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Pediatrics > VLC Peds: Derm / Rashes > Flashcards

VLC Peds: Derm / Rashes Flashcards

1
Q

A lesion that is <1cm and raised is a …

A

Papule

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2
Q

A lesion that is >1cm and raised is a ….

A

Plaque

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3
Q

A lesion that is <1cm and flat is a …

A

Macule

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4
Q

A lesion that is >1cm and flat is a …

A

Patch

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5
Q

A lesion that is 1-2cm and solid is a …

A

Nodule

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6
Q

A lesion that is >2cm and solid is a…

A

Mass / tumour

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7
Q

A lesion that is < 0.5cm and fluid-filled is a …

A

Vesicle

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8
Q

A lesion that is > 0.5cm and fluid-filled is a …

A

Bulla

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9
Q

A lesion that is < 1cm and filled with pus is a …

A

Pustule

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10
Q

A raised lesion that is transient, circumscribed, possibly with erythematous borders and pale centre is a …

A

Wheal

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11
Q

A surface break in the epidermis from wearing away is a …

A

Erosion

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12
Q

A surface break in the epidermis from scraping/scratching is a …

A

Excoriation

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13
Q

What is an ulcer?

A

A localized defect in the epidermis and dermis

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14
Q

What is an fissure?

A

Linear or wedge-shaped break in the epidermis

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15
Q

Visible flakes of keratin (fine or coarse, loose or adherent) are called …

A

Scale / scaling

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16
Q

Dried liquid debris (pus or serum) on the surface of the skin is called …

A

Crust

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17
Q

Diffuse epidermal thickening with accentuated skin lines is called …

A

Lichenification

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18
Q

How is a skin lesion characterized?

A
  1. 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
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19
Q

What are primary vs secondary lesions?

A

Primary: from the disease process Secondary: - evolve from primary - result of pt activities (eg scratching)

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20
Q

Name 5 terms that can be used to describe the arrangement of skin lesions (6 listed)

A

Symmetric Scattered Clustered Linear Confluent Discrete

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21
Q

A dilatation of superficial venules, arterioles, or capillaries visible on the skin is a …

A

Telangectasia

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22
Q

Tiny, non-blanchable red or purple macules

A

Petechiae

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23
Q

What are petechiae from?

A

Capillary hemorrhage under the skin or mucous membrane

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24
Q

Large, purple, non-blanchable lesions (may or may not be palpable) are …

A

Purpura

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25
Q

Why is it important to ask how the patient has been managing/treating?

A

Any previous treatments can modify the way the lesion looks (eg diphenhydramine)

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26
Q

What history points toward a rash being allergic?

A

FHx of atopy Recurrent rapid response and resolution Pruritis Hx of therapeutic response to an antihistamine

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27
Q

Name 5 conditions on the DDx for a rash in a child (8 listed)

A

Roseola Papular urticaria Streptococcal infection Erythema multiforme Erythema infectiosum (Fifth disease) Urticaria due to type 1 hypersensitivity Erythema migrans Drug eruption

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28
Q

What is roseola?

A

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).

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29
Q

What is papular urticaria?

A

Caused by bug bites 3-10mm papules, pruritis, recurrent or chronic

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30
Q

What rash is associated with streptococcal infection?

A

Most commonly, rash of scarlet fever: fine, erythematous, sandpaper-like rash, accentuated at skin creases Also can cause urticarial rash

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31
Q

What is Erythema multiforme?

A

An acute hypersensitivity syndrome Most commonly caused by herpes simplex infections, but may be associated with medications.

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32
Q

Describe the rash appearance and progression in erythema multiforme

A

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

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33
Q

Describe the rash of Erythema infectiosum (Fifth disease)

A

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.

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34
Q

What is the classic lesion due to type 1 hypersensitivity?

A

Intensely pruritic, circumscribed, raised, erythematous wheal, often with central pallor Usually asymmetric Individual lesions may enlarge and coalesce with other lesions.

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35
Q

What is the timing/progression of a classic type 1 hypersensitivity lesion?

A

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.

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36
Q

Why are type 1 hypersensitivity lesions pruritic?

A

Histamine release from mast cells

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37
Q

What is erythema migrans?

A

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)

38
Q

What are the two main etiologies of drug eruption?

A

Type 1 hypersensitivity Other (non-immunologic) triggers of mast cell release (eg NSAIDs)

39
Q

What is acute urticaria?

A

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”)

40
Q

What is seborrheic dermatitis?

A

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”

41
Q

What is the appearance of eczema?

A

Pruritic, erythematous, scaling plaques Extensor surfaces, posterior scalp Hx of atopy would support Dx; aka atopic dermatitis

42
Q

What is the presentation of candidal rash in an infant?

A

Commonly manifests as diaper dermatitis Inguinal erythematous papules and plaques, with satellite lesions

43
Q

What is the presentation of psoriasis?

A

Thick, non-waxy erythematous scale. May or may not be pruritic. Due to hyperproliferation of keratinocytes. +FHx in 40%.

44
Q

How does the presentation of psoriasis differ from the presentation of seborrheic dermatitis?

A

Psoriasis is more erythematous & borders are more defined

45
Q

What is this rash?

A

Atopic dermatitis

46
Q

What is this rash?

A

Candidal rash

47
Q

What is this rash?

A

Psoriasis

48
Q

What is this rash?

A

Seborrheic dermatitis (cradle cap)

49
Q

What is this rash?

A

Urticaria due to Type 1 sensitivity

Could alternately be

erythema multiforme, drug eruption, streptococcal infection

50
Q

What is the treatment for seborrheic dermatitis?

A

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

51
Q

What are open vs closed comedones?

A

An open comedo is a blackhead; a closed comedo is commonly known as a “whitehead” or “pimple”

52
Q

What is the DDx for pustular conditions?

A

Staphylococcal folliculuitis

Acne vulgaris

Hidradenitis suppurativa

Rosacea

Perioral dermatitis

53
Q

What is staphylococcal folliculitis?

A

Similar to nodular or cystic acne. Distribution is often below waist or in groin.

Specific etiology unclear; caused by s. aureus

54
Q

What is the pathophys of acne vulgaris?

A

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

55
Q

What is acne vulgaris?

A

Formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units

56
Q

What is hidradenitis suppurativa?

A

Pustular lesions caused by occlusion of the apocrine follicular units (instead of the pilosebaceous units).

Often superinfected with Staphylococcus aureus or Streptococcus pyogenes.

57
Q

What is the distribution of hidradenitis suppurativa?

A

Markedly different from acne.

Areas most likely affected in women: Axillae, Groin, Inframammary regions

In men: Perineal and perianal areas.

58
Q

What is rosacea?

A

Chronic inflammatory disorder characterized by

facial flushing

telangiectasias

erythema

papules

pustules

in severe cases: rhinophyma

59
Q

What is rhinophyma?

A

skin disorder characterized by a large, red, bumpy or bulbous nose

60
Q

What is the distribution of rosacea?

A

Malar and nasal surfaces

61
Q

What is the early form of rosacea?

A

Inflammatory papules, micropustules, redness

Seen in adolescents

62
Q

What is perioral dermatitis?

A

Variant of rosacea commonly seen in adoescents.

Distribution is actually around mouth, nose or eyes

May have erythema, scaling, papule, pustules, but no comedones

63
Q

What is this?

A

Staphylococcal folliculitis

64
Q

What is this?

A

Acne vulgaris

65
Q

What is this?

A

Hidradenitis suppurativa (of axilla)

66
Q

What is this?

A

Rosacea

67
Q

What is this?

A

Severe rosacea

68
Q

What is this?

A

Perioral dermatitis

69
Q

What factors are known to exacerbate acne?

A

Makeup

Mechanical factors (eg manipulation)

Occulsion (eg some sports gear)

Overzealous cleaning

70
Q

What is the definition of mild acne?

A

Comedonal acne with perhaps a few papules or pustules

71
Q

Describe moderate acne

A

Significant inflammatory lesions with concern for scarring

72
Q

Describe severe acne

A

Nodulo-cystic type, with a high risk for significant scarring

73
Q

Name 2 treatment options for mild acne

A

First step: OTC benzoyl peroxide: gel or skin wash

Drug of choice for comedonal acne: Retinoids (normalize keratinization)

74
Q

Name 2 treatment options for moderate acne

A

Same initial treatments as mild, + one of:

Topic Abx (active against p. acnes, like clindamycin)

Oral ABx

OCP (for women)

75
Q

How should patients with severe acne be managed?

A

Referral to dermatology

Most will manage with oral isotretinoin

76
Q

What is nickel contact dermatitis?

A

Delayed type IV hypersensitivity reaction; onset usually 24-72h from start of contact

77
Q

Name 3 common culprits for nickel contact dermatitis

A

Earrings, belt buckles, watches, buttons on jeans

78
Q

What are the typical features of acute contact dermatitis reactions?

A

Vesicles

Edema

Erythema

Pruritis

79
Q

What is impetigo?

A

acute superficial bacterial skin infection, characterised by pustules and honey-coloured crusted erosions

80
Q

What is this?

A

Impetigo

81
Q

What is this?

A

Impetigo

82
Q

Name 4 potential side effects of topical steroid use

A

Skin atrophy

Telangiectasias

Hypopigmentation

Suppression of the hypothalamic-pituitary axis

83
Q

Do adults or infants absorb more of a topical steroid?

A

Infants

84
Q

What class of steroids is the strongest?

A

Class 1

Eg clobetasol (class 1) is 1000x as potent as hydrocortisone ( OTC, class 6/7)

85
Q

What is this?

A

Chronic contact dermatitis (from nickel button)

86
Q

What are the common distribution sites for scabies?

A

Wrists, ankles, palms, soles, interdigital spaces, axilla, waist, and groin

87
Q

What is the classic scabies lesion?

A

5-10 mm curvilinear thread-like lesion–the burrow

88
Q

How are infants diagnosed with scabies?

A

Presentation is atypical; usually talking with family/household members is important

Definitive diagnosis requires examining specimens from skin scrapings under a microscope

89
Q

What is this?

A

Scabies

90
Q

What is the classic presentation of tinea corporis?

A

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

91
Q

What other types of tinea are there?

A

Tinea pedis

Tinea versicolor (actually a yeast)

Tinea capitis

92
Q

What is the DDx of ringworm?

A

Psoriasis

Nummular eczema

Pityriasis alba

Pityriasis rosea

Pediatrics (8 decks)

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