Dermatology Flashcards
1
Q
Hemangioma
A
- Most common tumors of childhood.
- Proliferative phase for a few months followed by an involution phase.
- Important complications:
- Periorbital location can infiltrate deep or the pressure from the hemangioma can affect the shape of the eye. Can also inhibit eyelid opening which will affect vision.
- Beard and neck distribution- Hemangioma may involve airway.
- Treatment:
- Uncomplicated hamangiomas can be monitored closely
- Topical beta blockers can be used (timolol)
- Complicated hemangiomas may need systemic beta blockers (propranolol)
2
Q
acne
A
- What is it?
- Chronic inflammatory process that affects the pilosebaceous unit (hair, sebaceous gland and pore).
- These units are prominent on the face, back and chest, which is where acne is most commonly found.
- Contributing factors
- Comedogenesis- Caused by obstruction of the pore from skin cells. This is either from over keratinization or abnormal adherence.
- Increased sebum production that is stimulated from hormones.
- Inflammation- Pro-inflammatory markers are produced by the keratinocytes.
- Bacteria- Proprionibacterium acnes. Normally harmless. In the case of acne they break down sebum and create more inflammation.
- Genetics
- Environmental factors- Stress, obstructive clothing or equipment, greasy skin preparations, medications (ex. Lithium, anabolic steroids, isoniazid).
- Vocabulary
- Open Comedones- Black heads
- Closed Comedones- White heads
- Papules- Raised areas in the skin that are less than 1 cm
- Pustules- Pus-filled papules that are 5mm or less
- Nodules- pustules greater than 5 mm
- Types of Acne-differentiated by age
- Babies and young children: Should be self-limited and mild. If more severe look for signs of precocious puberty (ex. testicular enlargment, breast budding, hair pattern).
- Neonatal
- Infantile
- Mid-childhood acne
- Preadolescent: 7-12 yo. Maybe one of the first signs of puberty. If severe again look for endocrine issues.
- Adolescent: Pubertal children. Can present in a variety of ways.
- Babies and young children: Should be self-limited and mild. If more severe look for signs of precocious puberty (ex. testicular enlargment, breast budding, hair pattern).
3
Q
atopic dermatitis AKA eczema
A
- What is it?
- Inflammatory condition that is due to abnormalities in the skin barrier.
- Associated with allergies and asthma (the atopic triad).
- Skin unable to keep in moisture which leads to dry, itchy skin. Scratching worsens this and introduces bacteria that can cause superinfections and make eczema worse.
- Often seen on face and flexural surfaces.
- Treatment
- Daily skin care
- Topical anti-inflammatory medications (steroids)
- Anti-itch medications
- Managing infections and infectious triggers
- Steroids
- Can be incredibly useful in treatment of eczema by reducing the inflammation.
- Not all steroid preparations are equal.
- Ointments are preferred to creams because they cause less of a burning sensation and they are more potent.
- Steroids are separated in classes from VII to I, with I being the most potent. Ex. Hydrocortisone 1% and 2.5% are Class VII and triamcinolone acitonide 0.1% cream is Class III. More potent medications may be well tolerated on thick plaques like on the elbows or knees, but would not be well tolerated in sensitive areas like the face.
- Side effects include skin thinning that can be permanent. Also, in babies need to be aware that they have a higher surface area and may absorb enough steroid for it to cause systemic effects.
- Preventing the Itch
- Some children need to be on daily antihistamines to help prevent itching.
- Cetirizine (Zyrtec)
- Loratadine (Claritin)
- Benadryl is effective but is sedating and chronic use of benadryl is controversial. Some studies have shown that it might effect cognitive outcome.
- Some children need to be on daily antihistamines to help prevent itching.
- Managing Infection
- Eczematous lesions can become superinfected with bacteria or viruses (seen in previous lecture).
- Sometimes will need systemic treatment in those cases.
- Bleach baths can decrease the bio-load of bacteria that exists on the
4
Q
contact dermatitis
A
- Dermatitis or inflammation as a result of contact with a substance.
- Most common is reaction to poison oak or poison ivy. Can also occur with clothes, detergents, jewelry.
- Affected area will be red, irritated and intensely itchy. Can have indiscriminate borders or be patterned depending on exposure.
- Treatment:
- Removal of the trigger
- Antihistamine medications
- Topical steroids
- Calamine lotion
- Systemic steroids for severe cases
5
Q
keratosis pilaris
A
- Benign condition that is caused by disorder of keratinization at the hair follicle.
- Generally found on the lateral surfaces of arms, thighs and face.
- Treatment:
- Can improve with age and time
- Gentle skin care (gentle soap, moisturizer)
Topical urea cream can be used for severe cases
6
Q
erythema multiforme
A
- Cause
- most minor form of widespread immune-mediated skin necrolysis as reaction to drug or infection
- examples: HSV (most common), Mycoplasma
- Appearance
- targetoid red lesions with inner pale rings & violet centers
- centers sometimes bullous
- either one mucosal surface affected or no mucosal involvement
- little to no systemic symptoms
- Treatment
- antihistamines may help
- acyclovir for patients with HSV lesions
7
Q
sunburn
A
- Predisposing risk for skin cancer
- children at higher risk than adults
- Prevention
- avoid sun exposure
- clothing
- SPF 15 or greater
- Treatment
- NSAIDs, acetaminophen
- anti-histamines
- cool compresses
- topical aloe or calamine lotion
8
Q
rules for sun safety from the AAP
A
- Babies less than 6 months:
- Use sun protective clothing.
- If clothing not available then use SPF 15 or higher on sun exposed areas
- Older than 6 months:
- Avoid sun during peak hours (10am-4pm)
- Sunscreen everyday SPF 15 or greater that protects against UVA and UVB
- Apply enough sunscreen (1 oz per application for teen)
- Reapply every 2 hours, especially if sweating or swimming.
- Things to know:
- Sunscreens work either through occlusive substances (zinc, titanium) or chemical UV filters.
- Some studies have shown chemical UV filters have been linked to cancer in rats. However, this the small amount used is not considered to be dangerous especially when compared to the risk of skin cancer.
9
Q
pityriasis alba
A
- Areas of hypopigmentation that are often seen on the face.
- Often asymptomatic, but can be pruritic.
- Due to non-specific dermatitis.
- Treatment: protect from sun (sunscreen), can try mild steroids.
10
Q
vitiligo
A
- Acquired disorder with depigmentation from destruction of melanocytes.
- Etiology not well defined (autoimmune, genetic, environmental stress).
- Severity of disease depends on amount of area affected.
- In mild cases, mid—high potency steroids are used. Would get dermatology involved to help follow
11
Q
seborrheic dermatitis aka dandruff
A
- Etiology is not well understood. Appears to involve sebaceous glands, but trigger and pathology is unclear.
- Affected areas: scalp, face, periorbital area, trunk
- Scalp- (most common and most mild)
- Scale and flakes with no underlying erythema (may have some inflammation in mores severe cases).
- Treatment (topical preparations):
- Antifungal (ketoconazole shampoo)
- Steroids
- Selenium
- Lithium sulfate
- Zinc
- Tar
12
Q
trichotillomania
A
- Hair loss resulting from hair pulling.
- Usually associated with stress and psych issues.
- Hair is of varying lengths and affected area is not well demarcated.
Treatment is of underlying stress triggering behavior.
13
Q
traction alopecia
A
- Loss of hair due to repetitive traction on the hair.
- Cause of hair loss is unknown.
- Early on presents with pustules and papules. Later with thinner caliber hair and patchy hair loss.
- Can be reversible if caught early and further trauma is prevented.
14
Q
alopecia areata
A
- Autoimmune associated disease.
- Affects 1:1000
- Generally presents before 30 yo.
- Smooth well circumscribed area of hair loss.
- 50% with patchy hair loss will recover in a year. Many will have recurrence.
- Small percentage will progress to alopecia universalis.
- Treatment: Intralesional or topical steroids
15
Q
SJS and TEN
A
- Mucocutaneous rash that arises as a response to infection (HSV, mycoplasma) or drugs (sulfa, anticonvulsants)
- Spectrum of illness
- Stevens-Johnson Syndrome <10% of body
- Toxic Epidermal Necrolysis >30%
- Appearance
- papules progressing to bullae
-
involvement of multiple mucosal surfaces
- oropharyngeal
- conjunctival
- nasal
- esophageal
- tracheal
- urethral
- vaginal
- rectal
- May include systemic dysfunction
- hepatitis
- nephritis
- Treatment
- hydration
- pain control
- emollients
- prevention of superinfection
- controversial
- Steroids
- IVIG
