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70 Cards in this Set

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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

aplasia cutis




Trisomy 13




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

aplasia cutis

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

Milia

Milia

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

Sebaceous Hyperplasia

Sebaceous Hyperplasia

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

Neonatal acne

Neonatal acne

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

Infantile acne

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

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

Epstein pearls

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

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

Miliaria rubra

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.

Erythema toxicum

Erythema toxicum

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

Transient neonatal pustular melanosis

Transient neonatal pustular melanosis

Neonatal candidiasis

Congenital Rubella

Congenital Syphilis

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

Hemangioma

PHACES Syndrome

* 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

PHACES Syndrome

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

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





Kasabach-Merritt syndrome

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

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

Nevus Simplex

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).

Nevus Flammeus (Port-Wine Stain)

what should you be concerned about this presentation?

what should you be concerned about this presentation?

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

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

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

Sturge-Weber syndrome




port-wine stain trigeminal nerve distribution + INTRACRANIAL VASCULAR MAL­FOR­MA­TION


(look for with MRI)


also glaucoma, seizures, cognitive defects

port-wine stains + hemihypertrophy on the lower extremities

port-wine stains + hemihypertrophy on the lower extremities

Klippel-Trenaunay syndrome




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

Sebaceous Nevus

"cape-like" 
"coat sleeve"
"bathing trunk"
"garment type"

"cape-like"


"coat sleeve"


"bathing trunk"


"garment type"

Giant congenital melanocytic nevus




5-15% lifetime risk of developing melanoma




Get MRI if overlying spine

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

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

Nevus of Ota

Syndromes associated with Cafe-Au-Lait spots

Syndromes associated with Cafe-Au-Lait spots

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)



"fish-scale" disease

often seen in atopic dermatitis patients

Treatment with ammonium lactate or alpha-hydroxyacid-containing agents

"fish-scale" disease




often seen in atopic dermatitis patients




Treatment with ammonium lactate or alpha-hydroxyacid-containing agents


(ex: urea-containing cream)

Ichythyosis Vulgaris

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

eyelashes missing, eyelids seem inverted

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




eyelashes missing, eyelids seem inverted

Lamellar ichthyosis (AKA collodion baby)

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

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

Harlequin ichthyosis

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

"CAFE SPOT"




Neurofibromatosis Type 1

Autosomal-dominant disorder:




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


*spinal cord tumors (ependymomas)


*meningiomas

Neurofibromatosis Type 2

*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.)

Chediak-Higashi Syndrome

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

Tuberous Sclerosis

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)

Incontinentia Pigmenti

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.

Hypohidrotic Ectodermal Dysplasia

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

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

Lichen Striatus

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

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

Lichen Sclerosus

rashes that spare the inguinal folds

contact dermatitis, eczema

many tiny skin-colored/pink follicular papules

many tiny skin-colored/pink follicular papules

keratosis pilaris

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

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




spares the interdigital skin area!

juvenile plantar dermatosis

hypopigmented dry white patches, on the cheeks and extensor extremities

hypopigmented dry white patches, on the cheeks and extensor extremities

pityriasis alba

erythema with greasy yellowish scales, usually on scalp in infants

treat with selenium sulfide or ketoconazole

erythema with greasy yellowish scales, usually on scalp in infants




treat with selenium sulfide or ketoconazole

seborrheic dermatitis (cradle cap!)

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

atopic dermatitis, eczema

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

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

nummular eczema

round or oval patches of hair loss




rarely associated with autoimmune diseases like thyroiditis

alopecia areata

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

Vesicles + Crusted Lesions.



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

eczema herpeticum

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

telogen effluvium

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

trichotillomania

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.

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.

psoriasis

periorbital heliotropic rash

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

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

dermatomyositis

vesicular rash, may be linear

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

vesicular rash, may be linear




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

Poison Ivy (Rhus) reaction




Type IV hypersensitivity rash,


Allergic contact dermatitis

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

Papular urticaria

deep, bluish, necrotic and boggy-looking ulcers

deep, bluish, necrotic and boggy-looking ulcers

Pyoderma Gangrenosum




associated with Crohn's disease

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

(can look like ringworm without scaling)

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




(can look like ringworm without scaling)

Granuloma Annulare

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

Stevens-Johnson Syndrome




Toxic Epidermal Necrolysis (if >30% BSA)

target lesions with dusky centers

only 0-1 mucous membranes involved

target lesions with dusky centers




only 0-1 mucous membranes involved

Erythema Multiforme




(major if patient appears toxic)

thickened tightened skin with a waxy appearance

thickened tightened skin with a waxy appearance

Scleroderma

saclike growths presents at birth

may contain hair or teeth

slow growing and can get infected so should be removed

saclike growths presents at birth




may contain hair or teeth




slow growing and can get infected so should be removed

Dermoid cyst (aka Epidermoid cyst)

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

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

Aphthous Ulcers

erythema, very painful, warm nodules on the shins

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

erythema, very painful, warm nodules on the shins




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

erythema nodosum

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

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

Lyme Disease (Borrelia Burgdorferi)

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

associated with Rheumatic fever

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




associated with Rheumatic fever

Erythema Marginatum

slapped cheek rash with diffuse lacy or reticular rash on extremities

Erythema infectiosum (Parvovirus B19, Fifth Disease)

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

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

Zinc deficiency

Rash of zinc deficiency + alopecia + diarrhea + FTT

Acrodermatitis Enteropathica