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216 Cards in this Set
- Front
- Back
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History of a child with a rash... |
-onset, duration -skin symptoms: itch, hurt -systemic symptoms: fever, malaise, pertinent ROS -exposures: travel, outdoor activities, animals, sick contact, new meds -pertinent PMH: immune status, chronic illness, valvular heart disease |
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what are you looking for with a rash? |
-primary lesions -secondary lesions -color -pattern -distribution |
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flat, less than 1 cm |
macule |
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raised less than 1 cm |
papule |
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flat greater than 1 cm |
patch |
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raised greater than 1 cm |
plaque |
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deep raised lesion greater than 1 cm |
nodule |
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blister less than 1 cm, clear fluid |
vesicle |
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filled with pus less than 1 cm |
pustule |
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fluid filled greater than 1 cm |
cyst |
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secondary part of epidermis is missing, shiny, oozing |
erosion |
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secondary deep hole with all epidermis gone |
ulceration |
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secondary yellowish dry serum +/- itfection |
crusting |
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secondary flaky bits of epidermis separating |
scaling |
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secondary punctate to linear scratch marks |
excoriations |
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secondary linear cracks |
fissures |
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skin exam: color |
red, yellow, brown, black, tan or blue |
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skin exam: pattern |
discrete, linear, grouped, annular |
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skin exam: distribution |
generalized or localized, specific areas |
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what are the differential diagnoses for rashes? |
-blistering disorders -papular disorders -erythemas -papulosquamos conditions -eczematous disorders -vascular lesions -pigmentation problems |
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fever and palpable purpura is _____ until proven otherwise. |
meningococcemia |
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palpable purpura is ____; there is no good ___ |
vasculitis, vasculitis |
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the ____ the purpuric lesion the worse the disease |
larger |
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widespread bullae represent ___ until proven otherwise |
TEN |
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all bullous eruptions should be assessed for _____ ___. |
nikolsky sign |
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____ tests take time, do not wait to start empiric therapy |
lab tests |
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most common skin disorders in peds are caused by ____ infections |
bacterial infections |
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upper arm bumps are called? |
keratosis pilaris |
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what are triggers in atopic dermatitis? |
-saliva, wet bibs, food spills -URI -soaps, detergents -bacterial skin infections (impetigo, folliculitis) -vaccinations -smoke, fragrences |
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toxic sock syndrome also known as ___ ___ ___ is eczema on the feet from sweaty, stinky feet. |
juvenile plantar dermatitis |
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how do you treat juvenile plantar dermatits (toxic sock syndrome) |
frequent sock and shoe changes and vasaline before putting on socks |
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Atopic Dermatits- Therapeutic Principles hydrate and |
lubricate |
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Atopic Dermatits- Therapeutic Principles ____ emollients; especially after bath |
unscented |
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Atopic Dermatits- Therapeutic Principles avoid irritants such as: |
-fragrances -cleaning agents -wool -heat -detergents |
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Atopic Dermatits- Therapeutic Principles control inflammation with |
-topical steroids -immunomodulators |
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Atopic Dermatits- Therapeutic Principles address the itch with |
-cool compresses -antihistamines |
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patient/parent education on atopic derm |
-educate parents to avoid triggers -help identify a food allergen if present -investigate IgE allergens and try to determine relevance |
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the opportune time to introduce solids is? |
4-6 months |
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82% of ___ allergic children have AD |
peanut |
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babies who develop severe AD in the first ____ months of life are at risk for food allergy like milk, egg, peanut |
3 months |
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peanut sensitization is independently associated with |
-soy formula -household peanut consumption -use of peanut oils in skin prep |
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early exposure to furry pets might have a ____ effect on AD |
protective |
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high dust mite counts have a ____ effect on AD |
protective |
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how often should barriers be applied in AD |
3-4 times per day |
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always lubricate immediately after |
a bath |
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after swimming... |
shower and lubricate immediately |
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intermittent ____ baths and inranasal ____ decrease severity of eczema |
-bleach baths -mupirocin |
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about how much bleach should go into a full tub? |
about 1/2 cup |
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newer generation topical steroids focus on increased _____ and _____ receptor affinity |
-lipophilicity -glucocorticoid (inflammation control only) |
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what are the safe topical steroids in kids? |
-mometasone -fluticasone -alclometasone -fluocinolone -desonide -prenicarbate |
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____ is only approved for 17 years and up because it has shown adrenal insufficiency and growth deficiency |
triamcelone |
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which two topicals have the best therapeutic index? |
-mometasone -fluticasone |
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what are the two macrolactam immunomodulators? |
-tacrolimus -pimecrolimus |
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macrolactam immunomodulators interfere with phosphate activity of the calcineurin/calmodulin complex leading to a potent ____ ____ effect without immunosuppresion. |
anti-inflammatory |
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prenatal and postnatal use of _____ reduce the risk of AD for the child |
probiotic |
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_____ ___ ____ is a delayed type hypersensitivity to a variety of antigens |
allergic contact dermatitis |
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what are the most common plants in contact derm? |
-poison ivy -poison sumac -poison oak |
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what are the most common non plant sources of contact derm? |
-nickel -neomycin (neosporin) -rubber |
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the rash of contact derm is papular to vesicular, intensely _____ and a _____ distribution |
-puritic -bizarre distribution |
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plant dermatitis is often ____ with lesions in different stages |
linear |
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how do you treat contact derm? |
-topical or oral steroids |
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poison ivy, oak and sumac can occur at any age. there is cross reactions with japanese lacquer tree, ginko, raw cashew sheels, mango skin. ____ is not useful |
hyposensitization |
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most insect bites produce ___ ____. |
papular urticaria |
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atopic children can have arthopod bite _____ reaction. |
hypersensitivity |
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arthopod bite hypersensitivity reactions can have puritic to tender nodules ___ cm in diameter that last for weeks. Associated ____. Excoriation and impetiginization common. |
-2 cm -lymphadenopathy |
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____ are the most common skin lesion for arthropods |
flea bites |
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flea bites are one to three bites, multiple often ____. |
linear (breakfast, lunch, dinner) |
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flea bites lead to ____ infection, common in kids. |
secondary |
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no insect repellents under age? |
2 months |
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insect repellent ____% DEET or ____% picaridin safe in children 2 months and up |
-30% DEET -20% picaridin |
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___ is for clothing only |
permethrin |
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oil of lemon eucalyptus is not recommended for kids under ____ |
3 years |
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topical steroids for itching should be class __-__, gels |
1-3 |
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for itch relief you can use ____ or camphor based counter-irritants |
menthol (pramegel, sarna, aveno anti itch, itch x) |
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Oral ____ are also used for anti itching |
antihistamines (diphenhydramine, chlorpheniramine, hydroxyzine, clemastine, doxepin) -cold compresses |
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what does a diaper rash irritant rash look like? |
-chapped appearance -poorly defined margins -spares folds *desitin and frequent diaper changes |
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what does a diaper rash candidal rash look like? |
-well defined -glistening surface -collarette of scale -satellies |
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what does a seborrheic diaper rash look like? |
-poorly defined -confluent erythema -fine scale throughout |
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what does a psoriactic diaper rash look like? |
-well defined -sharp edges -white scale -bleeding when scale picked off -involves scrotum and folds |
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seborrheic dermatitis aka? |
craddle cap |
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what does seborrheic dermatitis look like? |
-greasy yellow scale -minimal erythema -scale and diaper areas common then axilla |
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child form of seborrheic dermatitis is? |
-dandruff *don't forget tinea in child 1-10 years |
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hemangiomas are a dynamic process flat at birth grow to ___ birthday then start to ____ |
-1st birthday -involute |
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what are problematic areas for hemangiomas? |
-face -neck -periorbital -perineal -midline back |
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the hemanigoma may have underlying pathology... |
1. airway compromise on neck 2. kidney compromise on back 3. PHACES syndrome |
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capillary malformations are known as |
port wine stains |
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fixed lesion, no proliferative phase, may enlarge over time |
port wine stain |
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___ ___ are present in 1% of babies and small <20 cm are most common. may have increased risk of melanoma. |
congenital nevi |
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flat tan macules and patches |
cafe au lait |
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if cafe au lait spots are numerous (6 or more) or large (>5cm) they may suggest |
syndrome -no increased cancer risk |
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honey crusted or bullous lesion? |
impetigo |
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impetigo is almost always caused by ____ ___. |
staph aureus |
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to treat impetigo use an antibiotic effective against staph such as? |
-augmentin -cephalosporin |
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impetigo can be ___ but is most commonly MSSA |
MRSA |
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treatment of MRSA infections: uncomplicated infections |
incision and drainage alone |
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treatment of MRSA infections minor skin infections like impetigo can be treated with topical ____ alone |
mupirocin (bactroban) |
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treatment of MRSA infections if oral antibiotics are needed use? |
-clindamycin -bactrim -tetracycline (over 9) -linezolid |
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recurrent MRSA infections |
-good hygiene -covered with dry dressings -avoid sharing personal items |
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you decolonize MRSA if? |
all above personal hygiene measures are met |
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how to decolonize MRSA? mupirocin |
-BID for 5-10 days |
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how to decolonize MRSA? chlorhexidine baths bleach baths |
-daily 5-14 days -15 mins twice a week for about 3 months |
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how much bleach in a bleach bath? |
-1 teaspoon per gallon or -1/4 cup per 1/4 tub |
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do you give oral antibiotics for decolonization of MRSA |
Nope |
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most effective treatment for MRSA skin infections? |
-mupirocin plus bleach baths |
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which students are at the highest risk for MRSA? |
contact sport athletes -football and wrestling |
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how long are you band from contact sports with a MRSA infection? |
-on antibiotics for 72 hours -no new lesions for 48 hours -no active moist or draining lesions |
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multi system disease caused by staph aureus exotoxin, originally due to tampon use now most are non-menstrual |
staph toxic shock syndrome |
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symptoms of toxic shock syndrome -fever: -diffuse macular _____ -desquamation __-__ weeks after onset of illness -hypotension -involvement of __ or more systems (GI, muscular, CNS, renal, hepatic, mucosal, hematologic) -lack of evidence for other causes |
-fever: >38.9 -diffuse macular erythroderma (suburn like) -desquamation 1-2 weeks after onset of illness -hypotension <90 -involvement of 3 or more systems (GI, muscular, CNS, renal, hepatic, mucosal, hematologic) -lack of evidence for other causes |
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____ toxic shock syndrome is less common than staph form. usually due to deep seated infection |
strep |
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case definition of strep toxic shock |
-isolation of strep pyogenes -hypotension -two or more *renal impairment *coagulopathy *hepatic involvement *ARDS *generalized erythematous macular rash, +/- desquamation *soft tissue necrosis |
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produced by split in the granular layer of epidermis due to exfoliative toxins A or B |
staph scalded skin syndrome |
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what age usually gets staph scalded skin syndrome? |
younger than 5, can be any age though |
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tender diffuse scarlatinform erythema with perioral crusting and superficial fissuring may progress to full skin desquamation; worse in folds |
-staph scalded skin syndrome |
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nikolsky sign is? |
skin sloughing off when pressed on |
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the ___ are spared in staph scalded skin syndrome |
mucosa |
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to treat staph scalded skin syndrome use? |
penicillinase resistant beta lactam +/- clindamycin to stop toxin production |
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perianal strep cellulitis is mostly due to ? |
group A strep |
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perianal strep cellulitis has perianal and perineal irritation, ____ and pain, as it progresses ____ becomes painful. |
-itching -defecation (leads to encopresis and rectal bleeding) |
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what is the first line for perinal strep? alternatives? |
-penicillin V -other beta lactams or macrolides |
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what is the characteristic hemorrhage of meningococcemia? |
-large petechiae or stellate (star shaped) purpura -universal distribution of hemmorrhages |
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hemmorrhage in meningococcemia should have one or more greater than ___ in diameter |
-2 mm |
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two other variables in meningococcemia? |
-poor general condition -nuchal rigidity |
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if two or more variables of meningococcemia are present the probability of the disease is ? |
97% -other causes enterovirus, adenovirus, other bacteria |
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viral exanthems can be in what forms? |
-erythematous -papular -vesicular |
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most viral exanthems are ? |
erythematous (morbilliform, scarlatiniform) |
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associated signs of viral exanthems? |
-fever -malaise -HA -myalgia -respiratory -GI symptoms |
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how long does it usually take for a viral exanthem to resolve? |
1 week |
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what are the causes of viral exanthems |
-enteroviruses -adenovirus -rhinovirus -parainfluenza -RSV -influenza |
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in the warmer months viral exanthems are from? colder months? |
warm: enterovirus cold: respiratory virus |
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skin petechial exanthems are caused by? |
-enterovirus, EBV, CMV, menigococcemia, gonococcemia, RMSF, HS purpura, rate bite fever, ehrlichiosis, dengue fever, leptospirosis |
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mucosal petechial exanthems are caused by? |
-group A strep, rubella, EBV, arcanobacterium hemolyticum |
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____ is associated with a non-specific macular exanthem and gianotti-crosti syndrome |
hepatitis B |
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hepatitis B vaccine is been reported to cause? |
-urticara -erythema nodosum -erythema multiforme -lichen planus -lupus -buccal aphthosis -periarteritis nodosa |
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papular acrodermatitis, symmetric flat topped papules/vesicles on face, buttocks, extensor extremities |
gianotti-crosti syndrome (papulovesicular acrolocated syndrome) |
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how long dies gianotti-crosti syndrome last? |
-3 weeks in most -up to 12 weeks |
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etiology of gianotti-crosti? |
-EBV -coxsackie A16 -parainfluenza -CMV -RSV -parvo B19 -HHV-6 -rotavirus -hep B -immunizations |
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when can you have skin reaction from Hep B vaccine? |
within two months of shot |
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painful vesicles and shallow erosions throughout the oral cavity, dehydration is major concern, hurts too much to drink |
herpes simplex virus (gingiviostomatitis is primary infection in kids) |
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recurrent herpes labialis is most common in? |
adults |
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herpes gladiatorum: wrestlers will be ? |
disqualified |
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____ are occupational hazard in health care workers |
whitlow |
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____ ____ is generalized HSV in patient with primary skin disease such as atopic derm |
eczema herpeticum |
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non-enveloped DNA virus that targets erythroid progenitor cells |
parovirus B19 |
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intranasal exposure to parvo causes viremia in __-__ days |
5-6 days |
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what is the viremic phase of parvo? |
-fever -malaise -myalgia -headache -asymptomatic |
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peak viremia of parvo causes? |
pancytopenia |
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IgM antibody phase of parvo? |
-rash -arthralgia -arthritis |
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clinical association of parvo? |
-erythema infectiosum -arthropathy/arthritis -transient aplastic crisis -chronic anemia -hydrops fetalis -neuro dx -rheumatic disease -vasculitis |
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fifths disease occurs in children __-__ years old in ___ and ___. |
-4-15 years -winter and spring |
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prodrome of fifths disease? |
-respiratory symptoms -low grade fever |
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fifths disease has eruption on ___ phases |
3 |
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first phase of fifths disease |
slapped cheek-facial erythema |
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second phase of fifths |
lacy reticular eruption |
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third phase of fifths? |
recrudescence with heat, sunlight, exertion |
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when does fifths disease resolve? |
-spontaneously in 1-2 weeks |
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parvo can cause ___/___ in 8% of kids |
-arthralgia/arthritis *asymmetric, pauciarticular (knees) |
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acute self limited distinctive exanthem of hands and feet? |
papular-purpuric gloves and sock syndrome |
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rapid onset of petechial and purpuric papules on drosal hands and feet with subsequent involvement of plamoplantar surfaces |
papular-purpuric gloves and sock syndrome |
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papular-purpuric gloves and sock syndrome sharp ____ proximally is the rule, may be accompanied by fever, malaise, anorexia, arthralgias and myalgias |
-demarcation proximally |
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papular-purpuric gloves and sock syndrome resolves in __-__ weeks with out sequelae. most causes do to? |
-1-2 weeks -parvo B19 (coxsackie B6 and CMV too) |
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unilateral frequently becoming bilateral with continued accentuation on the originally effected side? |
asymmetric periflexural exanthem of childhood (unilateral laterothoracic exanthem) |
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median age for papular-purpuric gloves and sock syndrome? |
18-24 months |
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what are common things in papular-purpuric gloves and sock syndrome? |
-prodrome -pruritis -lymphadenopathy |
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how long does papular-purpuric gloves and sock syndrome take to resolve |
-most by 3-6 weeks |
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tinea corporis is a fungal infection with the most common organisms being |
-T. tonsurans -M. canis -T. rubrum -T. mentagrophytes |
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if tinea corporis is facial, think _____ or pet. |
scalp |
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_____ can have a similar rash in tinea corporis |
siblings |
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raised ring with erythematous borders, scale, central clearing |
tinea corporis |
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how do you treat tinea corporis? |
-azoles or allyamines (OTC) (not nystatin) |
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common infection among competitive athletes in contact sports, especially wrestling. round scaly patches with central clearing |
tinea gladiatorum |
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how long do you need therapy before you can go back to sports with tinea gladiatorum? |
72 hours and clearance from provider |
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what is the treatment for tinea gladiatorum? |
-topical azoles (clotrimazole, econazole, miconazole) -allylamines (terbinafine) *twice per day until clear |
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classic ringworm pattern, kerion, seborrheic pattern, patchy alopecia (+/- black dots), folliculitis pattern-in scalp |
tinea capitis |
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what is the most common organism in tinea capitits? |
trichophyton tonsurans |
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____ pattern on KOH for tinea capitis |
endothrix |
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in about half of tinea capitis cases there is an ____ ____. |
asymptomatic carrier |
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what is the oral treatment of choice for tinea capitis? |
-griseofulvin *11mg/kg/day approved but requires 20mg/kg/day |
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although griseofulvin is the treatment of choice, ____ has shown to be more effective |
terbinafine *itraconazole and fluconazole also effective |
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for tinea use what shampoo? |
selenium sulfide 2.5% |
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in tinea capitis you must eliminate ____ by sterilizing or replacing brushes, combs, hats, bows, ribbons etc |
fomites |
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seborrhea between ages 1-10 years should be considered ____ until proven otherwise |
tinea |
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griseofulvin doses below ____ are not effective |
20mg/kg/day |
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intensely itching, highly contagious, crusted small papules, linear burrows, erythematous papules |
scabies |
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where are scabies found? |
-finger webs -wrists -forearms -trunk -extremities -genitalia -soles of feet in babies |
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what do you treat scabies with? |
permethrin 5% cream overnight |
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if permethrin doesnt work or if it is a crusted variant scabies use oral _____ |
ivermectin |
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how long do female lice live and how many eggs do they lay per day? |
-3-4 weeks -10 eggs/day |
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typical hatch time of lice? |
8-9 days |
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topical therapeutic options for lice? |
-permethrin -pyrethrin/piperonil butoxide -malathion -benzyl alcohol
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repeat permethrin, prethrin/piperonil butoxide and benzyl alcohol in __ days |
9 |
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do not use _____ shampoo, agents interfere with residue effect |
conditioning |
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malathion gets applied to ____ hair and is highly _____. Only repeat in 9 days if lice is seen |
-dry -flammable |
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what is the new lice treatment? |
-natroba topical suspension spinosad 0.9% -shown to be more effective than permethrin |
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oral therapy for head lice is ____ ____ |
not recommended -not fda approved |
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____ ____ measures for lice are not approved. vinegar, mayo, petrolatum, olive oil, butter, isopropanol, water immersion and hair removal have not been proven effective. |
non-pharmacologic |
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manual combing with fine tooth nit removal combs is okay and is best with ____ hair. do not need to remove dead lice. no chemical loosening has been effective. no bug zappers either |
wet |
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head lice most products are not completely ovicidal must repeat in ___ days. |
9 |
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____ is no longer recommended for head lice |
lindane |
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no ___ policies at schools are inappropriate |
nit |
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remove the pediculocides over the ____ (not shower or bath) using warm water. |
sink |
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percutaneous penetration of the larval dog or cat hookworms usually after exposure of bare skin to moist sandy soil. |
cutaneous larva migrans |
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in cutaneous larva migrans, larvae will migrat for a few ___ to ____ and then die. |
days to weeks |
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serpiginous track that follows the path of the ____ |
worm |
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what are treatments for cutaneous larva migrans? |
-oral albendazole -oral ivermectin -topical thiavendazole |
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there is not enough evidence to show that any particular treatment is effective for treating ____ infection. |
molluscum |
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efficacy of salicylic acid in warts |
60-80% |
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efficacy of balneotherapy in warts? |
77-95% |
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efficacy of cryotherapy in warts? |
50% |
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there is no data for these wart treatments |
-imiquimod -tretinoin -5-fluorouracil -pulsed dye laser |
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there was no difference between cryosurgery and salicylic acid in warts but ____ was more expensive |
cryotherapy |
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cryotherapy is not tolerated due to what side effects? |
-pain -blistering -pigment changes -scarring |
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cantharidin for molluscum treatment is not fda approved because it is toxic but produces painful-nonpainful blisters that scab off in __-__ days |
5-10 |
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what are the side effects for tinea capitis treatment? |
-HA -fever -nasopharyngitis -GI complaints |
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warts and molluscum resolve spontaneously in ___ to couple ___ |
months to years |
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65% of warts disappear in ___ |
2 years |
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most molluscum disappear in __-___ |
6-9 months |
