Medical Archive

N25 Dermatology

188 Dermatology Assessment

Normal skin

Harlequine color change
Mongolian spot
Salmon patch
Erythema toxicum
Nevus flammeous (=portwine stain)
Mottling
Milia

  • Salmon patch (40%)
    • ?? ???? ?????, ???? salmon patch ? 50%? ??.
  • Erythema toxicum (50%)
    • ?/??? ?? ??. ??? ??.
    • Atopy? 2-3?? ???. ??? ???x
  • Nevus flammeous (=portwine stain, 0.3%)
    • ?? ??? ???? ???? ??.
    • ?? ????? ????
    • -> Pulsed dye laser (PDL)
    • Cosmetic camouflage

189 Acne Vulgaris

190 Atopic Dermatitis

191 Contact Dermatitis

192 Seborrheic Dermatitis

193 Pigmented Lesions

Congenital dermal melanocytosis (CDM, “Mongolian spots”)

Benign, flat, blue-gray patches that are usually found in infants over the lower back and buttocks.
Most infants of African, Asian, and Hispanic ethnicity have CDM at birth. Slowly fading, resolve by the age of 10.
No treatment is required as the hyperpigmentation usually fades spontaneously during the first decade of life.

# Congenital melanocytic nevus (CMN)

  • Within the first few months of life and are usually solitary, hyperpigmented lesions with increased density of overlying dark, coarse hair. Abdomen, buttock
  • Benign, can grow during infancy and appear as heterogeneously pigmented and raised.
  • Risk of transformation to melanoma
    • Large (~5%) lesions: often removed surgically to reduce risk.
    • Small or medium (<1%) lesions: exceedingly rare.

194 Vascular Anomalies

Infantile hemangioma

(=strawberry naevi)

  • Solitary lesion at birth, red, painless papule/macule, head or neck.
  • Rapid grwoth followed by spontaneous resolution by the age of 5 yrs.
  • Management: BB, Steroid, PDL

195 Erythema Multiforme, Reactive Infectious Mucocutaneous Eruption, SJS/TEN

196 Cutaneous Infestations

Cystic hygroma

???~?? mass, diffuse. Associated with Turner syndrome
venous drain ?? – ?? ?  MRI? extent ????.
Sclerosing agent+?????

Torticollis

  • Etiology
    • Birth trauma (eg, breech delivery)
    • Malposition of the head in utero (eg, d/t fetal macrosomia or oligohydramnios)
    • ? SCM injury and fibrosis
  • May have additional musculoskeletal anomalies
    • Hip dysplasia
    • Metatarsus adductus (ie, adduction of the forefoot)
    • Talipes equinovarus (ie, clubfoot)

2-4? ? ???.
1-6??? ???? ??? ??? ?? ??? ??? ?? ? (positional plagiocephaly)
12???? ??? ????? ???? ?? ?????.

C667 Cutaneous defects

Skin dimples

Sacral dimples

Cutaneous stigmata of occult spinal cord malformations

Redundant skin

Amniotic contriction bands

Preauricular sinuses and pits

Accessory tragi

Branchial cleft and thyroglossal cysts and sinuses

Brachial cleft cyst

  • ? ??~?? mass.
  • Often detected when it becomes secondarily infected after an URI
    • Erythema, tenderness, and sometimes drainage of fluid from a sinus tract.
  • ??? ?? or ??? ??

Thyroglossal cyst

Unlike branchial cysts, a thyroglossal duct cyst often appears after an URI

2nd remnant-m/c
SCM ?? 1/3??? ?

Clinical features

  • Located in the midline of the neck
  • Move upwards during swallowing
Evaluation
  1. Ultrasound
    • ??? ???? ? ???, ?? ???? ???? cyst ??? ?? ?? ??.
    • As well as to confirm that surgical excision of the cyst would not result in postoperative hypothyroidism
  2. TFT
    • May be normal even if the ectopic thyroid tissue is the only functioning tissue.
    • But it may be useful if the thyroid gland has an abnormal appearance or is not visualized on ultrasound.
  3. Scintigraphy
    • It is unnecessary to perform if the imaging method of choice reveals normal thyroid architecture and thyroid function testing is normal.
    • Additionally, exposing children to radionucleotide material should be avoided, if possible.

Sistrunk op.: hyoid ???? ?? ??

Supernumerary nipples

C673 Vesiculobullous Disorders

C673.1 Erythema Multiforme

C673.2 Stevens-Johnson Syndrome

C673.3 Toxic Epidermal Necrolysis

C673.4 Mechanobullous Disorders

Epidermolysis Bullosa

Inherited disorders characterized by epithelial fragility triggered by minor trauma.
Caused by mutations of proteins involved in intraepidermal and dermoepidermal adhesion complexes in the basement membrane zone.

Diagnosis: biopsy of a fresh blister for immunofluorescence microscopy

? Following 4 types.

Epidermolysis Bullosa Simplex

In children and young adults with friction-induced blisters at the palms and soles and other exposed areas.
The lesions typically heal with no residual scarring, although patients may have chronic thickening of the skin of the feet.

Infants: oral blisters with bottle-feeding

Junctional Epidermolysis Bullosa

Dystrophic Epidermolysis Bullosa

Kindler Syndrome

C673.5 Pemphigus

C673.6 Dermatitis Herpetiformis

C673.7 Linear Immunoglobulin A Dermatosis (Chronic Bullous Dermatosis of Childhood)

C674 Eczematous Disorders

C675 Photosensitivity

C676 Diseases of the Epidermis

C677 Disorders of Keratinization

Ichthyosis vulgaris

  • Pathogenesis
    1. Mutations of the filaggrin gene (AD)
      • Also seen in atopic eczema. Family history of eczema.
    2. Epidermal hyperplasia, defective keratinocyte desquamation
    3. Accumulation of dry, scaly skin with loss of normal barrier function.
  • Clinical lpresentation
    • Usually between 3 and 12 months of age
    • ??? ????(palmar hyperlinearity), ???, ????? ??? – rudnfdp tlagowla.
  • Treatment
    • ?? ?? ??? ?? ??! ?? ???? ?? ???
    • Skin moisturizers (eg, creams containing urea or pantheon)
    • Topical retinoids
  • Prognosis
    • Good; lesions disappear during adolescence

X-linked ichthyosis

Occurs almost exclusively in boys and causes dry, scaly lesions to appear in early childhood, with sparing of the antecubital fossa and popliteal fossa.
However, the scales in X-linked ichthyosis would be larger and brown in color, unlike the fine, light gray scales seen in ichthyosis vulgaris.
Also, the palms and soles would not be affected, and hyperkeratosis would be visible on the neck and the lateral aspects of the trunk.

C678 Diseases of the Dermis

Keloid

Striae cutis distensae (stretch marks)

Corticosteroid-induced atrophy

Granuloma annulare

Necrobiosis lipoidica

Lichen sclerosus

Morphea

Scleredema (scleredema adultorum, scleredema of buschke)

Lipoid proteinosis (urbach-wiethe disease, hyalinosis cutis et mucosae)

Macular atrophy (anetoderma)

Cutis laxa (dermatomegaly, generalized elastolysis)

Ehlers-danlos syndrome

Inheritance and severity vary (can be AD or AR).
Hyper-extensible skin, hypermobile joints, and tendency to bleed.

S3 The skeletal dysplasias

C682 Disorders of Hair

Traumatic alopecia (traction alopecia, hair pulling, trichotillomania)

Traction alopecia

Hair pulling

Trichotillomania

Alopecia areata ??? ???

Congenital diffuse hair loss

Menkes kinky hair syndrome (Trichopoliodystrophy)

XR connective tissue disease caused by impaired copper absorption d/t defective Menkes protein (ATP7A)
-> ? Activity of lysyl oxidase -> defective collagen -> brittle, ?kinky? hair, growth retardation, and hypotonia

C685 Cutaneous Bacterial Infections

Staphylococcal infections

https://hsnowhome.wpcomstaging.com/2020/03/18/c142-staphylococcal-infections

Impetigo contagiosa

  • S.aureus? ???, GAS? ????
  • Erythema -> vesicle -> seropurulent fluid -> rupture ? ???? ?? (crust) ??
  • ?? ? ?? ?? ???? ?? (?, ???? ??? ??)

Staphylococcal scalded skin syndrome; SSSS

Wart (Verruca)

Molluscum contagiosum

Trunk, intertriginous areas (eg, axillae), face (including eyelids)
? Reassurance. Self-resolve within 6-12 months.