CH 22 Derm in Infant

Question 1

hemangioma patho

Answer 1

-BENIGN tumor of endothelium
-local proliferative process that affects endothelial cells
-perhaps genetic mutation of epithelial regulation

Question 2

hemangioma presentation

Answer 2

NOT present at birth
grew rapidly from first days of life to 6 months
-slow proliferation for 6-12 months then involution/shrinks phase from 12 months to 3-6 years
-light port wine stain (1/3 have it)

Question 3

hemangioma management

Answer 3

-depends on location, risk of complication, scarring, ulceration
-can slow growth with: oral propranolol, systemic corticosteroids
-vinscristine, interferon alpha injection into lesion
-uncommon: injected steroids, laser therapy
-watchful waiting

Question 4

when would you do watchful waiting for hemangioma?

Answer 4

-for active nonintervention for superficial lesions in low function areas (thigh, upper arm)
-will involute slowly through early childhood

Question 5

port wine lesion patho

Answer 5

disorder of dermal capillaries and post capillary venules
- can be a/s with other congenital or genetic syndromes (Sturge-Weber (if on face) or AV malformation syndrome)

Question 6

port wine lesion presentation

Answer 6

ALWAYS present at birth
-blanchable (vascular) from red to dark pink, grows proportionally with child
-will darken and become more nodular as child grows and not regress
-lesions on face follow trigeminal nerve branches

Question 7

port wine lesion considerations

Answer 7

genetic and congenital syndrome when lesions are present, esp if face and eyelid involved

Question 8

port wine lesion management

Answer 8

Referrals:
-Derm for pulse dye laser therapy (lightens but doesn’t remove)
-ophthalmology if eyelids involved (glaucoma risk)
-neuro (on face = seizures)

Question 9

mongolian spot patho

Answer 9

diffuse melanocytes within dermis
- interrupted movement of melanocytes during
fetal development from neural crest to epidermis

Question 10

mongolian spot presentation

Answer 10

-blue-black-gray macular lesions (lower back, butt mostly)
-single or multiple lesions
NONtender (not bruises), no malignancy potential
-Asian, natives, Africans (rare in europeans)

Question 11

mongolian spot management

Answer 11

no treatment! lighten over time and often disappear during childhood

Question 12

milia patho

Answer 12

retention of keratin and sebaceous material in pilosebaceous glands

Question 13

milia presentation

Answer 13

raised white bumps mainly on nose and cheeks

Question 14

milia management

Answer 14

no treatment! resolves spontaneously 1-2 months
-reassurance to parents
-don’t pick or remove it = scar

Question 15

erythema toxicum neonatorum (ETN) path

Answer 15

unknown
-thought to be immaturity of pilosebaceous glands (hair follicles)

Question 16

erythema toxicum neonatorum presentation

Answer 16

-occasionally at birth, usu appears w/in first 2 days and resolves by day 5-7
-“flea bitten” appearance
-erythematous papules that progress to pustular lesions

Question 17

erythema toxicum neonatorum management

Answer 17

observation, no treatment indicated
-resolves sponatenously
-reassurance!
30-70% full term infants will experience these lesions

Question 18

atopic dermatits (eczema) patho

Answer 18

-impaired epidermal layer, with impaired barrier = irritants get into dermis
-decreased water content due to poor barrier
-itch-scratch cycle worsens condition
-genetic component

Question 19

atopic dermatitis presentation

Answer 19

-itchy, xerosis, red, crusty, extensor surface, face, neck, scalp
-child (2-12 years): lichenification of flexure surfaces (places the BEND: popliteal space, antecubital fossa)
-adult (>12 years): similar^, hand/feet

Question 20

atopic dermatitis management

Answer 20

3 prongs:
1. eliminate triggers
2. hydrate (use thick creams or ointments daily, no lotion bc it dehydrates when it evaporates)
-minimal soap use! bathe only 2-3x/week
-best hydration cream: Crisco cooking fat
3. control itch (sedating antihistamines qhs, topical cortiocs for flares)

Question 21

acne neonatorum patho

Answer 21

-from stimulation of sebaceous glands by maternal or infant androgens (acne is testosterone driven)

Question 22

acne neonatorum presentation

Answer 22

-face, forehead, nose, cheeks
-starts first months of life, lasting 1-2 months (longer than ETN) til ~4 months w/o scarring

Question 23

acne neonatorum management

Answer 23

-self-resolving
-don’t pick or squeeze lesions
-benzoyl peroxide 2.5% if extensive & few months
-affects 20% infants

Question 24

seborrheic dermatitis aka Cradle Cap patho

Answer 24

-usu in areas of dense sebaceous gland (scalp, face, groin, underwarms)
-overstimulation of sebum production
-possibly lipid dependent yeast

Question 25

seborrheic dermatitis infant - cradle cap presentation

Answer 25

-erythematous plaques -greasy with yellow scales -seen in infants and throughout life

Question 26

seborrheic dermatitis infant - cradle cap management

Answer 26

-infant scalp treatment = apply emollient (petrolatum, vegetable, mineral oil) overnight, then remove plaque with soft brush -for other parts of body = ketoconazole 2% cream QD x 1 week or low dose hydrocortisone 1% QD x 1 week

Question 27

keratosis pilaris patho

Answer 27

genetic disorder of hyperkeratinization of hair follicles of the skin

Question 28

keratosis pilaris presentation

Answer 28

-rough skin texture (chicken skin) - usu asymptomatic except of occasional pruritus - poor cosmetic appearance - upper arm most common

Question 29

keratosis pilaris management

Answer 29

-no cure or universal effective treatment available -regular skin are regimen with lotions and creams can lead to improvement -prevent excessive skin dryness with mild soapless cleansers and lubrication w/ moist lotions -lactic acid lotions, alpha hydroxy acid lotion, urea cream, salicylic acid, topic steroid creams, and/or retinoid acid products (Differin)

Question 30

keratosis pilaris more common in __ and worse in __ weather.

Answer 30

childhood and adolsecents -worsens with cold, dry winter weather (eczema variant) -improves with age

Question 31

1. Parents of Asian ancestry bring in their healthy 1-week-old daughter born at full term for a well child evaluation. Upon examination, you notice multiple non-tender blue-black flat lesions on the lower back and buttocks. The most likely diagnosis is: A. Port wine lesion. B. Milia. C. Keratosis pilaris. D. Mongolian spot.

Answer 31

D Mongolian spots look like a bruise but it's NON tender! african and asian most common -face and anterior trunk is spared. fades during prescale age uncommon in europeans

Question 32

2. Which of the following is false regarding hemangioma in infants? A. Almost always present at birth B. Systemic corticosteroids can be used to slow growth C. Involves a local proliferative process affecting endothelial cells D. Possibly genetic in origin

Answer 32

A is false. not always present at birth

Question 33

3. All of the following statements regarding keratosis pilaris are accurate except: A. Caused by hyperkeratinization of hair follicles in the skin. B. The condition frequently improves with age. C. Symptoms tend to be worse in hot andhumid environments. D. The condition is genetic in origin.

Answer 33

Eczema varient! so sx's are worse when air is dry and cold / winter time goosebumps rough feeling answer C

Question 34

4. During a well child visit of a 4-weekold girl, the parents express concern about raised white bumps on the infant’s nose and cheeks. The NP recognizes milia and recommends the following approach: A. No specific treatment as this condition will resolve spontaneously. B. Softly scrubbing the area twice daily with a mild moisturizing soap and warm water. C. Daily application of a low-potency corticosteroid cream to the affected area. D. Referral to a pediatric dermatologist.

Answer 34

answer A Milia is common in young babies and will go away on it's own. Discourage any picky = scarring or steroid use.

Question 35

Treatment of atopic dermatitis / eczema present on the cheeks and mouth of an otherwise healthy 4-month-old infant can include all of the following except: A. Moisturizing cream to hydrate the skin. B. Oral antihistamines to reduce itching. C. Topical antimicrobial to prevent infection. D. An appropriate potency topical corticosteroid to control flares.

Answer 35

C don't need antibiotics!!! 1. Hydration 2. LOW potenency for flares for short period of time. 3. Oral antihistamines for itchiness good! ecezma on face is most like in the young child drooling ~ 4 months irritates eczema doesn't matter what part of body, moisturizing is key!