Dermatology

Question 1

Cutis marmorata

Answer 1

Transient mottling of the newborns skin with lacey bluish appearance

50% Of these patients have one or more congenital skin conditions

Treatment: Temperature stability

Question 2

Erythema toxicum neonatoreum

Answer 2

Transient, benign, self-limited skin rash with lesions of varied morphology erythematous macules, wheels, vesicles, and pustules. Yellow white lesions on pink reddish base; maybe blotchy; rash can cover entire body (trunk) or minimal; sparing of palms &soles

Diagnostic: Wright’s stained smear (90% will be eosinophils NOT neutrophils) possibly culture

Spontaneous resolution in 5-7 days

Question 3

Milia

Answer 3

Benign and common condition of small yellow-white, 1to 2 mm size cysts filled with cheesy keratinous material on face of newborn; oral component of Epstein pearls

Occurs in 50% of newborns

Self-resolving
/ no treatment

Question 4

Nexus simplex (salmon patch)

Answer 4

Benign, flat, light-red to orange vascular birthmark on head and face
More common in girls, seen in 40 to 50% of newborns

Seen on eyelids nape of neck glabella or occiput

No treatment necessary, self resolving

Question 5

Port-wine stain

Answer 5

Benign, permanent, flat, dark red to purple vascular lesion, predominately on head and face

I may be associated with other conditions; lesions covering half the face/ bilateral may be associated with Sturge-Weber syndrome; Lesions on extremities – hypertrophy of soft tissue &bone, lesions on back (crossing midline)- spinal cord/vertebrae defects

Education - address psychological concerns, dermatology consult for laser treatment

Question 6

Strawberry negus; capillary hemangioma

Answer 6

Bright red or blue red nodular tumors varying in sizes & shape with a rubbery and rough surface predominately on head and face
more common in girls & light-skinned premature infants

External hemangioma —> may be internal too!

Treatment – depends on location and complications; oral propanolol or steroids

Question 7

Cafe au lait spots

Answer 7

Like to medium brown pigmented macular lesions of varying sizes and shapes found anywhere on the body; the color of coffee with milk from which the name is delivered
Greater incidence in darker skin population (20%), more common at birth but can occur at any age

No treatment necessary; refer to dermatologist other condition suspected

Question 8

Malignant melanoma

Answer 8

Lethal form of skin cancer involving melanocyte cells; may occur at any skin surface

Asymmetrical lesion with irregular ragged blurred borders; uneven colors of shades of blue black brown red and tan; bleeding and ulceration are late signs

Immediate dermatologist referral; educate on prevention

Question 9

Mongolian spots

Answer 9

Blue black and gray macular lesions of your irregular shape in varying sizes; usually on sacral region buttocks & lumbar areas but may involve extremities upper back and shoulder

Occurs in 90% of dark skin infants and 5% of light skin

No treatment necessary, Self resolving

Question 10

Albinism

Answer 10

Type 1 -affects entire skin hair and retina
Type 2 -Confined to a specific area of the skin
Type 3 -hair
Type 4 -eyes (pupil and retina)

Referred to dermatologist and ophthalmologist; education on protection from sunlight; psychological aspect

Question 11

Vitiligo

Answer 11

Acquired autoimmune condition involving patches of depigmentation on skin surface, mouth and genitalia

Milky white macular patches of depigmentation shape varies; condition is permanent

Referred to dermatology, educate on sun exposure and address psychological concerns

Question 12

Pityraisis alba

Answer 12

Acquired condition of hypopigmented finely scaled white (slightly erythematous)macular lesions of varying sizes and shapes with indistinct borders a occurring predominately on the cheeks
May be associated with overdrying of skin
Occurs primarily in children 3 to 12 years, more apparent in dark skin populations

Educated on use of sunscreen, moisturizer and self-resolvement in 3 to 4 months

Question 13

Pityrias rosacea

Answer 13

Acquired common mild inflammatory condition characterized by scaly, hypo pigmented, and hyper pigmented lesions predominately on the trunk, upper arms, and thighs
Possible puritis, prodrome of malaise and fever
Unknown causes, possibly viral, occurs more often in fall and spring, more common in older children
Herald patch occurs 5 to 10 days before generalized rash
Self-limiting, resolves in 3 to 4 months

Question 14

Psoriasis

Answer 14

Acquired chronic, relapsing inflammatory condition characterized by erythematous plaques with silver gray white scales
Psoriasis vulgaris -5 to 10 cm and plaques with thick silvery-white skills located on elbows and knees
Psoriasis guttatae -3 to 10 cm multiple teardrop round or oval papules That become covered by silvery gray weight scale and trunk and extremities
Bleeding occurs when scales removed, nail plates maybe thicker with pits, ridges, or oil spots
Treatment - Mineral oil, moisturizer, sun exposure edu, topical steroids

Question 15

Atopic dermatitis

Answer 15

Infant – erythema, itchy, scaly patches on cheeks and four head
Older children– more focal itchy patches on popliteal and anticubital creases
Chronic rash involves hyperpigmentation and lichenification

Treatment – topical steroids, moisturizers!, Oral antipyretics , mild soap some perfumes, reduce sweating
*rule out milk eggs nuts and citrus fruit correlation

Question 16

Contact dermatitis

Answer 16

Allergic response to local contact with an allergen manifested by development of skin eruptions at site of contact; Lesions confined area of direct contact with allergen, pruritis with varying degrees of intensity, erythema and edema, papules/vesicles/denudation

Treatment – avoid allergy and cold compress or borrows solution, topical or oral steroids, oral antihistamines, oral antibiotics if secondary infections, refer to dermatologist if condition does not improve in two days

Question 17

Contact irritant dermatitis ( diaper dermatitis)

Answer 17

Common disorder of genital-perineal area due to skin breakdown; characterized by erythema, scale, and vesicles/ crusts/erosions/ulceration
Fiery rash with satellite lesions on abdomen and thighs
Encourage no diaper —expose to air
Treatment:
Mild erythema- zinc oxide and petroleum jelly
Erythema with papules- topical steroids
Severe erythema with varying morphology- burrows compress, wet dressing, topical antibiotics
Monilial rash- topical nystatin, clotrimazole, oral nystatin for thrush

Question 18

Seborrhea dermatitis

Cradle cap/ dandruff

Answer 18

Newborns – areas of underlying erythema with crusts and greasy scaling on scalp and face
;more severe lesions maybe present on trunk, skin folds, and diaper area
Adolescence – white flakes and greasy scaling on scalp forehead eyebrows and face; severity varies from simple dandruff to extensive giving appearance of psoriasis, underlying erythema maybe present
Treatment -nonperfume shampoo, mineral oil, and for extreme cases topical steroids; adolescents may use anti-seborrheic soaps and shampoos

Question 19

Burns

Answer 19

Minor burns — less than 10% of body surface in less than 2% of burn is partial or full thickness
Major burns—10% or more of body surface involved, 2% or more of burn is partial or full thickness OR any burn on hands, feet, face, eyes, ears, perineal
Most common and toddlers and male, third leading cause of death in children, 10% of burns are thought to be intentional
Hospitalization for all major burns

Question 20

Sunburn

Answer 20

Erythema and edema with ill defined borders, tender, warm, regional lymphadenopathy may be present, fever, chills, malaise

treat with cool compress and oral pain meds, Petroleum jelly

Derm referral

Question 21

Cellulitis

Answer 21

Localized acute infection often precipitated by an insect bite or trauma that penetrates the protective skin barrier
Signs and symptoms – irregular shaped skin redness swelling, warmth and tenderness, fever &chills
Regional lymphadenopathy or maybe present, fever chills and malaise indicates the systemic involvement; blood and i&D culture
Severe- may need hospitalization( especially facial and orbital involvement), IM/IV/oral abx - culture and start with suspected specificity

Question 22

Impetigo

Answer 22

Localized bacterial infection of skin often precipitated by insect bites or trauma that breaks protective skin barrier; bullous ( most common in infants) and nonbullous (most common in 2 to 5 year olds)
Most occur in children under 6
Highly communicable with incubation period of 1 to 10 days
Honey colored crust with erosion of epidermis, underlying erythema with vesicles
Treat with topical or oral antibiotics, avoid school for 48 hours

Question 23

antibiotics

Streptococcus

Answer 23

Amoxicillin, erythromysin, cefazolin, nafcillin

Question 24

antibiotics

Haemophilus influenza

Answer 24

Augmentin

Question 25

Antibiotics Staph

Answer 25

Cephalexin, dicloxacillin

Question 26

Antibiotics MRSA

Answer 26

Clindamycin, Bactrim

Question 27

Staph scalded skin syndrome

Answer 27

Toxic mediated the systemic bacterial infection with skin manifestations Most comments in Neonates and infants, incubation of 3 to 10 days Presents with abrupt onset of fever, irritability, Malaise. Bright red painful rash, more pronounced around eyes, mouth, neck, under arms, elbow, and knees Light pressure causes extreme pain, after peeling of skin—>skin appears glistening and scaled Hospitalize neonates and severe cases, less severe can be monitored outpatient with cefazolin or dicloxacillin , antipyretics, fluids

Question 28

Acne vulgaris

Answer 28

Online, inflammatory, chronic skin disorder involving the pilosebaceous follicle unit. Predominately on face neck and chest and upper back, affects 70% of adolescents parallels puberty, more common in females. Mild acne - benzoyl peroxide Moderate - topical Tretinoin and benzoyl Severe- topical tretinoin, oral tretinoin, topical or oral abx (clinda(topical only), doxy, minocycline, tetracycline) UNRESPONSIVE acne - accutane/ isotretinoin

Question 29

Folliculitis, furuncles

Answer 29

Infectious condition involving pilosebaceous follicle occurring on any skin surface where hair follicles are present but predominately on face neck and scalp and buttocks Folliculitis - superficial involvement of upper follicle Furuncle- (boil) deeper involvement of follicle and dermal appendages Most often caused by staph ( less common strep) – Oral antibiotics and antimicrobial soap

Question 30

Herpes simplex/common cold sore

Answer 30

Type 1- most common , type 2- oral sex related Erythema with vesicles and crusting on the lips and oral cavity, regional adenopathy, halitosis, Present 10 to 14 days with incubation of 2 to 12 days May treat with acyclovir at first sign of prodromes, avoid spicy and acid foods, cool bland fluids, aseptic mouth rinse, Treat secondary bacterial infection with oral antibiotics; Educate on prevention and exposure methods

Question 31

Molluscum contagiosum

Answer 31

Common infectious, self limiting condition, characterized by waxy firm papules Predominately on face axilla abdomen and arms Common in children with atopic dermatitis HIV or AIDS, caused by pox virus, most common in children and adolescents, incubation of 2 to 8 weeks can last for six months to 2-3 years — occur in genital area in sexually active and abused No treatment necessary, topical tretinoin cream or cantharidin if near eyes; avoid direct exposure

Question 32

Vertical vulgaris

Answer 32

WARTS Caused by human papilloma virus, Incubation of two months to two years, Most common in the school age child, spreads by direct and indirect contact through auto inoculation and entering through minor skin trauma Flat verruca most common on face and extremities, common verruca most common on hands and fingers, plantar verruca of the foot Treatment- waterproof tape with keratolytics Widespread may be related to congenital or acquired immunodeficiency

Question 33

Tinea capitus

Answer 33

Ringworm of scalp - predominately caused by trichophyton tonsurans, Scaly patches of varying sizes with or without alopecia and Fridays, passwords, papules of areas of honeycomb crisis, tender erythematous areas with broken hairs at scalp level leaving a black dot appearance Diagnostics - KÖH scraping of Treat with griseofulvin x8 weeks (ultramicrosize formulation) , shampoo 2-3x per week with selenium sulfide

Question 34

Tinea corporis

Answer 34

Ringworm of the body Cleashen spread preferably as they heal centrally, lesions are scaly plaques of varying sizes with mild erythematous boarders Treat with topical anti-fungal such as clotrimazole x8 weeks, Re-current or non-responsive to treatment may require oral antifungal

Question 35

Tinea Cruris

Answer 35

Jock itch; fungal skin infection of the groin,upper thighs, and inguinal folds. Common in adolescence, athletes, obese children, and males. Small vesicles, central clearing, peripheral spreading may or may not be present. Erythematous, scaly red to brown lesions of varying sizes, Painful to touch often occurs with tinea pedis Diagnostics - KOH scraping , DTM to confirm Treatment - Topical antifungal’s for 4 to 6 weeks or oral antifungal for extensive disease

Question 36

Tinea pedis

Answer 36

Athletes foot; erythematous, scaly, occasionally blistered areas of the foot; cracks and scaling between toes, stinging or pain if cracks. Diagnosis- DTM Treated with topical antifungal for 8 to 12 weeks and antifungal powder

Question 37

Spider bite: brown recluse

Answer 37

Brown recluse spider – mature spider is gray, or varying shades of red or pale brown with a violin-shaped marking, most common in the Midwest and south Potential for Renal, respiratory, cardiovascular, neurological involvement ( same with black widow!!) Initial bite is unnoticed or with little pain, within 2 to 7 hours mild localize, tingling redness or blanching, within 48 to 72 hours blistering surrounded by blue-gray area, flulike symptoms Hospitalize

Question 38

Spider bite: black widow

Answer 38

Black widow spider- Mature female is shining, black, gray, or brown with an orange hourglass marking on the ventral surface Most common in Ohio, south, Southwest, and west coast Hypertension tachycardia and diaphoresis Initial sensation of pinch or sting often unnoticed, Within one hour though burning or pain at site, to read puncture marks surrounded by white area with bluish red border, muscle cramps and sweating, muscle spasms, can progress to shock, coma, and death Hospitalize

Question 39

All other spider bites ( not a brown recluse or black widow)

Answer 39

Treatment — Cool compress, oral antihistamines, monitor for hypersensitivity

Question 40

Scabies

Answer 40

Infants: Red brown papular, vesicular lesions on head neck palms and soles Older children: Red papular lesions on Web’s fingers and folds of wrists, elbows, axillae, waist, buttocks, knees, and ankles Burrows are fine gray to skin colored &superficial papular linear curved Treatment: permethrin 5%, topical steroids, oral antihistamines; environmental treatment

Question 41

Pediculosis infestation

Answer 41

Lice ; Common in caucasians, school-age children and adolescents as a result of sharing personal items Live louse and eggs (nits), most common on back of head and behind ears Treatment: topical antiparasytics - permethrin, pyrethrins, treat x2 , environmental care

Question 42

Drug eruption

Answer 42

Acute condition of the skin involving in allergic hypersensitivity reaction to a drug characterize predominately by morbilliform generalized rash Generalized and local pruritis, rash occurring on First trunk and progressing to extremities varying from macular to maculopapular —> papular and confluent Treatment: stop drug, oral steroid, oral antihistamines

Question 43

Erythema multiforme minor

Answer 43

Acute condition of the skin involving hypersensitivity reaction characterized by multi morphology skin and mucous membranes a ruction; last approximately 2 to 3 weeks with spontaneous resolution