Pediatric Dermatology

Question 1

• causes orolabial, genital and congential infections
• transmission occurs during asymptomatic and symptomatic periods of viral shedding
• majority of seropositive individuals report having no history of genital herpes infection
• prodrome of tender LAD, malaise, fever, localized pain, tenderness and burning
• symptoms appear 3 to 7 days after exposure
• usually presents as gingivostomatitis in children or pharyngitis and a mononucleosis-like syndrome in YA

Answer 1

Herpes simplex virus

HSV 1

• primarily associated with oral and labial lesions
• largely a childhood disease of oral mucosa, pharynx, lips and occasionally eyes

HSV 2

• primarily associated with anogenital lesions
• commonly spread via a sexual contact or neonates by passage through an infected birth canal

Question 2

• ooccurs in atopic dermatitis
• often acute worsening of the eczema (widespread eruption of monomorphic vessels and erosions, especially in areas of active eczema
• often with fever, adenopathy, irritability
• treatment: IV antivirals typically

Answer 2

HSV: Eczema herpeticum

Question 3

HSV treatment

Answer 3

Primary Orolabial

• self-limited but may treat if poor intake and dehydration
• most effective when started early (within 72 hrs of onset)
• acyclovir, valacyclovir for recurrent treatment

Question 4

• prodrome of mild fever, malaise and myalgia
• pruitic, erythematous macules and papules–> vesicles surrounded by red halos (dew drops on a rose petal–> pustules and crusts
• starts on the scalp and face then spread to the trunk and extremities. often involvement of the oral mucosa
• heals within 7 to 10 days
• lesions in all stages of development is the hallmark
• usually benign and self limited

Answer 4

Varicella

Question 5

complications of varicella?

Answer 5

• secondary bacterial infection with subsequent scarring is the most common complication
• reye’s syndrome, encephalitis and acute cerebellar ataxia are rare
• primary varicella in adults often more severe with more complications
• Congenital: low birthweight, cicatrical lesions, ocular abnormalities, cortical atrophy, psychomotor retardation and hypoplastic limbs

Question 6

• 3 c’s: cough, coryza and conjunctivitis
• prodrome of fever, cough, nasal congestion and rhinoconjunctivitis and koplik spots (gray- white papules on the buccal mucosa
• erythematous macules and papules begin on the forehead, hairline and behind the ears then spreads downward onto the trunk
• on 5th day exanthem starts to fade in the same order that it happened

tx: supportive, two dose vaccine

Answer 6

measles

Question 7

complications of measles?

Answer 7

• otitis, pneumonia, gastroenteritis, enecephalitis and myocarditis
• subacute sclerosing panencephalitis (delayed neurodegenerative disorder may occur many years later)

Question 8

• Aka Erythema infectiousum
• caused by parvovirus B19, a single stranded DNA virus
• transmission by respiratory secretions, blood products and vertical
• peak incidence during winter and spring
• most common in school-aged children
• may begin with mild prodrome of headaches, fever, chills or respiratory symptoms
• 2-3 days after prodrome, bright red macular erythema of the cheeks (slapped cheeks) spares nasal bridge and perioral areas
• 1-4 days after facial rash, erythematous macules and papules which progress to a lacy, reticulate pattern

Answer 8

fifth disease

Question 9

• Aka exanthem subitum or sixth disease
• causes by human herpes virus (HHV) 6 or 7
• transmission: saliva, horizontal
• most common in ages 6mon-3yrs
• peak incidence is 6-7 months
• high fever in infant who otherwise appears well
• diffuse rash appears after abrupt defervescence –> rose-pink macules and papules on the trunk, neck, proximal extremities and ocassionally face

tx: supportive, antipyretics

Answer 9

Roseola

Question 10

• caused most frequently by cosackie A16 (enterovirus)
• peak incidence is later summer and fall
• incubation is 4-6 days
• 1-2 day prodrome of fever, malaise, sore throat
• gray oral vesicles on red or flesh colored base on hands, feet (can also occur on buttocks, trunk face, and extremities: usually burn or pruritic)
• Vesicles rapidly ulcerate in mouth to leave erosions on tongue, buccal mucosa, posterior pharynx
• tx: supportive; usually clears in < 1 week

Answer 10

Hand-foot-mouth diseae

Question 11

types of diaper dermatitis?

Answer 11

• infant dermatitis
• candidiasis
• seborrheic dermatitis

Question 12

• due to moisture, feces, urine, bacteria,
• erythematous patches +/-blisters and erosions
• buttocks, vulva, perianal area, lower abdomen and proximal thighs
• spares skin folds

Answer 12

irritant contact dermatitis

Question 13

• c.albicans
• beefy red erythema
• erythematous papules that involve skin folds, with pinpoint pustulovesicular satellite lesions
• atopic dermatitis typically spares the groin and diaper area during infancy due to increased hydration/moisture

Answer 13

candidiasis

Question 14

• salmon colored greasy plaques with yellowish scale
• hypersensitivity to overgrowth of normal lipophilic yeast
• areas with the highest concentration of sebaceous glands- namely the scalp, face, postauricular, presternal and intertriginous areas
• erythematous, yellowish greasy scale or crusting eruption
• “cradle cap”
• tx: self limited- ketoconazole shampoo, topical corticosteroid to treat the infammation

Answer 14

seborrheic dermatitis

Question 15

• most commonly due to C. albicans followed by C. Trpicalis
• tongue, soft and hard palate and buccal and gingival mucosae
• white, friable patches or plaques overlying reddened mucosa
• predisposing factors in children and adults (diabetes mellitus, xerostomia, occlusion, hyperhidrosis, the use of corticosteroids and broad spectrum antibitotics and immunosuppresion, including HIV infection

Answer 15

Thrush

DX: clinical, KOH shows budding yeast, fungal culture

tx: nystatin oral suspension

Question 16

• most common benign soft tissue tumor of infancy
• more common in white infants
• most become apparent first 2-3 weeks of life
• if noted at birth, can be fully formed or more commonly show a precursor lesions
• three phases: period of growth (proliferative phase), period stability (plateau phase), period of regression(involution phase)

Answer 16

Hemangioma of infancy

Question 17

• constellation of clinical findings associated with extensive infantile hemangiomas
• majority female
• facial hemangiomas are usually large and sefmental
• hemangiomas may also occur in other non-facial locations inluding upper torso and arms
• screening with MRI of brain, echocardiography, opthalmologic examination and close neurologic and head circumference examination

Answer 17

PHACES syndrome

Question 18

Treatment of hemangioma of infancy

Answer 18

• active non-intervention
• local wound care for ulcerated hemangiomas
• current standard of care: oral beta-blocker propranolol
• topical beta-blocker timolol for smaller, localized and/or superficial
• topical or intralesional corticosteroids for localized superficial lesions
• oral corticosteroids

Question 19

• Isolated or multiple lesions
• multiple lesions sometimes a marker for multi system disease in various syndromes
• may be present at birth, but usually become obvious during early childhood
• located anywhere on the body, except mucous membranes
• color of coffee with milk, light to dark brown

Answer 19

Cafe au lait

Question 20

• Triad: cafe au lait macules, polyostotic fibrous dysplasia and precocious puberty
• cafe au lait macules typically in fewer in number, larger, darker and may follow blaschko’s lines
• predelection for areas with bony prominences: forehead, nuchal area, thorax, sacrum and buttocks
• commonly unilateral
• can be indistinguishable from cafe au lait macules in neurofibromatosis - axillary freckling does not occur

Answer 20

McCune-Albright syndrome

Question 21

diagnostic criteria for neurofibromatosis 1

Answer 21

• 6 or more cafe au lait macules measuring >5mm before puberty and > 15mm in post pubertal (usually in first year of life)
• freckling of axillary and or inguinal areas
• 2 or more neurofibromas or 1 plexiform neurofibroma (usually at puberty)
• 2 or more lisch nodules (iris hamartomas)
• optic nerve glioma
• skeletal dysplasia; (i.e tibial or sphenoid wing dysplasia
• 1st degree relative with NF1