derm Flashcards by Alyssa Nastro

dx with wright stain showing multinucleated giant cell and eosinophilic intranuclear inclusions

neonatal herpes

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incontinentia pegmenti

vesicles in a linear pattern without an erythematous base

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rash present at birth with multiple pustules, brown macule, vesicles, pustules on a non erythematous base

transient neonatal pustular melanosis
“leaving a collarette”
more common in African Americans

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gram stain in transient neonatal pustular melanosis

PMNs without organisms

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neonatal rash with yellow pustules on an erythematous base

E tox

not present at birth
spares palms and soles
not in premies
fades in ~1wk

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neonatal rash with generalized erythematous macules with solitary papules or vesicles in the center

E tox

not present at birth
spares palms and soles
not in premies
fades in ~1wk

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gram stain in E tox

eosinophils

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neonatal rash with diffuse scaling and erythematous papules and pustules

cutaneous candidiasis

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eczema herpeticum

invasion of eczematous skin with herpes virus
-inflamed eczema which is not responding to steroids or abx
-vesicle and punched out or crusted lesions
-usually see on the face
tx w/ acyclovir

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eczema with evidence of immunodeficiency

Wiskott Aldrich syndrome & hyperimmunoglobulin E syndrome

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young child with seb derm also w/ profuse ear discharge and profuse urine output

histiocytosis x

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how is the poison ivy rash contagious?

it isn’t!

fluid from the vesicles does not spread the rash

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rash to the soles of the feet that is scaly, thick and has hyperlinearity of the distal soles with nl normal interdigital skin

juvenile plantar dermatosis

type of contact dermatitis
tx with steroids cream-triamcinoloone

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erythematous plaques surrounded by thick adherent scales. with pinpoint hemorrhages under the plaques

psoriasis

pinpoint bleeding is called Auspitz sign

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round, oozing, crusting, erosions and dry macules with scaly pattern

nummular eczema

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small, oval, thick scaling plaques with the long axis lesions parallel to the likes of skin stress

pityriasis rosea

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treatment for pityriasis rosea

nothing

but exposure to sun or light improves sx and may hasten resolution

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thin scales with pasted on appearance

ichthyosis vulgaris

looks like fish skin

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treatment for ichthyosis vulgaris

keratolytic agents- ammonium lactate cream
alpha hydroxy acid
urea containing emollients

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non scaling annular lesion without epidermal involvement

granuloma annulare

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what is the cause of staph scalded skin syndrome

exotoxin produced by staph aureus

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what is the cause of toxic shock syndrome

caused by toxin production either by S aureus or strep- mortality of strep TSS is much higher than staph TSS

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what is the cause of scarlet fever

toxin caused by erythrogenic exotoxin produced by GAS- commonly a/w strep pharyngitis

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what is the difference of staph scalded skin and TEN

SSSS does not involve the dermis and TEN does

distinguish by biopsy
also SSSS often in younger kids and TEN in older kids

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what is TEN from

a hypersensitivity rxn

rash with boggy and blue ulcers on a necrotic base

pyoderma gangrenosum usual a/w systemic dz

erythema infectiousum

fifth disease slapped cheek a/w parvo

erythema marginatum

``` a/w rheumatic fevers Jones criteria Joint involvement w/migratory arthritis O myOcarditis Nodes subq Erythema marginatum Sydenham chorea ```

treatment for scabies

permethrin 5% | tx all family members bc highly contagious

how long can lice live away from scalp

36 hrs without a blood meal

maculae caeruleae

blue-grey macules on the abdomen or inner thigh | c/w pubic lice

treatment for molluscum

nothing! will clear in mos to yrs

wright stain for molluscum

viral inclusion bodies

pink, excoriated, pruritic lesions with central punctum in clusters on the extensor surfaces of the arms and legs

papular urticarial occurs typically at night can last up to 7 days

what is the cause of papular urticaria

delayed hypersensitivity rxn to an insect bite

what causes the black color of blackheads

melanin

adenoma sebaceum

angiofibromas that can appear red/pink/brown

meds that lead to acne

systemic steroids, anticonvulsants

side effects of isoretinoin

- dry lips - dry eyes - dry skin - nose bleeds - HA

gold standard for dx of tinea capitis

fungal cx

tx of choice for tinea capitis

griseofulvin 6-12 wks or fluconazole or terbinafine

what is telogen effluvium

loss of large amounts of hair after washing or brushing- triggered by stressful event/illness

pigmented lesions that turn into hives and develop blisters- particularly with rubbing

- also called darier sign - uticaria pigmentosa - occurs typically in first 6 mos of life - worsened by narcotics, NSAIDs, and contrast

how to dx tinea versicolor

KOH prep

how to tx tinea versicolor

astringents and topic antifungals | limit sun exposure as this worsens rash

incontinenentia pigmenti

xlinked dominant- lethal in males 1- erythematous papules and vesicles in crops along the lines of Blaschko that last 1-2 wks 2- swirls of warty growths 3- streaks of hyperpigmentation in marble cake pattenr 4- hypopigmentation

pityriasis alba

post inflammatory hypopigmentation in atopic skin

MRI finding in sturge weber

venous leptomeningeal angiomatosis- a/w port wine stain

tx of port wine stain

tunable dye laser (pulsed dye laser)

where is the port wine stain in sturge weber?

trigeminal distribution | need ophtho referral

what is the inheritance of ichthyosis vulgaris

what is the dx: child presents in the first year of life with prominent scales over the extensor surfaces with flexor sparing. The rash improves with warm/humid weather. On exam there is noted hyperlinearity of the palms and soles

``` ichthyosis vulgaris (AD) d/t loss of fxn of filaggrin tx with emollients and keratolytics (lactic acids) avoid salicylates ```

what are the adverse effects of topical steroids (6)

- folliculitis - perioral dermatitis - steroidal acne - skin atrophy - telangiectasias - adrenal suppression

what is the difference between eczema herpeticum and eczema coxsackium

eczema coxsackium is more superficial

what bony deformities are seen with NF1

``` macrocephaly short stature sphenoid dysplasia cervicothoracic kyphoscoliosis pseudoarthrosis of tibia pectus excavatum genu valgum/varum scoliosis ```

chromosome __ is involved in NF1

17q11.2 neurofibromin (guanosine diphosphate-activating protein GAP) = tumor suppressor

chromosome __ is involved in NF2

what is mccune albright syndrome (5)

``` large segmental cafe au lait also a/w... - accelerated linear growth - precocious puberty - skeletal defects- polyostotic fibrous dysplasia with bowing of arms - endocrine abnormalities ```

what is PHACES

``` Posterior fossa malformation Hemangioma (segmented, cervicofacial) Arterial anomalies (intracerebral) Cardiac anomalies/coarc Eye abnormalities Sternal defects ```

what do you need to investigate in children with lumbosacral hemangiomas

spinal cord or GU abnormalities

what do you need to investigate in children with beard-like hemangiomas

airway compromise

what do you need to investigate in children with multiple (>5) hemangiomas

internal/visceral hemangiomas (live, lung, GI, eyes, CNS)

what is the dose of griseofulvin for tinea capitits

20 mg/kg/d with fatty foods to increase absorption | tx 6-8 wks

what is the dx 2 week old infant with bullous rash noted to have staph colonization of the umbilical stump

bullous impetigo

how long does pustular melanosis last

present at birth-several mos

gram stain findings with: miliaria rubia (heat rash)

many PMN | no bacteria

gram stain findings with: e tox

many eos maybe some PMN no bacteria

gram stain findings with: transient neonatal pustular melanosis

many PMNs | no bacteria

gram stain findings with: bullous impetigo

any PMN | gram pos cocci in clusters

name the dx child with many 0.2-1 cm *scaly* papules and plaques distributed symmetrically over the trunk and proximal extremities following GAS

guttate psoriasis

what is the concern in an infant with a large congenital melanocytic nevi

neurocutaneous melanosis, melanoma, spinal dysraphism, dandy walker

what is the diagnostic criteria of juvenile dermatomyositis (5)

skin signs plus 3 - cutaneous featurs (heliotrope, gottons sign) - progressive symmetrical weakness of proximal mm - elevated muscle enzymes - myopathy on EMG or MRI - biopsy evidence of myositis and necrosis

what further work up must be done in a child with a midline facial dermoid cyst

need MRI to look for CNS comminication

what bug is usually a/w necrotizing fasciitis

GABHS

how do you transmit molluscum

skin to skin and autoinnoculation

what do you need to worry about in the future for children d/w lichen sclerosis

increase risk of lesional squamous cell carcinoma in affected adults

what is the inheritance of hidrotic ectodermal dysplasia

what is the inheritance of hypohidrotic ectodermal dysplasia

x linked R

name the dx child with nail dystrophy, hyperkeratosis of the alms and soles, and hair defects of note there are NO abnl facies

hidrotic ectodermal dysplasia

name the dx young boy with absent/reduced sweating, hypotrichosis, defective dentition

hypohidrotic ectodermal dysplasia