Derm Cram Flashcards
Immune cells found in erythema toxicum?
Eosinophilia
Pathogenesis of acne?
Abnormal keratinisation
Increased sebaceous gland production
P Acnes
Inflammation
Mechanism & indication for isotretinoin (Accutane)?
Severe nodulocystic acne
Reduces size and secretion of sea glands, normalises keratinisation
Course of 4-5 months
HIGHLY TERATOGENIC
Causes liver dysfunction (contraindication)
Treatment of allergic contact dermatitis?
Avoidance of trigger
Topical corticosteroids
Topical calcineurin inhibitors
Systemic corticosteroids indicated if >20% BSA or if affect the face, hands, feet or genitalia
Treatment of irritant contact dermatitis?
Increase emollient use
Topical corticosteroids
Gloves
Systemic corticosteroids are not indicated
Pathogen related to seborrheic dermatitis?
Pityrosporum ovale yeast
Treatment of seborrheic dermatitis?
If scalp - medicated shampoo, wet compresses +/- topical antifungals
If not scalp - topical corticosteroids +/- antifungals
Consider pimecrolimus in severe disease
Yellow-gold on wood’s lamp exam
KOH preparation shows groups of thick walled spores, short angular hyper resembling spaghetti and meatballs
Tinea/Pityriasis Versicolour
Preferred topical anti fungal agent?
When systemic therapy indicated?
Terbinafine
If chronic/resistant infection or scalp/nail involvement use systemic therapy
Baseline ALT/AST required prior to systemic therapy
Indications for treatment of haemangiomas?
If large/rapidly growing
Periorbital
Airway (beard distribution) / liver / GIT lesion
If ulcerating
> 5 haemangiomas?
Needs liver USS to investigate for liver haemangioma
Thrombocytopenia/coagulopathy with large haemangioma?
Kasabach-Merritt phenomenon
platelet trapping in vascular tumour
Segmental haemangioma on face/head?
PHACE Posterior fossa brain malformation Haemangioma Arterial anomaly Cardiac/coarctation Eye and endocrine
Segmental haemangioma on lumbosacral region?
Assoc myelopathy
Spinal and genitourinary anomalies
Needs MRI as investigation
Beard hameangioma
Airway haemangioma
Risk of airway sx at 6-12 weeks when haemangioma proliferation is rapid
SEs of propranolol?
Low BP and HR (peaks 2hrs post)
Wheeze & bronchospasm
Hyperkalaemia
Diarrhoea
Masks low BGL symptoms except sweating - parents need to be aware
Infants <2mths admitted for observation with first doses
When not to use propranolol in haemangiomas?
Sinus brady/1st degree heart block
Bronchial asthma
Hypersensitivity to BBs
Prem infant aged <5 weeks
PHACE with cervical stenosis/coractation
Drop in BP -> ischaemia
Itchy worse at night with tracks between fingers
Scabies
Treatment for scabies?
Ivermectin/permethrin
Flat, non-blanching red rash not crossing midline
Growing with child
Management?
Port Wine Stain/Naevus Flammeus
Pulsed dye laser - lightens without causing scarring
Associations with port wine stain?
Glaucoma
Spinal dyraohism
Stoft tissue/bony overgrowth
Port wine stain V1/V2 trigeminal distribution
Leptomeningeal angiomatosis
Glaucoma
Sturge Weber Syndrome
Port wine stain on limb
Venous/lymphatic malformation
Soft tissue/bone hypertrophy
Kippel-Trenaunay Syndrome
Port wine stain limb
AV shunts with CCF
AVM
Parkes-Weber Syndrome
Newborn with raised brown lesion with irregular margin
Biopsy shows nevus cells in lower reticular dermis
Congenital melanocytic naevi
Risk of malignant transformation in congenital melanocytes naevus?
5%
Risk proportional to size
Melanocytic nevus on biopsy shows atypical intraepidermal melanocytes +/- angiogenesis?
Atypical Melanocytic Naevi
Risk factors for paediatric melanoma?
Atypical mole/melanoma syndrome
Xeroderma pigmentosum
Acquired melanocytic naevi/atypical naevi
Hairless, red, dome shaped naevus
Spitz Naevus
Patchy skin pigmentation following lines of Blashko?
McCune Albright
Conditions presenting with lentigines?
Lentigines = small round dark brown macule like freckles/moles
LAMB syndrome
LEOPARD syndrome
Puetz Jeghers
Conditions presenting with cafe au last macule?
NF Tuberous sclerosis Turner's Fanconi Anaemia Russell-SIlver McCune Albright (Blashko) Bloom Cowden
Absent/reduced pigment in hair, skin, eyes?
Oculocutaneous albinism
Rash begins on face
Koplik spots
Measles
Rosy cheeks developing into lacy rash which spares the palms and soles
Parvovirus
Small raised erythematous lesions beginning on trunk and spreading to limbs
Roseola Infantatum
HHV6,7
Nonpruritic rash beginning on face and spreading downwards
Rubella
Umbilicated epidermal papules
Molluscum
In immune competent 50% have cleared within 12 months
HPV assoc w genital warts and respiratory papillomatosis?
HPV 6 and 11
11 more severe and more common
Treat with laser, cidofivir or interferon
HPV assoc w cervical Ca?
16, 18
Detected in 70% of Cervical Ca
RF for staph scalded skin?
Neonates - renal excretion of staph toxin reduced
Unwell infant week 1 of life with fever
Blistering skin which heals without scars
Nikolsky sign positive
Mucus membranes not involved
Staph scalded skin
Differentiation between staph scalded skin and TENS/SJS?
Staph scalded skin = intraepidermal cleavage and NO mucosal involvement
TEN = sub epidermal cleavage and necrosis and vast mucosal involvement
Scaling on extensor surfaces, flexural surfaces spared
Keratosis pillars
Hyperkeratosis of palms and soles
Icthyosis Vulgaris
Most common disorder or keratinisation
AD - fillagrin mutation
Treat with moisturiser and salicylic acid
Harlequin Ichthyosis treatment?
Oral retinoids
Now 80% survive beyond infancy
ABA12 mutation
Alopecia
Unilateral yellow, waxy, scaling
Hemidysaplsia
Limb defects
CHILD syndrome
Congenital Hemidysplasia with Ichthyosiform erythroderma and Limb Defects
Baby presents with unilateral facial swelling over a period of weeks-months
Painless mass that can be transilluminated
Sudden increase in size, accompanied by fever
Lymphatic malformation
50% head/neck
50% at birth and rest develop prior to age 2
Rapid enlargement can be due to bleed or infection
Skin thickening and tethering to underlying tissue
Renal failure
Nephrogenic systemic fibrosis
Most common superinfectioms in VZV?
Strep pyogenes
Staph Aureus
Erythematous macules in infancy with increasing wheals/dermatographism which touched
Urticaria pigmentosa
