Pediatrics EOR Final Exam 2023 With All Questions and Answers

DERMATOLOGY (15%) DERMATITIS (DIAPER, PERIORAL) CANDIDAL DIAPER DERMATITIS • Beefy red plaques and satellite lesions involving the inguinal folds, perineum, buttocks • KOH prep of skin scarping to confirm • TOC: topical antifungal (Nystatin ointment)  “Azoles” (clotrimazole, miconazole, ketoconazole) IRRITANT DIAPER DERMATITIS • Usually do not involve the inguinal folds • 1% hydrocortisone ointment • Zinc oxide ointment as a barrier cream • Mupirocin ointment used to treat mild bacterial super infections of irritant diaper dermatitis PERIORAL DERMATITIS (Papulopustular) • Distinctive scaly, erythematous papular eruption around mouth, nose, eyes (Resembles Rosacea) • Causes: Long-term use of topical steroids for minor skin alterations of the face often precedes the manifestation of perioral dermatitis o UV light, heat, wind worsen it o Cosmetic creams, make-ups and sunscreens • S&S: Burning feeling around the mouth, pus or fluid filled papules. o Erythmatous papulopustules on erythematous background, irregularly grouped, NO comedones o Similar rash may appear around the eyes, nose, forehead o TX: AVOID topical steroids (MAKES IT WORSE)  treat like ACNE o Metronidazole or Erythromycin (macrolide) gels or Doxycycline/minocycline/tetracycline (PO) o Isotrentinoin DRUG ERUPTIONS A.) EXANTHEMATOUS DRUG ERUPTION • MC of all cutaneous drug eruptions (90%)  limited to the skin • Initially on trunk and spread to extremities in a symmetric fashion o Appears usually 7-10 days after start of drug and persists 2-3 days after stopping drug • TX: resolves after stopping drug  supportive care (topical steroids, oral antihistamines, reassurance) B.) DRESS SYNDROME – Drug-induced hypersensitivity syndrome o SX: Fever, severe exanthematous rash that can be exfoliative, generalized lymphadenopathy, hematologic abnormalities  Mucosal lesions are RARELY seen (this differentiates it from Stevens-Jonhson or TEN) o Drugs: anticonvulstants, minocycline, sulfonamides, nitrofurantoin, allopurinol. o LIFE THREATENING: due to organ damage (carditis, hepatitis, nephritis) C.) STEVENS-JOHNSON SYNDROME (DESQUAMATION) • Life-threatening DELAYED hypersensitivity rxn that causes the epidermis to separate from the dermis  mucosal desquamation o MC in mouth, lips and genital regions o Involves 10% of body surface • Prodrome: 1-14 days of fever, sore throat, chills, HA, malaise, N/V • Skin disease begins as macules  papules/vesicles/bullae • TARGETOID LESIONS (PATHOGNOMONIC) • Location: Palms, soles, dorsum of hands, extensor surfaces • Etiology: Sulfa drugs = MC trigger, infectious(HIV, mycoplasma, HSV), malignancy-related, idiopathic • TX: ICU, burn unit, debride only frankly necrotic skin D.) TOXIC EPIDERMAL NECROLYSIS (DESQUAMATION)