Lecture 11: Dermatology & ID Flashcards
What is milia?
Tx needed?
keratin filled papules w/NO erythema (usu face)
No - benign/self-limiting
Mother brings newborn in concerned that the child’s pores looked clogged. Most likely Dx
What is this d/o related to & result?
Regression?
Sebaceous gland hyperplasia
related to maternal androgens –> incr # sebaceous cells
- regression when maternal hormones decline
When does neonatal acne appear/resolve?
Scarring Y or N?
Although self limiting - what is possible Tx for acne?
appears ~2wks and resolves after maternal hormones declines (3-4 mo)
- Note: also related to maternal androgens like sebaceous hyperplasia
NO scarring
Tx w/soaps or benzoyl peroxide (drying)
Infant comes in w/yellow-greasy scales on scalp, most likely Dx? name of this sign?
Dx = Seborrheic dermatitis
“Cradle Cap”
Cause of seborrheic dermatitis
Although Tx not necessary, what are 2 Tx options for this?
Malassezia furfur
Tx = Ketoconazole cream/shampoo or Topical Hydrocortisone cream
Baby comes in w/odd, widespread coloring of body that is transient. Most likely Dx?
What is the cause of this color change?
Harlequin Color Change (usu benign)
immature autonomic NS –> transient vasodilation
Baby presents w/pink-purple marbly/lacy pattern that is symmetric on extremities after baby left out on changing table for while. Dx?
What is the umbrella term for the pattern of rash in this d/o?
Mottling (cutis marmorata)
Livedo reticularis = umbrella term for pink-purple marbly/lacy pattern
Presentation of baby w/congential mottling (cutis marmorata telangiectasia congenita)
asymmetric size of one limb to the other
Normally mottling resolves w/warming (rash = response to cold trigger) If mottling (cutis marmorata) is unresolved with warming what does that indicate?
shock or poor CO
Presentation of erythema toxicum?
What is seen on pathology, which makes cause likely d/t?
small raised bumps w/surrounding erythema all over
Pathology = eosinophils
- cause could be Hypersensitivity (BUT NOT AN ALLERGY)
baby presents w/skin condition: vesicles w/cloudy fluid that crusted over and are now hyperpigmented macules. Pathology reveals neutrophils. Dx?
Pustular Melanosis
- no Tx
Key difference b/t presentation of allergic contact dermatitis and candidal diaper dermatitis?
Allergic contact – CREASES SPARED
candidal – affects creases/folds
How does exposure to irritant cause inflam in allergic contact dermatitis?
Tx for diaper area, face or severe?
irritant recruits pre-sensitized T cells –> inflam
Tx
- diaper area = Emollients (zinc oxide cream, petrolatum)
- face or severe = Hydrocortisone
Neonate comes in w/angry, beefy red lesions affecting folds and creases. Dx?
Name of these types of lesions?
Tx?
Candidal Diaper dermatitis
- a/w satellite lesions
Tx = topical Nystatin, keep dry
Pt presents w/benign blue/black patches on sacrum, back and extremities that fades after few years. Dx?
Slate gray patch (Mongolian spots)
Difference b/t Mongolian spot and bruise?
Mongolian spots - color doesnt change w/time like bruise
What skin condition is characterized by brown hyperpigmented, irreg shaped macules that are a/w genetic condition?
> 6 spots and more than 5 mm = concern for?
Cafe Au Lait spots
> 6 spots and > 5 mm –> Neurofibromatosis
What is a hemangioma d/t?
What 3 things make a hemangioma concerning?
dysregulation of endothelial stem cells
- area where vision, breathing, feeding affected
- very large –> ulceration & prone to inf
- midline on sacrum + dimple/tuft of hair –> occult spinal dysraohism/bifida
What is a port wine stain?
if affects what areas –> concern for what
Blanchable capillary malformation
affects upper and lower eyelids (V1 & 2 of trigeminal nerve) –> concern for Sturge-Weber Syndrome
Pt presents w/large ( > 6 cm) tan/black, irreg shaped lesion that also has hair w/in. Dx?
Why should you refer/be concerned?
Congenital Melanocytic Nevus
Concern b/c large –> risk of melanoma
9 Viral Diseases that cause rash
Vaccines for which 4?
- Measles (Rubeola)
- Mumps
- Rubella (+ congenital)
- Erythema Infectiosum (5th disease)
- Roseola Infantum (6th disease)
- Eczema Herpeticum
- Varicella-Zoster
- Herpes Zoster
- Molluscum Contagiosum
Vaccines = MMRV
How long are kids contagious for w/Measles (rubeola)
4 days before and after the rash
What is pathognomonic for Measles in the prodrome period?
What else is seen during the prodrome period (3)?
Koplik’s spots
Cough, Coryza, Conjunctivitis
Appearance of Koplik’s spots in Measles? where are they typically found?
Koplik’s spots
- grey/blue/white bumps on erythematous base
- in buccal + labia mucosa
Pattern for the classic exanthem in Measles
Rash spreading from the forehead down
- blanches then coalesces/darkens
You suspect a child has measles, what 3 tests can you do to confirm your suspicion?
What other precautions should be taken?
- RT-PCR
- IgM (active dz)
- IgG (acute or recovery stage)
put in isolation room, call health dept
worst complications of Measles? what type of dz is it?
when does it occur?
Others:
- PNA
- diarrhea
- encephalitis
SSPE (subacute sclerosing panencephalitis)
- progressive CNS dz
- occurs 7-10 yrs after Measles
Tx for kids w/Measles under age 2
- what is the benefit of this treatment
Vitamin A –> decr mortality
Classic presentation that occurs 48hrs that is a/w Mumps
Parotitis - swollen parotid gland (neck/face)
“Bump’s b/c of Mumps”
Child presents w/swollen neck and blurred angle of the jaw. What labs could be ordered/what seen to confirm the Dx (although not necessary - clinical dx)?
amylase (elevated)
lymphopenia
Dx = Mumps
Possible 5 complications that can occur w/Mumps?
- SHL
- Encephalitis
- Aeseptic Menigitis
4/5. Orchits or oophoritis
Tx for mumps:
What type of precautions? How long to isolate at home?
- droplet precautions
- isolate for 5 days after onset of Sxs
A child is brought in by his pregnant mother. He has had 3 days of low grade fever and LAD w/onset of a faint pink maculopapular rash that spread from the head down. What should you be concerned about?
Concerned about the pregnant mother
- she cant get the live virus Rubella vaccine to protect her against congenital Rubella syndrome
When is worse to acquire a Congenital Rubella Syndrome? Classic Triad in this time period?
What type of infection is Congenital Rubella Syndrome?
in the 1st trimester
- Cataracts, Cardiac defects, Deafness
TORCH infxn
A baby is born w/HSM and jaundice, microcephaly and has “blueberry muffin top lesions”. What is the dx?
What are “blueberry muffin top lesions” and what are they d/t?
What other TORCH infxn could cause these type of lesions?
Congenital Rubella Syndrome
“blueberry muffin top lesions” = purpura from low plts
- DDX = CMV
Girl w/SCD comes in w/ lacy rash on extensor surfaces of arms, trunk and neck. She had bright red cheeks a few days ago. Labs show low retics and anemia. What is the Dx? Cause?
What complication are you concerned about d/t low retics and anemia? Why? Tx?
Dx = 5th Dz (Erythema Infectiosum) Cause = Parvovirus B19
Concern –> aplastic anemia b/c she has hemolytic anemia
- she may need a transfusion
What does Erythema Infectiosum (5th Dz) cause if an intrauterine infection occurs?
Hydrops Fetalis
Cause of Roseola Infantum? Other name for this d/o?
Cause = Human Herpesvirus-6 (HHV-6)
Roseola Infantum = 6th Dz
Child presents w/ blanching, pink, maculopapular rash that started on neck/trunk then spread to face/extremities. A few days prior she had extremely high fever lasting 4 days and experienced one generalized seizure. Dx?
When do you become concerned about seizures?
Roseola Infantum/6th Dz
Concern about seizures if focal and more than 1 in 24hrs
What types of pts does eczema herpeticum usu occur in?
Cause?
kids w/atopic dermatitis or immunocompromised
Cause = HSV
Child presents w/ 1 day fever and “punched out” lesions (pustular/vesicular) that are very painful. What is the best Tx for her based on Dx?
What 2 signs indicate a bacterial superinfxn?
Tx = Acyclovir + anti-Staph ABX (+/- IVFs) Dx = Ezcema Herpeticum (caused by HSV)
swelling, erythema –> bacterial superinfxn
How to Dx Varicella Zoster?
Tx for kids > 12 or immunocompromised?
Med for supportive care?
Who should avoid contact w/these pts?
Clinically or scraping a vesicle
Tx
- cyclovirs
- Non-ASA antipyretics
any pregnant should avoid contact
Child w/cancer presents w/painful rash in single dermatome that originally tingled. What is Dx?
why does she need Tx, what are 2 other reasons to Tx? what is Tx?
Dx = Herpes Zoster (Shingles)
Tx needed b/c she is immunocompromised
- also tx if: > 12 or trigeminal area affected
- Acyclovir, Topical Antipruritics, PO analgesics
Child presents w/flesh-colored umbilicated, fluid filled pustules that all appear all over their body except palms and soles. pt denies pruritus.
What is Dx?
Tx needed?
Dx = Molluscum Contagiosum
Tx not needed
- options: cryotherapy; curettage or Cantharidin (removal)
2 y/o girl presents w/fever, generalized erythema w/flacid bullae in skin folds but no mucous membranes are involved. Some bullae have ruptured and have blistered over.
Best Tx for her?
(Dx?)
Tx = Admit –> ABX
- Naficillin, Clinda, Vanco
Dx = Scalded Skin Syndrome
3 y/o boy presents w/rapid onset of fever, HA, vomiting and intense leg pain. He also has non-blanching purpuric rash that is seen on extremities/trunk and positive Kernig’s sign.
What are you concerned he could progress to?
What is best management for this pt?
(dx?)
Progress quickly to AMS, shock, DIC
Tx = IV Ceftriaxone x 7 days
- dont wait more than 30 min to give to get CSF culture
Dx = Neisseria Meningiditis
Cause of Lyme dz? How spread?
Borrellia burgdorferi (spirochete)
spread by tic bite
Features seen in each phase of presentation for Lyme Dz
- Early localized
- Early Disseminated
- Late
- Early localized –> erythema nigrans (target lesion)
- Early Disseminated –> multiple erythema nigrans +
cardiac, neuro or non-spp Sxs - Late - arthritis in large joint
Tx for Lyme Dz: indications for
- Doxycycline
- Amoxicillin
- IV Ceftriaxone
- Doxycycline
- early localized and > 8 y/o
- early dissem: facial nerve palsy, 1st degree AV block
- late dz + NO neuro Dz - Amoxicillin
- early localized and < 8 y/o
- early dissem (same as Doxy) - IV Ceftriaxone
- worse early dissem: meningitis, 2nd/3rd degree block
- Late Dz + Neuro Sx
When does tissue damage occur in hyperthermia from fever
not until sustained temp b/t 41-42 C
describe typical fever presentation by age group:
- Neonates
- Older infants/young kids
- older kids/adolescents
- Neonates –> +/- febrile response –> may be HYPOthermic
- Older infants/young kids –> +/- exag febrile response
- older kids/adolescents –> unlikely to have high fever
3 General Tx options for fever (regardless of age)
- Acetaminophen
- Ibuprofen
- Alternating/combining 1 and 2
General Tx options for fever:
- Acetaminophen: what is risk?
- Ibuprofen: what age group must it be used in?
- Alternating/combining 1 and 2: what is benefit?
- Acetaminophen–> risk of hepatotoxicity w/chronic use and OD
- Ibuprofen–> must be < 6 mo –> risk of nephrotoxicity w/dehydration
- Alternating/combining 1 and 2 –> incr efficacy in lower temp
in kids < 3 mo which age group is at highest risk for IBI (invasive bacterial infxn)–> bacteremia, menigitis?
Tx for infants 28 days - 3 mo old?
infants < 28 days old
28 days - 3 mo old –> IM/IV Ceftriaxone or observation
What criteria must be met for a child w/ a fever to be treated in the outpatient setting?
- child 28 days - 3 mo of age
- must be low risk criteria
- reliable f/u in 24 hrs
Workup for _______ and ______
- Admit
- Workup
- cultures: blood, urine, CSF
- resp Sxs –> XR
- diarrhea –> stool study
- consider HSV if febrile + < 4 wks - broad spectrum IV `ABXs
Workup for infants < 3 mo + appear ill and ALL infants < 28 days
Definition of Fever of Unknown Origin (FUO)
How to manage FUO (2 things)?
Fever > 14 days + NO identified cause
Tx
- AVOID ABXs
- antipyretics + fluids
What are the 3 MC causes of FUO? What is unique about their presentation?
- sinusitis
- UTI
- septic arthritis
- uncommon/prolonged presentations of these illnesses
