Dermatology Flashcards
what are 4 risk factors for infantile hemangioma?
female
multiple gestation
prematurity
low birth weight
what is the natural history of infantile hemangioma
rapid growth out of proportion to Child’s growth, usually complete by 5 months
Plateau: ~12-18 months
Regression: ~18 months until 9-10 years of age
Residua: lasting skin changes in 50%
when do we worry about hemangioma of infancy?
Obstruction – Periorbital may impair vision – Large “beard-area” distribution-+/- airway IH • Associations – Mid-line lesions • Lumbosacral or mid-face – Large segmental on face: PHACES • Ulceration • Multiple
what is the treatment for infantile hemangioma?
95% require no treatment
– Anticipatory guidance
– Surgery or laser at later stage if not resolved
5% require treatment
first line- propranolol (Vision or airway threatening, significant cosmetic outcome)
oral corticosteroids also work but not first line
what should you monitor for a patient on propranolol for infantile hemangioma?
blood pressure
hypoglycemia
contraindications to propranolol for hemangioma
asthma, diabetes, PHACES
what is nevus simplex (storkbite)
40% of newborns
Naevus simplex is a common, benign capillary vascular malformation
It presents at birth as a pink or red patch and is most often observed on the nape of the neck, eyelid, or glabella (skin between the eyebrows)
Usually fade significantly except nuchal area
Nevus flammeus
port wine stain
persist lifelong
What doe PHACES stand for?
Posterior fossa brain malformations
Haemangiomas, particularly large, segmental facial lesions
Arterial anomalies
Cardiac (heart) anomalies and coarctation of the aorta
Eye abnormalities and Endocrine abnormalities
PHACES syndrome is PHACE syndrome plus:
Sternal cleft, supraumbilical raphe, or both
When do you worry about capillary malformations
– V1 distribution
• 10% have Sturge-Weber syndrome
– Lumbosacral capillary malformation (May have spinal abnormalities)
consider MRI
what is the difference between capillary malformation and hemangioma
capillary malformation- vascular malformation, grows with the child, never resolve
hemangioma- vascular tumor, rapid growth, resolve
When do you worry about nevi?
ABCD Asymmetry Border regularity Colour variety D- diameter >6mm worry E- evolution/change
what are the management options for nevi
Prevention – Sun Protection: • Sunscreen SPF 15 or greater • Hat, long sleeves/pants • Avoid direct sun 10:00am-4:00pm (seek shade) • Avoid tanning beds
- Review with patients: A B C D E
- Baseline photography for congenital, atypical
cafe au lait- what is the border like
irregular but sharp border
no scale
NF1 criteria
Need 2/7 criteria – >5 CALMS (>5mm prepuberty; >15 mm after) – Family history – Axillary or inguinal freckling – Specific bony abnormalities – 2 neurofibromas (or 1 plexiform neurofibroma) – Optic glioma – Lisch nodules (iris)
what is Vitiligo? tx?
autoimmune disorder that targets melanocytes Depigmented patches - Sharply marginated - No Scale - Tiny areas repigment
1st-line Tx= Strong topical steroids
what is commonly associated with post inflammatory hypopigmentation
eczema
poorly marginated, no scale
self-resolves, gets better with time
what is Pityriasis Alba? where do we see it? when? treatment?
pityriasis refers to its characteristic fine scale, and alba to its pale colour (hypopigmentation).
summer- often presents following sun exposure Hypopigmented Poorly marginated Fine white scale ** Face common
tx: 1% hydrocortisone for scale BID for 5-7 days
Hypopigment improves in time
what is tinea versicolor? tx?
common yeast infection of the skin, in which flaky discoloured patches appear on the chest and back
physical exam? Hypopigmented Can be hyperpigmented Sharply marginated Fine white scale*** Trunk, proximal limbs
Tx: Antifungal shampoo daily, 1-2 weeks (lathered to area)
topical antifungals
major criteria for TS
2 major features OR one major feature and 2 minor features
Hypopigmented macules >=3 – At least 5mm or bigger • Facial angiofibromas OR forehead plaque • Non-traumatic ungual or periungual fibromas • Shagreen patch • Subependymal nodule • Subendymal giant cell astrocytomas • Cardiac rhabdomyoma • Lymphangiomyomatosis • Renal angiomyolipomas
minor criteria for TS
Multiple randomly distributed pits in dental enamel • Hamartomatous rectal polyps • Bone cysts • Cerebral white matter migration lines • Gingival fibromas • Non-renal hamartomas • Retinal achromic patch • Confetti skin lesions • Multiple renal cysts
Staphlococcal Scalded Skin Syndrome? pain?fever? tx?
Bullous eruption from S. aureus toxins
pain is common
Fever and systemic symptoms uncommon
IV cloxacillin, some will add clindamycin
what is the treatment for scabies?
Permethrin 5% cream most effective
• Infants: treat whole body
• Older kids & Adults: treat from neck down
Leave on overnight and wash in am
• Re-treat 1 week later
Launder clothes/linen from last 3 days
what is the treatment for eczema herpeticum
• If unwell, <1 year, poor fluid intake, severe:
– Admit and treat with IV acyclovir
• If well, localized, good fluid intake, good f/u:
– Oral acyclovir for 10 days
what is the major agent for Tinea Capitis in North America? what are two fungus that cause it? tx?
T. Tonsurans major agent in North America
- Trichophyton (human reservoir)
- Microsporum (Cats and gods are reservoir)
Always Send Culture!!!
tx: oral terbinafine
SE terbinafine: liver enzymes, taste alteration, drug interactions, decreases pmns
clinical presentation for Tinea Corporis? tx?
Scaly, red plaques with central clearing
• Often have active border or leading edge
tx: Azoles: – ketaconazole – Miconazole – Clotrimazole • Allylamines: – Terbinafine • Ciclopirox Olamine NOT NYSTATIN
