Derm Flashcards
Several linear streaks of vesicles on her right arm and right lower leg, after playing outside in the park
Allergic Contact Dermatitis
- topical corticosteroids
- cool compress
- benadryl
Contacts:
- jewelry (especially jewelry containing nickel)
- clothing, shoes, henna tattoo dyes, and plants.
- poison ivy, poison sumac, or poison oak, and typically presents as linear streaks of vesicles in areas where the plant has come into contact with the skin.
Neonate born with localized bullae and erosion of the skin on the feet and lower extremities
Dx and Test to confirm
Epidermolysis bullosa
- Skin biopsy (major types of EB are identified based on the structural level of skin cleavage)
- epithelial fragility, characterized by bullous lesions that develop spontaneously or in response to mild or moderate trauma
Incontinentia Pigmenti
- birth-first few weeks: vesicles in a linear arrangement (filled with Eos)
- verrucous papules and plaques
- early childhood: linear and swirled hyperpigmentation, not present at birth, is characteristic of IP
- hypopigmented alopecic pathces replace the hyperpigmented areas
- Dental - delayed dentition, conical teeth
- Eye - strabismus, cataracts
- Neuro - seizures, metal disability
Incontinentia pigmenti is the result of mutations in the IKBKG (formerly NEMO) gene.
X-linked manner; the majority of cases occur in girls, suggesting that it is a lethal mutation in most boys.
Steven Johnson’s Syndrome
Triggered by
1 .Medications: Sulfa, Antiepileptics (phenobarb, carba, lamotrigine)
2. Mycoplasma, CMV, Herpes, HIV
Malaise, myalgia, arthralgia prodrome
Widespread erythematous macules -> vesiculobullous lesions -> erythroderma
- skin sloughing
- pain out of proportion to clinical findings.
Mucous membrane involvement: oral, conjunctival, urethra, lips, esophagus, or upper resp tract
Porphyria Cutanea Tarda
Vesicles on sun exposed areas
Increased pigmentation
Increased fragility
Milia formation
Liver cirrhosis and liver cancer
Triggers: alcohol, estrogen, iron
Serum sickness
Usually 6-12 days-3 wks after but if previous exposure occurred, can be 1-3 days
Does NOT require prior sensitization as it is not an IgE mediated allergy. Immune complexes!
Fever Skin rash - itching, redness, urticaria, edema Joint pain - IC precipitates in joints Muscle aches Proteinuria - IC precipitates in renal GI complaints - nausea, vomiting
Tx: STOP agent (abx) and treat symptoms.
NSAIDS, benadryl, hydroxyzine
Pred if severe
Papular Acrodermatitis (Gianotti Crosti)
Firm erythematous papules or papulovesciular lesions of similar size, which are distributed in a symmetrical fashion on the extensor surfaces of the upper and lower extremities (classically knees and elbows but any parts of limbs), face, buttocks. Spares the trunk
Associated with viral and bacterial infections.
EBV, CMV, Hep B
Tx: supportive
IgA bullous dermatosis
large tense bullae
deposition of IgA in a linear pattern along the basement membrane
spontaneous remission usually occurs prior to puberty
Tx: dapsone
What organism causes hot tub folliculitis?
Pseudomonas
Tx: supportive care.
PItyriasis Rosea
Oval scaling thin plaques, with long axes oriented parallel to lines of skin stress
HHV-6 or 7 has been implicated.
Herald patch -> Christmas tree. Resolves in 4-8 wks.
Supportive care with antihistamines, topical steroids.
Melanomas in Children
A = amelanotic, usually pink-red or wart like B = bump, bleeding - papules/nodules that may bleed/ulcerate C = color uniformity D = de novo, any diamater = usually don't arise from pre-existing melanocytic nevi
If a lesion is “EFG” (elevated, firm, and growing progressively for > 1 month), consider the possibility of an amelanotic or nodular melanoma.
Dermoid Cyst
- firm, noncompressible, skin-colored, subcutaneous nodule, slowly growing located most often on or near the lateral eyebrow.
- result of entrapment of ectodermal tissues along lines of embryonic fusion
- present at birth but not noticed until larger
- if located in the midline (glabella, occipital scalp, midline back) or midline dermal sinuses require imaging to assess for central nervous system extension.
Streptococcal Toxic Shock Syndrome
Varicella skin lesions are a portal for GAS entry
Shock, multiorgan involvement, STSS -> can progress to Nec Fas
Tx: PCN + Clindamycin and surgery if Nec Fas
Seborrheic Dermatitis
- affects areas in which sebaceous glands are concentrated.
- may be the result of an inflammatory response to the yeasts of the genus Malassezia.
SX: scaling of the scalp (ie, dandruff) or scaling and erythema of the eyebrows, eyelids, glabella, alar or retroauricular creases, beard or sideburn areas, or ear canals. Lesions on face can be hypopigmented.
TX:
low-potency topical corticosteroid (eg, hydrocortisone 1% or 2.5%)
OR agent active against yeast (eg, clotrimazole, miconazole nitrate, or ketoconazole) applied twice daily
Perianal Dermatitis
- intense, well-defined perianal erythema, often with maceration and exudate
- can be caused by Streptococcus pyogenes or Staphylococcus aureus
Tx: empiric treatment is with oral cephalexin or another antistaphylococcal antibiotic based on local sensitivity patterns (not just amox)
Hypohidrotic Ectodermal Dysplasia
- hypotrichosis - thin light hair
- hypohidrosis - can’t sweat, risk for hyperthermia
- hypodontia - delayed eruption, decreased # teeth, and conical shaped
- Faces: thin, lightly pigmented scalp hair; a prominent frontal bone; periorbital hyperpigmentation; and a retruded (moved backward) midface.
Incontinentia pigmenti
affects the skin, hair, teeth, nails, eyes, and central nervous system.
- swirling macular hyperpigmentation
- teeth that are reduced in number or absent, small, or abnormally shaped
Granuloma Annulare
- school age children
- cause is unknown
Appearance
- papules that form a ring; occasionally, the ring is incomplete
- skin-colored but can be erythematous/violaceous
- areas that are prone to trauma like the dorsa of the hands or feet
- have FIRM borders (bc its in the dermis)
VS:
Tinea corporis
- GA has no scale and a firm border
- TA usually has a more erythematous border
Nummular eczema
- NE has no central clearing and usually has crusting.
TX:***
no intervention, usually resolves in 2-4 years
Cafe au lait spots
6 or more > 5mm prepub > 1.5cm post is concerning for NF1
Get Optho consult for lisch nodules or optic gliomas
Other sx:
- axillary freckling
- neurofibromas
- osseous lesions (bowing of tibia/fibula or sphenoid dysplasia)
- developmental stuff
PItyriasis Alba
Hypopigmented Macules, with scale and indistinct borders. Normal skin tans but affected areas do not.
Post-inflammatory Hypopigmentation in pts with a hx of eczema
Tx: Emollient or short course of HC1%
Return of pigmentation takes months
VS:
Tinea versicolor - hypopigmented (light or darker) macules, borders are well defined. Tx: clotrimazole
Vitiligo - depigmented macules with well defined borders. no scale. Tx: corticosteroid, UVB phototherapy
Tinea Versicolor (Pityriasis)
Superficial infection with yeast, Malassezia globosa
Well-defined, round, hypo OR hyper pigmented macules that can coalesce into larger patches. Scale may be present.
Trunk, neck, prox extremities.
get WORSE with exposure to the sun.
KOH - “spaghetti and meatballs”
aka hyphae and spores
Tx:
1st = Topical
- Selenium sulfide, Ketoconazole shampoo
- Imidazole creams - practical only for local areas
Oral agents = only for those with resistant infections or cannot tolerate or effectively use topical
- Itraconazole or Fluconazole
Prevention:
prudent to advise once-monthly prophylaxis for 3 months using selenium sulfide (a single 8- to 12-hour application)
Tuberous Sclerosis
Skin:
- Hypomelanotic macules
- facial angiofibromas
- shagreen patches
- ungual fibromas
Tx: sirolimus
CNS: brain lesions (SEGA) , seizures, dev delay, neuropsychiatric (ADHD, etc) Kidney: angiomyolipomas heart: rhabdomyoma Lung: lymphangioleiomyomatosis Eyes: retinal hamartomas
Psoriasis
- erythematous papules and plaques covered by a thick, adherent scale. The extensor surfaces of the elbows and knees are commonly involved. Bleeds where scale is removed.
Tx: topical corticosteroid
https://2018.prepsa.courses.aap.org/course/resume-test?status=answered&req=201909102146526977
Infantile Hemangioma
Most are small, uncomplicated, and require no intervention.
Most infantile hemangioma growth occurs in the first 1 to 2 months after birth.
Infantile hemangiomas that should raise concern and may require intervention include:
- lesions near the eye, on the nasal tip, on the lip, in the beard area, or in the midline lumbosacral spine; ulcerated lesions; multiple lesions (5 or more); and large segmental lesions (on the face, in the lumbosacral area).
Tx: Propranolol
PHACE association (Posterior fossa abnormalities, Hemangiomas, Arterial anomalies, Cardiovascular abnormalities, and Eye abnormalities).
Tinea Capitis
Alopecia with black dot hairs
Inflammatory - pustules/crusting or kerion
Seborrheic - diffuse scaling with subtle alopecia
Trichophyton tonsurans
Tx: ORAL GRISEOFULVIN (terbinafine or fluconazole)
- also use an antifungal shampoo
- do not need to be excluded from school
- f/u in 1 month
Port-Wine Stain
Port-wine stains are vascular malformations that are present at birth and remain throughout life. Unlike hemangiomas, they do not proliferate.
Concern for Sturge-Weber syndrome exists when a facial port-wine stain involves the distribution of V1, especially the upper eyelid; involves V1 along with V2 and/or V3; or is bilateral.
Sturge-Weber: vascular malformations in SKIN, BRAIN, EYE
What derm lesion is associated with reactive arthritis?
Circinate (gyrate) balanitis (inflamed, hyperkeratotic, whitish plaques on the glans penis)
What infection can preceded psoriasis?
GAS infection.
Guttate psoriasis.
Erythema Multiforme is commonly a reactive process after what type of infection?
After HSV infection
Tinea Cruris and Pedis
Trichophyton rubrum
Isoretinoin - labwork to get prior to initiation
fasting serum triglycerides - can cause hypertriglyceridemia
liver function tests
serum or urine pregnancy test - it’s a teratogen
pseudotumor cerebri
Mycoplasma-induced rash and mucositis (MIRM)
- preceding malaise, fever, and cough,
- then develops a predominantly mucosal eruption, like an incomplete SJS. The oral mucosa and lips, conjunctivae, and anogenital regions are most often affected. The rest of the skin, when affected, may manifest as pink macules, papules, papulovesicles, or targetoid lesions
Pityriasis lichenoides et varioliformis acuta (PLEVA),
- mildly pruritic or burning eruption of inflammatory papules and papulovesicles, many of which often develop hemorrhagic crusts (may be misdiagnosed as varicella)
- As lesions resolve, hypopigmentation or hyperpigmentation often persist
- a relapsing and remitting course over several months is typical with successive crops of new lesions.
Spontaneous resolution may occur
but otherwise, treat with tetracyclines, erythromycin, or azithromycin*
Essential Fatty Acid Deficiency
aka linoleic acid deficiency.
- reduced growth velocity
- delayed neurodevelopment
- scaly dermatitis, poor wound healing
- increased susceptibility to infection.
Acne Management
A majority of adolescents can be treated with topical medications of 3 types:
- OTC benzoyl peroxide products (these are both comedolytic and bactericidal)
- Topical Retinoids (particularly effective for comedonal acne)
- Topical Antibiotics (primarily for antiinflammatory effects rather than antimicrobial properties).
- If there is an inflammatory component to the patient’s acne, addition of a topical antibiotic such as erythromycin or clindamycin can be helpful.
- If the inflammatory acne cannot be treated with topicals alone, oral therapy with tetracycline, doxycycline, minocycline, or azithromycin is helpful
Sweet syndrome
Sweet syndrome (acute febrile neutrophilic dermatosis). ** increased risk of acute lymphoblastic leukemia **
- preceded by URI sx
- elevated, indurated, violaceous, painful NODULES/PAPULES/PLAQUES asymmetrically distributed
- fever, arthralgias, leukocytosis
- BX: dense neutrophilic perivascular infiltration of the dermis
Dermatitis Herpetiformis
- intensely pruritic, grouped (“herpetiform”) papules and vesicles, which are symmetrically distributed over the extensor surfaces of the knees and elbows,
- presence of granular deposits of IgA within the dermal papillae
Keratosis Pilaris
papular, pustular, and/or erythematous follicular lesions most frequently located on the cheeks and extensor upper arms and thighs.
It is caused by plugging of the follicles by keratin that has failed to exfoliate
TX:
Moisturizing cream
Lactic acid cream**
Syringomas
Skin-colored or yellowish, nonpruritic papules vary in size from 1 to 5 mm and are characteristically located in the periorbital area, neck, and upper thorax
- benign tumors of eccrine structures that often appear or worsen in adolescence during the time of puberty
- esp in adolescents with trisomy 21, diabetes mellitus, and Marfan syndrome
Hashimotos associated with what type of hair loss?
Alopecia Areata
Id reaction
- type IV delayed type hypersensitivity reaction, such as with tinea capitis
Lymphocytes become sensitized locally in the scalp and then circulate, producing a diffuse dermatitis secondary to an immune response.
Lesions are typically symmetrically distributed, extremely pruritic, follicular, erythematous, maculopapular, and/or papulovesicular (in exuberant cases); the eruption occurs 1–2 weeks after primary infection or dermatitis.
Continue Griseofulvin and add steroids
