1
Q
transient vascular phenomena
A
- first 2-3 wks of life
- secondary to cold stress
- resolves w/ warming of skin
- associated w/ acrocyanosis and cutis marmorata
2
Q
acrocyanosis
A
- hands and feet symmetrically blue
- no edema or other cutaneous findings
3
Q
cutis marmorata
A
- reticulated cyanosis
- symmetrical to trunk and extremities
- can mimic CMTC which is persistent
4
Q
erythema toxicum neonatum
A
-MC pustular rash
-2nd - 3rd day of life
2-3 mm erythematous, blotchy macs/paps, evolve into pustules on broad erythematous base
-“Flea bitten”**
- on face, trunk, and proximal extremities
5
Q
transient neonatal pustular melanosis (TNPM)
A
- MC in black males
- usu present at birth
- small pustules on non erythematous base
- leave hyperpigmented macules w/ collarette of fine scale
6
Q
acropustulosis of infancy
A
- chronic or recurrent pustular eruption in newborn or early infancy
- esp on palms and soles, but can be widespread
- episodic w/ remissions q 1-3 wks but resolves by 2-3 yrs
- significant pruritus***
7
Q
which eruption resembles scabies?
A
acropustulosis of infancy
8
Q
miliaria crystallina
A
- obstruction to flow of sweat (eccrine duct obstruction)
- tiny vesicles on non-inflamed skin
9
Q
miliaria rubra
A
- small paps/vesicles or pustules w/ erythema
- obstruction is deeper** in epidermis than crystallina
- a response to thermal stress and resolves w/ cooling of skin
- common in first few weeks of life secondary to eccrine duct immaturity
10
Q
neonatal/infantile acne
A
- avg onset 3 wks but can be delayed to 3-6 mos
- inflammatory red paps/pustules, rarely cysts
- tx non usu necessary but topical acne preps or ketoconazole can be used in neonates
11
Q
suggested causes of neonatal and infantile acne
A
- neonatal: inflammatory rxn to malassezia
- infantile: likely triggered by endogenous androgens
12
Q
diaper dermatitis
A
- irritant is MC
- contact w/ irritants leads to erythema, scale and often erosion
- intertriginous areas usu spared**
13
Q
tx of diaper dermatitis
A
- gentle cleansing
- use of lubricants/barrier pastes
- may need low potency steroid ointment
- avoid offending agent w/ contact derm
14
Q
diaper candidiasis
A
- brilliant red eruption w/ sharp borders and satellite red paps or pustules
- intertriginous areas typically involved**
- topical antifungals to tx
15
Q
oral candidiasis (thrush)
A
- newborns may acquire from contact w/ vaginal tract and infants following abx tx
- white dots or patches and plaques; rubbing of lesions leaves a red spot and occasional superficial bleeding erosions
- MC on buccal mucosa, tongue and soft palate
- tx: nystatin or fluconazole
16
Q
capillary malformations
A
- salmon patch
- port wine stain
17
Q
salmon patch
A
- innocent pink to red macule on nape of neck (stork bite), glabella (angel’s kiss), forehead, upper eyelids, sacrum
- if on face, usu fades during 1st year but may persist indefinitely on neck/sacrum
18
Q
port wine stain
A
- persist during childhood; darkens and thickens in adolescence and adulthood
- gradual hypertrophy to underlying soft tissue
- unilateral to head/neck MC
19
Q
complications of port wine stain
A
- involvement to 1st division trigeminal nerve associated w/ Sturge-Weber syndrome
- may involve underlying meninges, cerebral cortex/eye; seizures, mental retardation, hemiplegia, glaucoma
20
Q
tx of port wine stain
A
pulsed dye laser - recurrence possible
21
Q
venous malformation
A
- slow flow venous abnormality of lg dilated vascular channel
- superficial blue or purple paps/nodules; deeper lesions w/ subtle blue hue at surface w/ compressible ropy texture
22
Q
arteriovenous malformation
A
- route from artery to vein, bypassing the capillary bed (uncommon)
- fast flow anomaly
- tense vascular mass; overlying skin is purple-ish, warmer, hair may grow faster and affected limb may be larger; possible palpable thrill or bruit
- US or MRI to evaluate
23
Q
infantile hemangioma
A
- dome shaped, dull to bright red
- generally grow over the first year, remain stable for period of months, then slowly involute spontaneously
- most require no tx
24
Q
involution of infantile hemangioma
A
- streaks or islands of white appear w/i as the lession flattens
- possible ulcerations
25
complications of infantile hemangioma
- can compromise vital fxn if located near anus, urethra, airway or eyes
- if > 5 cutaneous lesions it could indicate visceral involvement
- associated w/ extra cutaneous syndromes (vertebral, spinal, GU abnormalities)
- massive ones on the face/scalp have been associated with PHACE syndrome (posterior fossa brain malformations, arterial anomalies, cardiac defects, eye defects)
26
mongolian spots
- poorly circumscribed, gray to blue congenital macules or patches usu on trunk / proximal extremities
- AA>Asian>Caucasian
- no tx, usu fade by 3-5 yrs
27
epidermal nevi
- most appear at brith or early infancy
| - localized, linear**, verrucous, hyperpigmented plagues
28
sebaceous nevus
- linear, crescent, or round hairless, yellow, smooth to cobblestone-like plaque usu on scalp*
- benign hypertorphy and warty nodules expected around puberty
- <1% can lead to BCC
- elective excision can be delayed until after puberty
29
congenital pigmented nevi
- pigmented macules/plaques at birth or first few mos of life
- often develop dense hair growth
- small dark macules/paps may appear w/i
30
giant congenital pigmented nevi
- 20 cm or more
| - 2-15% incidence of melanomas developing in them
31
angiofibroma
- small reddish-brown paps on face
| - solitary in healthy individual but numerous are associated w/ tuberous sclerosis
32
tuberous sclerosis
genodermatosis associated w/ triad of angiofibromas, epilepsy and mental retardation
33
angiofibroma associaed tumors
- rhabdomyoma of myocardium
- brain tumors
- renal tumors
- retinal tumors
34
clinical presentation of angiofibroma
- can find ash leaf (hypomelanotic macules), shagreen patches (collagenoma), periungual fibromas and cafe au lait spots
- refer to ophthalmology and imaging
35
neurofibroma
- soft compressible, skin colored tumors
| - occurs sporadically in healthy or progressive in neurofibromatosis
36
neurofibromatosis
- autosomal dominant syndrome manifested by developmental changes in nervous system, bones, skin
- NF1 is MC: many cafe-au-lait spots, axillary freckles, lisch nodules
37
complications of neurofibromatosis type 1
-4x more likely to develop malignancies
38
diagnostic criteria for neurofibromatosis type 1:
| -2 or more of the following
- 6 or more cafe spots
- 2 or more neurofibromas
- axillary or inguinal freckling
- optic glioma
- 2 or more lisch nodules
- distinctive osseous lesion
- 1st degree relative w/ NF
39
atopic dermatitis / eczema
- chronically recurrent, genetically influenced rash
- associated w/ asthma and allergic rhinitis
- pruritis is hallmark**
- erythematous scaly paps/plaques w/ possible lichenification
- prefers flexural surfaces
40
pathophys of atopic dermatitis
- overzealous immunologic rxn to various Ags
| - filaggrin gene mutation leading to increase transepidermal water loss**
41
management of atopic dermatitis
- avoid irritants
| - keep water tepid, mild cleansers, moisturize daily
42
tx of atopic dermatitis
- low to med potency steroids x 1-3 weeks
- high potency if lichenification
- elidel or protopic
- sedating antihistamines for pruritis
- topical/oral abx for secondary infections
- bleach bath
43
keratosis pilaris
- commonly associated w/ atopic dermatitis
- retention of scale resulting in horny follicular paps w/ erythema
- upper arms, lower cheeks, buttocks and thighs
44
tx of keratosis pilaris
- emollients: urea, lactic acid, salicylic acid
| - often refractory to tx
45
seborrheic dermatitis
- chronic symmetric erythematous, greasy scaling eruption on hair bearing and intertriginous areas
- variable pruritis
- infants: cradle cap
- adolescence: dandruff
46
pathogenesis of seborrheic dermatitis
-possibly d/t the lipophilic yeast pityrosporum ovale
47
tx of seborrheic dermatitis
- OTC shampoos w/ pyrithione, selenium or salicylic acid
- antifungal shampoos/topicals
- short term topical steroid
48
tinea/pityriasis amiantacea
- variant of seborrheic / atopic, or psoriasis w/ probable secondary infection of staph
- proximal shafts of hair matted together in the scale
- tx: anti dandruff shampoo daily and topical steroid; lubricate w/ peanut oil or keratolytic prior to shampoo
49
herpangina
- multiple coxackieviruses, echoviruses and enteroviruses
- acute onset fever, HA, ST, dysphagia, anorexia, sometimes stiff neck
- 1 or more yellowish-white vesicles in throat
50
varicella
- scattered pruritic red paps that evolve in approx 24 hrs to vesicles on bright red base
- central umbilication then crusting and desquamation w/i 10 days
- preceding fever, ST, decreased appetite, malaise
51
hand foot mouth disease
- highly infectious coxsackie virus
- prodrome of fever, anorexia, ST - incubation 4-6 days
- 3-6 mm rapidly ulcerating vesicles w/ red halo w/i mouth, hands, feet
- lasts less than 1 week
52
impetigo
- group A beta hemolytic strep and or staph
- honey colored crusted patches or bullae
- topical or oral abx
53
staph folliculitis
- bacterial infection of hair follicles
- folliculocentric red paps/pustules on inflamed base - butt, thigh, arms, axillae
- consider MRSA
54
verruca vulgaris
-discrete, round, skin colored papillomatous papules
55
verruca plana
minimally pigmented flat topped paps
56
verruca plantaris
- bottom of foot
| - multiple black dots on surface are thrombosed capillaries
57
molluscum contagiosum
- poxvirus
- sharply circumscribed, superficial, pearly, dome shaped paps
- often umbilicated
- contagious
- if in genital area of teens/adults its an STD
- resolve spontaneously
58
pityriasis rosea
- self limited eruption of suggested viral
- prodrome of malaise, HS, mild viral sxs
- salmon-colored oval paps w/ fine collarette of scale - christmas tree pattern
- start w/ single larger herald patch
59
roseola infantum
- surprise rash d/t HHV6
- sudden unexplained high fever that occaisionally triggers febrile seizure and lymphadenopathy
- at around day 4 fever drops and rash forms - morbilliform erythema of discrete macules
60
measles (rubeola)
- high contagious viral illness spread by respiratory droplets w/ incubation 9-12 days
- prodrome of fever, malaise, dry cough, coryza, conjunctivitis (3 Cs)
- Koplik spots
- rash appears 14 days after exposure on face and spreads to trunk and LEs
61
potential complications of measles
- OM
- pneumonia
- meningitis
- acute encephalitis
62
rubella (german measles)
- aka 3 day measles
- caused by togavirus
- prodrome: 1-5 days low grade fever, malaise, ST, HA, eye pain, runny nose
- rash: exantheam, pink morbiliform macules, from face spreading caudally
63
erythema infectiosum (fifth dz)
- parvo B19
- prodome: occasionally mild viral prodrome precedes rash by 1-2 d
- rash: asx erythema of cheeks (slapped) then 1-4 d later, diffuse erythematous macules/pap which evolve into reticulate pattern
- after rash clears, will often recur when exposed to heat
64
gianotti crosti syndrome
- flat topped 3-10 mm pink-brown edematous paps, involving arms, legs, butt, face (occasionally vesicles)
- caused by various viruses
- most are asx
- eruption may last several mos
- can be associated w/ anicteric hepatitis, lymphadenopathy, splenomengaly
65
scarlet fever
- fine, red, pap, sandpaper-like rash
- starts at face/neck and generalizes to trunk/extremities
- usu follows onset of strep pharyngitis
- early white membrane on tongue that sheds leaving red strawberry tongue**
- desquamation of palms/soles 2 wks after
66
kawasaki dz acute phase
- 10-14 days
- abrupt onset high fever and extreme irritability
- rash: polymorphous, macular, morbillitform, urticarial, scarlatiniform or mized
- accentuated intertriginous w/ maceration
67
kawasaki dz subacute phase
- fever and rash improve
- carditis and coronary angitis and thrombocytosis --> occulsion of vessels and cardiac events
- widespread desquamation 1-2 weeks after clearing of rash
- tx: IVIG
68
henoch-schonlein purpura
- anaphylactoid or allergic vasculitis
- MC trigger: viral infection or strep
- 4-8 yo males
- palpable purpura and arthralgias MC
- possible abd pain and renal dz
69
henoch schonlein purpura rash
mottled palpable purpura to extensor aspects of extremitites and buttocks but may be preceded by urticarial lesions
70
systemic effects of henoch schonelin purpura
- scalp edema, periarticular swelling esp tp knees and ankles, abdominal colic w/ melena or frank blood stools are possible
- hematura
- vasculitis can involve kidneys, lungs, CNS
- if hemature, be cautious of development of glomerular dz and renal failure
71
what is the MC cause of hair loss in children?
tinea capitis
72
tinea capitis
- MC in black children
- annular patches of mild redness and scaling w/ partial alopecia
- hair breakage low on hair shaft --> "black dot" appearance*
73
kerion
a less common form of tinea capitis w/ intense inflammation w/ a tender boggy nodule
74
adenopathy associated w/ tinea capitis
occipital, post or pre auricular
75
MC fungus that causes tinea capitis
trichophytan tonsurans (microsporum species is 2nd MC)
76
alopecia areata
- asx, acute onet of 1 or several round patches of complete** hair loss
- scalp, eyebrows, eyelashes, trunk, extremities
- t cell mediated autoimmune dz
- no inflammation or scaling
- "exclamation point"*** hairs
77
other forms of alopeica
- totalis: entire scalp
| - universalis: entire body
78
common associations with alopecia areata
- nail pitting possible
| - atopic dermatitis and other autoimmune dz (SLE, thyroid, DM, vitilitgo)
79
tx of alopecia areata
-topical or IL steroids, local irritants, topical minoxidil, topical sensitizer and occ UV light
80
trichotillomania
- hair pulling
- common in toddlers, children and adolescents
- d/t repetitive pulling and/or twisting
- oddly shaped patches of hair loss w/ short broken off hairs at different lengths
- habitual, situational stress, and OCD
81
traction alopecia
- traumatic alopecia in young girls and women
- hairstyles that pull tightly on hair shafts
- can cause shaft fx and possible follicular damage
- MC to periphery of scalp (temple and above ears)
- permanent scarring can occur if prolonged
Pediatrics 2
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