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Board Review Dermatology August 2008

Board Review Dermatology August 2008. Pruritic lesions wrists/abdomen/feet Infant uncomfortable Siblings with few pruritic lesions Mom denies lesions but constantly rubbing interdigital webs of her hands What is this? What is the recommended therapy?. What is this?

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Board Review Dermatology August 2008

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  1. Board ReviewDermatologyAugust 2008

  2. Pruritic lesions wrists/abdomen/feet • Infant uncomfortable • Siblings with few pruritic lesions • Mom denies lesions but constantly rubbing interdigital webs of her hands • What is this? • What is the recommended therapy?

  3. What is this? • What is the management? • Permethrin 1 % OTC applied to scalp/hair x 10 mins • Others: Permethrin 5%, Lindane 1% shampoo • Treat bedmates and immediate household members • Wash linens/head gear, vacuum floors and furniture • Return to school day after tx • Not necessary to treat pets

  4. Infected with • HPV • Usually on hands/feet/fingers • Spread by nail biting, contact sports, sexual contact • 80% spontaneous remission by 2 years • Tx options: liquid nitrogen, laser, topical creams

  5. Pearly papular, pruritic lesions • Central umbilication • MOLLUSCUM CONTAGIOSUM • Poxvirus • Benign

  6. MILIA

  7. 30 mos old male • Brown, blotchy macules trunk/upper extremities • First appeared at 9 mos as red then turned into blisters • After rubbing lesion, edema within lesion and surrounding erythema • What is the most likely diagnosis? • URITCARIA PIGMENTOSA

  8. LANGERHAN CELL HISTIOCYTOSIS • Erythematouspapular rash w/petechiae • Seborrheic rash • Lytic lesions of skull • DI

  9. MONGOLIAN SPOT

  10. Erythematoxicumneonatorum 24 – 48 hours after birth Wright stain: Eosinophils ErythemaToxicumNeonatorum At birth Wright stain: PMNs Transient Neonatal PustularMelanosis

  11. Waxy yellow-orange plaque • Alopecia • Present at birth • Growth after puberty NEVUS SEBACEOUS

  12. IncontinentiaPigmenti • X linked, dominant • 3 Phases • Blisters/vesicles • Warty papules • Hyperpigmentation • Assoc. w/ CNS, Optho

  13. Strawberry hemangiomas • STRAWBERRY HEMANGIOMA • Superficial • Overgrowth after first weeks of life • Rapid growth x 6 mos • Slow regression • Remove if obstruction vital organ, ulceration, hemorrhage, cosmetic disfigurement

  14. Deep hemangioma Deep Hemangioma

  15. Port wine stain • Port Wine Stain • Present at birth • Stable and flat • Treat w/pulsed yellow laser • Asso. w/: • Sturge Weber • Klippel-Treanaunay-Weber

  16. Disease Associations • Sturge-Weber Syndrome • Opthalmic branch trigeminal nerve • Ipsilateral venous leptomeningealangiomatosa • Seizures, Hemiplegia • Mental retardation, Glaucoma • Klippel-Trenaunay-Weber Syndrome • PWS + Hemihypertrophy • Kassabach-Merritt Syndrome • Rapidly progressive hemangioma • Platelet sequestration and coagulopathy

  17. melanoma • What makes this a melanoma? • Change in size/shape • Irregular borders • Change in surface • Scaling, ulceration, bleeding • Change in color • Burning, itching, or tenderness

  18. This is the earliest cutaneous manifestation of what disease? • TUBEROUS SCLEROSIS • Ash leaf present at birth • 70-90% patients with TS • Periventricular/Cortical Tubers • Seizures Ash Leaf Spot

  19. Tuberous SclerosisOther cutaneous manifestations Adenoma Sebaceum Periungalfibromas Shagreen patch

  20. Vitiligo

  21. What is the prognosis? • ALOPECIA AREATA • Sudden onset • No changes of skin • May have assoc. nail pitting • Regrowth in 1 year

  22. Traction Alopecia Trichotillomania

  23. Tineacorporis SCALY GranulomaAnnulare NOT SCALY

  24. NEUROFIBROMATOSIS • Neurofibromas not seen until after puberty • NF1 • NF2 • Bilateral acoustic neuroma • Present teens/20s

  25. NF1 (von Recklinghausen Disease) • 6 or more café au laitmacules • 2 or more neurofibromas or 1 plexiformneurofibroma • Axillary or inguinal freckling • Optic glioma • 2 or more Lisch nodules • Sphenoid dysplasia or thinning of long bones • First degree relative with NF1

  26. Coast of what???? • NF1 • Coast of Cali • Smooth borders • McCune-Albright Syndrome • Coast of Maine • Irregular borders • Fibrous Dysplasia • Precocious Puberty Café au lait spots

  27. Have a wonderful day

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