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EOR - Pediatrics (Alice copy + Seth's) > Derm Obj with more detail (derived from Enoch's cards) (15%) > Flashcards

Derm Obj with more detail (derived from Enoch's cards) (15%) Flashcards

1
Q

What are the factors associated with development of acne vulgaris?

A

Increased sebum production
Follicular hyperkeratinization
Proliferation of cutibacterium acnes
Inflammation

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2
Q

What triggers acne in puberty?

A

Androgen stimulation of pilosebaceous unit
Changes in keratinization at follicular orifice

Hormones and keratinization

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3
Q

When does the follicular ostium dilate in acne?

A

Comedo formation

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4
Q

When does rupture of the follicular wall occur in acne?

A

Nodule/cyst

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5
Q

Which gender usually has more acne?

A

Women

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6
Q

Specifically in adult women, what kind of acne papules are found and where?

A

Deep seated & tender red papules along the mandibular jaw.

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7
Q

What are drug-induced acneiform eruptions usually composed of?

A

Monomorphic inflammatory papules and pustules

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8
Q

What is mod for comedone #?

A

20-100

above = severe
below = mild

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9
Q

What is mod for papules/pustules #

A

15-50

above = severe
below = mild

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10
Q

What is mod for nodule #?

A

<5

> 5 = severe

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11
Q

What could itchy acne be and what do we do then?

A

If itchy, could be papules that we can do KOH prep on.
Check for pityrosporum folliculitis (tx with keto shampoo)

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12
Q

MOA of retinoid

A

Decreases cohesion and increases turnover of epidermal cells

stops skin from being sticky and increases cellular death so that there is not time for acne to grow

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13
Q

t/f you can have retinoids in preggo?

A

FALSE

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14
Q

your patient has taken a lot of abx and you are worried about antibiotic resistance, so you consider ____ for treatment of their acne

A

benzoyl peroxide (BPO)

No bacterial resistance

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15
Q

SE of benzoyl peroxide (BPO)

A

Skin irritation
Bleaching of hair/clothing

B = Bleach

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16
Q

In what type of acne is topical abx indicated?

A

Papulopustular

think bacteria d/t puss

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17
Q

1st line topical abx

A

Clindamycin or erythromycin (my son has acne)

Often combined with BPO

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18
Q

when are oral abx indicated for acne?

A

Moderate acne: inflammatory papules or deep-seated lesions

20-100 comedones
15-50 papules/pustules
< 5 cysts

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19
Q

What are the oral abx for acne?

remember, indicated for moderate acne

A

Doxycycline
Minocycline

-cycline

3 month tapered course

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20
Q

MOA of oral abx for acne

A

inhibition of C. acnes

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21
Q

CI for tetracylcines used as oral ABX for acne

A

preggo or young

can use macrolides (mycin) if this is an issue

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22
Q

If a patient is not able to have -cycline or -thromycin for oral abx treatment for mod acne, what are the 2nd line options?

A

Bactrim DS
Keflex (safe in preggo but not that effective)

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23
Q

Treatment of severe resistant nodular/cystic acne

A

Isotretinoin (accutane)

last resort monotherapy

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24
Q

MOA of isotretinoin (Accutane)

A

Same as others: inhibition/decrease in C acnes

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25
Q

Apart from being CI in preggo, what is another CI of isotretinoin?

A

Use with an oral tetracycline

-cycline

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26
Q

You must monitor CMP/lipids this often () with isotretinoin and stop or use a statin if lipids reach ()

A

monthly
700-800

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27
Q

What is interesting regarding your blood when you are on isotretinoin?

A

You may not donate it

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28
Q

What is perioral dermatitis and MC demographic?

A

Discrete erythematous micropapules
MC in females

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29
Q

RFs for perioral dermatitis

A

Topical fluorinated glucocorticoids + inhalers
Fluroinated toothpaste
OCP

Fluorine

patient will likely be on one of these in a case scenario

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30
Q

Tx for perioral dermatitis

A

D/C Steroids

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31
Q

What is the most common form of alopecia?

A

Androgenic alopecia

Aka sex pattern hair loss

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32
Q

What is the underlying pathophysiology of androgenic alopecia?

____ are regressed into _______ hairs due to _____.

A

Terminal hairs are regressed into indeterminate/vellus hairs due to androgens.

Terminal hairs are affected by hormones!

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33
Q

What androgenic alopecia classification describes females vs males?

A

Females = Ludwig-Savin
Males = Norwood Hamilton

Women wear wigs
Alexander Hamilton was a man

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34
Q

What hormone specifically causes androgenic alopecia and the long-term result of exposure to it?

A

DHT
Successive cycles will produce shorter and thinner hairs

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35
Q

If I do a biopsy of androgenic alopecia, what do I expect to see?

A

Telogen phase & atrophic follicles

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36
Q

Minoxidil is typically the treatment for androgenic allopecia, but this medication () can be used for men and this () can be used for women

A

Finasteride for men (5-alpha-reductase inhibitor that inhibits conversion of T to DHT)
Spironolactone for women (prevents DHT from working but does not have direct affects on T)

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37
Q

what is the triad of atopy?

A
  1. Atopic dermatitis
  2. Allergic rhinitis (hay fever)
  3. Asthma

3 As

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38
Q

What is the cycle of atopic dermatitis?

A

Dry skin
Pruritis
Increased inflammation (from itching)
Lichenification

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39
Q

What are the three pathophysiologic causes of dry skin d/t atopic dermatitis?

A

Impaired filagrin production
Reduced ceramide levels
Increased trans-epidermal water loss

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40
Q

what inflammatory markers are expressed in atopic dermatitis?

A

IL-4
IL-13

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41
Q

Hallmark sign of atopic dermatitis

A

Intense pruritis

Leading to lichenification as you keep scratching. Also can lead to 2ndary infections.

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42
Q

Presentation of someone with atopic dermatitis

A

Chronic: periorbital plaques
Hyperpigmentation
Hyperlinear palms
Keratosis pilaris
Hx of allergies

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43
Q

What is the primary thing that clues you into atopic dermatitis?

A

Hx and FHx

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44
Q

What is the tx for atopic dermatitis?

A

Gentle cleansers
Low strength steroids

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45
Q

How do you manage striae in atopic dermatitis?

A

Ointment without preservatives
Damp skin or under occlusive dressings
AVOID soap except in body folds

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46
Q

Cream for localized dermatitis

A

Low potency: desonide BID
Medium potency: Triamcinoline/mometasone/fluocinolone BID
Non-steroidals (only use if >2y): Tacrolimus/pimecrolimus/crisaborole

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47
Q

Systemic tx for atopic dermatitis

A

Dupulimab SC

48
Q

Tx for pruritis in atopic dermatitis

A

Antihistamines

makes sense

49
Q

How do you differentiate between irritant contact dermatitis vs allergic contact dermatitis?

A

ICD: confined to area, sharply marginated, never spreads
ACD: spreading, type IV HSR

50
Q

your male patient comes in with dermatitis of the face, neck, upper chest, forearms, and palms - what type of dermatitis do you suspect?

A

Airborne contact dermatitis

sun exposed skin

51
Q

Diagnosis of contact dermatitis

A

Hx
Patch testing ((+) still requires you to clinically correlate)
Do not use skin prick test, which only tests Type 1 HSR

Patch testing is not the same as skin prick testing

52
Q

What is the underlying physiology of allergic contact dermatitis?

____, which bind to a carrier and cause a Type _____

A

Haptens, which bind to a carrier and cause a Type IV HSR

Re-exposure to a substance already sensitized to

53
Q

apart from avoid offending agents, how do you treat allergic contact dermatitis pharmacologically?

A

Steroids (topical/oral)

54
Q

What non-pharmacological therapy can help with contact dermatitis?

A

PUVA Phototherapy

psoralen utraviolet A

55
Q

what is miliaria?

A

blocked sweat ducts

56
Q

what type of dermatitis can miliaria cause?

A

Diaper dermatitis

57
Q

Apart from barrier creams and targeting the offending agent, this patient education for bathing is important for diaper rash

A

Dry well

Fungus loves a wet, warm environment

58
Q

What is ectothrix?

A

A grey patch with a scaly appearance
Hair shafts are broken off and brittle
An infection OUTSIDE of the hair shaft

for tinea capitis

59
Q

What is endothrix?

A

Black dot appearance
Infection within the hair shaft

for tinea capitis

60
Q

MC demographic for tinea capitis

A

AA children

61
Q

How does non-inflammatory tinea capitis appear?

A

Scaling
Pruiritis
Alopecia
Adenopathy

62
Q

Gold, mercury, and hep C are associated with this skin condition

A

Lichen Planus

63
Q

How does inflammatory tinea capitis present?

A

Painful
Tender
Alopecia

64
Q

How do the black dots appear in tinea capitis?

and MCCs

A

Broken off hairs => swollen shafts
Diffuse and poorly circumscribed
MCC: T tonsurans or violaceum
TVs in the house (endothrix is inside)

65
Q

What does KOH prep show for tinea versicolor?

A

Hyphae and budding yeast spaghetti and meatballs

very colored

66
Q

What are the 3 common types of verrucae seen in kids?

A

Verruca vulgaris: common (very) wart
Verruca plantaris: plantar wart
Verruca plana: flat wart (plain wart)

67
Q

Dermoscopy with oil of these small, flat-topped papule has white lines around it. What are these white lines and what condition is it?

A

Whickham striae seen in Lichen Planus

68
Q

How does verruca vulgaris present?

A

1-10mm papules
Isolated or multiple
Red and brown spots: thrombosed papilla capillary loops (seen on dermatoscope)

69
Q

Jetliner with a trail

A

Dermoscopy finding for scabies

70
Q

MCC of verruca vulgaris

A

trauma, hands/fingers/knees

71
Q

How does verruca plantaris present?

A

Shiny plaques with a rough, hyperkeratotic surface
Thrombosed capillaries
Skin lines decrease
Usually uncomfortable
Tender
reminds me of a cigarette butt

of the foot

72
Q

How does verruca plana present?

A

Sharply defined
1-5mm
Flat surface
Skin colored or light brown
Round, oval, polygonal, or linear

73
Q

MC location of verruca plana

A

face, beard, dorsa of hands and shins

73
Q
A
74
Q

Management options for verrucae

A

**Salicyclic acid
**Cryotherapy
Imiquimod
Cantharidin (blister beetle)
Electrosurgery + vacuum to prevent aerosolization

Podofilox not mentioned, maybe cause it doesn’t really spread?

75
Q

What does SA do?

A

Desquamation of hyperkeratotic epithelium
10-30% conc for small
40% conc for big lesions

76
Q

What else should you do when applying SA?

A

Sanding/filing

77
Q

What is cantharidin?

What is cantharidin?

A

Blister beetle substance, which causes a blister on the wart.

78
Q

Where is pediculosis capitis MC and how does it present?

A

Lice
MC in schools, day-cares, SNFs, dorms, prisons
Intense pruiritis of the scalp
MC in white school aged girls/mothers

Warmer months

79
Q

What does a louse look like vs nits?

A

Louse 1-3 mm long, flattened brownish-gray, 3 pairs of legs and claws
Nits are 1 mm and opalescent (eggs)

Humanus are in clothing, capitus on hair shafts

80
Q

lifespan of a louse (lice)

A

14-18 days

81
Q

What do lice and nits do to the scalp? What does microscopy show?

A

Mauculae cerulae or purpuritic stains may suggest infestation
Occipital lymph node involvement

Microscopy shows an oblong structure attached to hair an an acute angle with a breathing appartus at its superior end

82
Q

Diagnostic pearls for pediculosis capitis

A

Pyoderma + occipital/cervical LAN suggest infestation
Nits are oval and tenacious; they stay stuck
Nits fluoresce under Wood’s lamp

83
Q

Best tests for pediculosis capitis

A

Microscope
Wood’s lamp of nits

84
Q

Management of pediculosis capitis

A

Permethrin has increasing resistance
Manual combing via fine comb

85
Q

Should you treat a kid with empty nit cases?

A

No

Only live lice or eggs

86
Q

OTC tx for pediculosis capitis

A

Permethrin (Nix): dry hair then rinse after 10m. Repeat in 1-2 weeks
Pyrethrins + piperonyl butoxide(RID, Pronto): same as above

87
Q

Rx tx for pediculosis capitis

A

Spinosad/Natroba: children > 4y First line tx
Malathion lotion
Ivermectin lotion: 6 months or older & not preggo

88
Q

Tx for eyelid involvement of pediculosis capitis

A

Petrolatum BID for x8d

89
Q

What causes scabies and MC mode of transmission?

A

Mite: Sarcoptes scabiei var. hominis
MC: Direct contact
fomite spread is rare

90
Q

Overview of scabies

A

10-20 mites per infestation
Extremely pruiritic 2-6 weeks later
Persists without tx!

91
Q

Presentation of scabies and where it most often occurs (how does this differ from lice?)

A

Worse at night
Diagnostic sign: fine, thread-like line with tiny black speck at the end.
Small, erythematous papules
Rarely on head or neck

lice is most often on head (head lice)
scabies is MC on the shins

92
Q

Who is crusted scabies/norwegian scabies MC in?

A

Immunocompromised
Institutionalized

93
Q

What is crusted scabies like?

A

Thousands to millions of mites

94
Q

Tx of crusted scabies

A

Topical Permethrin 5% overnight
+
Oral ivermectin x5 dosing

95
Q

Best tests for scabies

A

Scabies prep via scraping and microscopy and mineral oil

Add on KOH for crusted scabies

96
Q

Management of scabies

A

First-line: permethrin 5% or Rid
Last resort: Lindane (Avoid in crusted)
Oral ivermectin (2nd line, 0.2mg/kg/d)

97
Q

What is the MCC of Pityriasis Rosea?

A

HHV6 & 7

spring/fall

Herald patch on the trunk

or Christmas Tree Rash

98
Q

what occurs first - christmas tree rash or herald patch for Pityriasis Rosea?

A

herald patch followed by christmas tree rash 1-2 weeks after

99
Q

Describe the exanthem associated with Pityriasis Rosea

A

Fine scaling papules and patches
Dull pink, salmon red

The Ps of Pityriasis = papules/patches

100
Q

What is used in the tx of Pityrasis Rosea? (4)

A

Oral antihistamines
Topical antipruritic lotions (Sarna)
Topical Triamcinolone BID x 4 weeks
Oral steroids

antihistamines
triamcinolone = tree

101
Q

What is the MCC of Lichen Planus?

A

idiopathic

we don’t know

102
Q

What kind of condition is Lichen Planus?

A

Inflammatory Dermatosis of the skin +/- mucuos membranes

Acute or chronic

103
Q

What does Lichen Planus look like?

A

Flat topped papules
Annular, purple pruritic

kinda look like RBCs to me

104
Q

Where does Lichen Planus tend to occur?

A

Wrists (flexor)
Lumbar
Shins
Scalp
Penis
Mouth

105
Q

Which Lichen Planus type involves cicatricial/scarring alopecia?

A

Follicular

think hair follicles

106
Q

Which Lichen Planus variant is associated with Bullous Pemphigoid?

A

Vesicular

think of how vesicles progress into bullae

107
Q

Involvement of this area with Lichen Planus is concerning?

A

Mouth

108
Q

If Lichen Planus occurs in the hair and nails, what may happen?

A

Scarring alopecia
Nail Bed destruction + longitudinal splintering

109
Q

What is the most concerning variant type of Lichen Planus that we need to consider DDx for?

A

Papular

lichen planus papular

110
Q

For cutaneous lesions of Lichen Planus, the preferred tx is…

A

Triamcinolone under occlusion BID x 4 weeks

Can also use ILK

111
Q

For Lichen Planus in the mouth, the preferred tx is…

A

Cyclosporine and Tacrolimus MOUTHWASH

LP and CT of th mouth

112
Q

Systemic tx of Lichen Planus can use 3 drugs and 1 therapy, which are…

A

Cyclosporine
Prednisone
Retinoids (adjunctive)
PUVA therapy

113
Q

What is the underlying pathophysiology of SJS & TEN?

A

Cytotoxic event destroying keratinocytes

114
Q

what is the shape of a SJS TEN rash?

A

Target lesions with rapid confluence

115
Q

When do you want to give to IV steroids and IVIG for SJS/TEN?

A

ASAP

EOR - Pediatrics (Alice copy + Seth's) (22 decks)

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