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Pediatric Derm

Pediatric Dermatology

QuestionAnswer
Epidermis the outer most portion of the skin. Made up of 2 major layers (stratum/corneum). Protective barrier of skin
Dermis Vascular connective tissue. Connected to the epidermis by connective tissue. has lots of nerve endings, very vascular
Hypodermis fatty layer, provides heat, shock absorption, insulation and a calorie reserve
Vernix cheesy layer present at birth
lanugo fine hair that covers the body of a newborn
What are some characteristics of infant skin Poor subcutaneous fat (risk of hypothermia). Increased permeability. Apocrine glands not functioning yet
What are some characteristics of adolescent skin? Apocrine (sweat) glands enlarged and activated. Increase sebum production (acne) Hair production (due to sex hormones)
What are some elements of an infant hx? Feeding hx (formula, breastfed), diapering, bathing, clothing, washing, home environment
What are elements of child's hx? Eating habits, sick contacts, allergies, animal/outdoor exposure, injuries, habits (pullying hair)
What do you look for on physical exam? Color, pigment, thickness, turgor, mositure, texutre, temperature, sensitivity, creases
In terms of lesions what do you look for on PE? size, shape, color, texture, exudate, configuration, patterns
In terms of hair, what do you look for on PE? texture, color, distribution, quantiy
What to look for in terms of nails? shape, color, length, symmetry, cleanliness, configuration
What is atopic dermatitis? Chronic allergic skin inflammation. Hereditary
When does AD usually begin? Usually begins in childhood, and resolves by age 30, but there are exceptions
When does AD typically first appear? over 3 months old
What are the phases of AD Infant eczema birth to 2 years. Childhood eczema 2-12 and Adult 12 and odler
What are some characteristics of AD? Periods of remission and exacerbation. Abnormally dry skin, pruritis, erythema.
What kind of cycle does AD have? itch-scratch cycle leads to weeping, cursting, then lichenification
What are some coexisting conditions of AD? Xeroderma (dry scaly skin), Dennie-Morgan folds (extra fold of skin under eyes), allergic symptoms
What effect does scratching of the skin have? can be traumatic to the skin, cause skin damage and lead to infection
What are differential diagnoses for AD? contact dermatitis, seborrheic dermatitis, nummular dermatitis (rare in children), scabies, tinea
What nonpharmacological treatment would you recommend for AD? Bathing and lubrication. Behavior modification (no scratching)
What pharmacological treatment would you recommend for AD? Hydrocortisone 1% or 2.5% BID x 7 days
What other categories of meds would you prescribe? Antihistamines (benadryl, xertec, claritin), Topical antipruritics (benadryl topical, calamine lotion, oatmeal baths).
What would you prescribe for more severe cases of AD? topical immunomodulators (Protopic, elidel)
How do you prevent AD? Reduce dryness and irritiation, Avoid drying soaps and hot water. "Soak then grease" Eliminate allergens, avoid irritants
What are the complications of AD? usually related to itching and damaging the skin (ie. infections)
What is seborrheic dermatitis? Cradle cap. Inflammatory disorder. Usually develops in first 3 monts. Scaly scalp eruptions.
What are the characteristics of mild SD? white or yellow, greasy scales on erythematous base. Can be very severe and flaky. Dull red plaques with thick scales.
What are the differential diagnosis for SD? psorias, tenia infection, rosacea (redness on the cheeks and face). The cradle cap sometimes goes all the way down to the face.
When does SD resolve? in about 12 months
Is itching involved in SD? No. very important part of hx. SD does not itch.
What is the nonpharmacological treatment for SD? Mild or medicated shampoo.
True or false? Baby oil is used to treat SD? False. Do not use baby oil, this can make it worse.
What are some complications of SD? watch for secondary infection (when you scratch the scalres you aslo scratch the upper layer of the epidermis
What is contact dermatitis? Skin inflammation due to irritants or allergans (irritants more likely)
What are clinical manifestations of acute CD? Acute: papules or vesicles, pathcy with weeping, edema, burning
What are clinical manifestations of persitant CD? patchy, lichenification, fissure (i.e. nickle allergy)
How can you tell the difference between CD and AD? Get a good history
What is the nonpharmacological treatment for CD? identify and eliminate the allergens
What is the pharmacological treatment of CD? Topical steroid (hyrdocortisone) or Occlusive ointment (A&D ointment)
What is allergic contact dermatitis? is a delayed hypersensitivity reaction that occurs after contact with an allergen
What is the most common allergen for ACD? poison plants (poison ivy, oak)
What is the first thing you would do if someone presents with ACD? Get a good hx. find out outdour exposure
What is the nonpharmacological treatment for ACD? Wash area, cold, wet compress. Calamine lotion, aveeno bath (or plain oatmeal) to control the itching.
How long does it take for symptoms to resolve for ACD? The itching stops in about 10-14 days.
What are some other allergens for ACD? Nickel, jewely latex, detergent, cosmetics.
What is the most common irritiant in children diaper dermatitis
What are some characteristics of DD? Peaks in 7-9 months. Irritants: Stool and urine
What is the microrganism involved in DD? candida
Describe the clinical manifestations of DD glistening erythema or beefy red eruptions
What are some common treatments for diaper dermatitis? Frequent diaper changes, expose bottom to air, cleanse bottom with water. Barrier ointment
What pharmacological treatment would you recommend for diaper dermatitis? Hydrocortisone 1% or Miconazole
What causes acne? multifactorial etiology. It can be caused by an increase in sebum production or the environent.
Why does acne increase during puberty? Increased sebum production
What are comedonal acne blackheads and whiteheads. not usually inflammed, but more pustule
What is the worst kind of acne? inflammatory, cystic (very destructive can lead to a lot of scarring)
What questions should you ask during the hx of an acne pt? What treatments have you used in the past. Exacerbations (what makes it better/worse), medical hx, personal habits, menstruation, OCPs, what age it first appeared, distribution,
Where can acne appear? On the face and on the back
What is the treatment for acne? Benzoyl Peroxide, Retin A, topical or oral antibiotics, hormonal therapy
What is the treatment for severe acne? Accutane (usually prescribed by a dermatologist)
If the patient is prescribed Retin A what additional teaching is required? Increases risk of burning in sun exposure.
How long should you wait before you refer patient to a dermatologist? 10-12 weeks.
What are the most common clinical manifestations of HSV1 and HSV2? HSV1 is usually orolabial. HSV2 is usually genital. But HSV2 has been found in other areas.
What are the signs/symptoms of HSV1? Recurrent painful vesicales, erode and then crust over
What diagnostics tests would you do for HSV1? Viral culture for herpes, HSV1 IgG or Elisa
What is the oral treatment for HSV1? Acyclovir, famcicolvir, valcyclvir
What is the topical treatment for HSV1? Denivir, Abreva (shortens the course of symptoms)
What nonpharmacological treatment would you recommend for HSV1? Protect the lips with chap stick, don't pick at it, good hand hygiene, cool compress (prn)
How is varicella spread? Airborne or direct contact
How long is the incubation period for varicella? 10-21 days
During what time period is someone with varicella contagious 2 days before rash and until after vesicles have crusted
What is the course of varicella? mild prodrome and then eruption of lesions
What is the hallmark of chicken pox symptoms? Crops of lesions pop up over several days, macules, papules, vesicles, then they crust over. Lesions are in different stages.
What are some complications of varicella? severe skin infections and sepsis, thrombocytopenia
What is the treatment for varicella? Chicken pox is rarely treated. Oral antiviral are given in rare cases.
What treatment would you recommend for varicella? Symptom control: Aveeno baths, Tylenol for fever and pain control
What is the most effective way to prevent varicella infection? varicella vaccine
What is Rubella? German measles. RNA virus, spread by direct or droplet contact.
What are the clinical manifestations of Rubella maculopapular rash (discreet, pink), lymphadenopathy
Where does Rubella generally start? Starts on the face and then spreads to the trunk and extremities
What organism causes warts? Human papilloma virus
What are warts? epithelial tumors common on hands and plantar surfaces
What is the treatment for warts? They resolve in 12-24 months without treatment
What pharmacological treatment is available for warts? Salicylic acid (Dr. Scholls), liquid nitrogen, duct tape (occlusion therapy)
What is the most common pathogen for impetigo Staph. aureus and Strep. pyogenes
How would you describe impetigo? Vesicles erupt into honey colored, moist, crusted erosion, usually on the face (ie lips), but can also be in the diaper area.
True or false? Impetigo can only be found on the face False. Impetigo can be found in the diaper area as well.
What is bullus impetigo? Looks like a big vesicle burst
What is the treatment for impetigo? Keflex or Dicloxacillin
What topical treatment is available for impetigo? Bactroban (Kill S. aureus)
What patient teaching would you offer to the parent of a child treated for impetigo? It's highly contagious but the child can return to school 24 hourse after antibiotics are started.
What are the most common fungle infections in children? Tinea capitis (scalp) and Tinea corporis (ring worm)
what is tinea capitis? dematophyte fungle infection of the scalp
How do you differentiate between tinea capitis and tinea corporis? Do a KOH wet mount
What is the definitive treatment for tinea capitis? Griseofulvin V 20 mg/kg/day BID
What pt education would you give for the treatment of tinea capitis? Take for 8 weeks and with high fat foods
What reason do parents typically bring chidren in for scalp diseases? there child is losing their hair
What is the clinical manifestation of tinea corporis? round scaly area, well demarcated.
What is the treatment for tinea corporis? topical antifungal (miconazole, clotrimazole, terminafine solution
what is the treatment for tinea corporis, pedis, and cruris? topical antifungals - miconazole, cotrimazole, terinafine solution
What is Tinea cruris? Jock itch. c/o groin itching. sharp borders. well demarcated redness. Spares the scrotum. Consider candida infection.
What is tinea pedis Athlete's foot, uncommon before puberty.
Where is it important to look for tinea pedis? Between the toes
What is tinea versicolor? Widespread macular eruptions on the skin, of various colors.
How do you differentiate tinea versicolor and vittiligo? The skin pigmentation in versicolor usually comes back to normal, vitilligo is a chronic skin condition
What is candidiasis? Yeast infection caused by C. albicans
What is oral thrush? Candidias found in the mouth. White plaques that don't scrape off. Milk curds scrape off.
What are the clinical manifestations of diaper candidiasis? Beefy red lesions. Can have satellite lesions
What is the difference between diaper candidiasis and contact dermatitis? Dermatitis from candida can spread out. Satellite lesions.
What is the treatment for Thrush? if oral: nystatin 1 ml to each side of mouth qid. Diaper: Nystatin cream
What teaching would you offer for treatment of oral and diaper yeast infection? Important to have medicine touch the infected surface. If mom is breastfeeding she can paint her nipples. For diaper, don't cover rash with any other medication, N. should be close to skin.
What is pediculosis capitis? Head lice. Eggs of mites attach to hair shaft near scalp, nits (empty egg cases) are more visible.
What is nonpharmacological treatment for p. capitis? Use nit comb, clean all combs/brushes
What is pharmacological treatment of p. capitis Nix OTC, Ovid, RID OTC
How soon can a child return to school if diagnosed with p. capitis? Return to school the day after treatment
What is pediculosis corporis body lice, less common in children. Associated with poor hygiene.
What is the treatment for p. corporis? improve hygiene and launder clothes
What is pediculosis pubis? louse that have infected the pubic hair
What is the treatment for p. pubis? Nix OTC, Kwell, RID OTC
What is scabies? mites spread by personal contact
What is the hallmark sign of scabies? Intense pruritus (itch)
What are other signs/symptoms of scabies? Burrows (long gray line) which may get destroyed because the pt has been scratching), vesicles, papules with erythema from scratching
What is the most common place of infestation of scabies for infants head and neck
What is the most common place of infestation of scabies for children hands
Other places scabies are found? Belt line, wrists, axilla
What is the treatment for scabies? Elimite cream
What patient education would you give to someone being treated for scabies put on entire body, leave it on for 8-14 hours, it won't kill if it's washed off before then)
What other options are available for scabies treatment? Ivermectin PO for severe cases
True or false kwell topical is approved for the treatment of scabies in children less than 2 years old False. It is not approved for children < 2
What nonpharmacological treatment is recommended for the treatment of scabies? Launder clothes and bedding. Wrap mattress in plastic bag for a week.
When can a child with scabies return to school? Following treatment
If a child is treated for scabies should anyone else be treated? yes, the entire household
What is the disease caused by ticks? Lyme disease cause by spirochete: borrelia burgdorferi
What history should you get for a pt presenting with ticks? camping, yard work, pets
What is a classic sign of Lyme disease? First stage: erythema migrans red macule/papule round lesion with cnetral clearing. Looks like a bullseye.
What organism causes pinworms? Enterobiasis
How are pinworms spread? Fecal-oral transmission
What is a common clinical manifestation of pinworms? anal pruritis
When are the pinworms most visible? At night in the anal area
What is the important thing to remember about Cafe au Lait spots Document size and number
What is associated with Cafe auLait spots? Tubulersclerosis and neurofibromatosis are associated with > 6 large spots
What is an hemangioma? A benign tumor of dilated blood vessels. Cam be vascular with a lot of bleeding
What is the important thing to remember about hemangiomas? Document, follow and refer
What is a splinter hemorrhage? A small linear hemorrhage under the fingernaisl or toenails. It may be due to subacute bacterial endocarditis
True or False Port wine stays may never disappear? True. Refer for laser treatment for help with fading
What is the important thing to remember about mongolian spots document
What is tractional alopecia hair loss from too tight hair style. Some kids can also get folliculitis, where hair follicles get inflammed and infected.
Scarlet fever diffuse red sand paper rashe. Often compared to goose bumps.
Where does scarlet fever start? On the trunk.
What disease condition is often associated with scarlet fever? strep pharyngitis
What other problems can scarlet fever lead to? glomerulonephritis, endocartditis.
What is drug eruption? Allergy to a drug. Get family hx or personal history to a drug.
What systemic diseases may present with diaper dermatitis Acrodermatitis enteropathica (an inborn error of metabolism) and histiocytosis x (immune disorder)
Created by: lknightly