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Pediatrics > BRS Dermatology > Flashcards

BRS Dermatology Flashcards

0
Q

examples of keratolytics (for thickened skin)

A

salicyclic acid
urea
alph-hydroxy acids
retinoic acid

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1
Q

ointment vs. cream vs. lotion

A
  • ointment- little or no water, maximal water retaining properties –> useful for very dry skin
  • cream- 20-50% water –> useful for skin of average dryness
  • lotion- more water than creams –> useful for minimally dry skin or for large surface areas
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2
Q

when should you worry about topical steroids having systemic effects

A

when very potent topical steroids are used on damaged or thin skin for longer than 2 weeks
-adrenal suppression, depressed growth, cataracts, glaucoma, cushing syndrome

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3
Q

what is tacrolimus ointment used for

A

atopic dermatitis

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4
Q

one to five percent sulfur is used for _____

A

acne

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5
Q

tar is used for _____ and ______

A

eczema and psoriasis

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6
Q

2 types of contact dermatitis

A

allergic contact dermatitis

primary irritant contact dermatitis

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7
Q

etiology of allergic contact dermatitis

A
  • direct T cell mediated response to an exogenous applied allergen
  • requires sensitization and then rechallenge, not dose dependent
  • poison ivy, oak, or sumac; nickel containing jewelry and belt buckes; topical lotions and cream; perfumes and soaps
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8
Q

what does allergic contact dermatitis look like

how to tx it

A

erythematous papules and vesicles in the area of contact

tx with topical steroids

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9
Q

etiology of primary irritant contact dermatitis

what’s the most common type

A
  • caustic substance irritates the skin
  • no sensitization needed, dose dependent
  • most common type is diaper dermatitis +/- Candida albicans secondary infection
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10
Q

what does diaper dermatitis look like

A
  • erythema with papules on the upper thighs, buttocks, and GU area without involvement of the inguinal creases
  • if inguinal creases are involved, there is more confluent erythema, and satellite lesions are present –> suspect candidal superinfection
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11
Q

how to tx diaper dermatitis

A

skin moisturizers
barrier creams and ointments (ex. zinc oxide)
frequent diaper changes
low potency steroids for severe inflammation
if there’s candidal infection, give nystatin or clotrimazole

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12
Q

eruption of red scales and crusts in ares with high numbers of sebaceous glands like the scalp, face, chest, and groin; skin lesions may be greasy
-what is this, what demographic

A

seborrheic dermatitis

-infants and teens

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13
Q

infants with seborrheic dermatitis on the head is called _______

A

cradle cap/seborrheic capitis

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14
Q

how to tx seborrheic dermatitis

A
  • low potency topical steroids
  • sulfur, zinc, or salicyclic acid based shampoos –> light scrubbing to remove crusts
  • topical antifungal to eradicate pityrosporium ovale (potential causative agent)
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15
Q

what age group do you see pityriasis rosea in

A

late childhood and teens

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16
Q

papulosquamous disorder that begins with a solitary large scaly erythematous lesion (herald patch) –> 1-2 weeks after, oval erythematous macules and papules erupt from chin to mid-thigh following skin lines in a christmas tree distribution

A

pityriasis rosea

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17
Q

how to tx pityriasis rosea

A

topical or stystemic antihistamines

exposure to UV light may help

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18
Q

scaling papules and plaques often on the scalp (non-greasy w/o hair loss), ears, elbows, knees, lumbosacral area, and groin; some lesions with silvery scale

A

psoriasis

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19
Q

in childhood onset psoriasis, what is the cause

A

often genetic with AD inheritance

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20
Q

psoriasis may exhibit koebner phenomenon, which is _____

A

new lesions develop at sites of skin trauma

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21
Q

nail involvement in psoriasis is _____

examples are ______

A

common

pits, distal thickening, lifting of the nail bed, nail destruction

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22
Q

how to tx psoriasis

A
  • moderate or high potency steroids
  • UV light therapy
  • analogs of vitamin D
  • 3% salicylic acid in mineral oil for scalp
  • retinoids
  • anthralin (down regulates EGF)
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23
Q

etiology of miliaria rubra

A

heat rash

-disrupted sweat ducts (caused by occlusion or friction) –> sweat released onto skin –> inflammatory response

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24
Q

small erythematous pruritic papules or vesicles occur in areas of occlusion or in areas that have been rubbed (inguinal region, axilla, chest, neck)

A

miliaria rubra

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25
Q

how to tx miliaria rubra/heat rash

A

avoid occlusive clothing

no meds needed

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26
Q

urticaria but then fever, arhtralgias, adenopathy, evidence of organ injury
-caused by meds like cephalosporins

A

serum sickness

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27
Q

______ is a severe reaction to drugs that cause widespread epidermal necrosis
> 30% skin loss
severe mucous membrane involvement
Nikolsky sign with high mortality (10-30%)

A

toxic epidermal necrolysis (TEN)

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28
Q

erythema multiforme is a hypersensitivity reaction to many different stimuli…what are the 3 major types?
what is the classic skin lesion in all cases?

A

erythema multiforme major
erythema multiforme minor
Stevens-Johnson syndrome
classic skin lesion is a target lesion: a fixed, dull red, oval macule with a dusky center that may contain a papule or vesicle

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29
Q

Stevens-Johnson syndrome

  • major cause
  • skin findings
  • mucous membrane findings
  • systemic findings
  • management
  • prognosis
A
  • drugs
  • widespread atypical, asymmetric target lesion, blisters, and necrosis
  • at least 2 mucosal surfaces (often mouth and eyes)
  • prodrome of high fever, cough, malaise, HA, arthralgias
  • supportive care, stop drug, ophtho consult, +/- steroids/IVIG/burn unit
  • high morbidity and mortality (5%)
30
Q

erythema multiforme major

  • major cause
  • skin findings
  • mucous membrane findings
  • systemic findings
  • management
  • prognosis
A
  • mycoplasma pneumoniae; drugs
  • typical symmetric target lesions; acral and truncal distribution
  • at least 2 mucosal surfaces (often mouth and eyes)
  • prodrome of low grade fever, arthralgias, myalgias
  • supportive care; erythromycin or azithromycin if M pneumoniae; stop the offending drug
  • good prognosis
31
Q

erythema multiforme minor

  • major cause
  • skin findings
  • mucous membrane findings
  • systemic findings
  • management
  • prognosis
A
  • HSV
  • symmetric target lesions; acral distribution
  • occurs in 25%; only one surface (often mouth)
  • prodrome of low grade fever, arthralgia, myalgias
  • supportive care; acyclovir may present recurrence
  • good prognosis; possible recurrence
32
Q

tinea capitis is a fungal infection of _____

MC organisms

A
  • hair

- 95% Trichophyton tonsurans, 5% Microsporum canis

33
Q
  • patchy hair loss in which hairs break off at the scalp (black dot ringworm) or in which broken hairs are thickened and white
  • scales and pustules
  • kerion- large red boggy nodule
  • occipital and posterior cerval LAD
A

tinea capitis

34
Q

how to dx tinea capitis

A

microscopic evaluation of hairs with 10% KOH
fungal cx
hairs fluoresce under woods light if it’s M. canis

35
Q

how to tx tinea capitis

A

systemic oral antifungal (ex. griseofulvin)

topical 2.5% or 5% selenium sulfide shampoo to reduce infectivity

36
Q 
tinea corporis
tinea pedis
tinea cruris 
tinea unguium (onychomycosis)
*where is the infection?
A

body
foot
groin
nails

37
Q

oval or circular scaly, erythematous patches with partial central clearing

A

tinea corporis (ringworm)

38
Q

post pubertal teens with scaling and erythema between the toes or on the plantar aspects of the foot

A

tinea pedis (athlete’s foot)

39
Q

scales and erythema in the groin and inguinal creases

A

tinea cruris

40
Q

how to dx and tx tinea corporis, tinea pedis, and tinea cruris

A

dx on H&P
can do KOH exam of skin scrapings
-tx with topical antifungal meds (clotrimazole, terbinafine, ketoconazole)

41
Q

how to tx tinea unguium (onychomycosis)

A
  • topical tx is challenging and unsuccessful most of the time
  • systemic meds like griseofulvin, terbinafine, and ketoconazole can be tried
42
Q

-fine scaly oval macules on the trunk, proximal arms, and face
-macules may be hypo or hyperpigmented and become more prominent with sun exposure
what is this and what is it caused by

A

tinea versicolor common in teens

caused by yeast pityrosporum orbiculare

43
Q

how to dx and tx tinea versicolor

A

KOH exam- spaghetti and meatballs, yellow/orange under woods lamp
tx with overnight application of 2.5% selenium sulfide weekly for 3-4 weeks, ketoconazole shampoo or cream, or systemic antifungals

44
Q

define exanthem and enanthem

A

exanthem- skin rash asso with a viral infection

enanthem- involvement of the oral mucosa

45
Q

erythema infectiosum (fifth disease) is associated with ______ infection, which may also cause these things

A

parvovirus B19

aplastic crisis, prolonged anemia, fetal hydrops or miscarriage in pregnant women

46
Q

URI –> slapped cheek appearance 1-2 weeks later –> lacy, reticular rash on the trunk and extremities for 3-5 days after the facial rash
what is it and how to tx
most common demographic

A

fifth disease/parvovirus B19 infection
supportive tx
school age children

47
Q

pts with slapped cheek rash are still contagious with parvovirus B19

A

F

they are no longer contagious when the facial rash appears

48
Q

_______ is caused by HHV 6 and 7 in children younger than 2 years
what are the clinical features and what is the tx

A

roseola infantum (exanthem subitum)

  • 3-5 days of high fever –> pink papular eruption that looks flat and confluent on the trunk that generally fades in 24-48 hours
  • tx is supportive
49
Q

gianotti-crosti (papular acrodermatitis) occurs in kids ______ of age and is associated with ______ infection

  • what does it look like
  • how do you tx it
A
  • younger than 3 years
  • hepatitis B (EBV, CMV, and coxsackievirus)
  • red or flesh colored flat topped papules in the acral areas (extremities, buttocks, cheeks)
  • treatment is supportive
50
Q

intensely pruritic erythematous macules that develop central vesicles within 1-2 days; “dew drop on a rose petal”/vesicle on a red background; fever
what is this and how to tx it

A

varicella (chickenpox)

  • tx with antipyretics, antibacterial soaps to prevent bacterial infxn, antihistamines, etc
  • acyclovir IV for varicella pneumonia and encephalitis, oral for high risk for complications, topically in eyes for those with ophthalmic involvement
51
Q

two types of HSV infection

A

neonatal infection- acquired through birth canal; 2/3 HSV2, 1/3 HSV1
gingivostomatitis- HSV1

52
Q

characteristic lesions are grouped vesicles on an erythematous base

  • young infants with grouped vesicles and ulcers on the lips, corners of mouth, tongue, drooling, fever
  • first week of life… may only have a few vesicles in one spot but may also have serious signs of meningoencephalitis, hepatitis, sepsis, shock
  • HSV1 infection of the thumb or fingers
A
  • HSV gingivostomatitis
  • neonatal HSV
  • herpetic whitlow
53
Q

HSV resides in the ______ after initial infection

A

DRG

54
Q

how to dx HSV infection

A

Tzanck preparation
direct fluorescent antibody testing
viral cx
PCR

55
Q

how to tx HSV infection

  • neonatal
  • cutaneous and oral
A
  • neonatal- this is a medical emergency!! immediate hospitalization and tx with IV acyclovir
  • cutaneous and oral- oral acyclovir
56
Q

vesicles, papules, pustules on the palms, soles, or fingertips and shallow ulcers on the soft palate/tongue
what is it, what’s the etiology, what’s the tx

A

hand foot mouth disease caused by coxsackievirus type A16
if it’s only oral lesions, it’s called herpangina
tx is supportive

57
Q

irregularly shaped, discrete flesh colored papules that may be smooth or rough
what is it and what is it caused by
how to tx

A

warts caused by HPV
if multiple external warts in the genital area –> condylomata acuminata
most resolve in 1-2 years… tx with liquid nitrogen, salicylic acid, etc

58
Q

flesh colored papules with central umbilication

  • what is it called
  • what’s it caused by
  • if extensive, think ______
  • tx?
A
  • molluscum contagiosum
  • poxvirus
  • HIV
  • tx is observation with expected resolution; can do curettage or liquid nitrogen, etc
59
Q

____ causes head and body lice
____ causes pubic lice
how to tx?

A

pediculum humanus
phthirus pubis

  • head lice: 1% permethrin shampoo and comb
  • body and pubic lice: 12 hour application of 1% gamma-benzene hexachloride lotion
60
Q

severe itching, S shaped burrows, pruritic papules or vesicles in dorsum of hands, groin, axilla, interdigital spaces

  • what is it
  • what is it caused by
  • how to dx
  • how to tx
A
  • scabies
  • sarcoptes scabiei
  • microscopic examination of a scraping demonstrates mite, egg, mite feces, etc
  • tx with overnight application of 5% permethrin lotion or 1% lindane (teens and adults only), wash everything, tx family members
61
Q

hypopigmented, dry, scaly patches- most commonly on the cheeks
what is it and how to tx

A

pityriasis alba

  • related to atopic dermatitis
  • tx with moisturizers and mild steroids
62
Q

complete loss of skin pigment in patchy areas 2/2 melanocyte destruction

A

vitiligo

no effective tx

63
Q

genetic defect in melanin synthesis

white skin and hair, blue eyes, photophobia, nystagmus

A

oculocutaneous albinism

no tx

64
Q

ash leaf spots (hypopigmented macules under woods light)
adenoma sebaceum (angiofibromas on nose or face)
shagreen patch (thickened orange peel appearance)
infantile spasms
#1 cause of neonatal cardiac tumors

A

tuberous sclerosis

65
Q

cafe au lait spots
axillary or inguinal freckling
optic glioma
lisch nodules (iris hamartoma)

A

NF-1

66
Q

congenital vs. acquired nevi

which is at higher risk of malignancy

A

giant nevi (a type of congenital nevus)

67
Q

autoimmune lymphocyte mediated injury to the hair follicles

  • complete hair loss occurs in one to three sharply demarcated scalp areas w/o any scalp inflammation
  • nail pitting can occur

what is this called, what are some subtypes, how to tx

A
  • alopecia areata
  • subtypes include alopecia totalis (loss of all scalp) and alopecia universalis (loss of all body and scalp hair)
  • tx with topical or injected steroids and topical minoxidil to speed up the process… regardless, hair will regrow spontaneously within 1 year
68
Q

traction alopecia

A

hair loss 2/2 constant traction or friction (tight hair braids, vigorous scalp massage, etc)

69
Q

telogen effluvium the second most common type of alopecia (after male pattern baldness) and is 2/2 ________

A

acutely stressful event that converts hairs from growing phase (anagen) to final resting phase (telogen)

  • causes generalized excessive hair loss
  • spontaneous regrowth occurs
70
Q

acne is associated with this bacteria

A

P acnes

71
Q 
open comedones (blackheads) and closed comedones (whiteheads) are associated with \_\_\_\_\_\_\_
erythematous papules, pustures, nodules, cysts are associated with \_\_\_\_\_\_
A

noninflammatory acne
inflammatory acne
*most ppl have both

72
Q

how to tx acne

A
  • noninflammatory and mild inflammatory: topical benzoyl peroxide, tretinoin, salicylic acid
  • inflammatory: antibiotics (oral or topical) and benzoyl peroxide
  • really intense tx that can cause teratogenic effects: systemic isotretinoin (accutane)

Pediatrics (14 decks)

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