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Things that make you go Hmmmmm ……. Or It is what it is!. Objectives. Identify benign skin lesions with confidence Identify resources for dermatology education AND one new thing about management of Hemangiomas. Lichen Striatus. Primary phase. - PowerPoint PPT Presentation
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THINGS TH
AT
MAKE YOU GO
HMMMMM……
ORIT
IS W
HAT IT IS
!
OBJECTIVESIdentify benign skin lesions with
confidenceIdentify resources for dermatology
education
AND one new thing about management of Hemangiomas
LICHEN STRIATUS Primary phase
SECONDARY PHASE
Fading and Flattening
-Common 9months to 6 years but can occur earlier or later
-Last 1-3 years
-Relapses of short duration have been noted after complete clearing
NEVUS DEPIGMENTOSISGenerally present at birth or within
several months, sometimes not obvious until sun exposure in fairer skin
Borders can be regular or irregularCan have whorled appearance
PIGMENTARY MOSACISM /HYPOMELANOSIS OF ITO
Follows blashkos lines
Can be associated with neurologic, skeletal, and/or ocular abnormalities
The hypopigmentation is secondary to hypofunctioning of melanocytes and is thought that mishap ear in embryogenesis is responsible for the mosaicism.
No consistent genetic defect.
Follow up depends on associated abnormalities.
BECKERS
NEVUSLarge, pigmented,
hairy nevus Most commonly
noted in adolescence
Benign
Larg
e derm
al nev
i com
monly
shoulder
but
not exc
lusively
MELAN0NYCHIA STRIATALONGITUDINAL MELANONYCHIAMost commonly seen in individuals with darker skin-
especially African-Americans in whom up to 90% may have at least one such streak
The pigmentation extends from the proximal nail fold to the distal margin of the digit
The width may vary from less than 1mm to several mm
But……. (there is always a but)
NAIL MATRIX MELANOMA SHOULD BE CONSIDEREDWorrisome features may include very dark, broad bands
ANDExtension of the pigmentation onto the proximal or lateral
nail folds (aka Hutchinson’s Sign)
Any patient with this presentation should be referred for nail matrix biopsy which can cause permanent damage to the nail plate
CONFLUENT AND RETICULATED PAPILLOMATOSIS
CRPETIOLOGY: UNKNOWN
Minocin 100mg BID x30 days then qd x 30 days
TERRE FIRMA FORME ORDUNCANS DIRTY DERMATOSIS
First described by Dr. Duncan in Houston in 1987
At fist glance these patients may appear to have confluent and reticulated papillomatosis (CARP) or acanthosis nigricans
In contrast to derma neglecta soap and water will not wash this off, isopropyl alcohol is necessary
When this condition is suspected, firm, persistent pressure should be applied while rubbing the skin with alcohol.
The cause of terra firma-forme dermatosis is unknown.
PITYRIASIS ALBA (AGAIN)
If you mom think it is fungal…..Do a culture
This a variant of dry skinIt is usually asymptomaticAppears worse in summer, better during school yearTreatment is sunscreen and moisturizer
KERATOSIS PILARIS
Very common!!
Become more extensive in drier climate.
Individual lesions represent plugs of stratum corneum in individual follicular openings ie: Skin Trash
Moisturizer with urea of lactic, salycylic acid May help but is not curative.
ID REACTION
Autosen
sitiza
tion D
ermati
tis
autoe
czemati
zatio
n
Hypopigmented thickened papules often on elbows , knees
Can be eczematous and very itchy
-found in up to 50% of patients with nickel dermatitis
-nearly always symmetrical-may also be seen in response to infectious
agents, particularly in bacterial and dermatophyte infections.
- In the case of tinea capitis the id reaction is usually seen on the head and neck and is often after initial of oral antifungal agent and is erroneously diagnosed as drug reaction
- Clearance occurs with resolving of the originial cause- nickel avoidance, clearance of tinea, etc.
KNUCKLE PADSKnuckle pads were medically first described by Garrod in 1893 and are also named Garrod's pads
.
There is no known established, generally successful therapy.
Injection of corticosteroids (triamcinolone) can soften and sometimes even shrink the pads. Radiation therapy has also been reported to be successful in some cases but not consistently.
Knuckle pads can be surgically removed in the case of pain associated with them. .
Aplasia Cutis Congenita
Developmental defect rather than birthmarkOccurs in about 1 in 5000 birthsUlcerated defects may heal with scar.
Although usually benign, the hair collar sign may be associated with other physical anomalies and malformation syndromes.
No specific laboratory tests are required, although a hair collar sign signals the possibility of a CNS malformation and thus may warrant an MRI scan to rule out an underlying pathology
NEVUS SEBACEOUS
Appears at birth as slightly raised yellow orange nevus
At puberty become raised and warty
Basal cell carcinoma and other benign tumors occur in 15-50% of the tumors
Excision recommended prior to puberty.
MASTOCYTO
MA
MASTOCYTO
SIS
U RT I CA R I A
PI G
M E N T O S A
Seen in less than 2% of childrenOften onset is after 12 months of age
More lesions accumulate slowly with age and lesions do not spontaneously resolve.
System symptoms develop with time in 2% of the children with this form (flushing, tachycardia, hypotension, hepatosplenomegaly
Hereditary FormURTICARIA PIGMENTOSA
MASTOCYTOMA
Solitary lesionWill not develop more Topical steroids for treatment
of symptoms
Non Hereditary Form of Mastocytosis is much more common
Blotchy macular and nodular pigmented lesions which appear in the first 8 months of life starts with one or 2 and then develop numerous lesions over months.
The hyperpigmented appearance may not appear until 6 months after onset
Darriers sign- stroking the lesion will cause tense edema and redness
Spontaneous clearing by 6 or 7 years of age is usual
Essential that children with any type of Mastocytosis not be given the following medications:
Opiates (codeine, demerol, morphine)Polymixin BAcetylsalicylic Acid
In the case of surgery very important that perioperative medications carefullySelected.
TREATMENT OPTIONSNonsedating Antihistamine (zyrtec, Allegra, etc)Regular daily dosing Can try every 6 months to stop and if starts flaring
then resume medication
Topical Steroids for itching in individual lesions BID For body Triamcinolone 0.025% or 0.1% For face/neck/groin/axilla/head Hydrocortisone
2.5% or Desonide 0.05%.
WHICH HEMANGIOMAS WARRANT THIS TREATMENT?
PROPRANOLOL PROTOCOL AT CMC DERMATOLOGY
Prior to initiation of therapy needs :BPPulseChest XrayECG
Propranolol 1mg/kg/dose administer BID (20mg/5ml solution)
PROPRANOLOLPropranolol 1mg/kg/dose administer BID 20mg/5ml solution
Taper Schedule:
Days 1-4 0.25mg/kg/dose BIDDays 5-9 0.5mg/kg/dose BIDDays 10-13 0.75mg/kg/dose BIDDay 14 and on 1mg/kg/dose BID
Can also divide the above doses to TID (.025mg/kg x2) 3
FOLLOW UP SCHEDULEFollow up is weekly x 3,then q2w x 4, then montly. BP q visit.
Infants younger than 3 months should have CBG monitored each visit.
Parents should be instructed how to count pulse and recognize low heart rate
They should watch for somnolence, perioral pallor, cold hands and feet.
Patients must be fed q4h while on this medication due to hypoglycemia possibility
11/17/12 baseline
11/26/12
12/3/12
12/10/12
12/17/13
12/31/13
01/17/13
3/5/13
9/13/13
3/17/14
DERMATOLOGY INFORMATION RESOURCESTextbooks:Color Textbook of Pediatric Dermatology- Weston, Lane, and
MorelliPediatric Dermatology- Bernard A CohenGreat for pictures and information that is clinically helpful.
DermNet NZ. Facts about the skin. www.dermnetnz.orgSkin Advocate App- available for free in app store- has
information on parent and patient support organizations and is set up for you to email the address directly to the patient with a share line. (Developed by UTSW Resident and received national award !)
Some things can be fixed and some cannot…..
However we do know that education and information is just as valuable as cures can be.
The goal is always………….
HAPPY PT., HAPPY MOMMA, HAPPY GRANDMA!!