Peds - Derm Flashcards
first degree burn
dry, red, no blisters
epidermis only
second degree burn
moist, blisters
extends beyond epidermis
third degree burn
dry, leathery, pearly, waxy
extends from epidermis to dermis to underlying tissues (fat, muscle, bone)
Of particular concern with significant burns?
HYPO thermia especially in young children
First 6 hours are critical, hospitalize immediately
Identifying factors in dermatology
MORPHOLOGY - character of lesion itself
CONFIGURATION - how the lesions present in relation to each other
DISTRIBUTION - where on the body the lesions appear
(morphology)
MACULE
small, flat discoloration
freckle, petechiae, flat nevi
(morphology)
PATCH
large, flat discoloration
may have surface changes
big macule
mongolian spots, cafe au lait spot
(morphology)
PAPULE
small, elevated skin lesion
< 1 cm
ant bite, psoriasis
(morphology)
NODULE
elevated, firm lesion
> 1 cm
(big papule)
fibroma
(morphology)
TUMOR
“mass”
firm, elevated lump
(big nodule)
can be benign or malignant
(morphology)
WHEAL
slightly raised and extending a bit below the epidermis
often allergic in origin
aka hive or PPD
(morphology)
PLAQUE
scaly, elevated lesion
classic for psoriasis
(morphology)
VESICLE
small lesion filled with serous fluid
< 1 cm
varicella, herpes simplex, herpes zoster
(morphology)
BULLA
large lesion filled with serous fluid (big vesicle)
> 1 cm
blister
(morphology)
PUSTULE
small lesion filled with pus
< 1 cm
acne, impetigo
(morphology)
ABCESS
large lesion filled with pus
> 1 cm
(morphology)
CYST
large, raised lesion filled with serous fluid, blood and pus
primary lesion
first appearing
secondary lesion
follow primary
(configuration)
SOLITARY or DISCRETE
individual lesions that remain separate
(configuration)
GROUPED
in a cluster
(configuration)
CONFLUENT
lesions that run together
(configuration)
LINEAR
scratch, streak, line, or stripe
poison ivy
(configuration)
ANNULAR
circular
ring worm
(configuration)
POLYCYCLIC
annular lesions that merge
Distribution
examples
Where on the body the lesions appear
face trunk extremities groin dermatomal feet axilla
Rash which typically is found in buccal cavity, palms, and soles
Rash of syphilis
ddx - pityriais rosea
Rash which follows dermatomes
Zoster
Rash which tends to be confluent
Tinea
Medications which exacerbate acne. (2)
steroids
anticonvulsants
NP management of acne
non-pharmacologic
avoid oil-based products
mild cleanser and moisturizer
NP management of MILD acne
pharmacologic (5)
topical treatment, generally in this order: benzoyl peroxide retinoic acid tretinoin salicylic acid topical ABT - erythromycin, clindamycin
NP management of MODERATE acne
pharmacologic
add systemic ABT to topical treatment:
Doxycycline
Erythromycin
Minocycline
NP management of SEVERE acne
refer to dermatology :-)
Which acne medication should be used at night because it is inactivated by UV light and oxidized by benzoyl peroxide?
tretinoin (Retin-A)
Why are erythromycin and clindamycin lotions or pads often effective in treating acne?
because the causative agent is often staph
jock itch
tinea cruris
scalp ringworm
tinea capitus
body ringworm
tinea corporis
athlete’s foot
tinea pedis
hypo- or hyperpigmented macules on the limbs
tinea versicolor
fungal infection of the nail
tinea unguium
onychomycosis
Which of the tineas tend to be pruritic?
tinea cruris
tinea pedis
Appearance of fungal infection on microscopic slide treated with KOH?
hyphae = “spaghetti and meatballs”
fungal infection of the hand(s)
tinea manuum
tinea capitus rx
griseofulvin x 6 weeks
tinea corporis rx
topical -azole
ketoconazole
micoconazole
tinea cruris rx
topical -azole
terbinafine cream
griseofulvin if severe
tinea pedis rx
tinea manuum
macerated stage - aluminum subacetate solution
dry, scaly stage - topical antifungals
oral therapy if severe
tinea versicolor rx
selenium sulfide shampoo x 7 days
itraconazole (Sporanox) PO
Chicken pox -
aka
caused by
varicella zoster - caused by the herpes virus
How is varicella spread?
direct contact with lesions or airborne
48 hours prior until after lesions are crusted
Varicella management
prevention - vaccine
for pruritis - topicals, antihistamine
for fever - acetominophen
acyclovir - if given in first 24 hours can reduce duration, severity; particularly important to immunocompromised
If unimmunized are exposed, what is management?
isolate from day 7 - 21
What are the likely causes of death from varicella?
pneumonia
hepatitis
What is a drug interaction concern with anti-fungals?
They are CYP 450 blockers
Management of molluscum (5 + 1 + 1)
trentinoin (Retin-A) Salicylic acid Liquid nitrogen Trichloracetic acid Silver nitrate
mechanical removal (NOT in 1* care)
OR wait for spontaneous resolution
Atopic dermatitis - diagnostics
Radio-allergosorbent test (RAST) or skin test –> dust mite allergy
Serum IgE
Eosinophilia
Atopic dermatitis - management
Extensive moisturizing
Topical steroids: hydrocortisone, desonide, triamcinolone
Systemic steroids: in extreme cases only
Acute or chronic
Results from direct skin contact with irritant
nickel is most common cause
Allergic contact dermatitis
Allergic dermatitis - management
Remove offending agent
Topical steroids - high potency if needed
Oral steroid taper
Irritant (Diaper) dermatitis - defined
Most common diaper rash
Irritant (Diaper) dermatitis - peak age
9 - 12 months
What happens if steroids are applied to fungal infection?
Condition worsens
Irritant (Diaper) dermatitis - management (1 + 5)
consider possible causes…
keep clean and dry
mild = barrier emollients - butt paste
erythema, papules = hydrocortisone
severe erythema, vesicles = burrow’s solution
secondary bacterial = mupirocin, bactroban
secondary fungal = nizoral, ketoconazole
A common, benign, hyperproliferative inflammatory skin disorder
Psoriasis
