Module 14 - Derm Flashcards
Examination of a healthy 3-day-old neonate shows multiple small, firm white papules on his cheeks and nose. The rest of the physical exam is normal. What is the best initial step in the management of this patient’s condition?
A. Incision and drainage
B. Electrocautery
C. Salicylic acid peel
D. Reassurance
D. Reassurance
Milia
Milia
(keratin filled)
- Often mistaken for whiteheads but they are not filled with pus
- Keratin filled
- Milia are called milk spots and usually seen on the face and eyelids
- These are harmless and do not require any treatment
- Reassurance
A 32-year-old female develops a pruritic, fine-scaling rash most prominent on her trunk. The rash was preceded by a 4-centimeter, red, scaling plaque. The lesions are maculopapular and follow the lines of skin cleavage. A few days before the rash appeared, the patient had a headache, sore throat, mild fever, and fatigue. Which of the following is most likely associated with this patient’s suspected condition?
A. Herald patch
B. Bullseye appearance
C. Vesicular appearance
D. Butterfly rash
A. Herald patch
Pityriasis rosea
- Pityriasis rosea is an acute maculopapular exanthem along the Langer’s lines of cleavage, giving characteristic “Christmas-tree” appearance that is usually preceded by a 2 to 5 centimeter erythematous, scaling lesion referred to as a herald patch.
- Pityriasis rosea affects the trunk and proximal extremities. Pityriasis rosea most often occurs in adolescents and young adults.
A 17-year-old boy is brought to the clinic with a 10-day history of a mildly pruritic rash on the trunk that started with a 3 cm solitary lesion. The patient has no significant medical history, unusual exposures, or medications. There are hyperpigmented plaques in a symmetric distribution on his trunk, but no lesions are noted on his face. The patient states that just before the more widespread rash, he remembers seeing a single pink lesion on his left upper back. On closer inspection, a 3 cm pink plaque with a fine central scale and an advancing border is noted on his left upper back. The patient is concerned about the rash. What should the clinician tell the patient about the prognosis, pathogenesis, and treatment of the disease?
A. As this is a malignant process, the patient should be referred to oncology for systemic chemotherapy.
B. As this is a self-limited process, it will resolve spontaneously and likely without the need for treatment within 6 to 8 weeks.
C. As this is an infectious process, the patient should be prescribed 6 to 8 weeks of antibiotics.
D. As this is an autoimmune condition, the patient should be prescribed high-dose systemic corticosteroids.
B. As this is a self-limited process, it will resolve spontaneously and likely without the need for treatment within 6 to 8 weeks.
Pity Rose
A 2-month-old child presents with a reddish-purple swelling on the right upper eyelid. The swelling is gradually increasing in size and causing mechanical ptosis. An MRI shows an ill-defined soft tissue mass in the superonasal extraconal compartment, which is isointense on T1W1 and hyperintense on T2W2. On gadolinium contrast, it shows brilliant enhancement with internal flow voids. What is the first-line treatment for this infant’s most likely condition?
A. Bleomycin injections
B. Topical timolol
C. Systemic corticosteroids
D. Oral propranolol
D. Oral propranolol
Hemangioma
A 10-year-old boy presents with a bluish plaque on his back that appeared a few months after his birth, grew in size, and has now remained the same size for some time. The patient is in good health and has no complaints On physical examination, the lesion on the left lower back is 5 cm in diameter, symmetrical, and blue in color. What is the most appropriate management of this complaint?
A. Propranolol
B. Prednisolone
C. Pulsed dye laser
D. No treatment required
D. No treatment required
Hemangioma
- Blanch with pressure and may increase in size after birth
- Can be treated with topical beta blockers but typically reassurance
Intertrigo, clinical exam findings
Commonly presents in the pediatric population as a form of diaper dermatitis
Wet diapers are the main causative cfactor in this population
Excess moisture trapped inside the diaper predisposes the individual to inflammation
A 9-month-old boy presents to the clinic for a one-week follow-up after being treated for an erythematous rash over the diaper area. The parents have been following the clinician’s advice on frequent diaper changes and using a topical emollient with every diaper change. However, the rash has worsened. Physical examination demonstrates bright red plaques on the buttocks, inguinal folds, and scrotum with scattered erythematous papules and pustules. What is the most likely cause of the exacerbation of this infant’s rash?
A. Irritant contact dermatitis
B. Superimposed infection with Candida albicans
C. Allergic contact dermatitis
D. Superimposed bacterial infection
B. Superimposed infection with Candida albicans
Diaper Dermatitis
- Emollients and not wet
- If Candid: beefy red plaques with characteristic satellite pustules or papules. The rash can be present in the skin folds, which helps differentiate it from irritant dermatitis.
IF NO SATELLITE DONT TREAT FOR FUNGAL
Treatment:
A 10-month-old boy presents with a persistent diaper rash over the last three days. His parents report that the rash developed after a bout of diarrhea that is still ongoing. They have used zinc oxide paste without much improvement. He has no significant past medical history and takes no medication. He is currently bottle-fed and eats some solid foods. On examination, he is well appearing, and his rectal temperature is 98.1 F (36.7 C). There is a large, erythematous, glossy patch overlying his lower abdomen, buttocks, and medial thighs, with sparing of the inguinal folds. Several shallow erosions are noted. What is the best next step in the treatment of this patient?
A. Talcum powder
B. Topical antifungal agent
C. Low-potency topical corticosteroid
D. High-potency topical corticosteroid
C. Low-potency topical corticosteroid
bc of the diarrhea
A 5-month-old baby girl was referred to health care providers due to a rash around the diaper area. On physical examination, you note erythema and scaly plaques, accompanied by edema, with a few satellite papules, located over the buttocks, anterior thighs, and involving the inguinal folds. Which of the following is the treatment of choice for this presentation?
A. Nystatin cream
B. Mupirocin cream
C. Low potency corticosteroids
D. Petrolatum ointment
A. Nystatin cream
SATELLITE AND INGUINAL FOLDS
A 2-month-old male presents to the clinic for a well-child care visit. He is up to date on his vaccinations. He was delivered at 38 weeks gestations and the delivery was uneventful. He is currently breastfed. Her mother tells you that her older son had several episodes of diaper dermatitis during infancy. She is asking what is the best way to prevent this from happening to the baby. Which is the most appropriate response by the provider?
A. Wait several hours in between diaper changes
B. Use of topical emollients at least twice a week
C. Switching from breastfeeding to formula feeding
D. Use soap containing cleanser
B. Use of topical emollients at least twice a week
A 2-month-old infant is brought in by his parents for evaluation of a red rash on his inguinal folds. On examination, there are beefy red plaques with sharp margins and surrounding scale with satellite lesions. Which of the following topical treatments is the most appropriate treatment for this infant?
A. Zinc oxide paste
B. Bacitracin ointment
C. Triamcinolone cream
D. Clotrimazole cream
D. Clotrimazole cream
SATELLITE
A 14-year-old female presents for a follow-up visit with a two-month history of lesions around her left eye. Despite watchful waiting, the lesions have increased in number and size. The patient admits to severe itching and rubbing her eye on and off. She has treated the lesions with a topical lotion to relieve the itching. HIV testing was negative. A detailed ocular examination is shown in the figure below. Visual acuity is 20/20. The mother states that she is concerned about the cosmetic appearance of her daughter. What is the best next step in management?
A. Topical antipruritic ointment and wait for self-resolution
B. Topical steroids and incisional biopsy
C. Surgical removal with cryotherapy or curettage
D. Cidofovir
C. Surgical removal with cryotherapy or curettage
mulloscum
Molluscum contagiosum
Lesions are transmitted by direct skin to skin (including sexual) or indirect (towels, toys, razors, tattoo supplies) contact
May also disseminate by autoinoculation to normal skin after Mollusca scraping by the patients
Presentation: also called water warts, dome shaped, round, pink/purple color, flesh colored, dimple middle indentation
Risk Factors: sexual transmission, immunocompromised
Treatment: watch it, 4-8weeks resolve
- 1st line: Cryotherapy
- 2nd line: Topical salicylic acid and imiquimod
