclamation point hairs, and specific histologic findings, and it is benign and will not expand.
What is the incidence of alopecia areata in children younger than 2 years of age?
The incidence of alopecia areata in children younger than 2 years of age is approximately 1-2%.
Why should patch testing or biopsies not be avoided in pediatric patients?
They should not be avoided simply because of a pediatric patient’s age.
What is a key consideration when examining infants?
Examine all creases and valleys of body folds and the diaper area at every visit.
What are some common cutaneous changes that may not be visible at birth?
Nevus depigmentosus and epidermal nevus may not be visible until early childhood.
What is telogen effluvium and when does it typically occur?
Telogen effluvium may be gradual or sudden and occurs as the first few days after birth with telogen hairs shed by 3-4 months of age.
What is nevus sebaceus and where is it commonly found?
Nevus sebaceus is a hamartoma of the head and neck, appearing as a waxy, yellowish plaque.
What are the key considerations when evaluating a pediatric patient with skin conditions?
Key considerations include:
-
Complete History:
- Gestational history (medications, illicit drugs, infectious diseases)
- Birth history (vigorousness, feeding, growth)
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Thorough Examination:
- Examine all creases and valleys of body folds
- Diaper area should be examined at every visit
- Address underlying problems (e.g., food intolerance)
-
Special Considerations:
- Inspect for vascular stains, cutaneous anomalies, and midline lesions that may have CNS connections.
How does the presence of a solitary café-au-lait macule in an infant relate to potential health concerns?
A solitary café-au-lait macule is extremely common and benign; however, it raises the possibility of neurofibromatosis type 1 (NF1). Therefore, while it may not be alarming on its own, it warrants further evaluation to rule out associated conditions.
What are the implications of systemic toxicity from topically applied substances in infants?
Infants have an increased risk for systemic toxicity from topically applied substances due to their underdeveloped skin barrier function.
A 3-month-old infant presents with a vascular stain and vasoconstricted macule. What should be your next step?
Evaluate for hemangioma as these may be presenting signs.
A 2-year-old child has a triangular-shaped patch of nonscarring alopecia at the frontotemporal scalp. What is the likely diagnosis and management?
The likely diagnosis is Triangular Temporal Alopecia (TTA). It is benign, will not expand, and does not require treatment.
What is the most common dermatophyte that causes infantile tinea capitis?
Trichophyton tonsurans is the most common dermatophyte associated with infantile tinea capitis.
What is the treatment of choice for tinea capitis?
The treatment of choice for tinea capitis is oral griseofulvin.
What benign condition is often seen in young girls associated with constipation and can be treated with a high-fiber diet?
Infantile perineal protrusion is a benign condition seen in young girls that can be associated with constipation and treated with a high-fiber diet.
What is the prognosis of trichotillomania in infants compared to adolescents and adults?
Trichotillomania in infants has a good prognosis, whereas hair pulling in adolescents and adults has a much poorer prognosis.
What is the most common dermatologic condition in babies and children?
Diaper dermatitis is one of the most common dermatologic conditions in babies and children, accounting for approximately 1 million pediatric consultations each year.
What is a characteristic feature of infantile granular parakeratosis?
Bilateral linear plaques in the inguinal folds.
What should be avoided during an examination of a young child?
Early prolonged or intense eye contact.
What is the recommended position for examining the perineum and genitalia of a child?
Knee-chest position on the table or the parent’s lap.
What is a common mistake when interpreting genital examination in infants?
Mistaking infantile perianal pyramidal protrusion for condyloma acuminata.
What are the potential dangers associated with biopsies in infants and children?
- Possible intracranial connection with biopsies or scrapings
- Risk of meningitis with biopsy
- Spina bifida occulta and meningomyelocele risks
- Intracranial connection in 100% of encephaloceles and gliomas may extend into nearby structures.
What is the maximum dosing for EMLA cream in children of different age groups?
Age Group | Max Dose |
|—————-|———-|
| 1 - 3 months | 1g |
| 3 - 12 months | 2g |
| 1 - 6 years | 10g |
| 7 - 12 years | 12g |
What are some alternative pain management techniques for young children undergoing procedures?
- Numb with ice or anesthetic cryospray
- Pacifier dipped in sucrose solution
- Baby swaddling
- Distraction techniques (e.g., music or movies)
- Alkalizing local anesthetics to pH 7
- Warming lidocaine to lessen pain
- Gentle vibrational motions during injection.
What are the top allergens identified in pediatric patch testing?
Allergen | Prevalence |
|———————|————|
| Nickel | 22% |
| Fragrance mix 1 | 11% |
| Cobalt | 9.1% |
| Balsam of Peru | 8% |
| Neomycin | 7% |
| Propylene glycol | 7% |
| Cocamidopropyl betaine | 6% |
| Bacitracin | 6% |
| Formaldehyde | 6% |
| Gold | 6% |
What strategies can be employed to ensure successful patch testing in children?
- Have the child stand up straight
- Use Hypafix tape or other dressings to ensure patches stay in place
- Advise to avoid sports or gym class to prevent sweating or movement.
What is a common concern regarding biopsies in infants and children?
There has been a widespread reluctance to biopsy skin lesions, which may lead to a delay in diagnosis.
What is the purpose of using EMLA cream in pediatric procedures?
To minimize pain during procedures.
What is a potential risk associated with the use of EMLA cream?
It can result in methemoglobinemia and seizures.
What is the maximum dose of EMLA cream for a child aged 1-3 months?
1g.
What technique can be used to reduce pain during venipuncture in infants?
Giving a pacifier dipped in a sucrose solution.
What is the prevalence of sensitization among children with suspected allergic contact dermatitis (ACD)?
65%.
What is a common allergen found in patch testing for children?
Nickel, which is found in 22% of tested children.
What should be considered when performing general anesthesia in healthy pediatric patients?
Weigh the risks and benefits, especially regarding the developing brain of young children.
What is a recommended technique for obtaining an MRI in infants?
Use ‘Feed and swaddle’ techniques to keep the baby motionless during the procedure.
What are the potential dangers associated with performing biopsies on infants and young children, and how can these risks be mitigated?
Potential dangers include:
- Intracranial connection risks with certain lesions (e.g., dermoid cysts, nasal masses).
- Risk of meningitis with biopsies or scrapes.
Mitigation strategies:
- Preoperative imaging (e.g., MRI) to assess risks.
- Consultation with specialists (e.g., neurosurgical).
- Proper management techniques to minimize risks during the procedure.
What are the recommended maximum doses of EMLA cream for different age groups in pediatric patients, and what precautions should be taken when using it?
Maximum doses of EMLA cream:
- 1-3 months: 1g
- 3-12 months: 2g
- 1-6 years: 10g
- 7-12 years: 12g
Precautions:
- Increased absorption on diseased skin can lead to toxicity.
- Monitor for methemoglobinemia and seizures as potential side effects.
What are the key considerations when administering general anesthesia to healthy pediatric patients, especially regarding elective procedures?
Key considerations include:
- Weighing the risks and benefits of general anesthesia (GA) against the unknown risks to the developing brain of young children.
What should a child do regarding posture?
The child should stand up straight.
What can be used to keep patches in place?
Use Hypafix tape or other dressings.
What should a child avoid to prevent sweating or movement?
Advise the child to avoid sports or gym class.
What limits the number of patches that can be placed on a child’s back?
The smaller surface area of the back in children may limit the number of patches.
What are key considerations when administering general anesthesia to healthy pediatric patients?
Weigh the risks and benefits of general anesthesia against the unknown risks to the developing brain.
Who should perform general anesthesia in pediatric patients?
Ensure that general anesthesia is performed by a qualified pediatric anesthesiologist.
What technique can minimize movement during procedures requiring sedation?
Utilize techniques like ‘feed and swaddle’.
What precautions should be taken for a 7-year-old requiring a biopsy?
Ensure proper preparation and avoid biopsy in detrimental situations.
What alternative can reduce pain for a newborn undergoing venipuncture?
A pacifier dipped in sucrose solution has been found superior to topical EMLA.
What is the maximum dose of lidocaine for a 10-month-old baby weighing 10 kg?
The maximum dose is 2 grams.
What are the top three allergens to test for in suspected allergic contact dermatitis?
Nickel (22%), Fragrance mix 1 (11%), and Cobalt (9.1%).
