Transcript Dermatology Board Review

 Tiny, whitish-yellow, firm papules
 Face of neonates
 Small epithelial-lined cysts
 Arise from hair follicles
 Persistent
 May resolve after months to years
 Timing
 Neonates
 Older children after skin injury
 Cause: obstruction of
eccrine sweat ducts
 Description:
 multiple 2-3mm sweat
retention vescicles
 Easily rupture
 Location
 Infants: Head, neck,
upper trunk
 Older Children: areas of
desquamating sunburn
 Aka “Prickly Heat”
 Cause:
 sweat duct obstruction in deeper
layers
 Results from use of thick lubricants
or tight-fitting clothing in hot,
humid weather
 Description: erythematous
papulopustular eruption
 Locationface, upper trunk,
intertriginous areas of neck
 Etiology unknown
 Course:
 wax/wanes
 Crops over hands/feet
 Resolve over 10-21 days
 Recur within few wks
 Resolves by age 3y/o
 Description
 Pinpoint erythematous papules
 Evolve to papulopustules or vesiculopustules
 Pruritic
 Treatment
 Topical steroids
 Antihistamines (itching)
 Location
 Hair-bearing and intertriginous areas
 “Cradle cap” … infants
 Scalp, eyebrows, eyelashes, perinasal,
presternal, postauricular, neck, axillae,
groin
 May become generalized
 Description
 Red, scaling eruption
 Nonpruritic, mild
 Pathogenesis
 Unknown
 Pityrosporum and Candida
 Treatment
 May resolve spontaneously
 Antifungal cream
 Low-potency topical steroid
 Antiseborrheic shampoos
 Multiple factors
 Urine and stool
 Ammonia formation
 Occlusion by plastic diapers
 Soaps and detergents
 Spares intertriginous areas
 Treatment




Frequent changes
Gentle cleansing
Application of barrier pastes
Topical steroids may be helpful
 Description
 Bright red eruption, sharp
borders, pinpoint satellite papules
and pustules
 Intertriginous areas
 KOH: Budding yeast and
pseudohyphae
 May have oral thrush
 Treatment
 Topical antifungals
 May require brief course oral
treatment
 Description
 Thin-walled pustules on
erythematous base
 Larger than cadida pustules
 Rupture and dry: collarette of
scaling around denuded base
 Treatment
 Oral and topical abx
 Description
 Salmon-colored lesions w yellow scale
 Prominent in intertriginous areas
 No satellite lesions
 Seb derm of scalp, face, postauricular
areas seen
 May have concurrent infxn with Candida
or Pityrosporum
 Description
 Recalcitrant scaly eruption
with elevated or “active”
scaly border
 Scales can be scraped and
demonstrated on KOH
 Treated with topical
antifungals
 Do NOT use topical steroids
A scraping of the skin lesions
that appeared 24h after birth
in the otherwise healthy
neonate shown will likely
reveal
A. Mulitnucleated giant cells
B. Neutrophils
C. Mastocytes
D. Eosinophils
E. Gram-positive bacteria
 Description
 Flat, slate-gray to bluish-black, poorly
circumscribed macules
 Location
 Lumbosacral and buttocks
 Can appear anywhere
 Size
 1-10cm
 Single or Multiple
 Ethnicity
 90% AA
 80% Asian
 10% Caucasian
 Path
 Accumulations of melanocytes deep
within dermis
 Fade by age 7
 Benign, self-limited
 Incidence
 50% full-term infants
 Timing
 24-48h after birth
 Up to 10th day
 Description
 Intense erythema with a central
papule or pustule
 Few to several hundred
 Size
 Pustule is 2-3mm
 Location
 Back, face, chest, extremities
 Palms and soles spared
 Smear
 Eosinophils
 May have a concurrent circulating
eosinophilia
 Course
 Fades in 5-7d
 Timing
 Present at birth
 Description
 1-2mm vesicopustules
 Ruptured pustules in 24-48h
 Pigmented macules with a
collarette of scale
 Location
 Neck, forehead, lower back, legs
 Can occur anywhere
 Smear
 Neutrophils
 Course
 Hyperpigmentation fades in
3wks to 3 months
 Common
 Description
 Multiple 1-2cm yellowish-
white papules
 Location
 Nose and cheeks
 Cause
 Normal physiologic response
to maternal androgen
stimulation
 Course
 Resolve by 4-6 months
 Description
 Papules and papulopustules
 Location
 Face, neck and trunk
 Cause
 Hormonal stimulation of
sebaceous glands
 Overgrowth of yeast
 Course
 Benign and self-limited
 Topical antifungals
 Description
 Transient, netlike, reddish-
blue mottling of the skin
 Cause
 Variable vascular constriction
and dilatation
 Location
 Symmetrically over the trunk
and extremities
 No treatment
 Normal response to chilling
 Abates by 6 months
 EB simplex
 AD
 Description
 Superficial blisters or just above
basal cell layer of epidermis
 Mild to severe blistering
 Location
 Widespread
 Pressure bearing areas
 After intense physical activity
 Timing
 Later infancy, childhood or
adolescence
 Course
 No scarring
 Secondary infections
 Some with atrophy
 Junctional Epidermolysis
Bullosa
 AR
 Description
 Presents at birth
 Generalized bullae and
erosions
 Junction of epidermis
and dermis
 Course
 Severe variant
 Fatal within first year
 Mild variant
 Resembles generalized
EB
 Dystrophic Epidermolysis
Bullosa
 Dominant and Recessive
 Description
 Deep within the upper dermis
 Scarring with milia
 Course
 Dominant
 Localized (feet)
 Recessive
 Growth and development
retardation
 Severe oral blisters
 Loss of nails
 Syndactyly
 For all types
 Diagnosis
 Skin biopsy
 Prenatal gene testing
 Treatment
 Symptomatic
 Supportive
 X-linked dominant
 Seen mostly in females
 Lethal in most males
 3 phases (may present in any phase)
 First phase
 Inflammatory vesicles or bullae
 Trunk and extremities
 First 2 weeks of life
 New blisters
 Next 3 months
 Biopsy
 Inflammation with intraepidermal
eosinophils and necrotic
keratinocytes
 3 phases
 Second phase
 Irregular, warty papules
 Resolves spontaneously
within several months
 Third phase
 Swirling or streaking
pattern (Blaschkoid
distribution) of brown to
bluish-gray pigmentation
on the trunk or extremities
 Lasts many years but
gradually fades
 Leaves subtle, streaky,
hypopigmented scars
 Systemic manifestations
 30% CNS
 Seizures
 MR
 Spasticity
 35% Ophthalmic
 Strabismus
 Cataracts
 Blindness
 Microphthalmia
 65%
 Pegged teeth
 Delayed dentition
 Treatment
 None
The parents of this newborn infant
pictured are inquiring about treatment
for the lesion shown. What do you tell
them?
The infant is at a high risk for cancer
with this lesion and needs referral to
surgery for excision
B. This is a normal variant and the
lesion will fade over the first year of
life. No treatment is necessary
C. The infant should be referred to
dermatology for pulsed laser therapy
D. While the lesion will not change with
time, treatment should be delayed for
at least a year
E. An oral course of steroids is necessary
to help resolve the lesion
A.