Derm Flashcards
Clustered or grouped vesicles on an erythematous base in a neonate?
Neonatal herpes
What is seen on Wright stain in neonatal herpes?
Multinucleated giant cell and eosinophilic intranuclear inclusions
Where do lesions of neonatal herpes often appear?
Buttocks or scalp (Often presenting parts closest to maternal lesions)
If you find a lesion on the scalp of neonate, what should you always consider?
If there was a scalp pH monitor
If you suspect neonatal herpes, what do you do?
Start IV acyclovir (even before confirmation of the diagnosis)
True or False: Most cases of neonatal herpes occur without a known history of maternal herpes?
True (Don’t be tricked just because they tell you the infants mother has a history of herpes)
What can present as vesicles, but in a linear pattern without an erythematous base?
Incontinentia pigmenti
Multiple pustules, brown macules, vesicles, and pustules on a non-erythematou base?
Transient neonatal pustular melanosis
Leaving a collarette?
Transient neonatal pustular melanosis
When does transient neonatal pustular melanosis present?
At birth
Who is transient neonatal pustular melanosis more common in?
African American infants
What is the treatment for transient neonatal pustular melanosis?
Nothing
What is the natural course of the rash in transient neonatal pustular melanosis?
Starts as pustules, becomes hyperpigmented macules
What does Gram stain or Wright stain show for transient neonatal pustular melanosis?
PMNs without organisms
What does a staph infection (usually involving the hair follicles) usually show on a Gram stain or Wright stain?
Both PMNs and gram-positive cocci
What is a very common rash that presents as yellow pustules on an erythematous base or generalized erythematous macules with solitary papules or vesicles in the center?
Erythema Toxicum Neonatorum
When does E-Tox usually present?
Within a few days of birth (not at birth)
What does Wright stain show for E-Tox?
Eosinophils
What does a Tzanck smear show for E-Tox?
Eosinophils, maybe neutrophils, otherwise negative
True or False: E-tox is present on the palms and soles?
False
True or False: E-Tox is common in preterm newborns?
False
One-day old infant with erythematous macules with an occasional vesicle in the center… Most likely diagnosis?
E-Tox (central vesicle in a macular lesion is consistent with E-Tox)
What is the treatment for E-Tox?
Reassurance- Rash will fade within a week
What presents as diffuse scaling and erythematous papules and pustules?
Cutaneous Candidiasis
Lichenification with scratching?
Atopic dermatitis
What is the distribution for atopic dermatitis?
Behind knees, antecubital areas, dry/chapped hands
What is a crucial component of atopic dermatitis?
Itching
True or False: Heredity plays a big role in atopic dermatitis?
True
What are 2 other conditions that commonly go with atopic dermatitis?
- Allergic rhinitis
2. Asthma
What might be a lab finding in cord blood that would make you think atopic dermatitis?
High IgE
What are factors that can worsen atopic dermatitis?
- Allergens (food)
- Chemical irritants
- Heat
- Physical trauma
- Drying elements
In an infant with eczema, what % chance is there that food allergy is a factor?
30%
What types of foods are often allergen triggers for atopic dermatitis?
Milk, eggs, soy, wheat, peanuts
True or False: Negative testing can rule out a food allergy?
True
True or False: Positive testing verifies a food allergy?
False- Verification will require either a food challenge or skin testing
True or False: Food elimination is recommended for atopic dermatitis?
False- Food allergy is not a factor in up to 70% of cases and food elimination can have negative impact on nutrition
How does tinea pedis present?
Itchy rash with scaling/peeling, involves plantar aspect and sometimes lateral aspect of foot (dorsal aspect spared), maceration
How does atopic dermaitis present on the foot?
Scaly, dry with lichenification, dorsal aspect of foot involved (in tinea pedis there is maceration and sparing of the dorsal aspect of the foot)
Child with eczema who has oozing/crusting of the skin that isn’t responding to usual treatment modalities?
Superinfection
What bug should you direct treatment at for an eczema superinfection?
S. Aureus
What is eczema herpeticum?
Invasion of eczematous skin by herpes
Inflamed eczema which isn’t responding to steroids and antibiotics?
Eczema herpeticum
Classic description for eczema herpeticum?
Vesicles, punched out lesions, crusted erosions
Where does eczema herpeticum usually occur?
Face (primary herpes infection)
What behavior might pre-dispose a child to getting eczema herpeticum?
Sucking thumb/finger
What is treatment for eczema herpeticum?
Acyclovir
If you have a child with eczema and concern for immunodeficiency, what are 2 things you should consider?
- Wiskott-Aldrich Syndrome
2. Hyperimmunoglobulin E syndrome
Greasy yellow patches on the scalp, face, behind the ears, and in skin folds during the first few months of life?
Seborrheic Dermatitis
How is seborrheic dermaitis treated?
Regular antifungal washes
Topical steroids
Child with Seborrheic Dermatitis, profuse ear discharge, profuse urine output…?
Histiocytosis X
What is another name for seborrheic dermatitis of the scalp?
Cradle Cap
What is a rash that involves erythema, edema, vesicle formation, exudate, and scaling?
Eczema
Are atopic dermatitis and eczema the same thing?
No… nummular eczema and contact dermatitis are forms of non-atopic eczema
What are the 2 types of contact dermatitis?
- Allergic
2. Primary irritant
What causes allergic contact dermatitis?
Delayed hypersensitivity reaction (requires multiple exposures- don’t be tricked if its something the child always wears)
Describe the rash of allergic contact dermatitis
Red, vesicular, can be crusting
What are 2 examples of things that can cause allergic contact dermatitis?
- Jewelry
2. Poison ivy
What are things that can trigger primary irritant contact dermatitis?
Soaps and detergents
How long is the delay in primary irritant contact dermatitis?
No delay in reaction
How is poison ivy described?
Linear vesicles and papules
What type of hypersensitivity reaction is poison ivy?
Type 4
Does the rash of poison ivy spread?
No- It’s just the slower appearance of lesions in areas with milder exposure
What can help limit the rash of poison ivy?
Washing with soap and water immediately after exposure
What can be given for severe cases of poison ivy?
Oral steroids (sometimes up to 21 days)
True or False: Exposure to poison ivy during the winter can cause rash?
True
True or False: Exposure to aerosolized poison ivy can cause rask (like if someone is raking it up a distance away)
True
True or False: Fluid from vesicles of poison ivy spreads the rash?
False
True or False: Poison Ivy rash is contagious?
False
True or False: Barrier preparations protect from poison ivy exposure?
True
True or False: There are no desensitization treatments available for poison ivy?
True
8 year old female with pruritic rash on soles of feet. Has minimal scaling, thickening of the skin, and hyperlinearity of distal soles. Interdigital skin normal… treatment?
Triamcinolone (this is juvenile plantar dermatosis)
*Not tinea pedis because of minimal scaling, interdigital skin being involved, and tinea pedis rarely happening before puberty
What type of dermatitis is juvenile plantar dermatosis?
Contact
What is juvenile plantar dermatosis a result of?
Occlusive shoes and synthetic sock
Silvery lesions on the elbows or knees?
Psoriasis
What happens when you pick off spots in psoriasis and what is this called?
Leave behind bleeding spots the size of pins- Auspitz sign
“Erythematous plaques surrounded by thick adherent scales”, “Pinpoint areas of hemorrhage”, “Thick scales on the scalp”
Psoriasis
What are 4 other conditions psoriasis might be confused with?
- Non-bullous impetigo
- Nummular eczema
- Pityriasis rosea
- Tinea corporis
How is non-bullous impetigo described?
Oozing and crusting
How is nummular eczema described?
Round, oozing, crusting erosions, dry macules with a fine scaly pattern
How is pityriasis rosea described?
Small oval, thick scaling plaques, long axis of the lesions parallel to the lines of skin stress
How is tinea corporis described?
Scaly lesions, but thin rather than thick, has central clearing
Small oval scaling patches of rash on the trunk and back. Herald patch in a Christmas tree pattern with the long axis of the lesions parallel to the lines of skin stress?
Pityriasis rosea
What is treatment for pityriasis rosea?
Not necessary- can try exposure to sun or other light (improves symptoms and can hasten resolution)
What are 4 rashes pityriasis rosea can be confused with?
- Secondary syphilis
- Nummular eczema
- Tinea corporis
- Tinea versicolor
How do you distinguish pityriasis from secondary syphilis?
Rash appears similar- Syphilis has fever/generalized lymphadenopathy. Syphilis often involves palms/soles, pityriasis doesn’t.
How do you distinguish nummular eczema and tinea corporis from pityriasis?
Herald patch can look the same…
- Tinea corporis has elevated border with central clearing
- Nummular eczema has crusting erosions
How do you distinguish tinea versicolor from pityriasis?
Tinea will be described as hyper/hypo-pigmented scaling macules
Dry skin with thin scales that have a pasted-on appearance?
Ichthyosis Vulgaris
When does icththyosis present?
Pre-school years
What is the treatment for Ichthyosis
- Keratolytic agents- Ammonium lactate creams
- Alpha hydroxy acid
- Urea-containing emollients
What % of patients with ichthyosis have atopic dermatitis too?
50%
What is a benign inflammatory condition that manifests as non-scaling annular lesions without epidermal involvement?
Granuloma annulare
What caues granuloma annulare?
Don’t know
What is the key part to distinguish granuloma annulare from ringworm?
Granuloma annulare is NON-SCALING
What is a papule caused by atypical mycobacteria and found on the sole of a child who likes walking bearfoot?
Swimming pool granuloma
How do you distinguish between swimming pool granuloma and granuloma annulare?
Swimming pool has a break in the skin, granuloma annulare skin is intact
What causes impetigo?
Strep or staph
What is the most likely cause of bullous impetigo and crusted impetigo?
S. Aureus
What is treatment for impetigo?
Mupirocin
True or False: Treatment of strep skin infection prevents post-strep GN?
False
What are the 4 key elements for cellulitis?
- Red
- Hot
- Tender
- Swollen
What are the 2 most common causes of cellulitis?
- Strep pyogenes
2. Staph aureus
If there is a low likelihood of MRSA, what is the treatment for cellulitis?
Cephalexin or amoxicillin0clavulanate
If cellulitis is more advanced or you are concerned about MRSA (more prevalent in community), what is the treatment?
Clindamycin, trimethoprim-sulfamethoxazole, or doxycycline (if child is older than 8)
What is due to an exotoxin produced by S. Aureus?
Staph Scalded Skin Syndrome
What causes toxic shock syndrome?
Toxin production by either S. Aureus or Strep
Which has a higher mortality… Strep TSS or Staph TSS?
Strep
What causes scarlet fever?
Erythrogenic exotoxin produced by group A strep
What does scarlet fever most commonly occur in association with?
Strep Pharyngitis
What are 3 dermatological conditions caused by toxin-producing bacteria?
- SSS
- TSS
- Scarlet Fever
Rash in a preschooler that starts out very tender and red, and spreads to become a sheet-like loss of skin?
SSS
What causes SSS?
Exotoxin produced by S. Aureus (don’t get tricked into thinking it’s due to earlier treatment with an antibiotic…that would be erythema multiforme)
What is treatment for SSS?
Antibiotics
What is erythema multiforme?
Hypersensitivity reaction in response to a veriety of triggers
What are the two forms of erythema multiforme?
Major and minor
What is the “buzzword” for erythema multiforme?
Target lesion
True or False: Children under 3 are often the patients that get erythema multiforme minor?
False (children under 3 rarely present with this)
What is the most likely trigger for erythema multiforme minor?
Primary or recurrent infection with Herpes Simplex
medications may also cause this
Where does the rash of erythema multiforme minor initially present then spread?
Appears abruptly on extremities then spreads to the trunk
What is treatment for erythema multiforme minor?
Treating the underlying infection or stopping the medication (AKA… geared towards triggering agent)
Child just completed antibiotic regimen, develops rash on distal extremities that’s maculopapular with some lesions appearing dusky in the center. They also have 1-2 lesions on the mouth. Otherwise well appearing…Diagnosis?
Erythema multiforme minor (especially with child being well-appearing… vs. erythema multiforme major/SJS)
What comes before the rash in SJS?
Fever, muscle aches, and joint aches
Describe the rash in SJS
Initially similar to EM minor (bullous or target lesions which can coalesce), but it spreads more quickly, progresses from primarily cutaneous to mucous membrane involvement (conjunctiva, oral mucosa, anogenital mucosa)
What often happens to the lesions involving the mucosa in SJS?
They become encrusted
Name 3 typical medications that can trigger EM major
- Sulfa drugs
- Anticonvulsants
- NSAIDs
How is EM major/SJS treated?
- Prevent dehydration
- Prevent superinfection
- Patients often managed in a burn unit
True or False: There is separation of the skin in sheets in SJS?
False- separation of skin in sheets is in SSS
What is the most severe form of erythema multiforme major?
TEN
Describe the skin in TEN
Sunburn-like erythema and sheet-like separation of skin, widespread bullae, denuded necrotic skin
How do you distinguish SSSS from TEN?
Biopsy
What is the difference in biopsy between TEN and SSSS?
- TEN involves dermis (like SJS)
- SSSS usually does not involve dermis
What age groups typically get SSSS v. TEN?
SSSS usually affects infants and younger children
TEN usually affects older children
Which has a higher mortality, TEN or SSSS?
TEN
What causes TEN?
Hypersensitivity reaction (NOT due to a toxin)
What are 2 forms of Erythema Multiforme Major?
- SJS
2. TEN
Boggy and blue ulcers with a necrotic base?
Pyoderma gangrenosum
What is pyoderma gangrenosum usually associated with?
Systemic disease
What 3 things does toxic shock syndrome present with?
- Fevers
- Hypotension
- Rash
Child comes in with sepsis-like picture and a rash…?
TSS
True or False: Tampons do not cause most cases of TSS anymore
True
What is treatment for TSS?
Antibiotics and aggressive supportive care
Erythema associated with SJS, oral lesions, mucous membrane involvement (anal/genital), foot involvement, starts with fever and other general symptoms?
Erythema multiforme
5th disease, slapped cheek fever, associated with Parvovirus B19?
Erythema infectiosum
Rash associated with Lyme disease (carditis, arthritis, neuritis), rash migrates?
Erythema chronicum migrans
What % of cases of Lyme have the classic bullseye rash?
70%
Rash that causes painful bluish lesions on the shin?
Erythema nodosum
What is erythema nodosum assocaited with?
- TB
- Birth control pills
- IBD
- Fungal infections
Rash associated with rheumatic fever (one of the major Jones criteria)?
Erythema marginatum
Describe erythema marginatum?
Erythematous macule on the trunk which clears centrally
Pruritic linear lesions that are papular or pustular, burrows, involvement between the digits?
Scabies
True or False: Scabies is high contangous and affects other family members?
True (if the say no other family members are affected, consider something else- papular urticaria)
What is classic/pathognomonic for scabies?
Burrows
How is scabies usually diagnosed?
Clinically… can be confirmed by identifying mites/eggs in skin scrapings
How is scabies treated?
Permethrin 5% cream (Elimite)
Do household contacts need to be treated for scabies?
Yes
In infants, what 2 unusual spots can you see scabies?
- Scalp
2. Palms/soles
2 kids from same family with intense scalp itching and excoriation on the nape of the neck and/or behind the ears?
Head Lice
How are nits from lice described?
On the hair shafts, white dots that can’t be removed
What is primary treatment for lice?
Permethrin cream rinse
How long does permethrin cream rinse need to be used for lice?
Initial treatment, then repeat a week after first application
Besides treating the patient, what 2 other things needs done for lice treatment?
- House should be thoroughly cleaned
2. Close household contacts treated preventatively
In lice, do asymptomatic classmates need treated?
No
True or False: Many areas of the country have lice resistant to permethrin?
True (there are many more expensive alternatives to try, but make sure they used permethrin correctly before doing this)
True or False: Even after successful treatment of lice, itching can continue?
True
What causes continued itching after treatment for lice?
Inflammatory reaction
What can help with the continued itching after treatment for lice?
Steroid creams, diphenhydramine, hydroxyzine
True or False: Nits must be removed before kids with lice can return to school?
False
How long ca lice live without a blood meal?
36 hours
How long until fresh lice eggs on hair shafts can hatch?
10 days later
True or False: Public lice can live in other locations?
True (like facial hair)
True or False: Head lice are slower moving than pubic lice?
False
Which type of lice impacts all races equally?
Pubic lice
Who does head lice rarely infest?
African Americans
What are pubic lice strongly suggestive of in children?
Sexual abuse (head lice are common in children, but public crab lice aren’t)
What are maculae caeruleae?
Blue-gray macules on the abdomen or inner thigh
What are maculae caeruleae consistent with?
Pubic lice
What is treatment for pubic lice?
Permethrin (same as head lice)
What is treatment for crabs (pubic lice) in the eyelashes?
Petroleum jelly applied TID for 10 days
Pearly papules with central dimpling?
Molluscum contagiosum
What is treatment for molluscum?
Nothing- it will clear in months to years
How is molluscum differentiated from warts and comedones?
By the central umbilication seen in molluscum
What is seen on wright staining in molluscum?
Viral inclusion bodies
Pink/excoriated pruritic lesions on the extensor surfaces of the arms and legs?
Papular urticaria
Clustered erythematous papules with a central punctum that recur episodically, often at night?
Papular urticaria
How long can the lesions with papular urticaria last?
Up to 10 days
How is papular urticaria differentiated from scabies?
No other family members are affected
What causes papular urticaria?
Delayed hypersensitivity reaction to an insect bite
What is the best management for papular urticaria?
ID the causative agent (so family can eliminate it)
Honey colored crusted lesions that are not recurrent of episodic?
Non-bullous impetigo
Translucent papules with central umbilication, no period with complete absence of lesions?
Molluscum contagiosum
What is one specific feature that differentiates molluscum from papular uritcaria?
Molluscum has no period with compelte absence of lesions
Small papules that appear in lines (not clusters)?
Scabies
How can the distribution of lesions with scabies versus papular urticaria distinguish between the two?
Scabies appears in lines, papular uritcaria in clusters
What are 3 rashes that might be confused with papular urticaria?
- Non-bullous impetigo
- Molluscum contagiosum
- Scabies
Toddler who has a 2 month history of a recurrent pruritic rash of clustered erythematous papules. No body else in family is similarly affected…. diganosis?
Papular urticara (don’t be tempted to pick scabies… no one else in family is affected)
What is produced in the skin in response to androgen production (in both girls and boys)?
Sebum
What does sebum form?
A plug which causes mature comedones
What is the bacteria most often associated with acne?
Propionibacterium acnes
What are the 2 major causes of acne vulgaris?
- Inflammatory
2. Non-inflammatory
What 2 things does non-inflammatory acne consist of?
- Closed Comedones
2. Open Comedones
What is a closed comedone?
Whitehead- follicles that are plugged, but covered with epithelium
What is an open comedone?
Blackheads- No epithelial covering
What causes the black color in a blackhead?
Melanin (not dirt)
What should the appearance of comedones prior to age 8 make you think of?
Precocious puberty
What 2 things in addition to acne warrant an endocrine workup?
- Hirsutism
2. Menstrual irregularity
If you have a child with acne plus hirsutism or menstrual irregularly, what should they bet worked up for?
Polycystic ovary disease
What 3 things does inflammatory acne consist of?
- Papules
- Pustules
- Nodules (cysts)
What are papules?
Small, red, solid lesions
What is something that can be mistaken for a papule due to acne?
Adenoma sebaceum
What is another name for ademona sebaceum?
Angiofibroma
What is a small papule that is firm and may appear pink, red, or brown in color?
Adenoma sebaceum/Angiofibroma
If you have inflammatory acne with lots of papules that is resistant to treatment (espiecally on nose/cheeks) what should you consider?
Angiofibroma/Adenoma sebaceum
What type of skin lesions are superficial and filled with pus?
Pustule
Describe a nodule (cyst)?
Deep, located in the dermis, red/painful
What type of skin lesions can lead to permanent scarring?
Nodule (cyst)
What 2 drugs can lead to acne?
- Systemic steroids
2. Anticonvulsants (phenobarbital/phenytoin)
Where does acne from systemic steroids appear primarily?
Trunk
Kid with acne mostly on trunk… what should you consider?
If they have any other conditions that might result in them needed systemic steroids
What 3 things does acne treatment depend on?
- Type of lesion
- Age of patient
- Distribution of lesion
True or False: Poor hygiene/improper bathing habits causes acne?
False
What must you do for psychological care of a teen with acne?
Reassure them that this is a normal part of growth/development
True or False: Chocolate doesn’t cause or accelerate acne?
True
Why shouldn’t teens vigorously scrub or squeeze pimples?
Can lead to permanent scarring
What is the treatment for neonatal acne?
None
How does benzoyl peroxide function?
Primarily bactericidal
How can the irritating effects of benzoyl peroxide be reduced?
If the right formulation is used
What effects to topical antibiotics have for acne?
- Bactericidal
2. Anti-inflammatory
What is the most commonly used topical antibiotic for acne?
Topical clindamycin
What type of acne are topical antibiotics typically used for?
Inflammatory acne
What is tretinoin derived from?
Vitamin A
How does tretinoin help prevent acne?
Halts the process that plugs hair follicles
What can topical tretinoin result in with initiation of use?
An initial flare-up of acne
What effects to oral antibiotics have for acne?
Anti-inflammatory
When are oral antibiotics used for acne?
When it is severe inflammatory acne
What location of acne are oral antibiotics particularly effective against?
Trunk
What are the 3 most commonly used oral antibiotics for acne?
- Tetracycline
- Doxycycline
- Minocycline
Why is continued use of oral antibiotics for acne not appropriate?
Because bacterial resistance is a problem (acne can be controlled, but oral antibiotics don’t cure it)
Why are OCP’s helpful in treating severe acne?
Because of the anti-androgenergic effects of estrogen
What 4 things does isotretinoin (Accutane) do?
- Antibacterial
- Reduces sebum production
- Anti-inflammatory
- Destroys comedones
What is isotretinoin often used in combination with?
Benzoyl peroxide
Who is isotretinoin often used in?
Patients with multiple inflammatory lesions (because it helps reduce the formation of new lesions)
What can worsen acne when taken at the same time as isotretinoin?
Steroids
What has to be ruled out before isotretinoin can be prescribed?
Pregnancy- This needs to be ruled out before, during, and after treatment
Name 5 side effects of isotretinoin
- Dry lips
- Dry skin
- Dry eyes
- Nosebleeds
- Headaches
What should you think of with hair loss and black dots or broken hairs noted on exam?
Tinea capitis
What might you find on scalp exam for tinea capitis?
Kerions
What is a kerion?
Tender, boggy areas of induration
What is gold standard for diagnosis of tinea capitis?
Fungal culture
What is treatment for tinea capitis?
Oral griseofulvin for 6-12 weeks
True or False: Alternatives for griseofulvin like oral fluconazole or terbinafine are acceptable for tinea cpitis?
True
True or False: A set of routine labs must be obtained prior to starting griseofulvin?
False
What condition causes hair loss with NO inflammation?
Alopecia Areata
What causes alopecia areata?
Unknown
What other dermatological finding can be seen in alopecia areata?
Nail pitting
Child with areas of complete hair loss with no scalp lesions noted. Also has nail pitting. Remained of PE negative. Hair is tightly braided. Most likely diagnosis and treatment?
Alopecia areata- Reassurance (could do steroids)
-Nail pitting makes this alopecia areata v. traction alopecia
What describes the sudden loss of large amounts of hair during routine activities such as washing and brushing the hair?
Telogen Effluvium
What type of hair loss is often triggered by stressful events (febrile illness, surgery, emotional stress)?
Telogen Effluvium
Complete areas of hair loss that are well defined round patches?
Telogen Effluvium
What can be seen on microscopic exam of shedded hairs in telogen effluvium?
Telogen bulbs
How is telogen effluvium distinguished from other forms of hair loss?
No inflammatory reaction
What type of hair loss is caused by tight pulling (hair in braids or trichotillomania)?
Traction alopecia
What is trichotillomania?
Habit of pulling on one’s own hair
What type of hair loss do you see irregular patches of hair loss or incomplete patches of hair loss?
Traction alopecia
What finding can help to distinguish traction alopecia from other forms of alopecia?
Hair shafts of different lengths
What refers to a group of non-inherited disorders with excess mast cell degranulation and mast cell accumulation in various tissues?
Mastocytosis
What is the most common form of mastocytosis?
Urticaria Pigmentosa
Pigmented lesions that turn into hives and develop blisters (particularly with rubbing)?
Urticaria Pigmentosa
What age group is urticaria pigmentosa typically described in?
Infant during first 6 months of life
What is the Darier sign?
Pigmented lesions that turn into hives and develop blisters (especially with rubbing)
What condition is the Darier Sign seen with?
Urticaria Pigmentosa
What is treatment for urticaria pigmentosa?
No treatment is needed
What 3 things should infants with urticaria pigmentosa avoid?
- Narcotic pain relievers
- Radiocontrast material
- NSAIDs
Hypopigmented patches that get worse with sun exposure
Tinea versicolor
What causes tinea versicolor?
Fungus
What confirms diagnosis of tinea versicolor?
KOH prep
What is the treatment for tinea versicolor?
- Astringents (strip superficial layers that are primarily involved)
- Topical antifungal creams
What is important in management of tinea versicolor?
Sun deprivation- May take a few months to get rid of it
What oral medications may be considered appropriate in certain situations for tinea versicolor?
Oral ketoconazole, fluconazole, and itraconazole
Besides astringents and topical antifungal creams, what else can be used for tinea versicolor?
Topical selenium sulfide
What skin mark may appear similar to tinea versicolor?
Ash leaf spot (seen in tuberous sclerosis)
How is incontinentia pigmenti inherited?
X-linked dominant
Who is affected worse by incontinentia pigmenti, boys or girls?
Boys- this is lethal in males
What are 4 stages of skin lesions in incontinentia pigmenti?
- Erythematous papules and vesicles in crops along the lines of Blaschko that last 1-2 weeks
- Swirls of warty growths
- Streaks of hyperpigmentation in marble cake pattern
- Hypopigmentation
What is an acquired autoimmune destruction of melanocytes leading to depigmentation?
Vitiligo
What causes vitiligo?
Exact cause unknown, appears to be a genetic component
What is treatment for vitiligo?
- Topical steroids
2. Tacrolimus/Pimecrolimus
What is the natural course of vitiligo?
Most cases slowly progressive, some exhibit spontaneous repigmentation
What is pityriasis alba?
Post-inflammatory hypopigmentation seen in atopic skin
What is the difference between pityriasis alba and vitiligo?
Pityriasis has hypopigmentation, vitiligo complete depigmentation
Name 5 characteristics of Sturge Weber
- Port wine stain in trigeminal distribution
- Developmental delay
- Seizure
- Hemiplegia
- Vision problems/calcification/glaucoma
What is another name for a port wine stain?
Nevus flammeus
In Sturge Weber, does glaucoma occur on the same or contralateral side as the port wine stain?
Same side
In Sturge Weber, do the focal seizures occur on the same or contralateral side as the port wine stain?
Contralateral
What CNS finding is the port wine stain in Sturge Weber often associated with?
Venous leptomeningeal angiomatosis
How is a venous leptomeningeal angiomatosis (seen with port wine stain in Sturge Weber) identified?
By MRI
True or False: The size of the port wine stain correlates with the extent of CNS involvement with a venous leptomeningeal angiomatosis in Sturge Weber?
False (You can have a venous leptomeningeal angiomatosis even with no skin lesion)
How can a port wine stain with Sturge Weber be treated?
Tunable dye (pulsed dye) laser
Besides Sturge Weber, what other syndrome can present with a port wine stain?
Klippel Trenaunay Weber Syndrome
What % of children with a facial port wine stain have Sturge Weber?
8%
What increases the likelihood of a port wine stain being due to Sturge Weber syndrome
If it is distributed along branches of trigeminal nerve
If you have a port wine stain in the distribution of the trigeminal nerve concerning for Sturge Weber, what needs done?
Immediate referral to opthalmology
What are genodermatoses?
Inherited single-gene disorders with skin manifestations
What are 7 genodermatoses?
- Neurofibromatosis
- Ataxia telangiectasia
- Incontinentia pigmenti
- Garder syndrome
- Peutz-Jeghers
- Xeroderma pigmentosum
- Epidermolysis bullosa
What 3 main categories does neurofibromatosis effect?
- Skin
- CNS
- Orthopedic
Which type of neurofibromatosis is more peripheral and which is more central?
1- Peripheral
2- Central
What is another name for Von Recklinghausen Disease?
Neurofibromatosis Type 1
Name the 7 criteria that can involved with neurofibromatosis.
- 6+ Café Au Lait spots (may appear after birth)
- Lisch Nodules
- Neurofibromas
- Optic Nerve Glioma
- Inguinal and axillary freckling
- Bony defects
- Family history of NF1 in a first degree relative
What size do Café Au Lait spots have to be in kids to fit criteria for neurofibromatosis type 1?
> 5mm wide
What is a Lisch Nodule?
An iris hamartoma
When do Lisch Nodules develop in neurofibromatosis type 1?
May not develop until adulthood
What is required to see a Lisch Nodule?
Slit-lamp exam
When do neurofibromas typically show up in neurofibromatosis type 1?
After onset of puberty
Of the 7 criteria, how many are required to make the diagnosis of NF1?
2/7
If you have a patient with 1/7 criteria for neurofibromatosis, what can help to make the diagnosis?
Genetic test (can be confirmatory) -Diagnosis is typically clinical)
Which type of neurofibromatosis is sometimes known as central neurofibromatosis and why?
NF-2, higher incidence of meningiomas and acoustic neuromas
How is neurofibromatosis type 1 inherited?
Autosomal dominant
Which chromosome is the gene for NF1 on?
17
What % chance does a parent with NF1 have to transmit this to any one child?
50%
What % of cases of NF1 are due to spontaneous mutation?
50%
What are neurofibromas?
Skin lesions that either appear on the surface or deep in the skin (found by palpation)
What vital sign abnormality needs to be monitored in kids with NF1?
BP- They can get pheochromocytoma and renal artery stenosis which can cause HTN
What are the classic features with neurofibromatosis type 2?
Acoustic neuroma- schwannoma
What chromosome is neurofibromatosis type associated with?
22
How do patient with neurofibromatosis type 2 usually present?
Hearing loss or tinnitus related to their acoustic neuromas
Other than hearing loss or tinnitus, how else can a child with neurofibromatosis type 2 present?
Ocular symptoms- due to cataracts or hamartomas of the retina
How is definitive diagnosis of neurofibromatosis type 2 made?
Bilateral cranial nerve VIII masses on CT or MRI
What can help support the diagnosis of neurofibromatosis type 2?
Presence of family history of NF2 along with schwannoma, neurofibroma, meningioma, glioma, or juvenile cataracts.
Name the 8 features of Tuberous Sclerosis.
- Ash leaf spots (>3)
- Periventricular/cortical tubers
- Sebaceous gland hyperplasia
- Shagreen patch
- Sub/periungual fibroma
- Cardiac rhabdomyoma
- Retinal nodular hamartomas
- Renal angiomyolipoma
What portion of cases of tuberous sclerosis develop cardiac rhabdomyoma?
Half (especially in infants)
What might adenoma sebaceum with tuberous sclerosis might be mistaken for?
Acne vulgaris
How many of the 8 criteria for tuberous sclerosis are needed for diagnosis?
2/8
What is another name for a hypomelanotic macule?
Ash leaf spot (Hypopigmented skin- ash colored)
What is often the earliest sign of Tuberous sclerosis?
Ash Leaf Spots
What is sometimes needed to visualize an ash leaf spot?
Wood’s lamp
Where is sebaceous gland hyperplasia (or adenomas) usually described in Tuberous sclerosis?
On the face
What is the name for cobblestone appearing skin which can be seen in tuberous sclerosis?
Shagreen patch
What feature of tuberous sclerosis typically presents and manifests as seizures?
Periventricular/Cortical tubers
What is the name for the group of inherited disorders that involve developmental abnormalities of the skin as well as the teeth, nails, hair, and sweat glands?
Ectodermal dysplasia
What are the group of inherited disorders that manifest as epithelial fragility?
Epidermolysis bullosa
Who should you suspect epidermolysis bullosa in?
Infants and children presenting with recurrent blistering of the skin and mucosa after minor trauma as well as nail changes
What is the common feature between ectodermal dysplasia and epidermolysis bullosa?
Both involve skin and nails
How can you distinguish between ectodermal dysplasia and epidermolysis bullosa?
ED: Developmental- presents as bad skin, teeth, and nails and they stay bad
EB: Starts normal and blisters on and off until the skin, nails, and mucosa scar
What is a benign neoplasm made up of prolferative and hyperplastic vascular endothelium?
Hemangioma
What are the 3 categories of hemangiomas?
- Superficial
- Deep
- Mixed
What is another name for a superficial or capillary hemangioma?
Strawberry hemangioma
Where are superficial or capillary hemoangiomas located?
Upper dermis
What is the time course for a superficial or capillary hemangioma?
Present at birth, gradually get larger, then resolve completely
When is treatment required for a superficial/capillary hemangioma?
When it interferes with vision, breathing, eating, hearing, or other normal functions
What is treatment for a superficial/capillary hemangioma?
Steroids and laser treatment
Where are deep/cavernous hemangiomas located?
Lower dermis, fat, muscle
What color are cavernous hemangiomas?
Often blue
What are treatment options for a cavernous hemangioma?
Steroids, laser, propranolol
What is the name for a hemangioma that enlarges rapidly?
Kasabach-Merritt Syndrome
What causes the hemangioma to enlarge rapidly in Kasabach-Merritt Syndrome?
Sequestration of platelets into the lesion
What are 2 problems with Kasabach-Merritt Syndrome?
- Low platelet coutns
2. Vulnerability to bleeding
What type of lesions are at risk for transformation into melanoma?
Congenital melanocytic nevi
What type of nevi have the greatest risk for later transformation to melanoma?
Giant congenital nevi
What are 3 main risk factors for melanoma?
- Sun exposure
- Family history
- Fair complexion
Describe how the risk for melanoma progresses.
Risk is cumulative- More sun exposure over time results in higher risk for malignant melanoma and other forms of skin cancer
True or False: Melanoma can appear in any part of the body (even those that have never seen the sun)
True
What are the ABCDs of melanoma?
Asymmetry
Borders (irregular, rough, notched)
Colors (unusual or change
Diameter (larger than 6mm)
