Dermatology

Question 1

What is the natural history of hemangiomas?

Answer 1

•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%

Question 2

List 2 locations of hemangiomas that are concerning and may require treatment

Answer 2

1. Periorbital may impair vision

2. Large “beard-area” distribution-+/- airway IH

Question 3

If you have a large segmental hemangioma of the face, what other investigations should you do?

Answer 3

Think PHACES

MRI brain
Eye exam
Echocardiogram

Question 4

If a child has more than 5 hemangiomas, what test should they get?

Answer 4

Abdominal US for liver hemangiomas

Question 5

List 5 indications for treatment of hemangiomas

Answer 5

Vision or airway threatening
Cosmetic

Treat with propanolol except in PHACES, asthma, diabetes

Question 6

If you have a capillary malformation (aka port wine stain) in V1 distribution, what tests should you do?

Answer 6

Think Sturge Weber

Opthalmology Q6 months
MRI brain if seizure or developmental delay

Question 7

When do worry about acquired nevus (>2 years of age)?

Answer 7

Asymmetric
Border (irregular)
Colour change
Diameter (>6 mm)
Evolution/change

Question 8

How many ash leaf spots do you need to consider TS work up?

Answer 8

> 3, each at least 5mm

Question 9

Treatment for Staph scalded skin

Answer 9

IV clox+/- clinda

Pain control

Question 10

Treatment of scabies

Answer 10

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

Question 11

Treatment of pityriasis rosea (christmas tree rash)

Answer 11

Nothing unless itchy (topical steroids)

Usually resolves within 12 weeks

Question 12

Difference between SJS and TEN

Answer 12

SJS <10% BSA

TEN >30% BSA

Question 13

List 3 medications that cause SJS

Answer 13

Carbamezipine
Phenytoin
Phenobarb
Sulpha drugs
Penicillins

Question 14

Treatment of SJS/TENS

Answer 14

1. Admit
2. If severe (TEN)-ICU/burn unit
3. IVIg
4. Stop offending drug

Question 15

List 3 complications of atopic dermatitis

Answer 15

• Sleep deprivation
• Scarring or lichenification
• Bullying, depression
• Pigmentary changes
• Infections

Question 16

What would you consider as second line treatment of eczema?

Answer 16

Calcineurin inhibitors (Elidel, Protopic) if >2 years

Question 17

4 stages of incontinentia pigmenti

Answer 17

Stage 1: erythema, vesicles, pustules

Stage 2: verrucous, hyperkeratosis

Stage 3: HYPERpigmentation

Stage 4: HYPOpigmentation, atrophy

Question 18

If baby <2 months presents with atopic dermatitis like rash, what is the differential?

Answer 18

Atopic dermatitis does not usually present <2 months

Ddx:
•	Seborrheic Dermatitis
•	Irritant Contact Dermatitis
•	Rare
–	LCH
–	Malabsorption
–	Netherton’s
–	Omenn syndrome

Question 19

List 5 steps in management of necrotizing fasciitis (past SAQ)

Answer 19

1. Surgical exploration and debridement asap
2. IV antibiotics – clindamycin + cloxacillin
3. Meticulous daily wound care
4. Send tissue for gram stain and culture from OR
5. Consider IVIg for severe GAS infections

Question 20

List 3 other causes on differential diagosis for tinea pedis (past SAQ)

Answer 20

1. Palmoplantar psoriasis
2. Chronic contact dermatitis
3. Interdigital candidal infection

Question 21

Treatment of miliaria rubra (past SAQ)

Answer 21

• Avoidance of irritation of the skin with synthetic fabrics, excessive soaps and detergents
• Cool water compresses