Pediatric Derm

Question 1

2 week old baby with funny bumps all over her nose
- noticed at birth
- on nose
- always there
- increasing in number

Answer 1

Milia

Question 2

Answer 2

Bohn Nodules (Milia)

Question 3

Answer 3

Epstein Pearls (Milia)

Question 4

6 week old baby with tiny blisters on body
- started a week ago
- head, neck, trunk
- always there but wax and wane
- vesicles appear, rupture, desquamate
- worse when hot, better when cool

Answer 4

Miliaria

Question 5

Answer 5

miliaria crystalline
-superficial eccrine closure
-usually no erythema
-hours to days

Question 6

Answer 6

miliaria rubra (heat rash)
-deeper sweat gland obstruction
-erythematous papules

Question 7

2 week old baby with rash on face after coming home from hospital
- 2 weeks ago
- face
- constant
- gotten worse

Answer 7

Acne noeonatorum (baby acne)
- tx: reassurance

Question 8

Answer 8

Baby acne
- 20% newborns
- open comedones/closed comedones
- stimulation of sebaceous glands by androgens
- no tx indicated or benzoyl peroxide lotion 2.5%

Question 9

2 week old infant blisters on skin leaving dark spots
-coming home from hospital
-chin, neck, forehead, chest, arms
-go away in 2 days but leaves macules

Answer 9

Transient neonatal pustular melanosis

DDx: congenital herpes simplex (will have erythematous base)

Tx: reassurance

Question 10

Answer 10

Neonatal Herpes Simplex Virus
- vertical transmission of HSV
- needs to be identified and treated

Question 11

4 month old with something on her face that is growing
- noticed at birth but smaller
- R side scalp
- 3 mos of growth
- deep red/purple, raised, large mass

Answer 11

Hemangioma of Infancy

Tx: reassure or refer, can spontaneously resolve but consider laser, cryo, steroids

-mutation of genes regulating endothelial cell proliferation
- superficial: bright red strawberry
-deep: blue or skin colored
-mixed: deep and superficial parts

Question 12

Answer 12

Hemangioma of Infancy

Question 13

Answer 13

PHACE syndrome

-Posterior fossa brain malformations
-large segmental infantile Hemangioma
-Arterial anomalies
-Cardiac anomalies
-Eye and Endocrine anomalies
-possible clefts

Question 14

1 week old baby with really large red spot on R side of face
- red skin, diffuse, no lumps or bruising

Answer 14

port wine stain/nevus flammeus
-Tx: reassurance vs referral

-blanchable pink/red patch
-unilateral, somewhat dermatomal
-will grow with child/thicker/darker
-cosmetic treatment

Question 15

Sturge-Weber syndrome

Answer 15

-port wine stain surrounding eye
-risk of glaucoma, seizures, intellectual disability
-refer to specialists

Question 16

1 week old baby with large red spot on neck
- nape of neck
- pink red

Answer 16

Nevus Simplex/Stork Bite/Angel Kiss/Salmon patch
-capillary malformation
-blanchable
-fades in 1-2 years
-look for sinus or pit, patch of hair for underlying spinal abnormalities if located at lumbosacral area

Question 17

1 week old baby with large blue spot on back at birth
- above buttocks, back
-bluish gray, looks like bruising

Answer 17

congenital dermal melanocytosis/slate gray nevus (used to be called Mongolian spot)

Tx: reassure and document

• delayed disappearance of dermal melanocytes
• completely benign, usually fade in 1-2 years and gone by age 6-10

Question 18

2 year old girl large spots getting darker
- early infancy
- trunk
- always there
- getting darker

Answer 18

cafe au lait spots

Tx: reassurance (refer or laser)

• early infancy and enlarge until about age 2
• vary in color
• caused by an increase in melanin/giant melanosomes
• smooth or irregular borders
• size and number varies
  -may be a marker of other genetic conditions/abnormalities and is observed in 95% of pts with neurofibromatosis type 1 (NF1) with 6 or more lesions

Question 19

2 month old with scales on head
- scalp
- 1 month
- gradually getting worse

Answer 19

Seborrheic dermatitis/cradle cap

Tx: gentle washing with emollients, antifungals or dandruff shampoo if suspecting fungus

• can be secondary to malassezia, biotin insufficiency, overactive sebaceous glands, immune disorders

Question 20

5 year old girl with rash on face
- 1 day
- both cheeks
- sudden and unchanging
- URI syx a few weeks ago that resolved
- nothing alleviating

Answer 20

Erythema infectiosum (5th Disease)

Tx: reassurance, tx for underlying symptoms

• parvovirus B19
• prodromal symptoms a week after exposure lasting a few days

Question 21

Phases of erythema infectiosum

Answer 21

1: 2-4 days slapped-cheek appearance

2: erythematous maculopapular rash that fades into reticular pattern

3: clearing and recurrence for weeks to months with exercise, irritation, stress, heat

Question 22

Answer 22

Erythema Infectiosum (Fifth disease)