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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?

yvonne-gilliam
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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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