Dermatological Disorders Flashcards

Question

Peds Derm - Skin Disorders - Acne Non-Pharmacological Management

Answer 1

-Avoidance of topical, oil-based products -Use of oil-free, mild soaps, cleansers, and moisturizers

Answer 2

-Mild acne: *Topical BPO (2.5%-10%) *If not responsive with BPO, retinoid acid (0.025%-0.1%) cream or gel - pregnancy category C *Tretinoin - inactivated by UV light, and oxidized by BPO, so apply Tretinoin at night and BPO in the morning *Most common side effects of mild tx: dryness, redness, and irritation - educate to not stop, just decrease strength or duration of application *Salicylic acid (Neutrogena 2% wash) *Topical antibiotics: Erythromycin or clindamycin lotions or pads -Moderate acne (or severe pustular acne) requires systemic antibiotics (-cyclines should be tried followed by macrolides) *Doxycycline *Minocycline *Erythromycin - only for patients who cannot use tetracyclines (pregnant patients or <8 years old) ***Tetracycline stains the teeth - do not give to patients <8 years old -Severe acne that does not respond to above tx, refer to derm -Patients may need double contraceptives if taking Tretinoin, due to risk of defects if they get pregnant while taking it

Answer 3

-Fungal organisms: Trichophyton (most common), or microsporum -Disorders: *Tinea capitis (scalp) - babies, cradle cap - Hallmark is a bald spot *Tinea corporis (body ringworm) - person that goes to the gym and sweats a lot - Hallmark is raised border with central clearing with pruritus *Tinea curries (jock itch) *Tinea manuum *Tinea pedis (athlete's foot) *Tinea versicolor (hypo/hyperpigmentation macules on limb) - pigmentation change can be more long-term in darker-skinned people

Answer 4

-S/S: *May be asymptomatic *Severe itching (cruris and pedis) *Erythematous rings (corporis) *Hypo/hyperpigmentation (versicolor) -Labs/Dx: *"Spaghetti and meatballs" hyphae microscopically when treated with potassium hydroxide (KOH)

Answer 5

-Keep dry and air out -Depending on the surface area: *> surface area: oral tx *< surface area: topical tx -Tinea capitis: Primary management with griseofulvin - topical tx does not work on capitis because it can go into hair follicles -Tinea corporis: Topical antifungals - miconazole 2%, ketoconazole 2% -Tinea cruris: Topical antifungals - terbinafine cream, griseofulvin for severe cases -Tinea manuum and pedis: *Macerated: aluminum subacetate solution, soak 20 minutes BID *Dry, scaly stage: topical antifungals (terbinafine) *Severe cases: oral therapy -Tinea versicolor: Selenium sulfide shampoo for 5-15 minutes daily for 7 days - for persistent cases or larger areas, 200mg itraconazole every day PO for 5 days

Answer 6

-Transmitted by direct contact with lesions or airborne -Contagious for 48 hours before outbreak until lesions have crusted over -Most common in children <10 years old -Risk greatly decreased with vaccination -S/S: *"Dew drop on a rose petal" *Erythematous macules, with papule developing over macule *Vesicles erupt usually first in the trunk, and then scalp and face *Intense pruritus *Generalized lymphadenopathy *Low-grade fever -Management: *Supportive care: calamine lotion, antihistamine, acetaminophen *Healthy children <12 years: self-limiting - can return to school once lesions have crusted over *At risk kids: oral acyclovir, given hint he first 24 hours to reduce magnitude and/or duration of symptoms (give as soon as possible)

Answer 7

-Benign viral skin infection -Very small, firm, pink- to flesh-colored discrete papule, which become umbilicate papule with a cheesy core - hallmark is dimpling in the middle, looks like a donut (umbilicated) -Children who are sexually active or with a hx of sexual abuse can have grouped lesions in the genital area -Children with eczema or immunosuppression can have severe infections

Answer 8

-S/S: *Most common in the face, axillae, antecubital fossa, trunk, crural fascia, and extremities *Itching at site of infection - teach to not scratch -Labs/Dx: *Clinical dx *History of exposure to molluscum

Answer 9

-Resolves spontaneously if left alone -Mechanical removal of central core prevents spread and autoinoculation -Curretage -Pharmacological agents: *Tretinoin cream at bedtime *Salicylic acid at bedtime *Podophyllotoxin cream - not recommended for pregnant women due to presumed toxicity to fetus *Liquid nitrogen *Trichloroacetic acid peel *Silver nitrate, iodine *Cantharidin (beetle juice) - avoid on facial lesions *Imiquimod -Prevent scratching and touching lesions to stop spreading -Spontaneous resolution may office within 6-9 months in some immunocompetent patients -Extensive lesions or if diagnosis is unclear, refer to derm

Answer 10

-Chronic, characterized by intense itching -Remission and exacerbation pattern -Triad: *Atopic dermatitis *Asthma *Allergic rhinitis -Elevated IgE and eosinophils

Answer 11

-S/S: *Intense itching - antecubital and popliteal folds *Dry scaly skin *Acute flare-ups: red, shiny, or thickened patches *Inflamed and/or scabbed: diffuse erythema and scaling *Dry, leathery, lichenified (thick & leathery) skin - if not well controlled -Labs/Dx: *Radioallergosorbent test (RAST) *Serum IgE *Eosinophilia

Answer 12

-Dry skin management (hallmark treatment): moisturizing lotion immediately after bathing, must BLOT dry -For flare-ups: topical steroids - starts with low %, hydrocortisone - adverse effects of hydrocortisone: bladder dysfunction, hyperglycemia, hypopigmentation/scarring - use topical steroid first and then seal with emollient cream -Systemic steroids in severe cases: prednisone taper -In acute weeping: *Saline or aluminum subacetate solution *Colloidal oatmeal baths *Bleach bath - 1/4-1/2 cup bleach in 40-gallon bathtub with warm water, apply moisturized afterwards -Dupilumab for moderate-severe cases - prescribed by derm

Answer 13

-Direct skin contact with chemicals or allergens -S/S: *Redness, pruritus, scabbing *Tiny vesicles and weepy *Lichenification in chronic phase *Affected areas are hot and swollen -Management: *Compresses locally, avoid scrubbing with soap and water *High potency topical steroids locally *If severe and systemic, prednisone taper

Answer 14

-Skin irritation in genital-perianal region -Most common type of diaper rash, caused by prolonged contact with urine and/or feces -Peaks at 9-12 months: babies are walking with their diapers on and causes friction -S/S: *Fiery red rash *Irritable infant -Management: *Mild cases - barrier emollients (Desitin) *With erythema/papules - 1% hydrocortisone *Burow's (Domeboro) compresses for severe erythema and vesicles *Secondary bacterial infection - topical antibiotics *Secondary fungal infection - topical antifungals *Prevention *Allow diaper area to air out several times per day

Answer 15

-Common benign hyperproliferative inflammatory skin disorder -Epidermal turnover time is reduced from 14 days to 2 days -Immature nucleated cells -Immunologically mediated -S/S: *Can be asymptomatic *Itching *Red, sharply defined plaques with silvery scales in extensor surfaces *Auspitz sign: droplets of blood when scales are removed *** Hallmark -Management: *Topicals for the scalp: tar/salicylic acid shampoo, topical steroid oil *Topical steroids for the skin: topical steroids twice daily for 2-3 weeks *UVB light if more than 30% of the body is involved *Moisturizers - emollient and unscented

Answer 16

-Mild, acute inflammatory disorder, self-limiting, lasts 3-8 weeks -More common in spring and fall -Most common after URI -More common in females -S/S: *Itchy *Initial lesion ("herald patch") *Pruritic rash in a Christmas tree pattern in the trunk -Labs/Dx: *Serologic tests for syphilis if the rash does not itch, or if the palmar surfaces, genitalia, or mucous membranes are involved -Management: *Daily sunlight exposure, UVB daily x3-5 days *Oral erythromycin -Management: If pruritic *Hydroxyzine (1st generation antihistamine - sedating) *Oral antihistamines *Topical antipruritic *Cool compresses, baths *Topical steroids

Answer 17

-Caused by group A beta-hemolytic streptococci (GABHS) -Contracted through contact with infected respiratory droplets or skin exudate -Complication of strep throat -More common in children 5-15 years -S/S: *Initial presentation (days 1-2) -*Fever (101F or higher) -*Exudative pharyngitis -*Swollen tongue with white exudate and/or red papillae (strawberry tongue) *Rash presentation (typically 12-48 hours after fever onset) -*Sandpaper-like papillae -*Appear on neck, armpits, and groin, before spreading to trunk and extremities -Dx: *Throat cx for strep -Management: *10-14 day course of PCN or amoxicillin - should see improvement 24-48 hours *Emollients or oral antihistamines for desquamating rash *Check urine for RBC 14 days after completing antibiotic to check for secondary glomerulonephritis

Answer 18

-Bacterial (strep or staph) -Usually involves the face, but can occur anywhere -Summer, fall -Highly contagious -S/S: *Inflammation *Pain, swelling, warmth *Regional lymphadenopathy *Classic honey-crusting lesions - hallmark sign -Management: *Topical antimicrobials for minor infections - Bactroban *Systemic treatment, only if severe - Augmentin *Clindamycin *Abstain from school or community events until 48 hours of treatment *Apply Burrow's (Domeboro) solution to clean lesions *Avoid sharing towels, clothing, kitchen utensils, communal surfaces *Trim fingernails to avoid transmission

Answer 19

-Highly contagious -Parasitic mite that burrows into the skin -incubation 4-6 weeks -Direct or indirect contact with personal items -S/S: *Intense itching *Linear or curved burrows *Infants: red-brown vesiculopapular lesions on head, neck, palms, or soles *** *Older children: skin folds, umbilicus, or abdomen *Regional adenopathy *Interdigital lesions -Labs/Dx: *Skin scrapings show mites, ova, and/or feces -Management: *Permethrin 5% rinse - leave on for 8-14 hours, repeat in one week *Ivermectin (not to be used if mother is pregnant, lactating, or for children <15 kg) *Wash all washable items *Store non-washable items for 1 week *Antihistamine for itching

Answer 20

-Roundworm that lives in colon and rectum -Common in school-aged children and younger -Spread by fecal-oral route -S/S: *Itching in perianal area *Appear nocturnally around the anus and may be seen visually -Labs/Dx: *"Tape test": press clear tape to skin around any, place on a slide and look under at microscope -Management: *Symptomatic - Benadryl for itching *Anthelmintics - pyrantel, mebendazole or albendazole

Answer 21

-Spirochetal disease -Most-common vector-borne disease in the US -Northeast, Upper Midwest, and Pacific Coast -Mice and deer tick -Borrelia burgdorferi (spirochete) -Tick must feed for more than 36 hours to transmit ***

Answer 22

-Stage 1: *Erythema migrant - bull's eye rash *** Hallmark *50% have flu-like symptoms *Joint pain -Stage 2: *Headache *Stiff joints *Cardiac symptoms *Bell's palsy *Peripheral neuropathy -Stage 3: *Subacute encephalopathy (Lyme meningitis) *Acrodermatitis chronic atrophicans: bluish red discoloration of the distal extremity with edema

Answer 23

-Labs/Dx: *ELISA screening *Western blot confirms -Diagnostic criteria: *Exposure to tick habitat within the last 30 days with: -*Erythema migrans, or -*One late manifestation, and -*Lab confirmation -Management: *Under 8 years: Amoxicillin or cefuroxime axetil *Over 8 years: Doxycycline

Answer 24

-Ordinary measles -Virus -Koplik spots ***

Answer 25

-3-day measles -Virus -Erythematous maculopapular rash -Starts on face, spreads to extremities, trunk; gone in 72 hours -Teratogenic

Answer 26

-Fifth disease -5-15 years -Human parvovirus B19 -"Slapped cheek" -Fetal aplastic crisis - hydrops fetalis -Not contagious after fever breaks

Answer 27

-Sixth disease -6 months-2 years -Herpesvirus 6 -High fever, then abruptly stops when rash appears *** Hallmark sign

Answer 28

-Highly contagious -Ulceration and inflammation of the soft palate (herpangina) and papulovesicular exanthema in the hands/feet -Affects children <10 years old -Resolves spontaneously in less than a week -Peeling/loss of nails is common -Spread by contact with unwashed hands or contaminated surfaces, or respiratory droplets -S/S: *Drooling *Papulovesicular rash *Poor oral intake -Management: *Acetaminophen *Topical applications for comfort

Answer 29

-Highly contagious -Infection primarily affecting salivary glands -"Chipmunk appearance" -Resolved within 2 weeks -Can cause complications: oophoritis, mastitis, pancreatitis, encephalitis, meningitis, and deafness -S/S: *Swollen salivary glands (parotitis) causing puffy cheeks -Labs/Dx: *Mumps IgM -Management: *Rest and isolation *NSAIDs *Warm or cold compresses for swollen glands *Sugar-free lemon drops to increase flow of saliva