Derm Flashcards by Samar Azzaidani

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

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What’s important to remember regarding Molluscum contagiosum?

Inflammation of lesions precedes resolution!

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Tx of Molluscum contagiosum

Watchful waiting

Cantharadin topical treatment

Cryotherapy

Keratolytics (Topical Retinoid)

Lemon Myrtle Oil 10%

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What is the BOTE (Beginning Of The End Sign)?

Molluscum Dermatitis - inflammation of molluscum contagiosum precedes resolution

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Why shouldn’t mid-high potency topical steroids, like triamcinolone, be used on skin infections?

They halt the immune system from clearing the infection.

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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

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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.

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Clinical findings for eczema herpeticum

Vesicles
Erosions
Pustules
Crust
PAIN!

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What’s a risk for developing eczema herpeticum?

Skin with poor barrier like with atopic dermatitis

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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

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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

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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

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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.

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What is a kerion?

A painful inflammatory plaque with pustules seen on tinea capitis

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Exclamation point hairs

Alopecia areata

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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