Pediatrics Board Review: Dermatology

Front 1

congenital absence of skin in a small area, after it heals a bald spot is left

if occurs in multiple places on the scalp, then associated with _________

if occurs as a midline defect, then look for _________ and get a ________ study

Back 1

aplasia cutis

Trisomy 13

spinal dysraphia and underlying skull defects (especially with hair collar sign - distorted/dense hair surrounding the lesion)....get an MRI

Front 2

Back 2

aplasia cutis

Front 3

tiny, pinhead-sized, white papules or epidermal inclusion cysts, seen in newborns most often on the face

Back 3

Milia

Front 4

Back 4

Milia

Front 5

Pinpoint white-yellow papules appear on the nose and central face. Caused by maternal androgen exposure.

Back 5

Sebaceous Hyperplasia

Front 6

Back 6

Sebaceous Hyperplasia

Front 7

inflammatory pustules on the cheeks and forehead without comedones; resolves spontaneously within first few weeks

Back 7

Neonatal acne

Front 8

Back 8

Neonatal acne

Front 9

inflammatory pustules with open and close comedones over the face, in an infant of 3-4 months of age; caused by androgenic stimulation of sebaceous glands

Back 9

Infantile acne

Front 10

small, benign whitish-yellow masses on either side of the raphe on the hard palate of a newborn

Back 10

Epstein pearls

Front 11

very superficial vesicles that are easily ruptured; occurs due to obstruction of sweat glands and is also called “prickly heat rash.”

Back 11

Miliaria rubra

Front 12

erythematous macules with raised central lesions (papules or vesicles filled with EOSINOPHILS)

Usually seen at birth or by DOL 2. Usually disappears by DOL 7.

Back 12

Erythema toxicum

Front 13

Back 13

Erythema toxicum

Front 14

present at birth, pustules that transform into scaly hyperpigmented macules of uniform size (no associated erythema), more common in African-American babies

hyperpigmented macules may persist for months

NEUTROPHILS on Tzanck smear

Back 14

Transient neonatal pustular melanosis

Front 15

Back 15

Transient neonatal pustular melanosis

Front 16

Back 16

Neonatal candidiasis

Front 17

Back 17

Congenital Rubella

Front 18

Back 18

Congenital Syphilis

Front 19

Red lesion that is elevated and enlarges, proliferating rapidly during first 6 months then eventually self-involute (usually starts at 2 yo and disappear by 5-10yo)

Only need treatment if found in certain areas: eyes, beard, ear/nose/lips, midline lumbosacral region (get MRI!)

Treatment involves propranolol, steroids

Back 19

Hemangioma

Front 20

PHACES Syndrome

Back 20

* Posterior fossa malformation (DANDY WALKER)

* Hemangioma. Often in the distribution of the Facial Nerve. Look for a large segmental hemangioma on the FACE. Segmental refers to what looks like a nerve distribution (usually V1). This can be associated with STROKES.

* Arterial cerebrovascular anomaly

* Cardiac anomalies: Especially COARCTATION OF THE AORTA

* Eye anomalies: MICROPHTHALMIA, STRABISMUS

* Sternal defect

Front 21

Back 21

PHACES Syndrome

Front 22

large, congenital vascular tumors (not true hemangiomas but can cause a severe CONSUMPTIVE COAGULOPATHY and death)

Back 22

Kasabach-Merritt syndrome

Front 23

Salmon colored lesion often called a stork bite or salmon patch; blanch with pressure

Back 23

Nevus Simplex

Front 24

Capillary malformations that start as pink/flat lesions that become dark red-purple. They then progress to being thick/raised in adulthood. Present at birth and are PERMANENT.

They are benign if noted in isolation. If noted on the face, they can be associated with glaucoma (increased intraocular pressure that can present as a red eye).

Back 24

Nevus Flammeus (Port-Wine Stain)

Front 25

what should you be concerned about this presentation?

Back 25

port-wine stains on the face may be associated with glaucoma

Front 26

port-wine stains involving the ophthalmic branch of the trigeminal nerve (V1) are associated with?

Back 26

Sturge-Weber syndrome

port-wine stain trigeminal nerve distribution + INTRACRANIAL VASCULAR MAL­FOR­MA­TION

(look for with MRI)

also glaucoma, seizures, cognitive defects

Front 27

port-wine stains + hemihypertrophy on the lower extremities

Back 27

Klippel-Trenaunay syndrome

*remember hemihypertrophy can also be related to Neuroblastomas, Beckwith-Wiedemann Syndrome, Russell-Silver Syndrome, Proteus Syndrome

Front 28

Back 28

Sebaceous Nevus

Front 29

"cape-like"

"coat sleeve"

"bathing trunk"

"garment type"

Back 29

Giant congenital melanocytic nevus

5-15% lifetime risk of developing melanoma

Get MRI if overlying spine

Front 30

unilateral, irregularly speckled areas of blush, should receive yearly ophtho checkups to look for melanoma

Back 30

Nevus of Ota

Front 31

Syndromes associated with Cafe-Au-Lait spots

Back 31

Neurofibromatosis type I:

>6 REGULAR café-au-lait macules.

If prepubertal,these are> 5 mm, if postpubertal, > 15 mm.

---Freckle-like in axilla or inguinal areas

McCune-Albright syndrome (in photo):

IRREGULAR café-au-lait macules, PRECOCIOUS PUBERTY, BONE PROBLEMS (fractures, cranial deformities)

Front 32

"fish-scale" disease

often seen in atopic dermatitis patients

Treatment with ammonium lactate or alpha-hydroxyacid-containing agents

(ex: urea-containing cream)

Back 32

Ichythyosis Vulgaris

Front 33

noted at birth with thin transparent film (similar to cellophane)

eyelashes missing, eyelids seem inverted

Back 33

Lamellar ichthyosis (AKA collodion baby)

Front 34

covering is hard (“armor-like”) and horny, movement is restricted, poor prognosis

Back 34

Harlequin ichthyosis

Front 35

Autosomal-dominant disorder:

*Cafe au last spots

*Axillary/Inguinal freckling

*Fibromatosis

*Eye-Lisch nodules

*Skeletal bowing/Scoliosis

*Positive family history (first-degree relative)

*Optic nerve glioma

Back 35

"CAFE SPOT"

Neurofibromatosis Type 1

Front 36

Autosomal-dominant disorder:

*acoustic nerve tumors (AKA neuromas or schwannomas) - can cause tinnitus or even hearing loss

*spinal cord tumors (ependymomas)

*meningiomas

Back 36

Neurofibromatosis Type 2

Front 37

*NEUTROPENIA, poor neutrophil chemotaxis, and platelet dysfunction (Neutrophils containing giant lysosomal granules)

*OCULOCUTANEOUS ALBINISM and frequent SKIN and LUNG INFECTIONS with Staphylococcus and Streptococcus. (They can have recurrent pneumonias.)

Back 37

Chediak-Higashi Syndrome

Front 38

Autosomal-dominant disorder with:

*facial angiofibromas

*ash-leaf spots

*shagreen patch

*periungual fibromas

*periventricular or cortical TUBERS: Usually associated with INFANTILE SPASMS or seizures

*cardiac rhabdomyomas: Look for a kid with arrhythmias!

*renal angiomyolipoma

Back 38

Tuberous Sclerosis

Front 39

x-linked dominant disorder (Lethal in males!)

Inflammatory vesicular phase

Verrucous phase

Hyperpigmentation phase noted along the lines of Blaschko, and finally a phase in which the hyperpigmentation disappears.

Can leave atrophy or hypopigmentation behind.

also a/w cicatricial alopecia, delayed tooth eruption (peg-shaped teeth)

Back 39

Incontinentia Pigmenti

Front 40

X-linked recessive (similar to incontinentia pigmenti but can occur in males)

HYPOHIDROSIS, decreased sweating, which can lead to hyperthermia; HYPOTRICHOSIS, sparse hair, so no eyebrows/lashes; DELAYED TOOTH ERUPTION;and DEFORMED/PEG TEETH.

Back 40

Hypohidrotic Ectodermal Dysplasia

Front 41

rash that looks like eczema, but is linear or papular and can follow the Lines of Blaschko

Back 41

Lichen Striatus

Front 42

chronic, inflammatory, dry, white, and somewhat scaly rash that is usually found in the genital area.

Back 42

Lichen Sclerosus

Front 43

rashes that spare the inguinal folds

Back 43

contact dermatitis, eczema

Front 44

many tiny skin-colored/pink follicular papules

Back 44

keratosis pilaris

Front 45

redness and fissuring of the weight-bearing part of the plantar surface of the foot

spares the interdigital skin area!

Back 45

juvenile plantar dermatosis

Front 46

hypopigmented dry white patches, on the cheeks and extensor extremities

Back 46

pityriasis alba

Front 47

erythema with greasy yellowish scales, usually on scalp in infants

treat with selenium sulfide or ketoconazole

Back 47

seborrheic dermatitis (cradle cap!)

Front 48

pruritic erythematous lesions that spare the folds

in older kids found in the antecubital fossa, popliteal fossa, back of neck, ankles, wrists, back of hands/feet

Back 48

atopic dermatitis, eczema

Front 49

coin-shaped eczematous lesions usually on the extensor surfaces of extremities. Lesions are uniform, without any central clearing.

Back 49

nummular eczema

Front 50

round or oval patches of hair loss

rarely associated with autoimmune diseases like thyroiditis

Back 50

alopecia areata

Front 51

Vesicles + Crusted Lesions.

**high index of suspicion for a rash “not improving with steroids and/or antibiotics.

Back 51

eczema herpeticum

Front 52

form of acute hair shedding that occurs diffusely. Instead of patches, you see “thinning” of the hair

often related to a psychological or medical stressor

Back 52

telogen effluvium

Front 53

loss of hair in an irregular pattern (not a nice circle) and hair of differing lengths

Back 53

trichotillomania

Front 54

well-defined erythematous skin lesions with silvery scales

sometimes results in punctate bleeding when scales are removed (this is called the Auspitz sign)

infants may have in diaper area and goes into the inguinal folds.

Back 54

psoriasis

Front 55

periorbital heliotropic rash with proximal muscle weakness

gottron papules - flat-topped reddish-violet skin over the knuckles

diagnose by biopsy

CK level will be high

Back 55

dermatomyositis

Front 56

vesicular rash, may be linear

will not spread once the affected area is washed with soap/water (fluid from vesicles CANNOT spread the rash)

Back 56

Poison Ivy (Rhus) reaction

Type IV hypersensitivity rash,

Allergic contact dermatitis

Front 57

rash due to hypersensitivities to insect bites of bedbugs/fleas/mosquitoes that results in edema, erythema, and pruritis, some lesions may be umbilicated

recurrent crops that wax and wane every few weeks or months

Back 57

Papular urticaria

Front 58

deep, bluish, necrotic and boggy-looking ulcers

Back 58

Pyoderma Gangrenosum

associated with Crohn's disease

Front 59

chronic skin condition with annular (circular) lesions, can by slightly pruritic

(can look like ringworm without scaling)

Back 59

Granuloma Annulare

Front 60

severe blistering! may be confluent

some lesions may look like a target or bullseye with the center dark/dusky

+Nikolsky sign

+at least two mucous membranes involved

associated with aromatic seizure meds, PCNs, NSAIDs, sulfa drugs

Back 60

Stevens-Johnson Syndrome

Toxic Epidermal Necrolysis (if >30% BSA)

Front 61

target lesions with dusky centers

only 0-1 mucous membranes involved

Back 61

Erythema Multiforme

(major if patient appears toxic)

Front 62

thickened tightened skin with a waxy appearance

Back 62

Scleroderma

Front 63

saclike growths presents at birth

may contain hair or teeth

slow growing and can get infected so should be removed

Back 63

Dermoid cyst (aka Epidermoid cyst)

Front 64

painful lesions in the oral mucosa with a grayish-white base and rim of erythema

can occur in isolation or be associated with Behcet's or Schwachman-Diamond Syndrome

Back 64

Aphthous Ulcers

Front 65

erythema, very painful, warm nodules on the shins

causes: sarcoidosis, Ulcerative colitis, OCPs/sulfas/PCNs

Back 65

erythema nodosum

Front 66

Bullseye lesion 1-2 weeks after tick bite

Treatment: doxy if >8yo (PCN or amox if not)

If has carditis, recurrent arthritis, or neuritis then treat with IV PCN or ceftriaxone

Back 66

Lyme Disease (Borrelia Burgdorferi)

Front 67

transient, erythematous, macular light-colored rash that is serpentiginous, margins progress with clear centers

associated with Rheumatic fever

Back 67

Erythema Marginatum

Front 68

slapped cheek rash with diffuse lacy or reticular rash on extremities

Back 68

Erythema infectiosum (Parvovirus B19, Fifth Disease)

Front 69

scaly and extremely erythematous rash in the premolar and perianal area that can desquamate

Back 69

Zinc deficiency

Front 70

Rash of zinc deficiency + alopecia + diarrhea + FTT

Back 70

Acrodermatitis Enteropathica