Dermatology Flashcards by Courtney Birkett

What is congenital melanocytic nevi (CMN)?

Proliferations of benign melanocytes

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Clinical presentation of congenital melanocytic nevi

Macules, papules or plaques at birth
Hair may or may not be present
Appearance may change with time
Lesions grow in proportion to individuals size

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When does congenital melanocytic nevi have a risk of malignancy?

Larger and giant lesions are at a much higher risk than small and medium sized

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What is the most common pigmented lesion in infants?

Mongolian Spot (congenital dermal melanocytosis)

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Clinical presentation of Mongolian Spot

Patch of bluish-grey pigmentation with irregular border and normal skin texture
Most commonly on butt and low back
Increased incidence in darker skin types
Usually present at birth/first weeks of life

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What is the difference between CMN and Mongolian Spots?

CMN grows with the patient while Mongolian Spots fade by age 2 and often disappear by 10

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What is nevus sebaceous?

Hyperplasia of the epidermis, sebaceous glands, hair follicles of apocrine glands

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Clinical presentation of nevus sebaceous

Primarily on scalp or face
Waxy, solitary, smooth, yellow-orange hairless patch that is often oval or linear in shape
Usually becomes more pronounced in adolescence (bumpy, warty, scaly)

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What might occur with a nevus sebaceous?

BCC or other malignancy may arise from the lesion (damaged tissue)

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What is aplasia cutis congenita?

Absence of skin present at birth that can be localized or widespread

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Clinical presentation of aplasia cutis congenita

Most commonly on midline posterior scalp
May have fluid-filled bulla
Can be isolated or have other developmental anomalies
Lesions well demarcated

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What is signified by a tuft of hair in aplasia cutis congenita?

Hair surrounding the defect may indicate a neural tube defect

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Clinical presentation of Cafe-au-lait macules (CALM lesions)

Discrete uniformly pigmented macules or patches
Present at birth or appear in early childhood
Most common in African American but seen in others

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What conditions are associated with cafe-au-lait macules?

McCune-Albright syndrome or neurofibromatosis type 1

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Signs and symptoms of NF1

Cafe-au-lait macules, axillary or inguinal freckling, neurofibromas, lisch nodules, optic gliomas, skeletal abnormalities
Need yearly ophthalmology exams
Autosomal dominant disease

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2 types of vascular anomalies

Vascular tumors (neoplasms proliferate and typically require tx to stop growth)
Vascular malformations (abnormal blood vessels without rapid proliferation)

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Types of vascular tumors

Infantile hemangioma, congenital hemangioma, pyogenic granuloma

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Types of vascular malformations

Capillary malformations like Port wine stain and nevus simplex

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What is a port-wine stain?

Cutaneous capillary malformation

Clinical presentation of port-wine stain

Presents at birth and does not regress

Pink or dark red patches (may darken or thicken)

What might be associated with Port-Wine Stain?

Soft tissue or bony overgrowth

Sturge Weber syndrome in V1 distribution (concern for congential glaucoma if affects eyelid)

What is a pulse dye laser?

Used for PWS and causes intravascular coagulation in abnormal vasculature without damaging surrounding structures (use in isolated areas)

Risk factors for infantile hemangioma

Low birth weight, female gender, twin gestation and fair skin

Clinical presentation of infantile hemangiomas

Majority not present at birth but appear shortly after
Superficial: bright red and minimally elevated
Deep: larger with a bluish color
Ulceration is common complication

Phases of infantile hemangiomas

Proliferative: Early is rapid growth during first 3 months and max growth at 5-7 weeks of age Late is less rapid but still ongoing and completed typically by 9 months Involution: Color darkens and tumors softens, ultimate residual skin changes vary

Other names for nevus simplex

Salmon patch, stork bite at nape of neck, angel kiss on eyelid

Clinical presentation of nevus simplex

``` Faint, transient capillary malformation Flat, pink/red patch Typically midline of forehead, scalp, upper eyelids, posterior neck and back Smooth appearance like surrounding skin Typically fade within 1-2 years ```

Presentation of pyogenic granuloma

``` Acquired lobular vascular tumor Occurs at any age Affects skin particularly prone to trauma (hands, fingers, face) and mucous membranes Develop rapidly (days to months) Friable ```

Why is the risk of recurrence high after treatment of pyogenic granulomas?

Treatment is traumatic and these happen in areas of trauma

Preferred tx of pyogenic granuloma

Surgical excision with primary closure

Why do you need a biopsy to confirm dx of pyogenic granuloma?

Because they may mimic malignant lesions

What is important with mandibular hemangiomas with stridor or hoarseness?

Need emergent ENT referral to evaluate for airway compromise

Most common cause of diaper dermatitis (rash)

Irritant/contact dermatitis (some are seborrheic dermatitis, atopic dermatitis, or other skin conditions)

Pathogenesis of diaper dermatitis

Excessive moisture, friction, increased pH causing localized skin break-down (macerated skin increasingly susceptibility for infection)

What do you suspect with persistent symptoms of diaper dermatitis?

Secondary infection with C. albicans or other microorganisms

Candidal superinfection

Beefy red plaques (involves skin folds) Dx is clinical or KOH prep/fungal culture *classic dermatitis does not involve skin folds

Impetigo

Secondary infection of S aureus or S pyogenes | Hallmark: fragile pustules and honey crusted erosions

Therapeutic options for diaper dermatitis

Barrier preps (OTC pastes and ointments) Low-potency topical corticosteroids Breast as just as effective as steroids (anti-inflammatory and antimicrobial) Topical antifungals or topical/oral antibiotics for super infections *Avoid powders

What is responsible for head lice in kids?

Pediculus humanus capitis (head louse)

When is there itching with kids that have lice?

When they are allergic to the saliva | Might see cervical LAD

How do you diagnose lice?

Visualize live lice (wet combing) | Nits may persist for months and might not be an active infection

Treatment of lice

``` Topical pediculicides (pyrethroids, malathion, benzyl alcohol, spinosad), skin irritation is side effect, don't use in kids under 2 Wet combing is mechanical removal of lice (15-60 every 3-4 days for several weeks) ```

Why is neonatal acne (neonatal cephalic pustulosis) not true acne?

It is an inflammatory rxn that might be due to Malassezia colonization Self-limiting and resolves by 6-12 mos (presents first 2-3 wks of life)

Clinical presentation of neonatal acne

Inflammatory papules and pustules on forehead, cheeks and nose No true comedones

What do you use when neonatal acne persists?

Ketoconazole or hydrocortisone

Presentation of infantile acne

Presents at 3-4 mos of age and commonly resolves by 2-3 yrs of age (true acne) Hyperplasia of sebaceous glands (androgenic stimulation) Inflammatory pustules, comedones, pustules

Tx for infantile acne

Tx to prevent scarring Benzoyl peroxide, topical abx, topical retinoids Oral only in severe cases