Dermatology Flashcards
What is this?
From Kraft, J. & Freiman, A. (2011). Management of Acne. CMAJ, 183 (7).
A blackhead is a closed comedone. For mild comedonal acne the first line therapy is topical retinoid with alternative topical retinoid and salicylic acid washes as the second line therapy.
What is this?
Tinea Capitis
What is this?
From Miller, M.L. & Cassidy, J.T. (2004). Chapter 144: Treatment of rheumatic diseases. Nelson Textbook of Pediatrics, 17th Edition, pp. 797.
Pseudoporphyria
Naproxen can cause a unique skin reaction characterized by small hypopigmented flat scars occurring in areas of even minor skin trauma and is more likely to occur in sun exposed areas.
What is this?
From Martin, K.L. (2016). Chapter 560: Vascular disorders. Nelson Textbook of Pediatrics, pp. 3122-3128.
Infantile hemangiomas are proliferative, benign vascular tumors of vascular endothelium that may be present at birth or, more commonly, may become apparent in the 1st 2 weeks of life, predictably enlarge, and then spontaneously involute. Approximately 60% of lesions reach maximal involution by 5yo and 90-95% by 9yo.
What is this?
From Darmstadt, G.L. & Sidbury, R. (2004). Chapter 655: Cutaneous bacterial infections. Nelson Textbook of Pediatrics, 17th Edition, p. 2225-2226.
Staphylococcal scalded skin syndrome
Scarlatininform erythema develops diffusely with accentuation in flexural and periorficial areas. Inflammed conjunctiva and occasionally purulent. Sterile flaccid blisters and erosions develop quickly. Areas of epidermis may separate in response to gentle shear force (Nikolsky’s sign). Patients may have pharyngitis, sonjunctivitis, and superficial erosions of the lips but intraoral mucosal surfaces are spared.
What is this?
From Kohl, S. (2004). Chapter 231: Herpes simplex virus. Nelson Textbook of Pediatrics, 17th Edition, p. 1052-1053.
Eczema herpeticum or Kaposi varicelliform eruption
The most serious manifestation of “traumatic herpes” results from a widespread infection of the eczematous skin with HSV. Vesicles develop abruptly in large numbers over the area of eczematous skin. They continue to appear for 7-9d. Wide denudation of the epidermis may occur and develop scabs which may eventually epithelialize. Patient can have high fever, loss of fluid, electrolytes, and protein through the skin, from dissemination of the virus or secondary bacterial infection.
What is this?
From Darmstadt, G.L. & Sidbury, R. (2004). Chapter 644: Vesiculobullous disorders. Nelson Textbook of Pediatrics, 17th Edition, pp. 2183.
Toxic epidermal necrolysis (Lyell syndrome)
The prodrome consists of fever, malaise, localized skin tenderness and diffuse erythema. Inflammation of the eyelids, conjunctivae, mouth, and genitals may precede skin lesions. Flaccid bullae may develop. Characteristically, full thickness epidermis is lost in large sheets. Nikolsky’s sign is present but only in areas of erythema. This condition can be triggered by amoxicillin.
What is this?
From Darmstadt, G.L. & Sidbury, R. (2004). Chapter 644: Vesiculobullous disorders. Nelson Textbook of Pediatrics, 17th Edition, pp. 2183.
Stevens-Johnson Syndrome
Clinical manifestations include:
- Lesions maybe preceded by a flu-like URTI
- Erythematous macules that rapidly develop central necrosis and form vesicles, bullae, and areas of denudation
- Involvement of mucosal surfaces with burning, edema, erythema, and bullae, ulceration and hemorrhagic crusting
- Corneal ulceration, anterior uveitis, panopthalmitis
- Bronchitis, pneumonitis
- Myocarditis
- Hepatitis
- Enterocolitis
- Polyarthritis
- Hematuria, ATN, renal failure
What is this?
From Todd, J.K. (2004). Chapter 166 Staphylococcus. Nelson Textbook of Pediatrics, 17th Edition, p. 865-866. Diagnostic Criteria of Staphylococcal Toxic Shock Syndrome
Major Criteria (all required):
- Acute fever (temp >38.8)
- Hypotension (orthostatic or shock)
- Rash (erythroderma with late desquamation)
Minor Criteria (any three):
- Mucous membrane inflammation
- Vomiting, diarrhea
- Liver abnormalities
- Renal abnormalities
- Muscle abnormalities
- CNS abnormalities
- Thrombocytopenia
Exclusionary criteria:
- Absence of an alternative explanation
- Negative BCx except for S. aureus
What is this and what condition is this associated with?
Lisch nodule
From Sahin, M. (2016). Chapter 596: Neurocutaneous syndromes. Nelson Textbook of Pediatrics, 20th Edition, pp. 2874-2882.
Neurofibromatosis Type 1 is diagnosed when any 2 of the following 7 features are present:
- Six or more café-au-lait macules >5mm in greatest diameter in prepubertal individuals and >15mm in greatest diameter in postpubertal individuals
- Axillary or inguinal freckling consisting of multiple hyperpigmented areas 2-3mm in diameter
- Two or more iris Lisch nodules
- Two or more neurofibromas or 1 plexiform neurofibroma
- A distinctive osseus lesion such as sphenoid dysplasia or cortical thinning or the long bones with or without pseudoarthrosis
- Optic gliomas
- A 1st degree relative w/ NF-1 whose diagnosis was based on the aforementioned criteria
What is this and what condition is this associated with?
Neurofibromas
From Sahin, M. (2016). Chapter 596: Neurocutaneous syndromes. Nelson Textbook of Pediatrics, 20th Edition, pp. 2874-2882.
Neurofibromatosis Type 1 is diagnosed when any 2 of the following 7 features are present:
- Six or more café-au-lait macules >5mm in greatest diameter in prepubertal individuals and >15mm in greatest diameter in postpubertal individuals
- Axillary or inguinal freckling consisting of multiple hyperpigmented areas 2-3mm in diameter
- Two or more iris Lisch nodules
- Two or more neurofibromas or 1 plexiform neurofibroma
- A distinctive osseus lesion such as sphenoid dysplasia or cortical thinning or the long bones with or without pseudoarthrosis
- Optic gliomas
- A 1st degree relative w/ NF-1 whose diagnosis was based on the aforementioned criteria
What is this and what condition is this associated with?
Cafe au lait spots
From Sahin, M. (2016). Chapter 596: Neurocutaneous syndromes. Nelson Textbook of Pediatrics, 20th Edition, pp. 2874-2882.
Neurofibromatosis Type 1 is diagnosed when any 2 of the following 7 features are present:
- Six or more café-au-lait macules >5mm in greatest diameter in prepubertal individuals and >15mm in greatest diameter in postpubertal individuals
- Axillary or inguinal freckling consisting of multiple hyperpigmented areas 2-3mm in diameter
- Two or more iris Lisch nodules
- Two or more neurofibromas or 1 plexiform neurofibroma
- A distinctive osseus lesion such as sphenoid dysplasia or cortical thinning or the long bones with or without pseudoarthrosis
- Optic gliomas
- A 1st degree relative w/ NF-1 whose diagnosis was based on the aforementioned criteria
What is this?
From (2004). Chapter 647: Diseases of the Epidermis. Nelson Textbook of Pediatrics, 17th Edition, pp. 2197.
Pityriasis Rosea
Clinical manifestations:
- Herald patch: solitary round or oval lesion, 1-10cm in diameter, annular with raised border w/ fine adherent scale
- 5-10d post herald patch develop widespread symmetric eruption of oval or round slightly raised pink-brown icm in diameter lesions with fine scale over the torso and lower extremeties
- Duration of the eruption varies from 2-12 weeks
Treatment
- Therapy is unnecessary
- Can give emollient for scaling
- Can give menthol or camphor topically or corticosteroid topically for itch
Contagious
- No
What is this?
From Martin, K.L. (2016). Chapter 662: Disorders of Hair. Nelson Textbook of Pediatrics, pp 3192-3197.
Alopecia areata is an autoimmune disorder characterized by rapid and complete loss of hair in round or oval patches on the scalp and on other body sites. An increased incidence of alopecia areata occurs in Down Syndrome (5-10%).
“The course is unpredictable, but spontaneous resolution in 6-12mo is usual. Recurrences are common. Onset at a young age, extensive or prolonged hair loss, and numerous episodes are usually poor prognostic signs.”
What is this?
PHACE syndrome
- Posterior fossa malformations
- Hemangiomas facial >5cm
- Arterial anomalies
- Coarctations of the aorta and other cardiac defects
- Eye abnormalities (coloboma, etc.)
- Sternal cleft
What is this?
From (2004). Chapter 656: Cutaneous Fungal infections. Nelson Textbook of Pediatrics, 17th Edition, pp. 2233.
Tinea pedis
- Infection of the toe webs and soles of the feet common in pre-adolescent and adolescent males
- Etiology: T rubrum, T mentagrophytes, and E. floccusum
- Lateral toe webs and the subdigital cervice are fissured with maceration and peeling of the surrounding skin
- DDx:
- Candida albicans
- Contact dermatitis
- Dyshidrotic eczema
- Atopic dermatitis
- Juvenile plantar dermatitis
- Simple maceration and peeling of the interdigital spaces
What is this?
From Banerji, A. (2015). CPS Position Statement: Scabies. Pediatric and Child Health, 20 (7): 395-398.
Scabies
- Pruritic rash worse at night
- Burrows, erythematous papules, generalized pruritus
- Typically between the fingers, in the flexure of the wrist, elbows or armpits, or on the genitals or breasts
- 5% premetherin cream applied topically
What is this?
From O’Connor, N.R. & McLaughlin, M.R. (2008). Newborn skin: part 1 common rashes. American Family Physician, 77 (1): 47-52.
Erythema Toxicum Neonatorum
- Most common pustular eruption in newborns 40-70%
- Presents at 2nd to 3rd day of life
- Erythematous 2-3mm macules and papules that evolve into pustules
- Each pustule in surrounded by a blotchy area of erythema, “flea bitten”
- Occur on face, trunk, and proximal extremities
- Palms and soles not involved
What is this?
Transient Neonatal Pustular Melanosis
- Vesiculopustular rash in 5% black newborns and 1% white newborns
- No surrounding erythema
- Lesions rupture easily leaving a collarette of scale and a pigmented macule that fades over 3-4wks
- All areas incld. Palms and soles can be effected
What is this?
Acne Neonatorum
- Occurs in up to 20% of newborns
- Closed comedones on the forehead, nose and cheeks
- Open comedones, inflammatory papules and pustules can develop
- Secondary to stimulation of sebaceous glands by maternal and infant androgens
- Usually resolve spontaneously within 4m without scarring
What is this?
Milia
- 1-2mm pearly white or yellow papules caused by retention of keratin within the dermis
- 50% of newborns
- Occur most often on the forehead, cheeks, nose and chin but may also occur on the upper trunk, limbs, penis, or mucous membranes
- Disappear spontaneously by 1-3mo
What is this?
Miliaria crystalline
- Results from sweat retention caused by partial closure of eccrine structures
- 40% of newborns
- Usually appears in the 1st month of life
- Miliaria crystalline: superficial eccrine duct closure, 1-2mm vesicles without surrounding erythema usu. head, neck and trunk. Each vesicle evolves w/ rupture followed by desquamation and may persist for hours to days
What is this?
Miliaria rubra
- Results from sweat retention caused by partial closure of eccrine structures
- 40% of newborns
- Usually appears in the 1st month of life
- Miliaria rubra aka heat rash caused by deeper level of sweat gland obstruction with small erythematous papules and vesicles usu. occurring on covered portions of skin
What is this and what conditions is it associated with?
Erythema Marginatum
- Rheumatic fever
What is this and what condition is it associated with?
Erythema migrans
- Lyme disease
What is this and what condition is it associated with?
Erythema multiforme
- hypersensitivity reaction to drugs, infections (i.e. mycoplasma), etc.
