Dermatology Flashcards
Cutis marmorata
Transient mottling of the newborns skin with lacey bluish appearance
50% Of these patients have one or more congenital skin conditions
Treatment: Temperature stability
Erythema toxicum neonatoreum
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
Milia
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
Nexus simplex (salmon patch)
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
Port-wine stain
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
Strawberry negus; capillary hemangioma
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
Cafe au lait spots
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
Malignant melanoma
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
Mongolian spots
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
Albinism
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
Vitiligo
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
Pityraisis alba
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
Pityrias rosacea
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
Psoriasis
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
Atopic dermatitis
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
Contact dermatitis
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
Contact irritant dermatitis ( diaper dermatitis)
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
Seborrhea dermatitis
Cradle cap/ dandruff
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
Burns
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
Sunburn
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
Cellulitis
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
Impetigo
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
antibiotics
Streptococcus
Amoxicillin, erythromysin, cefazolin, nafcillin
antibiotics
Haemophilus influenza
Augmentin
Antibiotics
Staph
Cephalexin, dicloxacillin
Antibiotics
MRSA
Clindamycin, Bactrim
Staph scalded skin syndrome
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
Acne vulgaris
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
Folliculitis, furuncles
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
Herpes simplex/common cold sore
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
Molluscum contagiosum
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
Vertical vulgaris
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
Tinea capitus
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
Tinea corporis
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
Tinea Cruris
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
Tinea pedis
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
Spider bite: brown recluse
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
Spider bite: black widow
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
All other spider bites ( not a brown recluse or black widow)
Treatment — Cool compress, oral antihistamines, monitor for hypersensitivity
Scabies
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
Pediculosis infestation
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
Drug eruption
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
Erythema multiforme minor
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
