List 4 things associated with acanthosis nigricans
- Obesity with insulin resistance
- Drugs: nicotinic acid
- Endocrinopathies: most commonly DM and , hyperandrogenic or hypogonadal syndromes
- Genetic disorders with mutation in FGFR gene
- Ethnicity: more common in hispanic and african american kids
How to treat acanthosis nigricans?
- Treat underlying disorder
- Weight loss for obese kids
- 40% urea cream
What is the first line treatment for uncomplicated comedonal acne?
- Topical retinoid
List three treatment options for mild to moderate papulopustular acne
- Topical retinoid + benzoyl peroxide
- Benzoyl peroxide + topical antibiotic
- Benzoyl peroxide + oral antibiotic
List two treatments for severe papulopustular acne
- Topical retinoid + benzoyl peroxide + oral antibiotic
- Isotretinoin 1mg/kg/day
List 4 possible hormone issues related to acne
- PCOS
- Menstruation
- Adrenal tumour
- Ovarian tumour
- Steroid use
What is the mechanism of action for retinoids?
- Inhibit formation and number of comedones, reduce mature comedones, reduce inflammation, encourage normal desquamation of follicular epithelium
- Side effect: irritation and dryness
What is the mechanism of action for benzoyl peroxide?
- Antimicrobial agent
What is one benefit of benzoyl peroxide?
- Does not enhance antibiotic resistance
List three systemic antibiotics used in the treatment of acne
- Tetracycline
- Minocycline
- Doxycycline
When to think about using systemic antibiotics to treat acne?
- When there is no response to topical therapy for 6-8 weeks
- For moderate to severe papulopustular acne
List three side effects of tetracycline
- Not used in pregnancy or children < 8 because can stain teeth
- Vaginal candida
- GI irritation
- Phototoxic reaction
- Brown discolouration of nails
- Esophageal ulceration
- Inhibition of fetal skeletal growth
List three side effects of minocycline
- Raised ICP
- Dizziness
- Blue discolouration to skin
- Hepatitis
- Pneumonitis
- Lupus like syndrome
What is the mechanism of action of isotretinoin/accutane
- Reduces size and secretion of sebaceous glands, normalizes follicular keratinization, prevents new microcomedone formation, decreases P. acnes and anti-inflammatory effect
What is the chances that accutane will work?
- 40% cured
- 45% still need topical therapies
- 20% need repeat course
List three side effects of isotretinoin
- Teratogenic
- Cheilitis
- Xerois
- Epistaxis
- Blepharoconjunctivitis
- Arthralgias
- Thinning of hair
- Increased risk of sunburn
- Pyogenic granulomas
- Colonization of skin with staph aureus: impetigo, infected dermatitis, folliculitis
- Increased TG and cholesterol: need to rule out underlying liver disease before starting
List 5 features of fetal isotretinoin syndrome
- Facial asymmetry
- External ear malformations
- Micrognathia
- Flat nasal bridge
- Ocular hypertelorism
- Conotruncal malformations
- Hydrocephalus, microcephaly
- Intellectual and learning disability
- Thymic aplasia/ parathyroid abnormalities
What is one acne medication that cannot be combined with isotretinoin?
Tetracycline because it can cause benign intracranial hypertension
List 5 dugs that can cause acne
- Corticosteroids
- Isoniazid
- Phenytoin
- Phenobarbitol
- Lithium
- Anabolic steroids
- Vitamin B12
List 5 differentials for angular cheilitis
- Dry lips
- Contact dermatitis from lip licking
- Hypervitaminosis A
- Iron deficiency
- Zinc deficiency
- Malabsorption syndromes
- Crohn disease
- Anorexia nervosa
- Accutane
- Oral thrush
How to manage contact dermatitis due to poison ivy exposure?
- Wash skin up to 2 hours after exposure with gentle detergent or soap formulated specially for contact dermatitis
- Oatmeal baths and cool compresses for symptomatic relief
- Antihistamines
- Topical steroids with 0.05% clobetasol propionate
- Oral steroids for severe cases or face/genital involvement
What type of immunodeficiency is seen in kids with anhidrotic ectodermal dysplasia?
Dysgammaglobulinemia
Why are congenital melanocytic nevi removed?
- For cosmetic reasons
- To decrease the chance of malignant transformation
List 5 ways to prevent skin cancer
- Sunscreen with SPF > 15-30
- Hat, long sleeves, pants
- Avoid direct sunlight from 1000-1600
- Avoid tanning beds
- Routine yearly skin examination for changing nevi
- Review ABCDEs with patients
- Baseline medical photography for congenital or atypical lesions
What is the natural history of a halo nevus?
- Subsequent disappearance of the central nevus over months
- Depigmented area may or may not repigment
List 5 things about a skin finding that would make you worried about malignancy
- Rapid increase in size
- Satellite lesions
- Change in colour, especially red, brown, gray, black, blue
- Change in texture with scaling, erosion, ulceration, induration
- Irregular borders
- Regional lymphadenopathy
What are the ABCDEs?
- Asymmetry
- Border irregularity
- Colour variability
- Diameter > 6mm
- Evolution: changes
List 5 treatments for common warts
- Duct tape: leave on for 6 days, repeat weekly for 2 months
- Liquid nitrogen
- Podophylin 25%: leave on for 4-6 hours
- Imiquimod: for genital warts
- Daily salicylic acid: slow but painless, need to apply daily for 5 days then take 2 days off
For how long is olluscum contagiosum contagious?
For the entire duration that the rash is present
List 5 differentials for erythema nodosum
- GAS infection
- TB
- Mycoplasma
- Yersinia
- EBV
- Sarcoidosis
- IBD especially Crohn disease
- Behcet disease
- Pregnancy
- Leukemia/lymphoma
- Medications: sulfonamides
How to manage erythema nodosum?
- Supportive care with NSAIDs
- If infection related will heal within 7 weeks; if related to active disease process can last up to 18 weeks
What is the pathogen that causes tinea versicolour?
Malassezia furfur
List three treatments for tinea versicolour
- Selenium sulfide topical therapy
- Imidazole or terbinafine cream BID
- Ketoconazole or fluconazole
List 4 risk factors for the development of dermatophytoses
- Immunosuppression
- DM
- Lymphoid malignancies
- High cortisol level
What is the treatment for tinea capitis?
- Terbinafine (lamisil) 5mg/kg/day for 6-8 weeks
- Draw baseline LFTs before starting terbinafine
- Can also do oral itraconazole
- Selsun blue shampoo or nizoral shampoo
- Oral steroids if severely inflamed kerion
What is the natural history of trichotillomania?
- Remits spontaneously in most kids
List 5 conditions that are associated with alopecia areata
- Hashimoto thyroiditis
- Atopy
- Nail pits/ridges/opacification
- Cataracts/lens opacification
- Addison disease
- Pernicious anemia
- Ulcerative colitis
- Myasthenia gravis
- Collagen vascular disease
- Vitiligo
What is the treatment for ringworm?
- Usually will clear spontaneously within several months
- If not can give a topical antifungal: terbinafine, ketoconazole, miconazole, cotrimazole BID for 2-4 weeks
What is the natural history of alopecia areata?
- Spontaneous resolution in 6-12 months
- High potency topical steroids
- Intradermal injection of steroids
- Systemic steroids
List 4 poor prognostic factors in alopecia areata
- Alopecia universalis
- Alopecia totalis
- Extensive and rapid hair loss
- Young age at onset
- Numerous episodes
List 5 things that can precipitate telogen effluvium
- Childbirth
- Fever
- Surgery
- Acute blood loss
- Severe weight loss
- Physical/emotional stress
- Stopping OCP or steroids
What is the natural history of infantile hemangiomas (previously called strawberry hemangiomas)?
- Usually not present at birth
- Rapid growth in the first few weeks of life followed by plateau of growth by 12-18 months then slow regression
- 95% involute by age 9
- 50% involute without a trace and 50% will leave a scar (these can be lasered)
List 5 indications for treatment of a hemangioma
- Concerning area
- Vision or airway threatening
- Impairing function
- CHF
- Kasabach Merritt Syndrome
- Rapidly growing
- Recurrent bleeding/ulceration/infection
List the 6 components of PHACES syndrome
- Posterior fossa malformations: Arnold Chiari and Dandy Walker malformations
- Hemangioma: large segmental on face
- Arterial anomalies: esp carotid, cerebral, vertebral
- Cardiac anomalies: esp AoC
- Eye abnormalities: hemangiomas, cataracts, amblyopia, proptosis, ptosis, heterochromia, refractive error
- Sternal or abdominal clefting
List 3 complications of a hemangiom
- High output CHF
- Ulceration
- Infection
- Bleeding
- Compression
- Beard distribution associated with upper airway involvement
- Kasabach Merritt Syndrome
See a child with nevus flammeus in the V1 distribution. What referral do you need to make and what complication are they are risk for?
- Ophthalmology
- Glaucoma
8 mo old child brought in with several brown lesions on the back. Parents say when they rub one a wheal forms. What is the condition?
- Urticaria pigmentosa
- Mastocytosis
Which metabolic abnormality is associated with subcutaneous fat necrosis?
Hypercalcemia
List 5 disorders that have cafe au lait macules
- NF1
- McCune Albright syndrome
- Ruberous Sclerosis
- Russell Silver Syndrome
- Turner syndrome
- Ataxia-telangiectasia syndrome
List 4 cutaneous manifestations of tuberous sclerosis
- Ask leaf spots
- Shagreen patch
- Periungal fibroma
- Angiofibromas
List 5 diseases associated with vitiligo
- Addison disease
- Hashimoto thyroiditis
- Pernicious anemia
- Diabetes
- Hypoparathyroidism
- IgA deficiency
- Alopecia
List 3 treatments for vitiligo
- Potent topical corticosteroid
- Topical tacrolimus or picrolimus
- UVB light
- Spontaneous remission in a small percentage
Which medication causes pseudoporphyria?
Naproxen
What is the typical presentation for pityriasis rosea?
- Herald patch presents first, can be anywhere, 1-10cm big, round with raised border and fine scale
- 5-10 days later get generalized eruption of round/oval lesions < 1cm in a christmas tree pattern on the back
- Can be asymptomatic or itchy
Is pityriasis rosea contagious?
No
List 2 treatment options for pityriasis rosea
- Observation
- Lubricating lotion
- Antihistamine or topical steroid for itching
Which individuals are you more likely to offer treatment for pityriasis rosea?
- Dark skinned individuals as there is a chance that there will be post inflammatory hyper/hypopigmentation
What is the typical presentation of psoriasis?
Erythematous papules that coalesce to form plaques with sharply demarcated irregular borders with thick silvery scale
What is Auspitz sign?
- Removal of scale that causes pinpoint bleeding
Picture shown of nail pitting. What is the diagnosis?
- Psoriasis
- Nail pitting seen in 40%
- In some patients this may be the only manifestation
List 4 treatments for psoriasis
- Topical therapy: corticosteroids, retinoid, vitamin D analog (calcipotriene), tar preparations, phenol and saline solution with tar shampoo
- Phototherapy: narrowband UVB light
- Systemic treatment: MTX, cyclosporine, oral retinoids
- Biologic response modifiers: TNF a inhibitors
What is the treatment for seborrheic dermatitis?
- Mineral oil followed by Selenium sulfide shampoo daily
In a child with a facial nevus flammeus who presents with a seizure, what would the expected finding be on head MRI?
Leptomeningeal venous angioma
List 3 complications associated with Sturge Weber syndrome
- Glaucoma
- Hemiparesis contralateral to facial lesion
- Seizures
- Developmental delay
What is the typical presentation of Klippel Trenaunay syndrome?
- Vascular malformation present at birth with hypertrophy of affected limb
What is the most common cause of erythema multiforme?
- HSV infection
- Mycoplasma infection also a common cause
List 5 medications that cause toxic epidermal necrolysis
- Sulfonamides
- Amoxicillin
- Phenobarbitol
- Hydantoin
- Allopurinol
- Ibuprofen
- Infections like mycoplasma
List 4 drugs associated with Steven Johnson Syndrome
- Sulfonamides
- NSAIDs
- Anticonvulsants
- Antibiotics