Derm Flashcards
prodrome of high fever and resp distress followed by red maculopapular rash on trunk that spares face; disappears in 1 to 2 days
Roseola (HHV-6)
Self-limiting (just reassure)
clusters of papules or vesicles on red base along w/ fever, malaise and anorexia –> crusted erosions or ulcerations
Varicella
How long is someone with varicella contagious?
4-5 days after rash appears
mild fever and upper resp symptoms then confluent erythematous macules on face that spares nose and periorbital area which lasts 2-4 days –> lacy, itchy exanthem on trunk and extremities for 1 to 2 w
Fifth’s Disease (parvovirus)
Erythematous papular rash from neck to trunk and extremities + strawberry tongue enanthem that all desquamates and fades in 4 to 5 days
Scarlet fever (group B strep)
Sand paper like rash
Measles v Rubella
- Measles - Maculopapular from forehead down; prodrome of Koplik spots, fever and malaise
- Rubella - macular rash from head and neck down; prodrome of fever, sore throat and malaise
macules, papules and pustules at same stage of development w/ fever, myalgias and malaise
Variola (smallpox)
vesicles on soft palate, pharynx and tonsils; maculovesicular rash on hands, feet, butt and groin
Coxsackie
Herpangina
Maculopapular rash w/o blanching
N meningitis
maculopapular rash on lower chest and abdomen (“rose spots”) w/ fever, myalgias, diarrhea, abdominal pain, hepatosplenomegaly
Salmonella Typhii (typhoid fever)
abnormal peeling of skin w/ erythematous, edematous and fissured skin underneath
Ichthyosis
gray/blue patches esp in darker-skinned infants usually on back or extremities
Mongolian Spots
Distinguish from bruises by lack of other colors like red or yellow and no pain
Usually disappear on own
Salmon Patch
(nevus simplex or angel kisses)
- capillary malformation present at birth; often on eyelids or forehead
- May fade over months to yrs but sometimes outline still present in adulthood
- If found on nape of neck then called “stork bites”
intense purple/red patches over a large surface area in neonate
Port Wine Stain
Discoloration not bad in and of itself but may be associated with underlying syndrome (ex - Sturge Weber)
Milia v. Neonatal Acne
- Milia - white papules; keratin-filled epithelial cysts; present at birth and go away w/in weeks
- Neonatal Acne - (sebaceous hyperplasia) from maternal hormones/androgens in utero; usually appear after 2 wks of age and spontaneously resolve; more yellow than milia
central yellow papules surrounded by halo of erythema; appear on day 1 or 2 of life then increase in number and resolve within first week or so
Erythema toxicum
Very common and no need for treatment
hyper pigmented spots with overlying pustules; hyper pigmented spots remain after pustules disappear; starts in utero so can be at any stage at birth
Transient Neonatal Pustular Melanosis
- Pustules only last 1-2 days then hyper pigmented spots also regress
Cutis aplasia
absence of small patch of skin; associated w/ trisomy 13 or isolated finding
Junctional Melanocytic Nevi
Sebaceous Nevi
Epidermal Nevi
- Junctional melanocytic - completely flat and benign
- Sebaceous nevi - yellow/orange, waxy pebble-like lesion on face or scalp that has no hair follicles; sensitive to androgens in puberty so may elect to remove
- Epidermal - firm papule w/o any evidence of inflammation; may be associated w/ CNS, bone and eye lesions esp if extensive; may also be benign; becomes more wart-like with time
dark erythematous streaking usually on 1 limb
cutis marmorata teleangiectasia congenita
Vs. normal transient mottling (lacy); normal mottling is called cutis marmorata
evaluate for associated defects and ulceration
Tinea Capitus, Corpis, etc
- Well demarcated annular lesion with raised border and central clearing
- Usually clinical diagnosis but can do KOH prep or fungal culture if unsure; KOH will show dermatophytes
- Tx = topical azole (clotrimazole) 2X/day or oral griseofulvin if in scalp or nails (check liver labs)
- If capitus (in scalp) see broken hairs
Tinea Versicolor
- hypo and hyper pigmented lesions in areas w/ inc sweating in humid climate
- Overgrowth of Malezzia furfur
- KOH - spaghetti and meatballs
- Tx = selenium or ketoconazole shampoo
Candida Diaper Rash
- beefy red w/ satellite lesions and IN SKIN FOLDS
- Use nystatin cream and if does not resolve then suspect non-albicans species
Oral Thrush
- Also Candida
- common in infants; not as easily scraped as formula; check breastfeeding moms for Candida on breasts
- Use nystatin swish and treat mom’s breast w/ nystatin cream (safe to still breastfeed)
Seborrhoeic Dermatitis
- Flaky erythema in places w/ hair (greasy)
- Tx = selenium shampoo or baby oil w/ soft toothbrush to remove scale
Erythema Multiforme
- Presentation - target like lesions
- More mild and less mucosal involvement than SJS
- Raised target shaped papules w/ symmetric and wide distribution over body
- Not transient like urticaria
- Often triggered by infection
- Tx - self resolves in about 2 wks; may give anti-histamines if itching
SJS/TEN
- Spectrum of drug reaction w/ skin necrosis and sloughing
- < 10% body surface area = SJS
- 10-30% = overlap
- > 30% = TEN
- Often have fever, malaise, URI prodrome
- Involvement
- 90% mucosal - blisters on lips and tongue
- Ocular - can cause corneal scars
- Pulmonary - severe form is bronchiolitis obliterates
- Tx
- STOP OFFENDING DRUG
- Treat wound w/ silver products and debridement
- Fluids and nutrition
- Analgesia
- Monitor for super-infection
DRESS
- Drug reaction w/ eosinophilia
- Common w/ phenytoin, carbamazepine, phenobarbital
- NSAIDs, abx, ACE inhibitor, beta blockers
- Other manifestations - fever, widespread erythematous macule, lymphadenopathy, elevated LFTs, thyroiditis, pneumonitis, pericarditis
- Tx - stop offending drug, steroids and support w/ pain control and anti-histamines if pruritic
Serum Sickness (pathophysiology, classic triad and tx)
- antigen-antibody complex (type III hypersensitivity reaction) to a drug
- Classic triad = fever, urticarial rash, later arthralgia
- Tx - stop drug
Eczema Herpeticum
- Herpes infection on top of eczema –> punched out erosions, hemorrhagic crusting and vesicles
- Important to treat w/ IV acyclovir and eye exam
- Can be life threatening or vision threatening
