Pediatric Dermatology Flashcards
Type of burns
First degree
-dry, red, no blisters, insoles EPIDERMIS only
Second degree
-(PARTIAL THICKNESS), moist, blisters, extends beyond epidermis
Third Degree
-(FULL THICKNESS), dry leathery, black, pearly, waxy, extend from epidermis,is to dermis to underlying tissues, fat, MUSCLE and/or BONE
how do you measure burn injuries in pediatrics
“rule of nines”
9%-head, front upper torso, back upper torso, front lower torso, back lower torso, front right leg, front left leg, back right leg, back left leg
4.5% each right arm, left arm
1% groin
Primary Management for burns in pediatrics
Assess ABCs, might require intubation if
-singed nares or eyebrows
-evaluate nares/mouth for soot/mucous
-DRENCH the burn w/ cool (NOT ICE) water
Evaluation of Skin Disorders 3 types
-morphology
-configuration
-distribution
lesion that developes on previously unaltered skin
primary lesion
Secondary skin lesion
lesion that either changes impression over time or occurs when a primary lesion is scratched (excoriation) it may become infected
flat discoloration skin lesion
Macule
ex. ephelides (freckles)
petechiae
flat nevi (moles)
Flat discoloration that looks as though it is a collection of multiple, tiny pigment changes, may be some subtle surface changes
Patch
ex. mongolian spot
-cafe au lait spot
elevated firm lesion >1cm
nodule
ex. Xanthoma
fibroma
Firm elevated lump
Tumor
ex-benign or malignant
small <1cm, elevated, firm skin lesion
Papule
example, ant bite
-elevated nevus (mole)
-verruca (wart)
Scaly, elevated lesion
Plaque
ex. classic psoriasis
Small <1cm lesion filled with serious fluid
Vesicle
ex. herpes simplex
varicella (chicken pox)
Serous fluid-filled vesicles >1cm
Bulla
ex. Burns
-superficial blister (sports runners)
-contact dermatitis
Lesion raised above the surface and extending a bit below the. spiders, many times and allergic reaction.
Wheal
ex. PPD test
-mosquito bites
Small <1 cm pus filled lesion
Pustule
ex: acne and impetigo
A pus filled lesion >1cm
Abscess
Large, raised lesions with serous fluid, blood, and pus
cyst
configuration of skin lesions
- solitary or discreet
-individuale or distinct lesions
ex. warts, ringworm - grouped
-linear cluster
ex. herpes simplex - confluent
-lesiomn that run together
ex. measles, urticaria
4.linear
-scratch, streak, line or stripe
ex. contact dermatitis, scratching
- annular
-circular, beginning in the center and spreading to the periphery
ex. tina corporis, erythema multiforme - Polycyclic
-annular lesions merge
ex. erythema ,multiforme, lips erythematosus
Distribution of a lesion?
where the lesion appear on the body
Acne
polymorphic skin disorder characterized by comedones, papule, pustules, and cysts
Open comedones
blackheads
Closed comedones
whiteheads
-obstructed opening which may rupture, causing low-grade local inflammatory reaction
Mild Acne Tx
- benzoyl peroxide (2.5%-10%)
- Tretinoin
-applied at night and not used concomitantly w/ benzoyl peroxide
-too much can burn skin
-decreases bacteria on skin - may need to decrease strength or duration of application for excess redness/ irritation
*do not stop but decrease - salicylic acid preparations
- Topical ABX, Erythromycin or clindamycin lotions or pads
Moderate Acne Tx
-cyclines first then macrocodes
- Doxycycline 50-100mg BID or 100mg QD
-Minocycline 50-100mg BID
*teeth discoloration
*DO NOT GIVE TOP <8year olds - Erythromycin (Macrolide)
-tends to upset stomach
Severe Acne Tx
refer to Dermatology
Fungal Infections in pediatrics
AKA Yeast, Candida, Fungus
most common Trichophyton
other Microsporum
Round bald spot, fungal infection
tine capitis (scalp)
Body ringworm, fungal infection
Tinea corporis
-raise border
-central clearing
*no bullseye
Jock itch
Tinea Cruris
fungal infection of hands and Athletes foot
Tinea manuum and *Tinea pedis
Tinea Versicolor
fungal infection causing hyper/hypo pigmentation macules on limbs
Skin Scrappings lab test
“spaghetti and meatballs” hyphae microscopically when treated w/ potassium hydroxide (KOH)
Tinea Capitis Tx
-griseofulvin 20-25mg/kg/day for 6-8 weeks
Tinea Corporis Tx
Miconazole 2%, Ketocconazole 2%
Tinea Versicolor Tx
Selenium Sulfide Shampoo
Chicken Pox/ Varicella Zoster Virus
acute contagious disease caused by herpes virus, transmitted by direct contact with lesions or AIRBORNE
*Dew Drop on a Rose Petal
-infected individuals are CONTAGIOUS FOR 48HOURS BEFORE outbreak and until lesions have crusted over
S/S of Varicella Zoster Virus
*Papules develop over macule
*intense pruritis
*generalized lymphadenopathy
-Vesicules erupt: usually distributes on the trunk, then scalp and face
Varicella Zoster VIrus Tx
*oral acyclovir 20mg/kg 5 times a day
-calamine/caladryl lotion (pink lotion)
-antihistamine
-acetaminophen
*return to school after lesion have crusted over
flesh colored discrete papules, which become UMBILICATED PAPULES with a CHEESY CORE
Molluscum Contagiousum
-viral skin infection
-resolves few weeks to a few month
*autoinoculated, more where skin rubs together
*do not pop lesions, more will appear
Molluscum Contagiousum management
Resolves spontaneously if left alone
Atopic Dermatitis aka?
Eczema
-chronic skin condition characterized by intense itching along with a typical pattern of distribution with periods of remission and exacerbation
*destroys 1st layer of skin, watch for secondary infections
Management for Atopic dermatitis (eczema)
Dry skin management (hallmark Tx)
-moisturizing lotion immediately after bathing
-must blot dry
-need lotion from a jar, lotions must be scooped out
-Topical Steroids (hydrocortisone)
*Adverse effects of hydrocortisone: Bladder dysfunction, hyperglycemia, hypopigmentation/ scarring. etc
Allergic Contact Dermatitis
acute or chronic dermatitis that results from direct skin contact with chemicals or allergies
Irritant (diaper) dermatitis
common skin irritation of the genital-perianal region
Psoriasis
common bench hyper proliferative inflammatory skin disorder
*think snake skin
-normal keratinization is faulty
*Ausptiz sign: Droplets of blood when scales are removed
Acute inflammatory disorder, usually self-limiting lasting 3-8weeks
Pityriasis Rosea
Hark the Harold Patch, Christmas tree rash pattern
(patch/pattern)
Pityriasis Rosea
*Christmas from fall to spring
*“harold patch”- initial lesion 2-10cm
Pityriasis Rosea LAB/Dx
”” Treatment
serologic test for syphilis should be performed
-if rash is not itchy this is worrisome
Treat pruritis
-hydroxazine (sedating)
-certirizine (non sedating)
-Topical steroids
-UVB daily x3-5 days
*Oral erythromycin (2 week course)
Scarlet Fever
Group A beta-hemolytic streptococci (GABHS)
S/S
*swollen tongue with white exudate and/or red papillae
*strawberry tongue
-confined, bright red, flat blotches that progress into WIDESPREAD SANDPAPER-LIKE PAPILLAE
Management
*10-14day course of penicillin or amoxicillin
-consider checking urine 14days after ABX Therapy for red blood cells with may suggest secondary glomerulonephritis
Impetigo
skin infection. by…
-Gram Positive Streptococcus
-Staphylococcus (S. aureus)
*classic honey-crusting lesions
Management
*Mupirocin
*apply Burow’s (Domeboro) solution to clean lesions
Scabies
High contagious
parasitic mite
burrows into stratum corneum
S/S
*infants
-red brown vesiculopapular lesions on head, neck, palms, or soles
*older children
-red papules on skin folds, umbilicus, or abdomen
TX
-Permetherin (Nix) 5% rinse (1st treatment-leave on for 8-14hours) repeat in week
Pin worms
“Tape Test”
-press clear tape to skin around anus, place on slide and look at under microscope
Tx
-Pyrantel (Pin-X) -OTC
Mice or DEER ticks cause this disease?
Lyme disease
These ticks must feed for more than 36 hours to transmit the infecting organism
Lyme disease is cause be which organisms and found where?
-Spirochetal
-Northeast, Upper Midwest, and Pacific Coast
S/S or stages of Lyme disease
stage 1
-Erythema migrans, flat or slight red lesion that expands over several days but has central clearing, “bulls eye” rash
-Joint pain
Stage 2
-Headache, stiff joints
-Bells palsy
Stage3
Joint and periarticular pain
Lyme disease Dx
ELISA screening (checks of antibodies)
*Western Blot is confirmatory
Dx criteria
1. erythema migrains or
2 one late manifestation and
3. laboratory confirmation
Tx for Lyme Disease
under 8: Amoxicillin or Cefuroxime axetil
Over 8: Doxycycline
Rubeola (measles)
koplik Spots
Rubella (3 day measles)
teratogenicity
Erythema infectiosum
Fifth disease
*slapped cheek appearance
Roseola Infantum
Sixth disease (herpesvirus 6)
*trunk rash then extremities
*high fever, abrupt end when rash develops
Coxsackie Virus
Hand Foot Mouth Disease
-resolves spontaneously in less than 1 week
-peeling/ loss of nails is common
-spread by contact w/ unwashed hands or contaminated surfaces as well as respiratory droplets
Mumps
S/s
-swollen salivary glands (ex. parotitis) causing puffy cheeks, and a tender, swollen jaw
Lab tests
-Mumps IgM
Tx
Lemon drops (sugar free) to increase flow of saliva
