Dermatology Flashcards
what drugs commonly cause Toxic Epidermal Necrolysis?
sulfa abx
phenytoin
phenobarbital
carbamazepine
what would you see with these lesion on a smear?
erythema toxicum neonatorum (ENT)
filled with eosinophils
not seen in premies
what infection is this rash associated with?
guttate psoriasis
strep infections (pharyngitis or perianal strep)
neonatal acne
birth-3 weeks
self-resolving
over what body parts should you be concerned about large congenital nevi?
neurocutaneous melanosis
scalp, midline neck, spine - may have leptomeningeal involvement
verterbral colum - may have spina bifida
what diseases/syndromes are associated with cafe-au-lait spots?
NF1
NF2
McCune-Albright
tuberous sclerosis
what is erythrodermic psoriasis?
exfoliative reaction
entire body is warm, red, scaly
cannot control body temperature
causes: sunburn, drugs (antimalarials, betablockers, lithium), infections (strep, viruses)
in what locations should you worry about hemangiomas?
beard distribution (airway involvement)
ocular (eye involvement)
midline lumbosacral (spinal dysraphism)
if you have bilateral facial port-wine stains, what workup do you need?
optho and radiology imaging
what infections (other than bacterial superinfection) are children with eczema at higher risk of?
widespread molluscum
or
widespread herpes (eczema herpeticum)
what is the difference between neonatal and infantile acne?
neonatal: birth-3wks, self-resolve
infantile: 3-4 months later, has comedones, may require trreatment, may be related to other conditions that cause androgen excess (tumor, CAH, etc)
what is this caused by?
Koebner phenomenon
psoriasis outbreak in the area of an abrasion
usually linear
what do you need to be worried about if you have more than 5 hemangiomas?
visceral involvement
at risk for heart failure, liver failure
what are some of the conditions associated with this painful rash?
Milia:
tiny, pinhead size
yellow-white
tiny, epidermal inclusion cysts
no treatment
what are the skin findings in zinc deficiency?
red, irritated, eczematous rash
around nose/face
in perianal area (burned diaper rash)
also can cause alopecia
commonly seen in children with diarrheal diseases
what is a shagreen patch?
plaque of thickened skin with a cobblestone or orange-peel texture often seen on the dorsal aspect of the trunk
seen with tuberous sclerosis
what is the underlying defect of oculocutaneous albinism
tyrosine deficiency
pitariasis rosea
herald patch
christmas tree pattern
where does the rash of measles start?
forehead and then goes down
what are patients with oculocutaneous albinism at higher risk of?
basal cell and squamous cell cancers
what drug causes hypertrophied gums?
phenytoin
what drug can cause necrotic skin patches 3-10 days after starting it?
warfarin
what happens if you try to remove a psoriatic plaque?
will have bleeding from capillaries underneath (auspitz sign)
what physical findings are associated with dermatomyositis?”
heliotrope rash
Gottron’s papules (eruptions over the knuckles)
rash over knees/elbows
nailbed teleangiectasias
tx with steroids +/- immunosuppresives
koplik spots
seen with measles (appear before rash)
small white papules on erythematous base
what medicine is used for severe psoriasis?
acitretin (TNF-alpha inhibitor)
has black box warning: increased risk of leukemia and other cancers
can also use methotrexate or cyclosporine (esp if arthritis)
what should you look for in a patient with x-linked icthyosis?
undescended testicles
underdeveloped penis or testicles
what can this be associated with?
polyglandular syndrome!
autosomal recessive
look for:
diabetes
graves
addison/adrenal insufficiency
hyper/hypo thyroidism
pernicious anemia
congenital herpes simplex
common around fetal scalp monitor or presenting part
more likely to happen if primary infection for mom or vesicles present
what can this sometimes be associated with
psorasis
what other physical findings are associated with psoriasis?
nail pitting and onycholysis (painless separation of the nail from the nail bed)
sebaceous hyperplasia
in differential of milia
concentrated around nose/lips
due to increased exposure to adrogens in utero
self-resolving
what is erythrasma
well-defined redding lesion with some scaling
found in axillae, under breasts, in between toes, and in groin
chronic infection
will fluoresce RED with woods lamp
tx with erythromycin and -azole cream
hyperpigmented gingivia
addison’s disease
how is this disease inherited?
incontinenia pigmenti
x-linked (thought to be fatal in males)
also associated with delayed eruption of teeth
teeth often cone shaped
alopecia
blindness
what ANA pattern is associated with cutaneous lupus?
speckled
have SS-A or SS-B (Ro/La) antigens
what is PHACES syndrome?
P: posterior fossa abnormalities
H: hemangioma (usually involve trigmeninal distribution)
A: arterial anomalies (intracerebral arteries)
C: cardiac defects (coarct)
E: eye abnormalities
S: sternal clefting
what is this rash seen on a well-appearing baby?
cutis marmorata
reticular lacy pattern seen when baby is cold
skin returns to normal when warm
usually goes away by 6 months of age
what is associated with ash leaf spots?
tuberous sclerosis
what is the Nikolsky sign?
seperation of skin with minimal pressure
seen in SSSS, TEN, and pempigus vulgaris
does the Ro (SS-A) or La (SS-B) antigen cause heart block in neonates?
Ro (SS-A) - can cross the placenta
number one cause of neonatal heart block
usually don’t have skin findings (periorbital erythema, round/annular patches)
what causes this type of alopecia?
(focus on second picture)
tinea capitis
breakage at the scalp with “salt and pepper” apperance
what is the underlying defect in x-linked icthyosis?
sulfatase deficiency
what else should you look for in a patient with this finding?
hearing loss (Wardenberg syndrome)
or
other neurologic deficits (Wolf-Hirschorn)
what other condition do you need to worry about with a port-wine stain?
if in opthalmic branch of trigeminal nerve (V1) then worry about Sturge-Weber syndrome
ipsilateral cerebral vascular malformation
(seizures, MR, contralateral hemiplegia, glaucoma)
peutz-jeghers syndrome
(multiple intestinal haramtomas/polyps)
what is the risk of melanoma with congential nevi?
yes.
very small for small to medium nevi
5-15% for large nevi
large nevi often in dermatome distribution
what would you seen on smear of these pustules?
transient pustular melanosis
pustules that turn to pigmented macules
neutrophils on smear
what is associated with lower extremity port-wine stains?
Klippel-Trenaunay syndrome
vascular malformation of limb
associated soft tissue overgrowth or limb overgrowth
varicose veins
miliaria rubia
caused by sweat retention/overheating
often on head and neck
miliaria crystallina: similar but clear fluid filled vesicles
what is the natural course of infantile hemangiomas?
may or may not be present at birth
grow rapidly
stabilize for 6-10 months
then begin to involute around age 2
50% gone by age 5
NF1
6 or more spots and axiallary/groin freckling is diagnostic for NF1!
what is the medical term for port-wine stain?
nevus flammeus
erythema multiforme
palms and soles frequently involved
fixed lesions
associated with HSV, mycoplasma,
what infection is this rash associated with?
congenital rubella
(also CMV)
Incontinentia pigmenti.
A, Linearly distributed vesicles on an erythematous base are seen on the legs of this neonate.
B and C, Subsequently, lesions evolve into warty papules, which can have thick overlying crusts.
D, Splotchy hyperpigmented patches replaced the warty lesions by 8 months of age.
E, In many cases the hyperpigmentation appears in swirls and streaks.
F, These hypopigmented reticulated lesions on the leg of an affected child’s mother represent old scars in areas of prior hyperpigmentation.
how is oculocutaneous albinism inherited?
autosomal recessive
what syndrome consists of
basal cell carcinoma in childhood
dysmorphic facies
palmoplantar pits
skeletal defects
jaw cysts
ovarian tumors
Gorlin Syndrome
autosomal dominant
what causes erysipelas?
group A strep infection
rapidly enlaring cellultiis with clear borders
culture the leading edge
what other physical finding may you find in a child with this disease?
pitted fingernails
occasionally associated with autoimmune diseases
if total hair loss - less likely to grow back
topical steroids can be tried but not super effective
Cutis Aplasia Congenita
abscence of skin
25% have underlying abnormalities
multiple spots: trisomy 13
midline defect: spinal dysraphia
name some of the side effects of isotretinoin
pseudotumor cerebri
depression
psychosis
pancreatitis
hypertriglyceridemia
hearing loss
vision loss
skeletal abnormalities
what other nutritional deficiency can result in symptoms similar to zinc deficiency?
biotin
can also have CNS symptoms
common in kids on hyper al
