PEDS DERM

Question 1

What is the MC chronic relapsing skin disease in infants and childhood

Answer 1

Atopic dermatitis

Question 2

What is atopic march

Answer 2

Predisposed to food allergy, allergic rhinitis, and asthma later in childhood

Question 3

What are the cardinal features of Atopic Dermatitis

Answer 3

Intensepruritus, often nocturnal, andcutaneous reactivityare the cardinal features of AD.

“Itch that Rashes”

Question 4

What part of the body is usually spared in the Atopic dermatitis pt

Answer 4

The diaper area is usually spared!

Question 5

What is the cornerstone Tx for Inflamation in Atopic dermatitis

Answer 5

Cornerstone is corticosteroids (twice/day; start low-potency)
Hydrocortisone, triamcinolone, desonide

Question 6

Bathing recommendations for Atopic dermatitis

Answer 6

Daily short bath → lukewarm NOT hot water
-Short = under 10 minutes

Apply moisturizer immediately afterward to trap moisture

Timing matters—longer bath can remove natural oils

Bleach baths—1/4 cup bleach in full bathtub
Kills bacteria in skin that may be worsening symptoms

Question 7

Use of Immune modulators in Atopic Dermatitis

Answer 7

• Pimecrolimus (Elidel 1% for mild to moderate)
• Tacrolimus (Protopic 0.1% & 0.03% for moderate to severe)

Both are approved for short-term or intermittent long-term treatment of AD in patients ≥2 yr if:

• disease is unresponsive
• Or who are intolerant of other conventional therapies
• Or for whom these therapies are inadvisable because of potential risks

Great for steroid phobia pts

Question 8

What is the peanut introduction strategy for pts with eczema

Answer 8

Allergy referral prior to introduction of peanuts if severe eczema

Question 9

A pt with “beefy” red-pink, tender skin that has numerous 1-2 mm pustules and satellite papules in the diaper area

Think

Answer 9

Candida

Question 10

Medical care for Diaper dermatitis

Answer 10

First-line therapy: protective barrier agent
(ointment or paste) w/petroleum or zinc oxide at every diaper change.

Low-potency steroid, ex. 2.5% hydrocortisone, may be used for short time periods (3-5 days)—reduce inflammation

Candida diaper dermatitis: tx with antifungal agent
(ex: nystatin, clotrimazole)

Pearl: If using multiple topical agents–protective barrier should be applied last.

Not responding? Longer differential

Question 11

Dry to wet behaviors like lip licking lead to dry skin dermatitis

What is the 1st line tx

Answer 11

First line: eliminating the offending wet-to-dry behavior—not easy in Peds!

Additional tx:
Moisturizer cream BID: decreases transepidermal water loss and replenishes skin lipids to improve hydration—most effective at night to avoid being wiped off quickly

Steroids or topical antibiotics if refractory and suspect infection

Question 12

Cell mediated immune reaction in the skin (type IV or delayed sensitivity reaction)

Think

Answer 12

Allergic contact dermatitis

2/2:
Airborne sensitizers usually affect exposed areas, such as the face and arms (perfume)
Jewelry, topical agents, shoes, clothing, henna tattoo dyes, plants, and even toilet seats cause dermatitis at points of contact.

Question 13

What are the topical ABX that cause allergic contact dermatitis

Answer 13

Neomycin in Neosporin

Question 14

What is the tx approach to Allergic contract dermatitis

Answer 14

Exposure avoidance
Washing after exposure

Barrier creams pre-exposure

Topical corticosteroids

Severe reactions of allergic contact dermatitis → high-potency corticosteroids or oral corticosteroids
->Long taper to avoid rebound flare

Antihistamines for itching

Question 15

A pt presents with well defined, thick, greasy, yellow scales
With an aS/s eruption

Think

Answer 15

Seborrheic Dermatitis

Question 16

What is the treatment approach to cradle cap

Answer 16

Aka Seborrheic Dermatitis

Self limited condition

Persistent lesions: can tx with low-potency topical corticosteroids if inflamed (applied once daily for 1 wk)
and a topical antifungal (e.g., ketoconazole 2% cream twice daily).

Antifungal shampoos such as ketoconazole 2% shampoo should be used cautiously because they are not tear-free.

Question 17

What is the difference in presentation of Adolescent compared in infantile Seborrheic Dermatitis

Answer 17

Loss of hair is common, and pruritus varies

Unlike infantile seborrheic dermatitis, adolescent seborrheic dermatitis generally does not self-resolve and has a chronic relapsing course.

If severe, erythema and scaling occur at the frontal hairline, the medial aspects of the eyebrows, and in the nasolabial and retroauricular folds.

Question 18

What is the tx approach for adolescent Seborrheic dermatitis

Answer 18

First-line scalp: antifungal shampoo used 3-4 times weekly up to daily (selenium sulfide, ketoconazole, ciclopirox, zinc pyrithione, salicylic acid) (Selsun Blue)

Inflamed scalp lesions: Mid-potency topical corticosteroids such as fluocinolone 0.01% shampoo applied once daily for 2-4 wk.

Nonscalp lesions: low-potency topical corticosteroid cream for face, mid-potency elsewhere, combo with topical antifungals (ketoconazole 2% cream or ketoconazole 2% shampoo used as a body or face wash)

Once acute disease is controlled, antifungal shampoo used on a weekly basis is effective maintenance to reduce risk of relapse.

Question 19

3 components of acne

Answer 19

Obstructed hair follicle with keratin (hyperkeratosis)

Increased sebum production

Propionibacterium acnes proliferation (normal skin flora)

Leads to inflammation of the pilosebaceous unit (hair follicle w/ associated sebaceous gland)

Question 20

Severe acne

Answer 20

Nodulocystic acne and conglobate acne including large inflammatory painful nodules

Question 21

Tx for mild acne

Answer 21

Topical retinoid

Question 22

General treatment for acne

Answer 22

Topical retinoid + Benzyol peroxide
+ topical ABX

Oral reserved for severe

Question 23

What is the most effective monotherapy for acne

Answer 23

Retinoids: ↓ keratin & sebum production + some anti-inflammatory & antibacterial activity → most effective monotherapy

Question 24

What is the topical ABX used to treat acne

Answer 24

Antibiotics: erythromycin, clindamycin

Often combined prep: Benzoly + topical abx

Question 25

What are the oral abx for acne

Answer 25

For deeper cystic lesions
In combination w/ topical regimen
Tetracycline, doxycycline, minocycline—3 months 1-2x daily

Question 26

Treatment for Molluscum Contagiosum

Answer 26

Treatment → usually none recommended

For extensive disease:
Cryotherapy w/ topical liquid nitrogen (if limited #)

Vesicant therapy w/ topical 0.9% cantharidin

• Not on face!
• Very limited availability

Removal by curettage

Question 27

What is the treatment for cellulitis

Answer 27

Empirical antibiotic treatment:
1st-generation cephalosporin ex. cephalexin

If local MRSA rate is high → clindamycin or trimethoprim-sulfamethoxazole

Question 28

ABX for Perianal Dermatitis

Answer 28

oral penicillin or amoxicillin