Dermatology Flashcards
What is the natural history of hemangiomas?
•Proliferative: first few weeks until 3-12 months
–Rapid growth “out of proportion” to child’s growth
–Rapid growth usually subsides by about 3-5 months
•Plateau: ~12-18 months
•Regression: ~18 months until 9-10 years of age
•Residua: lasting skin changes in 50%
List 2 locations of hemangiomas that are concerning and may require treatment
- Periorbital may impair vision
2. Large “beard-area” distribution-+/- airway IH
If you have a large segmental hemangioma of the face, what other investigations should you do?
Think PHACES
MRI brain
Eye exam
Echocardiogram
If a child has more than 5 hemangiomas, what test should they get?
Abdominal US for liver hemangiomas
List 5 indications for treatment of hemangiomas
Vision or airway threatening
Cosmetic
Treat with propanolol except in PHACES, asthma, diabetes
If you have a capillary malformation (aka port wine stain) in V1 distribution, what tests should you do?
Think Sturge Weber
Opthalmology Q6 months
MRI brain if seizure or developmental delay
When do worry about acquired nevus (>2 years of age)?
Asymmetric Border (irregular) Colour change Diameter (>6 mm) Evolution/change
How many ash leaf spots do you need to consider TS work up?
> 3, each at least 5mm
Treatment for Staph scalded skin
IV clox+/- clinda
Pain control
Treatment of scabies
5% permethrin cream (>2 months of age)
- Apply to whole body (esp skin folds, finger/toe nails, behind ears, groin), face/scalp
- Wash after 8-12h (<6yr 8-9 hrs, >6yr 12-14 hrs)
- One Dose usually curative, can repeat after 1 week if live mites still seen
Launder clothes/linen from last 3 days
Treatment of pityriasis rosea (christmas tree rash)
Nothing unless itchy (topical steroids)
Usually resolves within 12 weeks
Difference between SJS and TEN
SJS <10% BSA
TEN >30% BSA
List 3 medications that cause SJS
Carbamezipine Phenytoin Phenobarb Sulpha drugs Penicillins
Treatment of SJS/TENS
- Admit
- If severe (TEN)-ICU/burn unit
- IVIg
- Stop offending drug
List 3 complications of atopic dermatitis
- Sleep deprivation
- Scarring or lichenification
- Bullying, depression
- Pigmentary changes
- Infections
What would you consider as second line treatment of eczema?
Calcineurin inhibitors (Elidel, Protopic) if >2 years
4 stages of incontinentia pigmenti
Stage 1: erythema, vesicles, pustules
Stage 2: verrucous, hyperkeratosis
Stage 3: HYPERpigmentation
Stage 4: HYPOpigmentation, atrophy
If baby <2 months presents with atopic dermatitis like rash, what is the differential?
Atopic dermatitis does not usually present <2 months
Ddx: • Seborrheic Dermatitis • Irritant Contact Dermatitis • Rare – LCH – Malabsorption – Netherton’s – Omenn syndrome
List 5 steps in management of necrotizing fasciitis (past SAQ)
- Surgical exploration and debridement asap
- IV antibiotics – clindamycin + cloxacillin
- Meticulous daily wound care
- Send tissue for gram stain and culture from OR
- Consider IVIg for severe GAS infections
List 3 other causes on differential diagosis for tinea pedis (past SAQ)
- Palmoplantar psoriasis
- Chronic contact dermatitis
- Interdigital candidal infection
Treatment of miliaria rubra (past SAQ)
- Avoidance of irritation of the skin with synthetic fabrics, excessive soaps and detergents
- Cool water compresses
