Professional Documents
Culture Documents
Dermatology
Dermatology
PEDIATRICS 2
7)
8)
Wheal
DERMATOLOGY
Structure of the Skin:
Epidermis
Dermis
Subcutaneous tissue
Functions of the Skin:
Physical protection
Metabolic
Sensory
Immunologic
Approach to Diagnosis:
History
History of Present Illness
Family History
Review of System
Physical Exam:
Inspection and palpation morphology (color, texture, shape,
distribution, arrangement), primary vs secondary lesions
Distribution of Lesions:
Sun Exposed Sites
Flexural Rashes
Dermatomal
Truncal e.g. Ptyriasis rosea
Lines pf Blaschko
Primary Lesions:
1)
2)
3)
4)
5)
6)
<pattzu&co>
Secondary Lesions:
1)
2)
3)
4)
5)
Excoriation
Page 2 of 4
Impetigo
-
Folliculitis
Cellulitis
Erosions covered by honey-colored crusts
Group A strep/staph
Common with secondarily-infected dermatitis
Local (mupirocin)
Or systemic reaction Cephalexin, Amox/Clav 1st line
MRSA possible
Gram stain and culture helpful
Folliculitis
Pustule At Follicle Opening sometimes with intense
Erythema
Staph and Strep
Treatment: cool compresses
Anti-staph solution/foam eg. clindamycin
Severe systemic antibiotics
Furuncles, Carbuncles
Isolated or scattered
Staph
When resistant: often with family history of abscesses
and recurrent folliculitis
Treatment: drainage, warm compresses
Dicloxacillin, cephalexin but consider MRSA
Cellulitis
-
Fungal infections
Dermatophytes
Candida albicans
Malassezia
Fungal culture
Gold standard
Saborauds glucose agar
Hair brush
Skin scale
Nail nail plate
Candida albicans
Diaper dermatitis: very red appearance
May see weeping, vesicles, pustules and papules
Characteristics satellite lesions
Thrush thick white plaque on oral mucosa
Treatment: Nystatin
Azoles
Malassezia (Tinea versicolor)
Scaling hypo or hyperpigmented plaques (thus
versatile color)
Usually chest neck location
Usually asymptomatic, or mild pruritus
KOH: spaghetti and meatballs
Treatment: Ketoconazole shampoo/solution
Alternative treatment: Oral Fluconazole
Viral infections
Herpes simplex
Varicellaa (Chicken Pox)
Herpes zoster
Virus-induced tumors
Herpes simplex
Grouped vesicles or grouped erosions
HSV I acute gingivostomatitis
Periorbitally or on thumb
HSV II genitalia and mouth via close sexual contact
Treatment: Acyclovir
Oral anesthetics
Tinea capitis
Hair infection
Scaling, erythema, broken hairs, pustules
Human to human or animal to human
Treatment: Griseofulvin PO
Alternative treatment: Terbinafine, Azoles
Herpes zoster
Reactivation of HZV
Grouped vesicles in dermatomal distribution
Natural course
Treatment: Acyclovir/valacyclovir
Pain medications
Laboratory Diagnosis:
Dermatophytes
Tinea capitis and Tinea corporis
<pattzu&co>
Page 3 of 4
Virus-induced Tumors
Molluscum Contagiosum umbilicated, white papules
in groups on genitalia or trunk
Treatment: Wait; Cantharadin; Extraction; others
Warts skin colored papules with irregular surfaces
Treatment: electrocautery; liquid nitrogen; salicylic
acid; others
Condyloma acuminatum perineal warts
Podophyllin, imiquimod
Viral Exanthems
Measles
Paramyxovirus
Incubation period: 9-14 days
Contagious from onset of respiratory symptoms to 3-4
days after rash
Pink, maculopapular rash, confluent on face, discrete
on extremities
Prodrome: high fever, conjunctivitis, hacking bark-like
cough
o 3 Cs: cough, coryza, conjunctivitis
Rubeola (Measles)
Kopliks spots pathognomonic enanthem; blue
specks on buccal mucosa opposite 2nd molar
Lymphadenopathy generalized
Rash lasts 5-6 days
Complications:
o Encephalitis (most dreaded
o Thrombocytopenia
o Otitis media
o Pneumonia
o Aggravation of TB
Treatment:
o Symptomatic
o Prevention vaccination (MMR)
Scabies
Linear burrows around wrist, ankles, finger webs,
areolas, genitalia and face
Intensely pruritic especially at night
Excoriations, honey-colored crusts, papules
Diagnosis: microscopic exam definitive diagnosis
Treatment: Permethrin 5%
Educate
Pediculosis (louse infestations)
Head lice
o Infect scalp
o Transmitted by close contact and sharing
personal items
<pattzu&co>
Acne
-
Birthmarks
Pigmented
o Caf au lait spots
Vascular birthmarks
o Stains: nevus simplex, port-wine stain
o Hemangiomas
Salmon patch/stork bite/angel kiss
Seen in 22% of asians
Flat pink birthmarks (also called capillary
hemangiomas)
Lightens as the child gets older
May occur on the forehead, nose, eyelids, back of neck
Common Lesions in the Newborn:
What you may see on the first day
Vernix caseosa cheesy material
Desquamation peeling
Physiologic peeling of skin
More pronounced when born later than due date
At home
Acne neonatorum
Page 4 of 4
-
Miliaria
Due to sweat retention
Immature sweat glands
Common in the Philippines
2 kinds in the newborn: shallow (miliaria rubra);
deep (miliaria pustulosa)
Prevention: dress baby in light cotton
Use fan for gentle breeze
Avoid use of powders
Milia
Tiny cysts caused by the retention of old skin
cells and oily material (keratin) within hair follicles
Scattered or grouped
May be found on cheeks, forehead, nose, chin,
trunk, limbs, genitalia
May occur until 2nd to 3rd month
Mongolian Spots
Bluish gray flat birthmark
Common in asians (84-86%)
Collection of pigment producing cells within the
skin
<pattzu&co>
Seborrheic dermatitis
Greasy, waxy, yellow scaling with a red base
May be seen on the forehead, eyebrows, sides of
the nose, ears and diaper area
First few months of life
Cause: unknown
Treatment: mild shampoo, mineral oil
Can last up to 12 months old