Peds DERM

Question 1

Rashes classification

Answer 1

Fungal
Bacterial
Viral
Atopic/Allergic/Contact
Infestation/Bites

Question 2

Cradle Cap (Seborrheic Dermatitis)

Answer 2

Seborrheic dermatitis is a common, inflammatory disease of the newborn with a characteristic pattern for different age groups
Usually occurs because the parent is reluctant to scrub over the anterior fontanel
May occur on the face

Question 3

Exanthem

Answer 3

a skin eruption occurring as a symptom of a general disease

Question 4

Enanthem

Answer 4

eruptive lesions on the mucous membranes

Question 5

Tinea capitis

Answer 5

Tinea capitis is a fungal infection of the scalp that most often presents with pruritic, scaling areas of hair loss.
TrichophytonandMicrosporumspecies of dermatophyte fungi are the major causes of tinea capitis.
The infection is often contracted from another human or an animal through direct contact.
Treatment:
Oral antifungal treatment:
Griseofulvin

Question 6

Griseofulvin dose

Answer 6

Microsize: Oral: 20 to 25 mg/kg/day in single or 2 divided doses; maximum daily dose: 1,000 mg/day
Ultramicrosize: Oral: 10 to 15 mg/kg/day once daily; maximum daily dose: 750 mg/day
**Microsize oral suspension, tablets: Administer with a fatty meal (eg, whole milk, ice cream, peanut butter) to increase absorption; shake suspension well before use.

Question 7

Fungal rashes

Answer 7

The history is longer, it progresses for long periods of time.
Sometimes it improves but it is persistent
Spreads slower, progresses at a longer rate

Question 8

Diaper dermatitis (diaper rash)

Answer 8

Most common skin eruption in infants and toddles

Question 9

Fungal diaper rash

Answer 9

well-demarcated border, smooth, shiny, “fire engine red”, papular rash
Occasional satellite lesions
Candida albicans

Question 10

Impetigo

Answer 10

CLASSIC LESION IS HONEY COLORED CRUSTED LESION
Bacterial skin infection caused by invasion of the epidermis by pathogenic Staphylococcus aureaus or Streptococcus pyogenes, or a combination of the two.
Determine if febrile
Examine all skin looking for erosions covered by honey-colored crusts
Check for regional lymphadenopathy
HIGHLY CONTAGIOUS–change sheets

Question 11

Impetigo treatment

Answer 11

For multiple lesions, systemic antibiotics may be needed.
Bactrim
Keflex
If only a few lesions are present, consider use of topical Bactroban TID for 7-10 days, re-evaluate if no response in 3-5 days
Gentle washing with an antibacterial soap to remove crust must be done if Bactroban is used
Condition is highly contagious.
follow up in one week to determine response to treatment

Question 12

Molluscum Contagiousum

Answer 12

viral rash, benign with no systemic manifestations
Characterized by waxy, discrete, flesh-colored umbilicated or dome-shaped papules
A part of the Pox family of viruses
Hang out for months up to a year

Question 13

Viral exanthems

Answer 13

viral rashes
Roseola
Varicella
HFM

Question 14

Roseola-Exanthem Subitum

Answer 14

Acute viral infection occurring primarily in children under 3
Incubation 5-15 days
Adute onset of prodromal fever lasting 3-7 days, mild adenopathy
Abrupt resolution of fever and eruption of rash occur.
Rash begins on trunk and spreads to face and extremities.
Discrete pinkish maculopapular rash that last 1-2 days
Treatment: symptomatic for fever
The rash of roseola appears as the fever abates. It starts on the neck and trunk and spreads to the extremities. As depicted above, it is erythematous, blanching, and macular or maculopapular

Question 15

Coxsackie viruses A and B

Answer 15

causes roseola rash

Question 16

varicella zoster

Answer 16

Herpes virus –contagious via airborne droplets or by direct cutaneous contact with fluid filled vesicles
The average incubation period for varicella infection is 14 to 16 days, although this interval can range from 10 to 21 days. The period of infectivity is generally considered to last from 48 hours prior to the onset of rash until skin lesions have fully crusted

Question 17

chicken pox

Answer 17

Vesicular lesions on an erythematous base are characteristic of chickenpox. The lesions occur in crops and are present in a variety of stages from maculopapular to vesicular or even pustular. Central necrosis and early crusting is also visible.

Question 18

Parvovirus b19–

Answer 18

“slap cheek”
most classically causes erythema infectiosum (EI), a mild febrile illness with rash. It often occurs in outbreaks among school-aged children, although it can occur in adults as well. EI is also referred to as “fifth disease” since it represents one of six common childhood exanthems, each named in order of the dates they were first described.
make sure not to come around pregnant people

Question 19

Atopic dermatitis

Answer 19

ECZEMA
Extremely puritic skin disorder involving cutaneous hypersensitivity
Hereditary component
Patients with acute, severe dermatitis should be referred to a specialist
Education of parent on the chronicity of the condition
management goal is to reduce dry skin
Keep skin well hydrated with daily baths in only warm water, soak for 10 minutes, use mild soap such as Dove, and avoid over scrubbing
Pat skin dry after a bath and apply moisturizer immediately to damp skin
Wear 100% cotton clothes

Question 20

atopic dermatitis treatment

Answer 20

recommended moisturizers
Eucerin
Aquaphor
Aveeno
Pharm tx
Topical Steroids
Apply thin layer 2 times a day for 7-14 days
Infants and children: Hydrocortisone ointment 2.5% (use 1% on face and intertriginous areas)
Adolecents: Triamcinalone acetonide ointment 0.1%
Milder cases can use steroid cream instead of ointment

Question 21

Urticaria/ Hives

Answer 21

Viral and bacterial infections– Acute urticaria may develop during or following a viral or bacterial infection, particularly in children. Infections are associated with over 80 percent of cases of acute urticaria in some pediatric series. Immune activation, involving immune complex formationand/orcomplement activation, is a proposed mechanism, although the exact pathogenesis is unclear.

Question 22

Scabies

Answer 22

Scabies is a cutaneous infestation caused by the miteSarcoptes scabiei. Classic scabies is typically characterized by an intensely pruritic eruption with small, often excoriated, erythematous papules in sites such as the fingers, wrists, axillae, areolae, waist, genitalia, and buttocks

Question 23

peticulosis

Answer 23

Pediculosis capitis is a common condition caused by infestation of the hair and scalp byPediculus humanus capitis(the head louse), one of three distinct varieties of lice specifically parasitic for humans
Pruritus occurs as an allergic reaction to lice saliva injected during feeding. In a patient without prior infestation, the onset of itching may be delayed until sensitization occurs after four to six weeks
Treatment of pediculosis capitis is recommended. Topical pediculicides are the most common initial treatments. Manual removal of lice (wet combing) is sometimes used as an alternative to topical pediculicide therapy. Oral therapy is occasionally required for refractory infestations

Question 24

scabies treatment

Answer 24

Topicalpermethrinis highly effective for scabies, with cure rates in randomized trials approximating or exceeding 90 percent. Oralivermectinis an alternative first-line treatment that has the advantages of ease of administration and lower cost. Special considerations are warranted for young children and pregnant women.

Question 25

classic childhood exanthems

Answer 25

Measles
scarlet fever
rubella
Erythema infectiosum
roseola infantum

Question 26

Measles-paramyxovirus

Answer 26

Prodrome: day 7-11 after exposure
– Fever, cough, coryza, conjunctivitis
* Enanthem: Koplik’s spots appear 2 days
before the rash, last 2 days into the rash
Morbilliform exanthem presents 14 days after exposure

Question 27

Scarlet fever

Answer 27

“Strawberry tongues”
Abrupt onset fever, headache, vomiting,
malaise, sore throat
* Enanthem
– Bright red oral mucosa
– Palatal petechiae
– Tongue change

Question 28

Hand-foot-mouth disease

Answer 28

Coxsackie virus A16
Highly contagious
Incubation period: 4-6 days
* Prodrome: 1-2 days before rash
– Low-grade fever, anorexia, malaise, sore mouth
Nail matrix arrest (finger nails lift and patients will loose nails)

Question 29

Rosceola

Answer 29

rash presenting after resolution of a high fever, whereas the distinguishing features in pityriasis rosea are a herald patch and
a bilateral and symmetric rash in a Christmas tree pattern.

Question 30

Impetigo

Answer 30

superficial bacterial
infection that most commonly affects the face and extremities of children.

Question 31

Erythema infecteousum

Answer 31

is characterized
by a viral prodrome followed by the “slapped cheek” facial rash.

Question 32

molluscum contagiosum

Answer 32

Flesh-colored or pearly white papules with central
umbilication it is a highly contagious viral infection that usually resolves without
intervention

Question 33

Tinea

Answer 33

common fungal skin infection in children that affects the scalp, body, groin, feet, hands, or
nails.

Question 34

Atopic dermatitis

Answer 34

Atopic dermatitis

Question 35

Kawasaki syndrome

Answer 35

Fever ≥ five days and four of the following five:
1. Bilateral conjunctival injection
2. Oral mucosal changes
3. Rash: not vesicular
4. Extremity changes
5. Cervical adenopathy

Question 36

Ibuprofen dosing

Answer 36

100mg/5ml
Infant and child> 6months—
5-10mg/ kg/dose q6-8hr

Question 37

Tylenol dosing

Answer 37

Concentration 160mg/ 5ml
10-15mg/kg/dose PO q4-6 hrs
Max dose 75mg/kg/24 hours

Question 38

Amoxicillin

Answer 38

125, 250mg/5ml and 200, 400mg/5 ml
Neonate—3 months or younger 20-30mg/kg/ 24 hours divided by 2 doses
Child standard dose—25-50mg/kg/ 24 hrs divided by 2 or 3 doses.

Question 39

CASE PRESENTATION
* A one week old female presents with
erythema surrounding the umbilical stump
that is starting to extend to the abdominal
wall. She is afebrile, vital signs are stable,
she is alert and interactive. She is breastfeeding well, and has no history of
vomiting, and no ill contacts. What is the
diagnosis? Should this patient be
discharged?

Answer 39

Omphalitis
Clinical Presentation
* Fever may or may not be present
* Mild erythema surrounding the umbilicus
* Necrosing lesions surrounding the
umbilicus and extending to the abdominal
wall
* Systemic symptoms may be absent
Treatment
* Perform septic workup
* Start IV antibiotics
* Surgical debridement for abscessed lesions
* Do not discharge these patients!

Question 40

Café-au-lait macules

Answer 40

Café-au-lait macules are flat, uniformly hyperpigmented macules that appear during the first year after birth and usually increase in number during early childhood. The number of café-au-lait macules then stabilizes over time.