Pediatric Dermatology

Question 1

Treatment of tinea capitus and other severe cases of tinea

Answer 1

griseofulvin 20mg/kg/day for six weeks

monitor LFTs

Question 2

Varicella zoster

Answer 2

• pruritic, vesicles, “dew drop on a rose petal”, fever, adenopathy
• back to school 48 hours after last lesion dries
• acetaminophen, antihistamine, caladryl lotion, oral acyclovir

Question 3

Molloscum contagiousum

Answer 3

pruritic, umbilicated, flesh-colored papules with a cheesy core

Question 4

Atopic triad

Answer 4

Personal or family history of asthma, allergic rhinitis, atopic dermatitis

Question 5

Atopic dermatitis/eczema

Answer 5

• dry, red, itchy patches (“the itch that rashes”)
• elevated IgE, eosinophilia, allergy testing
• dry skin management, topical steroids

Question 6

Allergic contact dermatitis

Answer 6

• red, vesicles, warm, swollen, pruritic
• poison ivy, nickel
• high potency topical steroids, Prednisone taper

Question 7

Treatment of irritant (diaper) dermatitis

Answer 7

• Barrier emollient in mild cases (zinc oxide)
• for erythema/papules: Burow’s/Domeboro, hydrocortisone
• fungal co-infection: topical antifungal
• bacterial co-infection: topical antibiotic (bactroban/mupirocin)
• keep open, clean, and dry as much as possible

Question 8

Psoriasis

Answer 8

• hypoproliferative disorder
• skin cell turnover reduced from 14 (normal) to 2 days
• immature nucleated cells are seen on the horny layer
• “sharply defined plaques with silvery scales”
• Auspitz’ sign
• refer to derm, topical steroids, tar shampoo

Question 9

Pityriasis Rosea

Answer 9

• may be related to virus/recent URI
• more common in spring and fall
• herald patch, Christmas tree pattern, pruritic
• EEC x2 weeks, oral antihistamines, sunlight exposure
• check for syphilis if non-pruritic, or on palms/soles/mouth

Question 10

Impetigo

Answer 10

• bacterial infection, staph or strep
• “honey colored crusts”
• topical (bactroban) for minor cases
• oral antibiotics: dicloxacillin, cephalexin (Keflex), EEC, clindamycin
• Domeboro solution to clean

Question 11

Lyme disease

Answer 11

• Borrelia burgdorferi, tick must feed 24hr to transmit
• screen with ELISA, confirm with Western blot
• Treat with doxycycline (amoxicillin or cefuroxime under age 7)
• Refer stage 2 or 3 Lyme disease

Question 12

Lyme disease stages

Answer 12

Stage 1: erythema migrans (bulls eye rash), flu symptoms
Stage 2: cardiac dysrhythmias, aseptic meningitis, Bell’s palsy, peripheral neuropathy
Stage 3: joint pain, subacute encephalopathy, bluish-red discoloration and edema of extremity distal to bite

Question 13

Measles: Rubeola

Answer 13

• ordinary measles

- fever, rash, URI symptoms, Koplik’s spots

Question 14

Measles: Rubella

Answer 14

• “3-day measles”
• rash gone in 72 hours, malaise, joint pain, fever, adenopathy
• teratogenic

Question 15

Measles: Roseola Infantum

Answer 15

• “Sixth disease”
• Herpesvirus 6
• URI symptoms, rash, high fever for up to 8 days that comes to abrupt end when rash develops

Question 16

Measles: Erythema infectiosum

Answer 16

• “Fifth disease”
• human parvovirus B19
• “slapped cheek” appearance, lacy reticular exanthem
• may return to school after fever breaks
• Fetal aplastic crisis

Question 17

First, Second, and Third Degree Burns

Answer 17

First- dry, red
Second- “partial thickness”, moist, blisters
Third- “full thickness”, black, waxy, deeper

Question 18

Hand-Foot-and-Mouth disease (Coxsackie Virus)

Answer 18

• viral, resolves spontaneously in less than 1 week

- papulovesicular rash on hands/feet/mouth, fever, malaise, vomiting, drooling

Question 19

Biggest risk of burns

Answer 19

Hypothermia (heat loss) and dehydration
Prophylactic intubation for singed eyebrows/nares/mouth
First 6 hours are critical

Question 20

Calculating burns

Answer 20

Head- 6 to 10%
Upper and lower arm- 2%
Hand- 1%
Chest and back- 13%
Genitals- 1%
Thigh- 3-5%
Calf- 2-3%
Foot- 2%

Question 21

Calculating burns >9 years old

Answer 21

Head- 4.5%
Arms- 4.5%
Chest and back- 18%
Legs- 9%
Genitals- 1%

Question 22

Treatment of tinea manuum and pedis

Answer 22

Macerated stage- aluminum subacetate soak for 20 minutes BID

Dry stage- topical antifungals

Question 23

Treatment of tinea versicolor

Answer 23

Selenium sulfide 2.5% shampoo topically for 15min daily x7 days