Peds Dermatology

Question 1

What are skin protectants you can recommend for diaper dermatitis?

Answer 1

Boudreaux's Butt Paste
Desitin Rapid Relief
Triple Paste
Burt's Bees Baby Bee Diaper Ointment
Cetaphil Baby Diaper Relief Cream

Question 2

How would you treat mild/localized bacterial diaper dermatitis?

Answer 2

topically w/ muciprocin 2% (bactroban)

Question 3

How would you treat SEVERE BACTERIAL diaper dermatitis?

Answer 3

oral abx 10-14 days (penicillin V/amoxicillin, macrolide, clindamycin, penicillinase-resistant PCN or cephalosporin)
(combo w/ muciprocin may be helpful)

Question 4

how would you treat fungal/candidal diaper dermatitis?

Answer 4

• symptoms should have been present 3+ days
• antifungal cream/ointment 2-3x/day until resolved (nystatin, clotrimazole, miconazole)
• recommend against combo products

Question 5

febrile infant presents w/ bright red, blood-streaked stools and pain w/ defecation. what do you suspect?

Answer 5

secondary infection of diaper dermatitis w/ strep or staph

Question 6

infant presents w/ maculopapular lesions and red plaques in butt skin folds. it has a recent hx of abx, diarrhea, and thrush. what do you suspect?

Answer 6

secondary infection of diaper dermatits w/ candida

Question 7

febrile pt presents w/ vesicular, pustular lesions on butt. what do you suspect?

Answer 7

herpes simplex virus (possible child abuse)

Question 8

what are ways to manage diaper dermatitis non-pharmacologically?

Answer 8

increase diaper changing frequency
use disposable diapers
use diaper wipes w/ NO alcohol, perfumes or soap in ingredient list

Question 9

pt presents w/ crusted, superficial lesions on the skin. what do you suspect?

Answer 9

impetigo

Question 10

pt presents w/ punched out ulcers covered by greenish-yellow crusts on the lower extremities. what do you suspect?

Answer 10

ecthyma caused by group A strep (deeper infection than impetigo)

Question 11

how would you tx ecthyma?

Answer 11

oral abx

Question 12

pt has impetigo w/ few lesions. how should they be treated?

Answer 12

topical only (mupirocin or retapamulin) 2x/d for 5 days

Question 13

pt has impetigo w/ many lesions. how should they be treated?

Answer 13

oral abx for 7 days:

• cephalexin 25-50 mg/kg/day in 3-4 divided doses
• dicloxacillin 25-50 mg/kg/day in 4 divided doses

Question 14

pt has impetigo w/ many lesions and you suspect MRSA. what should you prescribe?

Answer 14

clindamycin 30 mg/kg/d in 3 divided doses
SMZ-TMP 8-12 mg/kg/d in 2 divided doses (avoid in <2 months of age)
doxy 2-4 mg/kg/d in 2 divided doses (take w/ full glass of water, avoid in <8 yrs of age)

Question 15

pre-pubertal child presents w/ scaly patches w/ alopecia, visible black dots, pruritis, and inflammatory plaques w/ pustules on the scalp, eyebrows and eyelashes. what do you suspect?

Answer 15

tinea capitis

Question 16

what is the 1st line treatment for tinea capitis?

Answer 16

griseofulvin for 6-12 wks 
microsize: 20-25 mg/kg/d 1x/day
ultramicrosize: 10-15 mg/kg/d 1x/day 
*take w/ fatty meal
monitor LFT/CBC

Question 17

what is the alternative 1st line treatment for tinea capitis?

Answer 17

terbinafine (pill) for 4-6 wks
10-20 kg: 62.5 mg 1x/d
20-40 kg: 125 mg 1x/d
>40 kg: 250 mg 1x/d

Question 18

what are the tx options for tinea corporis, tinea pedis, and tinea cruris?

Answer 18

topical meds if hair/nails not involved:
allylamines (terbinafine, naftifine), clotrimazole, miconazole, ciclopirox
apply 2x/d for 3-4 wks

Question 19

how do you tx tinea versicolor?

Answer 19

selenium sulfide, zinc pyrithione 
topical antifungals (antidandruff shampoo)
fluconazole single dose

Question 20

newborn presents w/ erythematous scaly skin on face/scalp/perineum accompanied by overproduction of sebum. what do you suspect and how do you tx?

Answer 20

seborrheic dermatitis

brush and baby shampoo

Question 21

adolescent presents w/ erythematous scaly skin on face/scalp/perineum accompanied by overproduction of sebum. what do you suspect and how do you tx?

Answer 21

seborrheic dermatitis
low-potency topical corticosteroids
ketoconazole shampoo
anti-dandruff shampoo

Question 22

what is the 1st line tx for molluscum contagiosum?

Answer 22

usually self-limiting

cryotherapy and curettage, also cantharidin and podofilox

Question 23

pt presents with small, firm, raised round lesions that have a dimple in the center. they are painless. what do you suspect?

Answer 23

molluscum contagiosum

Question 24

what are tx options for cutaneous warts?

Answer 24

2/3 of warts in children will resolve w/in 2 years
salicylic acid (1st line), but not recommended in <2 yrs old

Question 25

what are non-pharmacologic tx options for eczema?

Answer 25

soak and seal
moisturize w/ ointments
wet wrap therapy
allergen avoidance

Question 26

what is an OTC tx for eczema?

Answer 26

hydrocortisone

Question 27

what are low potency steroids for eczema?

Answer 27

hydrocortisone, desonide

Question 28

what are moderate potency steroids for eczema?

Answer 28

hydrocortisone valerate, fluocinolone acetonide

Question 29

what are high potency steroids for eczema?

Answer 29

fluocinonide

Question 30

what topical steroid would you recommend for acute eczema on arm w/ moderate amount of hair?

Answer 30

high potency steroid (betamethasone)

Question 31

what topical steroid would you recommend for severe chronic eczema w/ lichenification.

Answer 31

start w/ moderate

Question 32

what is an injectable tx option for severe atopic dermatitis?

Answer 32

dupilumab

Question 33

what is a well-tolerated ointment tx for mild-moderate atopic dermatitis in children >3 months old?

Answer 33

crisaborole

Question 34

pt presents w/ circular lesion w/ raised annular border that is itchy. vitals are normal. what do you suspect?

Answer 34

tinea corporis

Question 35

what labs should be performed for tinea corporis?

Answer 35

KOH prep to remove keratin

Question 36

what is the tx for tinea corporis?

Answer 36

ketoconazole

oral antifungals if not resolved topically w/ griseofulvin