Derm Flashcards
Firm, dome-shaped papules with central umbilication
Molluscum contagiosum virus (MCV) (poxvirus)
Pearly white, pink, or skin colored
Average number of papules is 10-20
Affect any part of skin, but most common on trunk, antecubital and popliteal fossae, axillae
What’s important to remember regarding Molluscum contagiosum?
Inflammation of lesions precedes resolution!
Tx of Molluscum contagiosum
Watchful waiting
Cantharadin topical treatment
Cryotherapy
Keratolytics (Topical Retinoid)
Lemon Myrtle Oil 10%
What is the BOTE (Beginning Of The End Sign)?
Molluscum Dermatitis - inflammation of molluscum contagiosum precedes resolution
Why shouldn’t mid-high potency topical steroids, like triamcinolone, be used on skin infections?
They halt the immune system from clearing the infection.
The fancy word/words for warts is caused by which virus? Tx?
Verruca vulgaris is caused by HPV
Tx:
- Topical salicylic acid: Wart Stick
- Cryotherapy
- Candida antigen injections
- Cimetidine
What pertinent information on HPI should be asked about when eczema herpeticum is on your ddx?
If there was a close contact with a recent cold sore.
Clinical findings for eczema herpeticum
- Vesicles
- Erosions
- Pustules
- Crust
- PAIN!
What’s a risk for developing eczema herpeticum?
Skin with poor barrier like with atopic dermatitis
How would you differentiate between hand, food, mouth disease and eczema herpeticum?
Coxsackie virus (hand, food, mouth) does not show up on culture, while HSV (eczema herpeticum) does
Tx for eczema herpeticum
Acyclovir
Ophthalmology consult if near eyes
Do not use topical steroids on suspected HSV
Topical ointment Emollients: Vaseline or Aquaphor
Consult Dermatology
Painful oral vesicles that begin as small red spots and advance to ulcers
Exanthem: non-painful or pruritic vesicular or maculopapular lesions on distal extremities
Hand, food, mouth disease (coxsackie)
Common to have diaper dermatitis also
How would you differentiate between alopecia areata and tinea capitis?
Alopecia areata: smooth, circular patches of complete hair loss. Painless and non-pruritic.
Tinea capitis: Scaly patchy alopecia with broken hair and possible pruritis and erythema. May present with lymphadenopathy.
What is a kerion?
A painful inflammatory plaque with pustules seen on tinea capitis
Exclamation point hairs
Alopecia areata
MC organisms that cause tinea capitis
Trichophyton tonsurans, T. violaceum, M. canis
Tx of tinea capitis
Oral Griseofulvin microsize
This is a chronic scarring disease of the apocrine glands that affect the axilla, inguinal folds, anogenital area, and breasts.
Hidradenitis Suppurativa
A patient presents with a painful, inflammatory abscess that drains purulent material and has sinus tract formation. On exam, you notice scarring and deep fibrosis. What is the most likely diagnosis and how would you treat it?
Hidradenitis Suppurativa
Refer to derm
Topical clindamycin
Doxycycline PO
When a patient presents with vitiligo, what other diseases are you concerned of?
Thyroid Disease and Alopecia Areata
A benign soft tissue tumor that could be superficial/deep/mixed and localized/segmental
Infantile hemangioma
Occurs at 2-3 weeks of life
Tx of infantile hemangioma
Refer!
If small or on scalp - observe
Timolol or Propranolol (topical) - AE: low blood sugar
Steroids
When do scabies hatch?
Every 3-4 days
A patient comes in complaining of extreme pruritis. On exam, you notice a delta sign, papules, nodules, burrows, and vesiculopustules in the interdigital spaces, wrists, ankles, axilla, groin, palms, and soles. What is the most likely diagnosis and how would you treat it?
Scabies
Tx: - Permethrin 5% cream: Head/ scalp down in infant Neck down in child. 2 treatments, 7 days a part
Sulfur 6% compounded in Vaseline
Ivermectin if severe infestation that’s resistant to topical treatment
Moderate potency topical steroids (class 3-5) like triamcinolone may be used where?
Body only!
Not on face, axilla, or groin.
Low potency topical steroids (Class 6-7) like hydrocortisone 0.5% and 1% may be used where?
Face, axilla, or groin
Describe the bullae phase of Staph Scalded Skin Syndrome
Sterile, large, superficial fragile blisters occurring 1-2 days post-erythema
A patient presents with what appears to be a skin infection. On PE, you note a positive Nikolsky sign. What is the most likely diagnosis and what does this sign mean?
How would you treat it?
Nikolsky sign: gentle pressure on skin causes separation of dermis and blister rupture
Staph Scalded Skin Syndrome
Tx: Oral antibiotics - Keflex, Clindamycin
A patient presents with dry, rough skin that waxes and wanes. Parent notes that this rash responds to moisture and topical steroids. What is the most likely diagnosis and what is the hallmark of this diagnosis?
Atopic dermatitis
Hallmark: pruritis
A patient presents with 3-5 days of a 102 F fever, vomiting, and diarrhea. On exam, the patient appears lethargic and irritable. You send the patient home, prescribing supportive care. A few days later, the parent calls, saying that the fever has resolved but the child now has a non-itchy rash that started on the trunk. What is the most likely diagnosis and how would you treat it?
Roseola
HHV-6
Supportive tx (self-limited)
Family/patient education
Tylenol PRN
Keep skin cool and dry, hypoallergenic lotions/calamine if needed
A 13 yo patient comes in complaining of a rash. Upon further questioning, it is delineated that prior to the formation of the rash, the child had red eyes, a sore throat, and a headache. On exam, you notice a lacy maculopapular rash on the trunk, extremities, and face. The patient also complains of arthralgias. What is the most likely diagnosis and how would you treat it?
Erythema Infectiosum (Fifth Disease)
Parvovirus B19
Tx: supportive
A patient comes in complaining of a rash that comes and goes. He states that the rash disappears and then reappears when exposed to sunlight or hot/cold temperatures. What is the most likely diagnosis and how would you treat it?
Erythema Infectiosum (Fifth Disease)
Parvovirus B19
Tx: supportive
What patient populations are you most concerned about when it comes to parvovirus B19?
Pregnant women (fetal death) Sickle cell or immune deficiencies (severe acute anemia)
A 17 yo pt comes in freaking out over a rash that’s pretty itchy and is especially itchy with the heat/cold–he can’t decide. He notes that it started off as a single macule on his trunk which then exploded into a bunch of smaller patches throughout his trunk and extremities. You chuckle, thinking about the irony of the Christmas season and this kid getting this rash at this time. What’s the most likely diagnosis and how would you treat it?
Pityriasis Rosea
Supportive
What are normal findings on a baby that may not appear normal to parents? (10)
Milia Sebaceous hyperplasia Salmon Patch / Stork Bite Forceps / Vacuum marks Slate gray nevus Nevi Cafe Au Lait Erythema Toxicum Transient Neonatal Pustular Melanosis Peeling skin
A new parent comes in complaining that their newborn has excess tearing. On PE, you notice obstruction of the nasolacrimal duct. What is the most likely diagnosis and how would you manage it?
Dacryostenosis
If not resolved by 6 months, refer to ophthalmology
What is the normal heart rate of a newborn?
120-160
