Dermatologic - aa

Question 1

A blue-black macule found over the lumbosacral area in 90% of infants of Native-American, African-American, and Asian descent is called a _____. These spots are occasionally noted over the shoulders and back and may extend over the buttocks. The lesions FADE somewhat with time as a result of darkening of the overlying skin, but some traces may persist into adult life.

Answer 1

Mongolian spots

Question 2

A _____ is a light brown, oval macule (dark brown on brown or black skin) that may be found anywhere on the body. These lesions PERSIST throughout life and MAY INCREASE in number with age.

Answer 2

café au lait macule

Question 3

The presence of six or more café au lait macules over 1.5 cm in greatest diameter is a major diagnostic criterion for what?

Answer 3

neurofibromatosis type 1

Question 4

A red, rubbery vascular plaque or nodule with a characteristic growth pattern is a _______. The lesion is often not present at birth but is represented by a permanent blanched area on the skin that is supplanted at age 2–4 weeks by red papules. The lesions then undergo a rapid growth or “proliferative” phase, where growth of the lesion is out of proportion to growth of the child. At 9–12 months, growth stabilizes, and the lesion slowly FADES over the next several years.

Answer 4

hemangioma

Question 5

What is the treatment for complicated hemangiomas?

Answer 5

prednisolone or propranolol

Question 6

Erosions covered by honey-colored crusts are diagnostic of ______. Staphylococci and group A streptococci are important pathogens in this disease.

Answer 6

impetigo

Question 7

Thickened, broken-off hairs with erythema and scaling of underlying scalp are the distinguishing features of _____. In some forms, hairs are broken off at the surface of the scalp, leaving a “black dot” appearance.

Answer 7

tinea capitis

Question 8

This presents either as annular marginated plaques with a thin scale and clear center or as an annular confluent dermatitis. The diagnosis is made by scraping thin scales from the border of the lesion, dissolving them in KOH, and examining for hyphae.

Answer 8

tinea corporis

Question 9

What are the most common tinea corporis organisms?

Answer 9

Trichophyton mentagrophytes, T. rubrum, M. canis

Question 10

_____ are tiny epidermal cysts filled with keratinous material. These 1- to 2-mm white papules occur predominantly on the face in 40% of newborns. Their intraoral counterparts are called Epstein pearls and occur in up to 60%–85% of neonates. These cystic structures spontaneously rupture and exfoliate their contents.

Answer 10

milia

Question 11

Commonly, obstruction of the eccrine duct deeper in the epidermis results in erythematous grouped papules in the same areas and is called ____ ____. Rarely, these may progress to pustules. HEAT and HIGH HUMIDITY predispose the patient to eccrine duct pore closure. Removal to a cooler environment is the treatment of choice.

Answer 11

miliaria rubra

Question 12

When does neonatal acne most commonly occur, and when does it resolve?

Answer 12

Although neonatal acne can be present at birth, it most often occurs between 2 and 4 weeks of age. Spontaneous resolution occurs over a period of 6 months to 1 year.

Question 13

______ is characterized by sharply defined BEEFY RED patches, sometimes with eroded areas. Pustules, vesicles, or papules may be present as SATELLITE LESIONS. Similar infections may be found in other moist areas, such as the axillae and neck folds. This infection is more common in children who have recently received antibiotics.

Answer 13

Candida diaper rash

Question 14

What is the treatment for candida diaper rash?

Answer 14

~topical imidazole cream

~refractory candidiasis: a brief course of oral fluconazole

Question 15

What is the most common form of primary irritant contact dermatitis seen in pediatric practice?

Answer 15

diaper dermatitis

Question 16

Your 6 month old patient has erythema and scaling of the skin in the perineal area and a history of prolonged skin contact with urine or feces (as is frequently seen in the “good baby” who sleeps many hours through the night without waking). What is it and what is the treatment?

Answer 16

~diaper dermatitis

~change diapers frequently

~only wash area following a bowel movement

~don’t use rubber or plastic pants over diapers

~allow area to air dry

~apply a barrier cream such as zinc oxide

Question 17

A type of vascular birthmark that consists of dark red macules appearing anywhere on the body

Answer 17

port wine stain

Question 18

Treatment for port wine stains?

Answer 18

pulsed dye laser

Question 19

Erythema toxicum, a transient disease of the newborn:

~when do lesions appear?

~what do they look like?

~where do they appear?

~how many lesions?

~how long do the lesions last?

Answer 19

~At 24–48 hours of age, blotchy erythematous macules 2–3 cm in diameter appear

~Most prominently on the chest but also on the back, face, and extremities

~Vary in number from a few up to as many as 100

~Incidence is much higher in full-term versus premature infants

~The macular erythema may fade within 24–48 hours or may progress to formation of urticarial wheals in the center of the macules or, in 10% of cases, pustules.

~Lesions contain numerous eosinophils.

~The lesions fade and disappear within 5–7 days.

Question 20

What are the two most common birthmarks?

Answer 20

~Mongolian spots

~nevus simplex (aka stork bite, salmon patch, nevus flammeus, angel’s kiss)

Question 21

~A capillary malformation of the skin that occurs most commonly on the glabella, upper eyelids, and nuchal area.

~Appears with high frequency in all races, occurring in 70% of white infants and 59% of black infants.

~Regress spontaneously, usually by the age of 2.

Answer 21

nevus simplex, aka salmon patch

Question 22

What is the treatment for seborrheic dermatitis?

Answer 22

low-potency topical steroids

Question 23

An erythematous scaly dermatitis accompanied by overproduction of sebum (yellow stuff!) occurring in areas rich in sebaceous glands (ie, the face, scalp, and perineum).

Answer 23

seborrheic dermatitis, aka cradle cap (in infants)

Question 24

What skin condition has the following pathogenesis?

(1) plugging of the sebaceus follicle;
(2) increased sebum production;
(3) proliferation of Propionibacterium acnes in the obstructed follicle, and
(4) inflammation.

~Many of these factors are influenced by androgens.

Answer 24

acne vulgaris

Question 25

What are the treatments for acne vulgaris?

Answer 25

~firstline: topical retinoid and benzoyl peroxide

~topical or systemic abx

~oral retinoids

~oral contraceptives

Question 26

What is this?

~a hereditary disorder characterized by dry skin, the presence of eczema, and onset before age 2 years

~begins on the cheeks and scalp

~usual age of onset is 2-3 months, usually goes away by 18 - 24 months

Answer 26

atopic dermatitis in infants (infantile eczema)

Question 27

What are the 3 stages of atopic dermatitis in children?

Answer 27

~Many (not all) patients go through three clinical phases. In the first, infantile eczema, the dermatitis begins on the cheeks and scalp and frequently expresses itself as oval patches on the trunk, later involving the extensor surfaces of the extremities.

~Only one-third of all infants with infantile eczema progress to phase 2 childhood or flexural eczema in which the predominant involvement is in the antecubital and popliteal fossae, the neck, the wrists, and sometimes the hands or feet. This phase lasts from age 2 years to adolescence.

~Only one-third of children with typical flexural eczema progress to adolescent eczema, which is usually manifested by the continuation of chronic flexural eczema along with hand and/or foot dermatitis.

Question 28

What is the treatment for seborrheic dermatitis in infants?

Answer 28

For cradle cap, removal of crusts with warm olive oil compresses, followed by baby shampoo, 2% ketoconazole shampoo, and application of 1-2.5% hydrocortisone cream, 2% ketoconazole cream, and 1% pimecrolimus cream.

Question 29

What is the treatment for atopic dermatitis/eczema?

Answer 29

Acute: wet dressings and medium-potency topical corticosteroids

Chronic: avoid irritants and restore water to the skin.
~No soaps or harsh shampoos
~Avoid woolen or any rough clothing
~Bathing is minimized to every second or third day
~Twice daily lubrication of the skin; nonperfumed creams or lotions, petroleum jelly; Cetaphil
~Bedroom humidifier
~Topical corticosteroids should be limited to medium strength

Question 30

What is the treatment for tinea capitis?

Answer 30

If hair is involved, must use a systemic med since topicals won’t penetrate enough.

Griseofulvin!

Question 31

How griseofulvin taken?

Answer 31

Oral with fatty food, such as whole milk or ice cream

Question 32

What is the treatment for tinea corporis?

Answer 32

topical imidazoles, allylamines, benzylamines, or ciclopirox

Question 33

How can you differentiate visually and on labs between candidal and contact diaper rash?

Answer 33

Candidal: in skin folds

Contact: not in skin folds

(UpToDate)

KOH!