Dermatology Flashcards
Erythema toxicum neonatorum
Transient, benign, polymorphous skin rash of infancy.
Erythematous macules followed by wheals, vesicles, and sometimes pustules.
Palms and soles spared
Incidence, risk factors and typical age for erythema toxicum neonatorum
Occurs in 50-60% of newborns
More common in full-term/post-term infants and those with >2500g birth weight
Usually appears 24-48 hours after birth and resolves in 5-7 days
Acne neonatorum: definition and management
A new vulgaris appearing in the first 2-6 weeks of life, presumably 2/2 maternal and neonatal androgens
Self-limiting, occurs in 20% of infants
“6-week rash”
Port wine stain
Possible complications and associated conditions
Lesions covering entire half of face or bilateral face may be associated with Sturge Weber syndrome (neuro-ocular manifestations)
Hypertrophy Of soft tissue and bone with extremity lesions
Lesions on back, particularly crossing midline, associated with spinal/vertebral malformations
Port wine stain management
Refer to dermatologist early. Pulsed dye laser treatment recommended early in infancy, definitely before 1 year
Growth pattern for capillary hemangioma
Rapid growth beginning at birth and peaking around 6 months.
Involution begins between 9-12 months
10% resolution per year (10% at 1 year, 50% at 5 years, etc)
Complications of hemangiomas
Depth rather than size determines risk
Very deep may cause cardiovascular compromise
Thrombocytopenia may occur from platelet sequestration
Visual disturbance with orbital/eyelid/periorbital
Occult hepatic hemangiomas possible
Head/face lessons carry risk if subglottic lesion with airway compromise (hoarseness and stridor rapidly worsening in first weeks of life)
Ulceration as involution occurs
Lesions concerning for neurofibromatosis or Albright syndrome
Cafe au lait spots that are > 1.5cm or 6 or more in number
Risk factors for malignant melanoma development
Sunburn and excessive exposure prior to 10yoa
Family history
Albinism management
Sun protection counseling
Derm referral for skin changes
Ophtho referral for vision assessment
Vitiligo
Definition
Acquired autoimmune destruction of melanocytes resulting in hypopigmented areas on skin, oral mucosa and genitalia
Segmental- unilateral, 2 dermatomes
Generalized- >2 dermatomes, often bilateral
Vitiligo management
Sun protection
Topical steroids
Topical tacrolimus (inhibits T-cels)
Derm referral for other therapies
Psoriasis definition
Acquired inflammatory disorder with chronic relapsing-remitting pattern of erythematous plaques With silver-grey-white scales
Psoriasis guttate
Small patches primarily on trunk, upper arms and thighs
Often follows strep infection
Psoriasis vulgaris
Large plaques primarily on elbows and knees
Often associated with constant rubbing and trauma, “Koebner’s response”
Psoriasis management
Controlled and limited sunlight exposure
Topical corticosteroids
At least BID moisturizer or mineral oil
Atopic derm
Etiology/incidence
Disorder of skin barrier function, chronic forms often associated with filaggrin mutation and deficiency. Some associated with high IgE levels and altered immune function
10-15% incidence
Up to 50% develop other atopic disease
Up to 25% have symptoms that persist into adulthood
Dermatitis management
Topical steroids, oral antihistamine for pruritis, topical antibiotic for secondary infection
Diaper/atopic: emollients
Seborrheic: antiseborrheic shampoos, mineral oil, topical steroids, or topical salicylic acid. Some infants benefit from topical ketoconozole (melasezzia species may play too in etiology)
Burn classification
Superficial: epidermis only; erythema, edema, and dry tenderness
Partial-thickness: involve epidermis and part of dermis; includes moist areas and blisters
Full-thickness: Epidermis, dermis, and dermal appendage involvement; white, brown, black, swollen, dry areas with loss of sensation
Define minor burn
Less than 10% BSA for superficial burns
Less than 2% BSA for partial- or full-thickness
Define major burn
More than 10% BSA for superficial burns
More than 2% BSA for partial- or full-thickness burns
Any burns of hands, feet, face, eyes, ears, and perineum, regardless of BSA involved
Burn diagnostics
Electrolyte studies, especially if burn is extensive
Culture of secondary infections
Burn management - when to admit
Inpatient admission for all major burns, suspected abuse, esophageal or airway burns, or concomitant injuries (i.e. fractures)
Outpatient burn management
Cool compresses
Pain control - acetaminophen or ibuprofen
Prophylactic antibiotics on open blistered areas (mupirocin or silver sulfadiazine [don’t use on face])
Push fluids for hydration
Topical emollients to repair and maintain barrier
Recommended SPF for children
greater than 30, apply 20 minutes before exposure
Cellulitis - common pathogens
Strep
H. influenzae
S. aureus
MRSA
Cellulitis management
Burrow’s solution compresses
Topical antibiotics - mupirocin
Oral abx: Staph- cephalexin or dicloxacillin
Strep - amoxicillin, cehazolin, nafcillin
H. flu - augmentin
MRSA- Bactrim or clindamycin
impetigo - pathogens
Staphylococcus aureus (most common) Streptococci
Impetigo management
Topical mupirocin for most cases
Oral abx for extensive disease, entire family affected, athletes, daycare: cephalexin or dicloxacillin
Use amoxicillin if strep suspected
Use bactrim or clinda if MRSA suspected
Staphylococcal Scalded Skin syndrome
Definition
Toxin-mediated systemic bacterial infection with skin manifestations.
Caused by toxin produced by S. aureus
Staphylococcal Scalded Skin syndrome
presentation
Abrupt onset fever and malaise
Generalized erythema and swelling, particularly perioral, periorbital, elbows, knees, groin, and axilla
Light pressure causes pain and desquamation
Vesicles and bullae
Staphylococcal Scalded Skin syndrome
Diagnostics
Blood culture or secretion culture to confirm S. aureus
Staphylococcal scalded skin syndrome
management
Hospitalize all neonates and sever cases for IV abx
Mild cases with stable environment: outpatient cefazolin or dicloxacillin, encourage fluids, fever and pain control
Acne vulgaris, mild - treatment
First line: Either BP or topical retinoid, or a combination of the two. May add topical antibiotic in fixed-ratio combination therapy
Alternate: topical dapsone
Acne vulgaris, moderate - treatment
First line: Combo therapy containing BP + retinoid and/or antibiotic -or- PO antibiotic + BP + retinoid +/- topical abx
Alternate: consider adding OCP or isotretenoin
Acne vulgaris, severe - treatment
Likely requires derm referral
First line: PO abx + combo therapy with BP + retinoid + topical abx -or- PO isotretenoin
Alternate: Consider OCP, spirinolactone in older teens
Topical abx in acne vulgaris
not recommended as monotherapy due to high resistence
PO abx in acne vulgaris
Extended release minocyline only FDA approved abx; use in kids >12yoa
Tetracycline and doxycycline also used
Viral warts - treatment
salicylic acid and occlusive tape
pyogenic granuloma
definition and management
lobular capillary hemangioma - bleed easily
treatment required, either shave excision and cautery or surgical removal
Tinea versicolor
Macules/patches that are hypo- or hyperpigmented, or erythematous; caused by Malassezia species
treat with topical ketoconozole or selenium sulfide
Repigmentation may take months
Tinea corporis - presentation/management
Pruritic, erythematous, annular patch with central clearing and scaly raised border.
Topical terbinafine or azole antifungals
Tinea capitis - management
Topicals ineffective, requires PO griseofulvin for 10-12 weeks and terbinafine for 6 weeks. Selenium sulfide shampoo may shorten length of fungal shedding and reduce familial infection
Telogen effluvium
Most common cause of diffuse hair loss
Mature hair follicles switch prematurely to telogen (resting) state then shed within 3 months
Typically occurs after major stress (pregnancy, surgery, major illness, severe weight loss)
Self-limited with regrowth over a few months
Transient Neonatal Pustular Melanosis
Self-limiting condition most common in full-term infants with darker skin pigment. Pustules erupt to leave an erythematous or hyperpigmented macule with collarette of scale. Macules fade over a few months
Pityriasis Alba - description
Acquired condition Scaly, hypopigmented macules Indistinct borders Various shapes/sizes Primarily on cheeks
Pityriasis alba - clinical course
May be pruritic or erythematous
Exacerbated by sunlight
Spontaneous resolution in 3-4 months
Moisturize and protect from sunlight
