Pediatric Dermatology

Question 1

Major differences between children and adult skin:

Answer 1

Kids Skin is:

• Drier
• Chaps easier
• Less hair
• Less collagen
• Weaker epidermal-dermal attachment
• Lose water faster
• Absorbs substances better

Question 2

When does skin develop?

Answer 2

By 24 weeks gestation

Question 3

Premature vs mature skin:

Answer 3

• Premature skin 5x thinner

- May seen blood vessels through skin

Question 4

Protective covering on newborn skin:

Answer 4

• Vernix caseosa
• Protects from excessive dryness in the womb
• Desquamation 24-36 hrs after birth through 3rd week of life

Question 5

Benign neonatal skin lesions/rashes:

Answer 5

• Erythema Toxicum Neonatorum
• Transient Neonatal Pustular Melanosis
• Miliaria
• Milia
• Cephalic Pustulosis (Neonatal Acne)

Question 6

Erythema Toxicum Neonatorum:

Answer 6

• Most common rash of full term newborns
• 24 hrs after birth (not at birth)
• Eosinophils in Pustular Fluid

Question 7

Transient Neonatal Pustular Melanosis:

Answer 7

• Full term infants
• Present at birth
• Higher incidence in babies with dark pigmentation
• Neutrophils in Pustular Fluid

Question 8

Miliaria (Prickly Heat):

Answer 8

• Newborn rash due to climates too warm for them or over wrapping
• Sweat retention from obstructed eccrine sweat glands in corneum
• Clear pinpoint vesicles (crystallina) or small erythematous papules (rubra)

Question 9

Milia:

Answer 9

• Small keratin and sebaceous material retention cyst in pilosebaceous follicles
• Face and Nose
• Present at birth

Question 10

Cephalic Pustulosis (neonatal acne):

Answer 10

• Due to androgens (maternal and endogenous) on sebaceous glands
• Inflammatory papules/pustules without comedones
• Not true acne therefore does not scar
• Forehead nose cheeks

Question 11

Birthmarks:

Answer 11

• Nevus Simplex
• Nevus Flammeus
• Mongolian Spot
• Cafe-au-lait Spot

Question 12

Nevus Simplex:

Answer 12

• Pink-red macules that blanch when compressed
• Eyelid, glabella, nape of neck
• Resolve

Question 13

Nevus Flammeus:

Answer 13

• Port wine stain
• Congenital capillary/venous malformation (dilated vessels)
• Unilateral face
• Associated with Sturge-Weber when located in distribution of CN V ophthalmic branch
• Does not enlarge or involute

Question 14

Mongolian Spots:

Answer 14

• Dark skin infants
• Blue grey lesion
• Fade but not completely
• Document if unusual site as it may be abuse
• Sacrum and back mostly

Question 15

Cafe-au-late Spot:

Answer 15

• Hyperpigmented macule

- Found in NF-1 or McCune-Albright syndrome

Question 16

Diaper Dermatitis:

Answer 16

• Prolonged contact with feces and urine

- Maceration and dampness allows for secondary infection

Question 17

Irritant/Contact Diaper Dermatitis:

Answer 17

• Contact with chemicals, enzymes in stool, soap etc.
• Convex surfaces of buttock
• Spares Intertriginous creases

Question 18

Diaper Candidiasis:

Answer 18

• Widespread, raised, beefy red lesion with PINPOINT PUSTULOVESICULAR SATELLITE LESIONS
• Satellite lesions are diagnostic hallmark
• Always look in mouth for thrush
• Can follow systemic antibiotic use

Question 19

Bacterial Diaper Dermatitis:

Answer 19

• Secondary infection to irritant dermatitis
• Staphylococcal or Streptococcal
• Papules -> Vesicles surrounded by erythema -> golden crust appearance

Question 20

Seborrheic Diaper Dermatitis:

Answer 20

• Salmon colored greasy plaques with yellowish scale
• Intertriginous areas
• Also check scalp face other areas for seborrheic dermatitis

Question 21

Seborrheic Dermatitis:

Answer 21

• Plaque with greasy yellow scales
• Sebaceous gland areas
• Scalp hairline

Question 22

Telogen Effluvium:

Answer 22

• Most common cause of DIFFUSE hair loss
• Occurs within 3 months of stress event
• Mature follicles switch to telogen resting state and shed within 3 months
• Self limiting

Question 23

Trichotillomania:

Answer 23

• Compulsive urge to pull hair
• Incomplete hair loss
• Anxiety, depression or OCD

Question 24

Alopecia:

Answer 24

• Due to chronic inflammation
• Normal appearing scalp
• Areata: small patches; most common
• Totalis: entire scalp; autoimmune
• Universalis: all body hair

Question 25

Traction Alopecia:

Answer 25

• Hairline hair loss
• Due to hairstyles with too much tension
• Non-inflammatory
• Can scar

Question 26

Tinea Capitis:

Answer 26

• Fungal infection of scalp
• Contagious
• KOH
• Oral antifungals

Question 27

Aplasia Cutis Congenita:

Answer 27

• Absence of skin on portion of scalp
• May be associated with underlying skull or intracranial malformation
• Hair collar sign: thicker darker hair growth around lesion on scalp that is indicative of CNS abnormality