PEDS DERM Flashcards
What is the MC chronic relapsing skin disease in infants and childhood
Atopic dermatitis
What is atopic march
Predisposed to food allergy, allergic rhinitis, and asthma later in childhood
What are the cardinal features of Atopic Dermatitis
Intensepruritus, often nocturnal, andcutaneous reactivityare the cardinal features of AD.
“Itch that Rashes”
What part of the body is usually spared in the Atopic dermatitis pt
The diaper area is usually spared!
What is the cornerstone Tx for Inflamation in Atopic dermatitis
Cornerstone is corticosteroids (twice/day; start low-potency)
Hydrocortisone, triamcinolone, desonide
Bathing recommendations for Atopic dermatitis
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
Use of Immune modulators in Atopic Dermatitis
- 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
What is the peanut introduction strategy for pts with eczema
Allergy referral prior to introduction of peanuts if severe eczema
A pt with “beefy” red-pink, tender skin that has numerous 1-2 mm pustules and satellite papules in the diaper area
Think
Candida
Medical care for Diaper dermatitis
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
Dry to wet behaviors like lip licking lead to dry skin dermatitis
What is the 1st line tx
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
Cell mediated immune reaction in the skin (type IV or delayed sensitivity reaction)
Think
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.
What are the topical ABX that cause allergic contact dermatitis
Neomycin in Neosporin
What is the tx approach to Allergic contract dermatitis
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
A pt presents with well defined, thick, greasy, yellow scales
With an aS/s eruption
Think
Seborrheic Dermatitis
What is the treatment approach to cradle cap
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.
What is the difference in presentation of Adolescent compared in infantile Seborrheic Dermatitis
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.
What is the tx approach for adolescent Seborrheic dermatitis
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.
3 components of acne
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)
Severe acne
Nodulocystic acne and conglobate acne including large inflammatory painful nodules
Tx for mild acne
Topical retinoid
General treatment for acne
Topical retinoid + Benzyol peroxide
+ topical ABX
Oral reserved for severe
What is the most effective monotherapy for acne
Retinoids: ↓ keratin & sebum production + some anti-inflammatory & antibacterial activity → most effective monotherapy
What is the topical ABX used to treat acne
Antibiotics: erythromycin, clindamycin
Often combined prep: Benzoly + topical abx
What are the oral abx for acne
For deeper cystic lesions
In combination w/ topical regimen
Tetracycline, doxycycline, minocycline—3 months 1-2x daily
Treatment for Molluscum Contagiosum
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
What is the treatment for cellulitis
Empirical antibiotic treatment:
1st-generation cephalosporin ex. cephalexin
If local MRSA rate is high → clindamycin or trimethoprim-sulfamethoxazole
ABX for Perianal Dermatitis
oral penicillin or amoxicillin
