Lecture 11 - Derm/ID Flashcards
Milia
keratin filled papules usually found on the face, without erythema
benign, self-limiting after papules open up
often confused with sebaceous hyperplasia (on nose), or neonatal acne (but milia is without erythema)
Sebaceous hyperplasia
related to maternal androgens causing increase in number of sebaceous cells (similar to neonatal acne)
regression occurs when hormone levels decline
often mistaken for milia
Neontal acne
does NOT put the child at risk for early puberty
due to maternal androgenic hormones (like sebaceous hyperplasia)
-causes sebaceous gland blockage —> comedones, pustules
-no scarring
presents around 2 weeks
resolves with decline in maternal hormones in 3-4 months
tx: self resolves
-can use soaps or benzoyl peroxide
Seborrheic dermatitis
caused by malassezia furfur
“Cradle cap”
presentation:
-yellow/pink greasy appearing scale on scalp and erythematous scaling on neck and face
-in older children/adults: often itchy, erythematous scaly rash on face
tx:
Ketoconazole 2% cream/shampoo 2x/week
OR
topical hydrocortisone 1% cream (if mostly erythematous)
What is the treatment for seborrheic dermatitis?
Ketoconazole 2% cream/shampoo 2x/week
OR
topical hydrocortisone 1% cream (if mostly erythematous)
Harlequin color change
transient well defined color change in neonates
hypothesized to be due to immaturity of autonomic nervous system causing transient vasodilation
benign
associated with prematurity, use of prostaglandin or certain types of anesthesia and even meningitis
can be confused with port wine stains (but harlequin is transient)
Mottling
otherwise known as “cutis marmorata”
appears as pink marble or “lacy” pattern, usually bilaterally, symmetrical
benign if transient
typically caused by capillary constriction in response to a cold trigger
occasionally can be congenital “cutin marmorata telangiectasia congenita” which is usually more severe, only on one extremity which is asymmetric in size to others
Livedo Reticularis
umbrella term for pink purple lacy pattern that is mottling
if related to cold –> cutis marmorata
if unresolved with warming –> can indicate shock or poor cardiac output
Erythema toxicum
unknown cause
appears in 50% newborns in 2-5 days of life –> spontaneously resolves
ddx: HSV, staph pustulosis
path: eosinophils
no treatment
What is the treatment for erythema toxicum?
none
Pustular Meanosis
vesicles with cloudy fluid (at birth) –> denuded, forming white crust –> hyperpigmented macules (within hours to few days)
cause unknown
path: neutrophils
benign
sometimes mistaken for HSV (difference is pustular melanosis lacks erythematous base, is less clustered, and less likely on a presenting part –presenting part like during labor and delivery (was the head first or butt, etc))
self resolves
Allergic contact dermatitis?
cause: exposure to irritant –> recruits pre-sensitized cutaneous T-cells to skin –> inflammation
tx:
avoid contact with irritant
keep skin surface dry
for diaper area, use emollients as barrier (zinc oxide cream, petrolatum)
hydrocortisone 1% or 2.5% ointment (for face; can use in severe diaper dermatitis)
mometasone (trunk/extremities)
Candidal diaper dermatitis
candidal (diaper) dermatitis
- satellite lesions
- beefy red
- affects folds/creases
tx: topical nystatin
Contact diaper dermatitis
spares inguinal folds
rx: barrier cream
zinc oxide
Slate grey patch
mongolian spot
benign hyperpigmented (usually blue/back) patches, usually on sacrum but can be over back and extremities (usually not on face)
not associated with any condition
can be mistaken for ecchymoses, so document
Cafe au lait spot
benign hyperpigmented (usually brown) irregularly shaped macule or patch
found anywhere on body
if >6 spots, >5mm, it supports the likely dx of neurofibromatosis
Infantile hemangioma
vascular overgrowth due to dysregulation of endothelial stem cells
present at birth but grows rapidly throughout the first 6-12 months of life
then, it begins to spontaneously involute
tx: usually since they self resolve, its only a cosmetic issue
options tx are: propranolol (oral), steroids, and laser therapy
When to treat? (=when to worry)
if they are in a location where vision, breathing, or feeding can be affected
if they are very large (they can ulcerate and be prone to infeciton)
if they are midline over the sacrum along with a dimple (occult spinal dysraphism is more likely)
When should you be worried about hemangioma?
if they are in a location where vision, breathing, or feeding can be affected
if they are very large (they can ulcerate and be prone to infeciton)
if they are midline over the sacrum along with a dimple (occult spinal dysraphism is more likely)
What are you worried about for a child with hemangioma on the eyelid?
occludes vision, leading to amblyopia
Why are you worried about a child with hemangioma on sacral dimple or tuft of hair?
could indicate spinal dysraphism
obtain spinal US
If you are going to treat hemangioma, what is the treatment?
usually since they self resolve, its only a cosmetic issue options tx are: propranolol (oral), steroids, laser therapy
Port Wine Stain
blanchable capillary malformation
usually are isolated lesions, but can be associated with genetic conditions (Sturge-Weber, Klipple-Trenaunay)
When to refer?
-if segments 1 and 2 of trigeminal nerve are affected (upper and lower eyelids):
its more likely to be associated with Sturge Weber sydnrome (if both the top and bottom eyelid are affected)
-if neurologic signs (seizures)
-can be associated with glaucoma
Congenital Melanocytic Nevus
rare tan-black color hamartomas made of melanocytes, present at birth
can be small, medium, large, or giant sized
ofentimes are irregularly shaped and have pilosebaceous glands (have hair)
when to refer:
- large or giant 3-5% chance of melanoma –may require excision and grafting for cosmetic and oncologic purposes
- small or medium: recommend routine monitoring by PMG and family for melanoma potential (1%) that occurs mostly after puberty
Measles (Rubeola)
caused by measles virus (a paramyxovirus)
epi: prior to vaccine in 1963, affected >500,000 people per year
declined to <500
spread by respiratory transmission
contagious for 4 days prior to rash onset and 4 days after the rash
When is measles contagious?
contagious for 4 days prior to rash onset and 4 days after the rash
How does Measles present?
incubation period (10-12 days)
-occurs after virus is spread to the respiratory mucosa
prodrome (2-4 days)
-high fever (103-105F), malaise
-“cough, coryza, conjunctivitis”
-enanthem: Koplik’s spots (1-3mm grey/blue/white bumps on an erythematous base, usually in buccal and labial mucosa)
Exanthem - (begins 2-4 days after fever)
-erythematous maculopapular (initally blanching, then darkens and coalesces) rash beginning on forehead –> spreading down
rash starts 2-4 days after fever onset. usually not pruritic
-generalized lymphadenopathy; possible splenomegaly
-fever lasts 2-4 days into rash, then self-resolves
What age do you get the measles vaccine?
12 months
Incubation period of measles
incubation period (10-12 days)
-occurs after virus is spread to the respiratory mucosa
prodrome (2-4 days)
Prodrome period of measles
prodrome (2-4 days)
- high fever (103-105F), malaise
- “cough, coryza, conjunctivitis”
- enanthem: Koplik’s spots (1-3mm grey/blue/white bumps on an erythematous base, usually in buccal and labial mucosa)
Koplik’s spot
seen in prodrome of measles pts
Exanthem phase of measles
Exanthem - (begins 2-4 days after fever)
-erythematous maculopapular (initally blanching, then darkens and coalesces) rash beginning on forehead –> spreading down
rash starts 2-4 days after fever onset. usually NOT pruritic
-generalized lymphadenopathy; possible splenomegaly
-fever lasts 2-4 days into rash, then self-resolves
How do you dx measles?
a high level of suspicion
consider in immunocompromised, under-immunized children with possible exposure
appears “sick”
testing: detecting measles RNA with RT-PCR
positive measles IgM or rise in measles IgG during acute and convalescent stages
if suspected:
place child in airborne isolation room
-call health department
What are the complications of measles?
secondary infections (PNA, diarrhea, encephalitis)
SSPE (subacute sclerosing panencephalitis)
-occurs 7-10 years after infection, progressive CNS degenerative disease
What is the treatment of measles?
supportive care
vitamin A (2 doses) for children -decreases mortality for children under 2 years
best treatment is prevention: vaccinate! (age 1 and 4 years)
Mumps
caused by mumps vius (a paramyxovirus)
epid:
prior to vaccine in 1967, was a common cause of encephalitis, orchitis, parotitis, and sensorineural hearing loss
spread by respiratory droplets and direct contact
How to pts present with mumps?
nonspecific prodrom: fever, malaise, HA, myalgias
Parotitis: usually 48 hours after prodrome not always present can last up to 10 days
