Derm Flashcards
2 commonest disease assoc with SJS
Preceding herpes simplex or Mycoplasma pneumoniae infections
How many cutaneous strawberry naevi should raise suspicion for internal lesions?
6 or more - need further investigation
AKA haemangioma
What is tinea incognito
Fungal skin infection in which the appearance has been altered by inappropriate tx with steroids
A very firm, white or violaceous patch of skin. As it develops it will have a well demarcated red/violaceous edge
Morphoea
As the lesions develops the edge will become the same colour as the center of the lesion, it will become very firm with an atrophic glazed surface appearance
Scabies can present with a rash on the body that is similar to eczema but should also have involvement of palms, soles and/or genitals T/F
T
Isotretinoin can cause hirsutism T/F
F side effect can be diffuse alopecia areata
What labs need to be monitored for a pt on isotretinoin
Serum lipids and LFTs - prior to tx, 4 weeks and maybe also 8 weeks
Pregnancy needs to be avoided in a pt on isotretinoin and for 6 months after tx T/F
F - For up to one month after tx
Haemangiomas are more common in what race and sex
White
Females x3 more common than males
Also more common in preterm infants
% resolution of haemangiomas by age
50% 5 yrs
70% 7 yrs
90% 9 yrs
Indications for tx of haemangiomas?
- Psychological distress
- Impinging on vital structures - vision, airway
- Ulcerated and bleeding
- Secondary infection
Steroids can be used in the tx of haemangiomas T/F
True - systemic or intralesional
Also beta blocker; subcut interferon gamma, laser or excision
The majority of haemangiomas are present at birth T/F
F - only 30% are present at birth
About half of haemangiomas leave some form of permanent skin change T/F
T - eg telangiectasiae, superficial dilated veins, epidermal atrophy
Port wine stain on a limb with associated soft tissue and bony over overgrowth. Can also have venous malformations. Syndrome?
Klippel-Trenauay syndrome
Tuberous sclerosis is associated with what skin abnormality?
Hamartomas Shagreen patches Ash leaf macules Perungual fibromata Facial angiofibromata
Features of pompholyx
Rare in children less than 10 yrs old
Sudden onset of crops of clear vesicles, usually bilateral involving fingers, toes, palms and soles. Often recurrent
Often hx of atopy
When is typical age of onset of epidermolysis bullosa simplex
Onset in early childhood, around the time child starts to walk
EB simplex is localised to fiction sites, usually hands and feet
When and where does chronic bullous disease of childhood usually present?
Usually > 3 yrs old (note older than EB simplex)
Lesions typically affect the peri anal area and spread to the trunk, thighs, limbs, hands and feet. There may also be mucosal involvement (mouth, genitals, eyes and nose)
AKA linear immunoglobulin A disease
What is the mechanism of action of UBV phototherapy for psoriasis
Induction of pyrimidine dimerisation
Note: disease is due to increased cell turn over
Classification of acne?
Mild: <20 comedones and < 15 inflammatory lesions (or less than 30 lesions total)
Mod: 20-100 comedones and 15 -50 inflammatory lesions (or 30-125 lesions total)
Severe: > 100 comedones, >50 inflammatory lesions and > 5 pseudocysts (or > 125 lesions total)
Where is dermatitis herpetiform classically?
Symmetrically distributed
On the extensor surfaces ( elbows, knees, neck) and back
Note: it is very itchy and comes and goes
Describe the hair loss and scalp findings in alopecia areata?
Hair loss is well circumscribed
Scalp is normal
Note: also can be assoc with nail changes.
In tinea capitis there is variable amount of erythema and scaling of the scalp
Presentation of telogen effluvium?
Sudden increase in hair shedding, diffusely, 3-4 months after an inciting event such as an illness, pregnancy, loss of loved one or medication.
Note: tx is reassurance only
Other causes of diffuse hair loss are hypothyroidism and Zn deficiency
Most common cause of acute urticaria in children?
Viral trigger
Keratoderma blenorrhagica is highly diagnostic of what disease?
Reactive arthritis
Note: they are brown aseptic abscesses on soles and palms
What is the typical distribution of chronic bullous disease of childhood?
Typically affects the perianal area and spread to the trunk, thighs, limbs, hands and feet
Note: they are small tense blisters on an erythematous background
What is the difference between SJS and TEN?
The amount of skin involved
SJS <10% (dense dermal neutrophilic infiltrate)
TEN > 30% (minimal to no dermal infiltrate)
Between 10 - 30% is SJS/TEN overlap
Note: erythema multiforme is when there is no mucosal involvement
Differentiate vitaligo from piebaldism distribution?
Hands and feet are spared in piebaldism
Gradually progressive red plaque, annular in shape with crusting and induration at the periphery and scaring at the centre. Tinea corporis vs Lupus vulgaris
Lupus vulgaris - most common manifestation of cutaneous TB. Starts as a painless reddish- brown nodules and then progresses to an irregular red plaque and can ulcerate if not treated
Note: tine corporis has a central clearing
Papular lesions, symmetrically distributed, spaces trunk. Flat, monomorphous and flesh toned - brown in colour. What pathology?
Gianotti- Crosti syndrome (aka papular acrodermatitis of childhood)
What is the most common infection associated with Gianotti- Crosti syndrome?
EBV
What are the most common systemic manifestations of incontinentia pigmenti?
Dental changes (pegged teeth)
Nail changes
Alopecia
Retinal detachment due to neovascularisation is a serious complication
Note: derm manifestations have 4 overlapping stages -
- inflammatory vesicles and bull associated with eosinophilia (can have similar appearance to herpes)
- Warty lesions
- “Swirly” brown, bluish-grey pigmentation which first darkens and then slowly faded
- Hypopigmentation
Recurrent episodes of smooth “glazed” erythema and fine scaling of toes and distal soles with sparing of the interdigital webs. What is the diagnosis and tx?
Juvenile plantar dermatosis
Avoid impermeable footwear and apply emollients
Erythema nodosum is commonly associated with beta haemolytic strep T/F
T - also associated with other infections, sarcoidosis, Behcets, IBD and malignancy
Occular features of albinism?
Photophobia
Decreased visual acuity/blindness
Nystagamus
Albino individuals may be more susceptible to nephrotoxins T/F
F - they may be more susceptible to otoxotins due to decreased melanin within the cochlea
What is the cause of id reaction/autoeczematization?
Tx?
Thought to be a type IV hyper sensitivity reaction to dermatophyte (such as those that cause tinea) or may be associated with a severe contact dermatitis
Tx: continue any anti fungal; symptomatic tx for itch and tapering steroids if severe
Which rash is more widespread id reaction or drug reaction?
Drug reaction
Note: id reaction lesions begin and remain most prominent on the scalp, face and neck; they may spread to trunk though
Hyperlinear palms are often seen in association with what skin condition?
Ichthyosis vulgaris
Disorder of cornification characterised by dry, plate like (fish like) scales which are typically most prominent over the extensor surfaces of the extremities
Ichythosis vulgaris
Tx for sebaceous nevus?
Elective surgical excision (when old enough to tolerate with local anaesthesia)
Or watchful waiting
Where does dyshidrotic eczema typically affect?
Form of hand dermatitis –> palms, soles and sides of digits. Typically symmetrical
Note: Characterised by small firm multilocular vesicles and or bullae, pruritic. Associated with hyperhidrosis
Spironolactone can be used as 2nd line tx for hidradenitis suppurative T/F
T - can be used in females for anti androgen properties. 1st line tx is antibiotics (topical and systemic)
Note: can use systemic steroids for severe cases
What does a Wright stain in transient neonatal pustular melanosis show?
Neutrophils
Note: more common in darker skinned; pustules with a non erythematous base; often on scalp, neck, chin and trunk, typically rupture after several days, leaving behind a central hyper pigmented macule that is initially slightly scaly in appearance
What does a Wright stain in E tox show?
Eosinophils
What is the treatment of transient neonatal pustular melanosis?
Reassurance only
Guttate psoriasis is associated with what bacterial infection?
Streptococcal infections
Biopsy is required for diagnosis of lichen sclerosis T/F
F - clinical diagnosis
Features of fatty acid deficiency?
Reduced growth velocity
Delayed neurodevelopment
Scaly dermatitis
Increased susceptibility to infection and poor wound healing
Side effects of long term use of topical steroids?
Hypo-pigmentation
Telangiectasias
Atrophy
What is the treatment of chronic bullies disease of childhood (aka Linear IgA bulls dermatosis)?
Dapsone.
Although tend to have spin remission of disease by puberty
Crowe sign is a cutaneous findings associated with what disease?
NF 1
It is multiple freckles in the axilla/groin
Medications associated with telogen effluvium?
Betablockers Amphetamines ACEi OCP Retinoids Li
Alopecia areata is associated with a personal or family history of what disease?
Thyroiditis
T1 DM
Brown skin lesion, appears at puberty, grows in size and becomes hairy about 1-2 yrs after first noted. What pathology and mgmt?
Becker nevus - more common in males
Mgmt: cosmetic intervention if desired by pt
Note: can be congenital but more often appear in adolescence
Tx of granuloma annulare?
Topical steroids
Or watchful waiting - will usually resolve by itself in a period of months to years
Note: lesions are NOT scaly. They are smooth, enlarge slowly and surrounded by raised elevated borders made up of pustules and/or small nodules. Typically on dorsal or lateral surfaces of hands, feet or ankles.
Nevus of Ota is commonly associated with___
Gluacoma and haemangioma of optic disc
Note: very rarely melanoma. Nevus of Ota aka oculodermal melanocytosis (blueish grey patchy irregular pigmentation in ophthalmic and/or maxillary distribution)
