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Flashcards in Dermatology Deck (65)
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1
Q

what are 4 risk factors for infantile hemangioma?

A

female
multiple gestation
prematurity
low birth weight

2
Q

what is the natural history of infantile hemangioma

A

rapid growth out of proportion to Child’s growth, usually complete by 5 months
Plateau: ~12-18 months
Regression: ~18 months until 9-10 years of age
Residua: lasting skin changes in 50%

3
Q

when do we worry about hemangioma of infancy?

A
Obstruction
– Periorbital may impair vision
– Large “beard-area” distribution-+/- airway IH
• Associations
– Mid-line lesions
• Lumbosacral or mid-face
– Large segmental on face: PHACES
• Ulceration
• Multiple
4
Q

what is the treatment for infantile hemangioma?

A

95% require no treatment
– Anticipatory guidance
– Surgery or laser at later stage if not resolved

5% require treatment
first line- propranolol (Vision or airway threatening, significant cosmetic outcome)
oral corticosteroids also work but not first line

5
Q

what should you monitor for a patient on propranolol for infantile hemangioma?

A

blood pressure

hypoglycemia

6
Q

contraindications to propranolol for hemangioma

A

asthma, diabetes, PHACES

7
Q

what is nevus simplex (storkbite)

A

40% of newborns
Naevus simplex is a common, benign capillary vascular malformation
It presents at birth as a pink or red patch and is most often observed on the nape of the neck, eyelid, or glabella (skin between the eyebrows)
Usually fade significantly except nuchal area

8
Q

Nevus flammeus

A

port wine stain

persist lifelong

9
Q

What doe PHACES stand for?

A

Posterior fossa brain malformations
Haemangiomas, particularly large, segmental facial lesions
Arterial anomalies
Cardiac (heart) anomalies and coarctation of the aorta
Eye abnormalities and Endocrine abnormalities

PHACES syndrome is PHACE syndrome plus:

Sternal cleft, supraumbilical raphe, or both

10
Q

When do you worry about capillary malformations

A

– V1 distribution
• 10% have Sturge-Weber syndrome

– Lumbosacral capillary malformation (May have spinal abnormalities)
consider MRI

11
Q

what is the difference between capillary malformation and hemangioma

A

capillary malformation- vascular malformation, grows with the child, never resolve
hemangioma- vascular tumor, rapid growth, resolve

12
Q

When do you worry about nevi?

A
ABCD 
Asymmetry 
Border regularity 
Colour variety 
D- diameter >6mm worry
E- evolution/change
13
Q

what are the management options for nevi

A
Prevention
– Sun Protection:
• Sunscreen SPF 15 or greater
• Hat, long sleeves/pants
• Avoid direct sun 10:00am-4:00pm (seek shade)
• Avoid tanning beds
  • Review with patients: A B C D E
  • Baseline photography for congenital, atypical
14
Q

cafe au lait- what is the border like

A

irregular but sharp border

no scale

15
Q

NF1 criteria

A
Need 2/7 criteria
– >5 CALMS (>5mm prepuberty; >15 mm after)
– Family history
– Axillary or inguinal freckling
– Specific bony abnormalities
– 2 neurofibromas (or 1 plexiform neurofibroma)
– Optic glioma
– Lisch nodules (iris)
16
Q

what is Vitiligo? tx?

A
autoimmune disorder that targets melanocytes
Depigmented patches
- Sharply marginated
- No Scale
- Tiny areas repigment

1st-line Tx= Strong topical steroids

17
Q

what is commonly associated with post inflammatory hypopigmentation

A

eczema
poorly marginated, no scale
self-resolves, gets better with time

18
Q

what is Pityriasis Alba? where do we see it? when? treatment?

A

pityriasis refers to its characteristic fine scale, and alba to its pale colour (hypopigmentation).

summer- often presents following sun exposure
Hypopigmented
Poorly marginated
Fine white scale **
Face common

tx: 1% hydrocortisone for scale BID for 5-7 days
Hypopigment improves in time

19
Q

what is tinea versicolor? tx?

A

common yeast infection of the skin, in which flaky discoloured patches appear on the chest and back

physical exam?
Hypopigmented
Can be hyperpigmented
Sharply marginated
Fine white scale***
Trunk, proximal limbs

Tx: Antifungal shampoo daily, 1-2 weeks (lathered to area)
topical antifungals

20
Q

major criteria for TS

A

2 major features OR one major feature and 2 minor features

Hypopigmented macules >=3
– At least 5mm or bigger
• Facial angiofibromas OR forehead
plaque
• Non-traumatic ungual or
periungual fibromas
• Shagreen patch
• Subependymal nodule
• Subendymal giant cell
astrocytomas
• Cardiac rhabdomyoma
• Lymphangiomyomatosis
• Renal angiomyolipomas
21
Q

minor criteria for TS

A
Multiple randomly distributed
pits in dental enamel
• Hamartomatous rectal polyps
• Bone cysts
• Cerebral white matter migration
lines
• Gingival fibromas
• Non-renal hamartomas
• Retinal achromic patch
• Confetti skin lesions
• Multiple renal cysts
22
Q

Staphlococcal Scalded Skin Syndrome? pain?fever? tx?

A

Bullous eruption from S. aureus toxins
pain is common
Fever and systemic symptoms uncommon

IV cloxacillin, some will add clindamycin

23
Q

what is the treatment for scabies?

A

Permethrin 5% cream most effective
• Infants: treat whole body
• Older kids & Adults: treat from neck down

Leave on overnight and wash in am
• Re-treat 1 week later
Launder clothes/linen from last 3 days

24
Q

what is the treatment for eczema herpeticum

A

• If unwell, <1 year, poor fluid intake, severe:
– Admit and treat with IV acyclovir
• If well, localized, good fluid intake, good f/u:
– Oral acyclovir for 10 days

25
Q

what is the major agent for Tinea Capitis in North America? what are two fungus that cause it? tx?

A

T. Tonsurans major agent in North America

  1. Trichophyton (human reservoir)
  2. Microsporum (Cats and gods are reservoir)

Always Send Culture!!!
tx: oral terbinafine

SE terbinafine: liver enzymes, taste alteration, drug interactions, decreases pmns

26
Q

clinical presentation for Tinea Corporis? tx?

A

Scaly, red plaques with central clearing
• Often have active border or leading edge

tx:
Azoles:
– ketaconazole
– Miconazole
– Clotrimazole
• Allylamines:
– Terbinafine
• Ciclopirox Olamine
NOT NYSTATIN
27
Q

what is Pityriasis Rosea

A

Pityriasis rosea is a viral rash which lasts about 6–12 weeks. (?HHV6 or 7)
Characterised by a herald patch followed by similar, smaller oval red patches that are located mainly on the chest and back.
“christmas tree pattern”
tx: usually none
topical steroids or oral macrolides can help

28
Q

molluscum contagiosum

A

Umbilicated, waxy, flesh-colored papules
• Often have surrounding dermatitis
• Resolving lesions: crusted, erythematous
• Can occur anywhere but groin/axillae common
• Can leave scars even with no treatment

29
Q

what are some treatment options for molluscs contagiosum

A
Cantharidin
• Applied to lesions by physician and washed 4 hours later
– Curettage
• Painful, needs topical anesthesia
– Liquid nitrogen
• Painful, can leave depigmented areas
– Topical tretinoin
• Immune enhancer
– Imiquimod (off-label)
30
Q

what is Verrucae? cause?

A

viral wart
HPV
tx: Best available evidence supports use of topical treatments containing salicylic acid, cryotherapy, curettage and cautery, laser, duct tape

31
Q

SJS versus TEN

A

SJS <10%

TEN >30%

32
Q

What are possible causes of SJS? (2)

A
  1. Infection: most common cause is MYCOPLASMA 2. Drugs: NSAIDs, sulfonamides, antibiotics, anticonvulsants
33
Q

Treatment of SJS/TEN

A
Life-threatening!
• Admit (severe may need ICU or burn unit)
• Supportive management
• History for all medications, infections
• Consider mycoplasma and treatment
• Treatments of bullous eruption:
• IVIG (.75-1g/kg/day x 3 days)
– Always in drug reaction
– Consider in mycoplasma
• Steroids (controversial)
34
Q

Drug Hypersensitivity Syndrome

A

Morbilliform drug eruption WITH one or more of:
– Fever lymphadenopathy
– Pharyngitis Eosinophilia
– Elevated Liver Enzymes

35
Q

what is the diagnostic criteria for atopic dermatitis

A
Pruritus
• Early age of onset
• Typical morphology and distribution
• Chronically relapsing course
• Xerosis
• Personal or family history of atopy
36
Q

what are some complications of atopic dermatitis

A
Complications
• Sleep deprivation
• Scarring or lichenification
• Bullying, depression
• Pigmentary changes
• Infections
37
Q

treatment for atopic dermatitis

A

Ointments are best
• Mild potency cortisone for face/groin/folds
– Eg. 1% hydrocortisone
• Moderate potency cortisone for limbs/trunk
– Eg. 0.05% betamethasone valerate

2nd line: Calcineurin inhibitors (Pimecrolimus, Tacrolimus)

38
Q

what is the cause of Seborrheic Dermatitis

A

M. furfur

39
Q

seborrheic dermatitis versus atopic dermatitis

A
Seborrheic Dermatitis
• Thick, greasy scale
• Scalp, face, groin
• +/- itchy
• No 2o infection
tx: topical anti fungal
Atopic Dermatitis
• Fine, white scale
• Face, Flexors
• Prominent itch
• 2o impetigo common
• Cause:
– Excess inflammation
– Barrier defect in skin
tx: emollients, topical steroid
40
Q

what is Alopecia Areata? what are the 3 patterns?

A
Sharply defined areas of hair loss
• Skin below is normal
– Patch Alopecia--one or more patches
– Alopecia Totalis - all scalp hair lost
– Alopecia Universalis - all body hair lost

tx: Potent topical or mid-potent injected steroids
• First-line
screen for autoimmune diseases
Increased incidence in Down syndrome

41
Q

classification fo acne?

A

Mild:
– comedones &/or few inflammatory lesions
• Moderate:
– comedones & significant inflammatory lesions
• Severe:
• Persistent or recurrent inflammatory nodules
• Ongoing scarring
• Persistent purulent or serosanguinous drainage

42
Q

what is Pilomatricoma

A
Benign growth of hair follicle
• Firm, irregular, lobulated nodule
• Often bluish-purple or flesh coloured
• Head and neck common
• Can be tender
• Tend not to resolve on own
43
Q

how do you confirm the diagnosis of mastocytoma?

A

Confirm diagnosis with Darier’s Sign

– Stroke lesion to produce urticaria (diagnostic test)

44
Q

what is mastocytoma

A

Mastocytoma is most often diagnosed in an infant aged 0 to 3 months of age

dermal accumulation of mast cells forming one to thee solitary lesion

45
Q

what is nevus sebacous

A
Birthmark of abnormal sebaceous glands
• Always present at birth
• Typically on head, scalp and neck
• Yellow-pinkish plaque
• Barely palpable
• No hair within plaque
• Often linear configuration
Grows with child proportionately
• Puberty: can thicken considerably
– Hormonal stimulation of sebaceous glands
• Persists permanently
46
Q

Juvenile Xanthogranuloma

A
Benign collection of macrophages
• At birth or early in life
• Yellow-red papules with telangiectasia
• Soft and well-circumscribed
• Usually solitary, can be multiple
• Asymptomatic
• Regress over several years
• Rarely associations (liver, eye)
47
Q

Pyogenic Granuloma

A
reactive proliferation of capillary blood vessels. It presents as a shiny red lump with a raspberry-like or minced meat-like surface.
Acute, red, domed papule
• Often bleeds and crusts
• Benign growth of blood vessels
– During pregnancy, after trauma, idiopathic
• Can regress spontaneously over months
• Treatment options:
– Preferred (histology confirms Dx):
• Curettage
• Excision
48
Q

Erythema Toxicum Neonatorum

A
  • Red macules, papules and pustules
  • Palms and soles not involved
  • between 24-48 hours of age
  • Lesions last 1-2 days, new crops q few days
  • Common in term infants; rare in prems
  • Dx: clinical; smear of pustule: eosinophils
  • Tx: none
49
Q

Transient Neonatal Pustular

Melanosis

A
More common in term infants
• More common in dark-skinned infants
• Lesions always present at birth
• Dx: Clinical; smear of pustule shows PMNS
• Tx: none
50
Q

neonatal acne

A

Develops in first few weeks

• Resolves by around 3 months

51
Q

what is the cause of neonatal acne

A

• Caused by malassezia

52
Q

what are the 4 stages of Incontinentia Pigmenti

A

Stage 1: erythema, vesicles, pustules (linear array of vesicles)
• Stage 2: verrucous, hyperkeratosis (wart-like lesions)
• Stage 3: HYPERpigmentation
• Stage 4: HYPOpigmentation, atrophy

53
Q

Congenital Candidiasis

A

Onset from birth to first week
• Risk Factors:
– Prematurity
– Maternal history of vaginal candidiasis
• Eruption:
– Generalized red papules with pustules and scale
– Often palms and soles involved
• Systemic: baby unwell, temp instability
• DX: KOH for yeast cells and culture
• TX: Systemic antifungals

54
Q

how does benzoyl peroxide work?

A

Reduces bacteria-does not induce resistance

55
Q

is molluscum pruritic?

A

No!

56
Q

what is first line treatment for black heads (comedomal acne)

A

topical retinoin

57
Q

when do strawberry hemangioma usually appear

A

first or second month of life

58
Q

An 8 month old child is brought in with several small brownish nodules on his back and extremities. The parents have observed that when they touch the nodule, wheals develop around it, it it transiently becomes erythematous and their child starts to scratch it. What is the diagnosis?

A

mastocytosis

59
Q

Telogen effluvium

A

hair loss occurs approx 3 months after precipitative/stressful event
no treatment; complete regrowth occurs within a few months unless another stressful event occurs

60
Q

alopecia arreata has increased incidence with what syndrome

A

Down syndrome

61
Q

what is one medication that can cause a hypo pigmented scar after exposure to sunlight

A

NSAIDs

62
Q

what are two causes of erythema multiforme

A
  1. herpes simplex

2. mycoplasma

63
Q

what is the treatment for labial adhesions

A

topical estrogen cream

64
Q

Child with trisomy 21 has three discrete hairless patches on scalp, no other findings.
Likely diagnosis?
What will you tell mom about the natural history?

A

alopecia areata

Many patients with limited patchy hair loss experience regrowth within one year, but recurrence is common

65
Q

2 y/o with diffuse atopic dermatitis. He is compliant with steroid treatment but is not improving. What topical agent could be the next line?

A

tacrolimus