Dermatology Flashcards
Name this
atopic dermatitis
Key phrase to ID atopic dermatitis
erythematous salmon colored patches
Atopic dermatits is primarily what kind of dysfunction?
barrier
A patient tells you that steroids bleached his skin. What do you say?
steroids cause hypopigmentation, not skin bleaching; it will resolve over time
Kiddos with more barrier dysfunctions are at risk for what?
skin infections:
- staph
- strep
- HSV
How is atopic dermatitis managed?
- regular (Daily?) bathing
- gentle soap
- moisturizer
- topical steroids
- manage infections
Steroid maintenance schedule
3 days on
4 days off
Good steroid ointment for face
Hydrocortisone 2.5%
Good steroid ointment for body
Triamcinolone 0.1% ointment
Non-steroid medications for atopic dermatitis
- tacrolimus
- pimecrolimus
- Crisaborole
Name this
port wine stain
Name this
infantile hemangioma
What is an infantile hemangioma?
- capillary overgrowth
- grows quickly during the 1st year, then fades
- NOT cancer
When do we get concerned about infantile hemangiomas?
- if on the face
- if on the neck (breathing)
- if on the back (spinal involvement)
- if they bleed
- if 5 or more, might be on the liver (do abdominal U/S)
How are infantile hemangiomas treated?
oral propranolol
OR
topical propranolol + topical steroid
Who manages facial hemangiomas?
dermatology
If a child is on propranolol, of what do we need to be aware?
- propranolol can mask wheezing, so be aware that any wheezing may be worse in severity than it appears
- can cause hypoglycemia, so give with food
Name this
molluscum contagiosum
Name this
chicken pox
What causes molluscum contagiosum?
pox virus
Classic description of molluscum contagiosum
small “waxy” dome shaped flesh colored papules with an umbilicated core
What common skin condition can worsen molluscum contagiosum?
eczema
How to keep molluscum contagiousum from spreading if it is surrounded by eczema?
use a maintenance steroid regimen, 3D on, 4D off
What irritants can be used on molluscum contagiousum lesions?
zutea tree oil, apple cider vinegar, Zymaderm, Canthiridin
What is this?
impetigo
Name this
acne vulgaris
4 components of acne
- abnormal keratinization
- sebum overproduction
- bacteria
- inflammation
Name the therapeutic ladder for acne
- retinoid
- benzoyl peroxide + retinoid or topical ABX
- TRIPLE THERAPY: BP + retinoid + oral ABX
What antibiotic–and what dosing–is used for acne vulgaris?
doxycycline 100mg PO daily or BID x 3 months
What should patients be taught about doxycycline?
photosensitivity –> use sunscreen
take with water to avoid pill esophagitis
take with food to avoid stomach upset
Name a retinoid
differin
How long will a retinoid take to address acne?
6W to kick in; 3-4 months to plateau
What do patients need to be taught about retinoids?
- causes photosensitivity –> use sunscreen
- dries the skin; use a moisturizer
What benzoyl peroxide concentrations are used?
4-10%
How does benzoyl peroxide address acne?
kills bacteria that are responsible for white heads and inflammation
What is this?
verruca vulgaris
What causes the black dot appearance in warts?
thrombosed blood vessels
What causes warts?
HPV
Medical terminolgy to describe a wart
verrucous EXOPHYTIC papules with “black dot” appearance
Name this
Alopecia
Name this
tinea capitis (Ringworm of the scalp)
What organisms cause impetigo?
- group A beta-hemolytic streptococcus (Streptococcus pyogenes)
- Staph. aureus
- MRSA
How long does a patient with impetigo need to be out of day care/school?
until at least 24 hours of antibiotic treatment is completed
2 most common causes of cellulitis
- Strep. pneumonia
- Staph. aureus
What patients with cellulitis should be hospitalized?
- neonate or febrile infant
- acutely ill or toxic
- periorbital cellulits
common history with candidiasis infection
- antibiotic or steroid use over previous weeks
- occurrence of rash in warm, moist area
What causes tinea capitis?
- Trichophyton tonsurans or Microsporum canis
- fomites invade the scalp and hair shaft, causing inflammatory response and hair shaft fragility
What medications are used for tinea capitis?
griseofulvin or terbinifine
**be sure to dose correctly in children
What skin condition has a classic honey-colored crust?
impetigo
What ointment is used for impetigo?
mupirocin ointment TID x 10 days
What oral antibiotic is used for impetigo?
Keflex
What is pediculosis capitis?
head lice
What is tinea cruris?
jock itch
What is tinea pedis?
athlete’s foot
What is onychoycosis?
fungal infection of the nails
For head lice, how long does it take a nymph to become an adult? What is the implication of this?
7 days, must be treated 2x to kill all lice
Describe a louse’s dependence on humans
- cannot hop or fly
- dies w/in 2-3 days w/o feeding
- viable eggs are w/in 6mm of skin for warmth
Active ingredient of Nix
permetherin 1% cream rinse
How to kill lice in the home
launder bedding > 5min at temps > 128.3 degrees F
How to kill lice with shampoo?
- Nix
- Treat 2 x, once and then again 7-9 days later
- leave cream on scalp 10 min, then rinse
- comb out nits with fine-toothed comb
3 C’s of Measles
- cough
- coryza
- conjunctivitis
Where does the measles rash begin?
face/behind ears (spreads to trunk/extremities)
What are the name of the enanthem found in the mouth in a measles infection?
Koplik spots
What is coryza?
upper respiratory infection/common cold
Name these lesions
Koplik spots
How long does a patient with rubella need to avoid school?
7 days after rash onset
Another name for the German measles
Rubella
How does rubella impact a pregnant patient?
can cause serious birth defects; pregnant patients should stay away
Name some symptoms that would make you suspect measles or German measles (Rubella)
- cough, coryza, conjunctivitis
- rash starting on the face and spreading to the trunk/extremities
- Koplik spots
- pink papules and blotchy blanchable macules
Name this rash, associated with fever, headache, sore throat, and abdominal pain
Scarlatina (associated with strep throat)
Name and describe the rash associated with strep throat
Scarlatina: fine rough textured blanchable papules on trunk and armpits
What is this called?
palatal petichiae
What oral lesions are associated with scarlatina?
- palatal petichiae
- strawberry tonuge
Name some complications of GABHS infection
- rheumatic fever
- glomerulonephritis
- PNA
- pericarditis
- meningitis
When can a patient with strep throat return to school?
after 24 hours of antibiotics
Name this infection
Fifth’s disease
When does viremia end with fifths disease?
with rash onset
A bath can make the rash of fifths disease reactivate; how long does this last?
weeks
Describe the rash of fifths disease
lacey maculopapules on the extensor surfaces/trunk with a circumoral pallor
What is Erythema infectiousum?
fifth’s disease
Name this infection:
- 6 months old
- fever of 104F for 3 days
- fever broke
- rash appeared on trunk, spreading to extremities
roseola (sixths disease)
What child’s rash has rose-pink macules and papules with halos of blanching?
Roseola
Define defervescence
abatement of a fever
What can cause this?
hand-foot-mouth disease
What causes hand-foot-mouth disease?
coxsackie virus
What causes Roseola?
HSV 6
What does Exanthem subitum mean? What disease is this?
“sudden rash”;
Roseola
A patient has hand-foot-mouth disease; when can he return to school/day care?
after resolution of lesions
What disease is this: “mixed erythematous macules, papules, and vesicles in different stages of healing?
varicella
What causes chicken pox?
varicella zoster
Where does the chicken pox rash begin?
trunk
Describe this lesion
“dew drop on a rose petal”
When can a patient with chicken pox return to school?
when all the lesions are crusted over
Describe the rash of chicken pox; how does it progress?
PRURITIC papular rash on the trunk, evolving to papules and vesicles; spreading to face and head
Differentiate these lesions
LEFT: erythema migrans
RIGHT: nummular eczema
Complications of Lyme Disease
- arrhythmias and/or heart block
- meningitis
- arthritis
- neurological sequelae
medication and dosing to treat Lyme Disease in children
must be over 8 years old
doxycycline 4mg/kg/D
divided in 2 doses (BID)
up to 100mg
x 3-4W
What life-threatening disease should be considered for a rash that starts peripherally and spreads centrally?
Rocky Mountain Spotted Fever
For what disease is doxycycline used, regardless of age?
Rocky Mountain Spotted Fever
What key symptoms might indicate Rocky Mountain Spotted Fever?
- severe sudden headache unrelieved by analgesics
- myalgias, particularly calf and thigh pain
How does Rocky Mountain Spotted Fever start? How does it progress?
- faint macules on wrists/hands
- spreading centrally and becoming petechial
How does the rash of Measles spread?
head down
Another name for 3-day measles
German measles
Erythema infectiousum rash looks like…
slapped cheeks
cause of warts
Why are there genital warts, plantar warts, common warts in certain parts of the body?
Some kinds of warts infect specific body sites
name for common wart
name for plantar wart
name for flat (plane) warts
options for treatment of warts
- depends on location and type
- spontaneous resolution can occur – happens quicker in children than adults
- destruction of tissue (salycilic acid, cryotherapy, surgery, laser)
- enhancement of immune response (imiquimod)
- antiproliferative therapy (fluorouracil, bleomycin)
- resolution is unpredictable
- elmination of wart does not eliminate virus from body
most common treatment of warts
- cryotherapy and salycilic acid
- can be used alone or in combination (salicylic acid in between cryotherapy sessions)
patient education for cryotherapy to treat warts
- response: pain, hemorraghic blistering, tenderness
- healing usually in 4-7 days
- local hypopigmentation can occur
- occasionally: blistering can spread virus to adjacent skin and cause larger wart
