DERM- skin lesions Flashcards
cafe-au-lait spots
tan to dark brown anywhere on body, size increases with growth, permanent
usually not treatment req
appear singly or in pairs
6 or more should be eval for NF or other conditions
Salmon patches
light red macule
nape of neck, upper eyelids, glabella (between eyes on bridge of nose)
40% newborns have on neck
always present at birth and dont resovle spont, fade with time around kindergarden age 5-6
port wine stains
growth with child
flat, pink, vascular lesion-common face/neck, can happen anywhere
ALWAYS present at birth
refer to derm for laser or cosmetic treatment
get fam hx, can be associated with genetic conditions
hemangiomas- 3 stages
girls 3X more than boys- irregular shape, locatized mass of tissue
present at birth 40% of time
rapid growth (proliferative stage)
stability (plateau phase)
regression (involution phase)- occurs slowly approx 10% per year, but spontaneously
30% by 3 years, 50% by 5 years, 70% by 7 years
90% by 9-10 years
average involution phase
regression between 12-24 months old
gray area in lesion followed by flattening from center outward
infantile hemangiomas cause and prevanlence
common proliferation of endothelial tissue-can be allarming, discuss with parents expectations
affects 4-5% of infants
most have rapid phase of growth in first several months of life
max size is at 9 months old, or 12 months old, then plateau then involution
what is the main sign of sterge webber syndrome
port wine stain
congenital, not inherited, disorder that affects the skin, neuro system and sometimes eyes
watch for seizures and dev delays
goals of treatment
goal to decrease psycosocial distress but also avoid agressive treatment for lesions that can resolve spontaneously - stress spont resolution taking time to parents
identify associations with other anomalies
treat ulcerations-prevent disfigurement
prevent life threatingin complications- hemm on mouth/neck might occlude airway
special considerations
hemm with lumbarsacral area with tethered cord- refer to neuro surg
hemm on chin- airway- refer to ent
serial eval in young infants, may preceed dev of symptomatic airway
deep hemm- involves deep dermis, bluish nodule
Hemangiomas that req active intervention
periorbital tumors- prevent vision damage, astygmatism d/t pressure on globe
involving airway- chin, beard distribution esp during prolif phase
extracutaneous lesions- may conpromise vital structures bc of size, bleeding, rare
causing permanent disfigurement
those in centrofacial area in contours facial skin- also phychosocial distress
hemm topical therapy
beta blockers
only for smaller hemm
Timoptic, timolol
used for vasocontriction
hemm topical therapy
corticosteroids
used to be first choice but caused s/e
2-5mg/kg/day
response variable, s/e irritability, GI upset, sleep disturbances, growth retardation, adrenal supression
most kids catch up growth
Hemm systemic therapy
propranolol
mecahanism of action unknown
becoming first line
high risk patients- kids at risk for adverse reactions
mew pediatric formulation- hemangiol
systemic propanolol considerations- baseline eval and who needs hospitalization?
ongoing debate or need for baseline eval and monitoring during dose escalation
baseline ECG and cardiac exam by exp cardiologist
brief hospitalization in <2months or <48 weeks corrected, significant comorbidities or life threatning IH (infantile hemangioma)
systemic propanalol outpatient criteria
older infants, children w.o comorbidities, gradual titration to target dose over weeks, monitor VS and for hypoglycemia at initiation and escelation of dose
