Dermatology

Question 1

what are kertain filled papules without erythema found on the face of infants?

Answer 1

milia

Question 2

what is sebaceous hyperplasia?

Answer 2

maternal androgens cause hyperplasia of sebaceous cells leading to “pimples” esp. on nose

declines with maternal hormones

Question 3

when does neonatal acne present?

Answer 3

around 2 weeks

resolves with decline in maternal hormones at 3 months

Question 4

what’s the treatment for neonatal acne?

Answer 4

nothing - resolves on its own without scarring

can wash with soap or benzoyl peroxide

Question 5

what is the causative organism for “cradle cap”

Answer 5

Malessezia furfur

greasy, erythematous scale

(older kids an adults get around eyebrows and on face)

Question 6

what’s the RX for cradle cap?

Answer 6

Ketoconazole 2% cream/shampoo 2x/week

– OR topical Hydrocortisone 1% cream (if mostly erythematous)

Question 7

what is this?

Answer 7

Harlequin color change

benign

due to vasomotor instability

(associated with prostaglandins and prematurity)

ddx with port wine stain - this is transient

Question 8

what is the formal name for mottling?

Answer 8

cutis mammorata

triggered by cold expsosure

Question 9

what do you suspect if you see mottling that is not transient with warming?

Answer 9

cutis mammorata telangiectasia congenita - in one extremity

sepsis or shock if capillary refill >3 sec.

Question 10

what is erythema toxicum?

Answer 10

a benign skin condition that appears in 50% of newborns on days 2-5 of life

believed to be eosinophilic

*not grouped or vesicular like HSV

Question 11

how long does it take pustular melanosis to go from pustules to hyperpigmented spots?

Answer 11

hours to a few days

Question 12

how do you distinguish pustular melanocytes from HSV?

Answer 12

p.m. not grouped, non-erythematous base, and not on a presenting part

Question 13

what’s the treatment for irritant contact dermatitis?

Answer 13

avoid irritant contact

keep area dry

for diaper, use barrier creams (zinc oxide)

hydrocortisone 1 or 2.5% (face/severe diaper)

mometasone (trunk or extremities)

Question 14

what are the characteristics of diaper rash?

Answer 14

• satellite lesions
• beefy red
• affects folds/creases

Question 15

how do you treat candidal diaper rash?

Answer 15

topical nystatin

Question 16

what # and distribution of cafe au lait spots supports a diagnosis of neurofibromatosis?

Answer 16

>6 spots >5mm anywhere

Question 17

what is infantile hemangioma?

Answer 17

vascular overgrowth due to dysregulation of endothelial stem cells - grows rapidly during first 6-12 months of life and then starts to involute

Question 18

when do you treat infantile hemangioma?

Answer 18

• when they can interfere with breathing or eating
• when they are very large and can ulcerate and get infected
• if they are midline over the sacrum (need u/s to rule out spinal dysraphism)

Question 20

what is a port wine stain?

Answer 20

blanchable capillary congenital lesions

usually isolated, but can be affiliated with genetic conditions

Question 21

when should you consider Sturge-Weber syndrome in a child with a port wine stain?

Answer 21

If 1st and 2nd segments of the trigemminal nerve are affected (upper and lower eyelid)

Question 22

when do you refer a child for further work up with port wine stain?

Answer 22

evidence of glaucoma

seizures

1st and 2nd segment of trigemminal nerve involvement

Question 23

what is the change that a large or giant congenital melanocytic nevus will transform to melanoma? What about a small one?

Answer 23

3-5%

1%

Question 24

What is the causative organism of bullous impetigo?

Answer 24

S. aureus

Question 25

what is bullous impetigo?

Answer 25

bacterial infection, often around nose and mouth, that begins as red macules and progress to bullae on an erythematous base that eventually rupture with varnish on top as coating.

Question 26

what causes non-bullous impetigo?

Answer 26

Group A beta-hemolytic strep

and S. aureus

Question 27

what does non-bullous impetigo look like?

Answer 27

papules —> vesicles —-> pustules

rupture, leaving honey-colored crust over shallow ulcerated base

can have local lymphadenopathy with strep.

Question 28

Definition of urticaria (hives)?

Answer 28

raised, pale pink pruritic wheals that involve the upper layers of dermis

Question 29

urticaria with fever and arthritis suggests what?

Answer 29

serum sickness = treatment is to withdraw offending agent and treat symptoms (NSAIDs, etc.)

Question 30

what is the treatment for hives?

Answer 30

antihistamines, H2 blockers first line

low dose corticosteroids, low dose cyclosporin 2nd line

Question 31

when are hives considered chronic?

Answer 31

when they last for more than six weeks

Question 32

What is erythema multiforme?

Answer 32

acute, self-limited hypersensitivity reaction

can be due to drugs, viruses, foods, immunizations

Question 33

what are the lesions of erythema multiforme?

Answer 33

symmetrical, evolving, often on dorsum of hands and extensor surfaces of extremities - can spread to trunk

evolution is over days - erythematous maculues, papules, plaques, vesicles, target lesions

Question 34

what are the systemic manifestations of erythema multiforme?

Answer 34

• itching
• fever
• arthralgias
• malaise

Question 35

What is Stevens-Johnsons Syndrome?

Answer 35

Most severe form of erythema multiforme

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