missed rosh review - DERM Flashcards
This condition is a toxin-mediated bacterial skin disorder that primarily affects young children ages 0-6. Characteristics include erythroderma and blisters in area w/ high mechanical stress
staph scalded skin syndrome (SSSS)
what is the clinical characteristic of SSSS
- diffuse skin pain, erythema, superficial blisters, and desquamation
- prodrome of low-grade fever, irritability, poor oral intake, impetiginous lesions and bacterial conjunctivitis
- + Nikolsky sign
- blisters in areas of mechanical stress
what is the classic sign known as SSSS sad face?
thick perioral crusting with a dried oatmeal appearance that can develop around the mouth, nose, and sometimees eyes
what is a significance of difference between SSS and SJS/TEN
SSSS typically does NOT have mucous membrane involvement
what is the first line tx of SSSS
IV abx: penicillinase-resistant penicillin (oxacillin, nafcillin)
what is the most common type of psoriasis in children?
chronic plaque psoriasis
is psoriasis typically on EXTENSOR or FLEXOR surfaces
EXTENSOR - elbows and knees
what are the key clinical features of plaque psoriasis?
- well demarcated, erythematous placques with a overlying silvery-white scaling
- elbows and knees are most common site
- SYMMETRIC
- children - involvement of face, scalp, and intertriginous areas
what is the treatment for plaque psoriasis?
< 10% BSA - topical corticosteroid (dexamethosone, indamethasone)
> 10% BSA - systemic or phototherapy (methotrexate, biologics)
intreginous - calcinerin inhibitors
what is the cause of lesions presentign as small erythematous papules with linear tracts/burrows on the pals, soles, wrists, axillae, waist, genitalia, and buttock?
scabies
what is the treatment for scabies
1st line in kids (>2mo) = topical permethrine
infancts < 2 mo and pregnant patients = topical sulfur
oral ivermectin is effective, but not recomended for children < 5y/o
what is different in estimating the BSA% of burns in infants < 1 y/o?
- head - 19%
- arm - 7% ea.
- ant. trunk - 13%
- post. trunk - 13%
- leg - 13% ea.
only partial-thickness and full thickness burns are included in the estimation
Excess of what hormone leads to androgenic alopecia?
**dihydrotestosterone (DHT)
**
* why? –> high a-5 reductase levels, which promotes conversion of testosterone to DHT
* high DHT levels result in shortening of anagen (growth) phase -> follicular miniaturization and loss of terminal hair fibers
clinical characteristics of androgenic alopecia?
- follicular miniaturization (shorter, thinner, vellus hairs)
- loss of terminal hair fibers
- ASYMPTOMATIC –> no itching, burning, or tenderness of the scalp
- NO inflammation or scarring present
- Location: midfrontal scalp, temporal scalp, or VERTEX
treatment of androgenic alopecia? how do they work?
1st line agents: topical minoxidil and oral finasteride
* minoxidil - promotes duration of anagen phase and enlarges miniaturized follicles by vasodilation
* finesteride - 5-alpha-reductase inhibitor, lowers serum and scalp levels
definitive: surgical hair transplant
which exanthem is tetarogenic if maternal infection occurs (esp in 1st tri)
Rubella
what are the clinical manifestations of congenital rubella syndrome?
*** decreased hearing
* cataracts
* cardiac dz **
* fetal growth restriction
* infantile glaucoma
* petechiae and purpura that appears as a blueberry muffin rash
* hemolytic anemia
Which congenital condition is Hutchinson teeth, or peg-like incisors or molars, associated with?
Congenital syphilis
what is the first line self-administered vs. clinician-administered treatment for warts?
self - salicylic acid (painless, best for younger children)
clinician - cryotherapy (painful, better for older children and adults)
causes of cutaneous and genital warts?
soles and palms - HPV 1
common warts - HPV 2 & 4
genital - HPV 6 & 11
how are TEN and SJS differentiated
Toxic epidermal necrolysis and Stevens-Johnson syndrome are differentiated by the percent of total body surface area involved, with the former including > 30% and the latter including < 10%. These conditions overlap in patients with skin detachment of 10–30% of total body surface area.
treatment for SJS/TEN
stop the offending agent, supportive care and crystalloid administration, transfer to specialized center
* high risk for electrolyte imbalance and infection!!!
clinical manifestations of SJS/TEN
- widespread blistering and sloughing of the skin and mucous membranes
- begins with diffusely red, sunburn-like tender skin with scattered target lesions and bullae
- Bullae coalesce as the disease progresses
- full-thickness epidermal necrosis and detachment –> skin sloughing
- **lesions typically originate on the face and trunk before spreading to distal extremities **
what are the clinical manifestations of atopic dermatitis (eczema)
- birth to 2 years of age, patients typically present with lesions on extensor surfaces, face, and scalp
- diaper area is usually spared
- older children, the lesions are drier and are more notable on flexural surfaces, like in elbow and knee creases and neck folds
- lichenification
what locations are commonly involved in nummular eczema?
legs and upper extremities
*if face and neck involved –> think alternative dx
What laboratory test rules out scabies infection?
Mineral oil slide preparation.
physical exam findings of candidal diaper dermatitis
beefy red plaques, inguinal folds with papular** satellite lesions**
how does irriatant contact dermatitis from diaper differ from candidal infection?
Irritant contact diaper dermatitis presents as red, scaly, eroded, painful plaques on the convex surfaces of the groin, buttocks, and lower abdomen. The inguinal and gluteal folds are spared
Candidal diaper dermatitis presents with bright red (beefy red) plaques in the inguinal and gluteal folds with satellite pustules.
treatment for infantile seborrheic dermatitis (craddle cap)
self-limited, with treatment involving gentle removal of scale using warm olive or** mineral oil** and a low-strength corticosteroid
what causes molluscum contagiosum?
poxvirus
what are the clincial characteristics of molluscum contagiosum?
characterized by a firm, flesh-colored, dome-shaped papule with a shiny surface and central umbilication
what is the tx for molluscum contagiosum?
First-line treatment options include cryotherapy, curettage, and cantharidin
what is the MCC of erythema multiforme?
HSV
other: Mycoplasma pneumoniae
Drugs: sulfa, oral hypoglycemics, anticonvulsants, penicillin, NSAIDs (SOAPS)
what is the preferred tx of erythema multiform in children?
acyclovir 20 mg/kg for 6 mo
