VLC Peds: Derm / Rashes Flashcards
A lesion that is <1cm and raised is a …
Papule
A lesion that is >1cm and raised is a ….
Plaque
A lesion that is <1cm and flat is a …
Macule
A lesion that is >1cm and flat is a …
Patch
A lesion that is 1-2cm and solid is a …
Nodule
A lesion that is >2cm and solid is a…
Mass / tumour
A lesion that is < 0.5cm and fluid-filled is a …
Vesicle
A lesion that is > 0.5cm and fluid-filled is a …
Bulla
A lesion that is < 1cm and filled with pus is a …
Pustule
A raised lesion that is transient, circumscribed, possibly with erythematous borders and pale centre is a …
Wheal
A surface break in the epidermis from wearing away is a …
Erosion
A surface break in the epidermis from scraping/scratching is a …
Excoriation
What is an ulcer?
A localized defect in the epidermis and dermis
What is an fissure?
Linear or wedge-shaped break in the epidermis
Visible flakes of keratin (fine or coarse, loose or adherent) are called …
Scale / scaling
Dried liquid debris (pus or serum) on the surface of the skin is called …
Crust
Diffuse epidermal thickening with accentuated skin lines is called …
Lichenification
How is a skin lesion characterized?
- Palpability (raised/flat) 2. Color/pigmentation 3. Shape/symmetry 4. Texture/surface features 5. Size 6. Location and distribution PPPSSS: palpability, pigment, place; shape, surface, size SPSPSP (order): size, palpability, shape, pigment, surface, place
What are primary vs secondary lesions?
Primary: from the disease process Secondary: - evolve from primary - result of pt activities (eg scratching)
Name 5 terms that can be used to describe the arrangement of skin lesions (6 listed)
Symmetric Scattered Clustered Linear Confluent Discrete
A dilatation of superficial venules, arterioles, or capillaries visible on the skin is a …
Telangectasia
Tiny, non-blanchable red or purple macules
Petechiae
What are petechiae from?
Capillary hemorrhage under the skin or mucous membrane
Large, purple, non-blanchable lesions (may or may not be palpable) are …
Purpura
Why is it important to ask how the patient has been managing/treating?
Any previous treatments can modify the way the lesion looks (eg diphenhydramine)
What history points toward a rash being allergic?
FHx of atopy Recurrent rapid response and resolution Pruritis Hx of therapeutic response to an antihistamine
Name 5 conditions on the DDx for a rash in a child (8 listed)
Roseola Papular urticaria Streptococcal infection Erythema multiforme Erythema infectiosum (Fifth disease) Urticaria due to type 1 hypersensitivity Erythema migrans Drug eruption
What is roseola?
Viral exanthem, typically 3-5d after febrile illness As the fever resolves, patients develop a pink, maculopapular rash that starts on the trunk and may spread to the face and extremities. Caused by human herpes virus-6 (HHV-6).
What is papular urticaria?
Caused by bug bites 3-10mm papules, pruritis, recurrent or chronic
What rash is associated with streptococcal infection?
Most commonly, rash of scarlet fever: fine, erythematous, sandpaper-like rash, accentuated at skin creases Also can cause urticarial rash
What is Erythema multiforme?
An acute hypersensitivity syndrome Most commonly caused by herpes simplex infections, but may be associated with medications.
Describe the rash appearance and progression in erythema multiforme
Symmetrical rash: Starts as a dusky red macules Evolves into sharply demarcated wheals Then into target-like lesions. Individual lesions stay fixed for one to three weeks; does not come and go
Describe the rash of Erythema infectiosum (Fifth disease)
Rash starts on the face with a “slapped”-cheek appearance Followed by a reticular (lacy) erythematous rash on the trunk and extremities. Caused by parvovirus B19.
What is the classic lesion due to type 1 hypersensitivity?
Intensely pruritic, circumscribed, raised, erythematous wheal, often with central pallor Usually asymmetric Individual lesions may enlarge and coalesce with other lesions.
What is the timing/progression of a classic type 1 hypersensitivity lesion?
The lesions continually change, with new lesions occurring as old ones resolve. Individual lesions tend to last only 12-24 hours. Individual lesions may enlarge and coalesce with other lesions.
Why are type 1 hypersensitivity lesions pruritic?
Histamine release from mast cells
What is erythema migrans?
Lesion associated with early localized Lyme disease. Starts as a red papule at the site of a tick bite, progressed to classic target rash (large erythematous annular patch)
What are the two main etiologies of drug eruption?
Type 1 hypersensitivity Other (non-immunologic) triggers of mast cell release (eg NSAIDs)
What is acute urticaria?
Commonly known as hives Rash that comes and goes rapidly (almost as you watch) Caused by histamine release; trigger can’t always be identified, but is often allergic. (from Latin for “nettle”)
What is seborrheic dermatitis?
Erythematous plaques with fine to thick, greasy yellow scale. Typically seen on the scalp, but may spread to the ears, neck, and diaper area of infants. Common; also known as “cradle cap”
What is the appearance of eczema?
Pruritic, erythematous, scaling plaques Extensor surfaces, posterior scalp Hx of atopy would support Dx; aka atopic dermatitis
What is the presentation of candidal rash in an infant?
Commonly manifests as diaper dermatitis Inguinal erythematous papules and plaques, with satellite lesions
What is the presentation of psoriasis?
Thick, non-waxy erythematous scale. May or may not be pruritic. Due to hyperproliferation of keratinocytes. +FHx in 40%.
How does the presentation of psoriasis differ from the presentation of seborrheic dermatitis?
Psoriasis is more erythematous & borders are more defined
What is this rash?
Atopic dermatitis
What is this rash?
Candidal rash
What is this rash?
Psoriasis
What is this rash?
Seborrheic dermatitis (cradle cap)
What is this rash?
Urticaria due to Type 1 sensitivity
Could alternately be
erythema multiforme, drug eruption, streptococcal infection
What is the treatment for seborrheic dermatitis?
Most children grow out of it; no treatment is required.
Symptomatic:
Baby oil and a small brush to remove the scales
Frequent (i.e., daily) shampooing with a gentle baby shampoo, or prescription shampoo
A low-potency topical steroid cream
What are open vs closed comedones?
An open comedo is a blackhead; a closed comedo is commonly known as a “whitehead” or “pimple”
What is the DDx for pustular conditions?
Staphylococcal folliculuitis
Acne vulgaris
Hidradenitis suppurativa
Rosacea
Perioral dermatitis
What is staphylococcal folliculitis?
Similar to nodular or cystic acne. Distribution is often below waist or in groin.
Specific etiology unclear; caused by s. aureus
What is the pathophys of acne vulgaris?
Mechanisms:
1) Keratinous material and excess sebum (due to androgenic influence) plug the pilosebaceous gland.
2) Increased sebum provides a growth medium for superinfection with Propioniobacterium acnes.
Areas of the body with the greatest number of sebaceous glands usually affected, including:
Neck
Face
Chest
Upper back
Upper arms
What is acne vulgaris?
Formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units
What is hidradenitis suppurativa?
Pustular lesions caused by occlusion of the apocrine follicular units (instead of the pilosebaceous units).
Often superinfected with Staphylococcus aureus or Streptococcus pyogenes.
What is the distribution of hidradenitis suppurativa?
Markedly different from acne.
Areas most likely affected in women: Axillae, Groin, Inframammary regions
In men: Perineal and perianal areas.
What is rosacea?
Chronic inflammatory disorder characterized by
facial flushing
telangiectasias
erythema
papules
pustules
in severe cases: rhinophyma
What is rhinophyma?
skin disorder characterized by a large, red, bumpy or bulbous nose
What is the distribution of rosacea?
Malar and nasal surfaces
What is the early form of rosacea?
Inflammatory papules, micropustules, redness
Seen in adolescents
What is perioral dermatitis?
Variant of rosacea commonly seen in adoescents.
Distribution is actually around mouth, nose or eyes
May have erythema, scaling, papule, pustules, but no comedones
What is this?
Staphylococcal folliculitis
What is this?
Acne vulgaris
What is this?
Hidradenitis suppurativa (of axilla)
What is this?
Rosacea
What is this?
Severe rosacea
What is this?
Perioral dermatitis
What factors are known to exacerbate acne?
Makeup
Mechanical factors (eg manipulation)
Occulsion (eg some sports gear)
Overzealous cleaning
What is the definition of mild acne?
Comedonal acne with perhaps a few papules or pustules
Describe moderate acne
Significant inflammatory lesions with concern for scarring
Describe severe acne
Nodulo-cystic type, with a high risk for significant scarring
Name 2 treatment options for mild acne
First step: OTC benzoyl peroxide: gel or skin wash
Drug of choice for comedonal acne: Retinoids (normalize keratinization)
Name 2 treatment options for moderate acne
Same initial treatments as mild, + one of:
Topic Abx (active against p. acnes, like clindamycin)
Oral ABx
OCP (for women)
How should patients with severe acne be managed?
Referral to dermatology
Most will manage with oral isotretinoin
What is nickel contact dermatitis?
Delayed type IV hypersensitivity reaction; onset usually 24-72h from start of contact
Name 3 common culprits for nickel contact dermatitis
Earrings, belt buckles, watches, buttons on jeans
What are the typical features of acute contact dermatitis reactions?
Vesicles
Edema
Erythema
Pruritis
What is impetigo?
acute superficial bacterial skin infection, characterised by pustules and honey-coloured crusted erosions
What is this?
Impetigo
What is this?
Impetigo
Name 4 potential side effects of topical steroid use
Skin atrophy
Telangiectasias
Hypopigmentation
Suppression of the hypothalamic-pituitary axis
Do adults or infants absorb more of a topical steroid?
Infants
What class of steroids is the strongest?
Class 1
Eg clobetasol (class 1) is 1000x as potent as hydrocortisone ( OTC, class 6/7)
What is this?
Chronic contact dermatitis (from nickel button)
What are the common distribution sites for scabies?
Wrists, ankles, palms, soles, interdigital spaces, axilla, waist, and groin
What is the classic scabies lesion?
5-10 mm curvilinear thread-like lesion–the burrow
How are infants diagnosed with scabies?
Presentation is atypical; usually talking with family/household members is important
Definitive diagnosis requires examining specimens from skin scrapings under a microscope
What is this?
Scabies
What is the classic presentation of tinea corporis?
Annular, well-circumscribed, scaly plaque with a raised border and a center that is brown or hypopigmented
Lesions gradually enlarge and may coalesce with surrounding lesions. May be mildly pruritic
What other types of tinea are there?
Tinea pedis
Tinea versicolor (actually a yeast)
Tinea capitis
What is the DDx of ringworm?
Psoriasis
Nummular eczema
Pityriasis alba
Pityriasis rosea
