Pediatrics Dermatology (PAEA)
15 yoF presents with comendomes and a few papules on face. How is this treated? Mild Acne Vulgaris
Tx: BPO wash + retinoid
14 yoM presents with comedones and erythematous papules. his mother is concerned about his
appearance but he doesnt seem to mind. How is this treated? No treatment! Only if patient wants to
treat.
17 yoM presents with comedones with erythematous skin and multiple pustules and papules. He's
already tried a retinoid and BPO wash with minimal improvement. Tx? Moderate Acne Vulgaris
ADD ON: Oral Abx (Minocycline / Doxycycline) and consider SPironolactone
18 yoF is frustrated with her acne after oral Abx with retinoids and BPO wash have not helped. Patients
face has papules > 5mm and cystic lesions scattered amongst pustules on erythematous skin. A new
medication is to be started , What adverse effects must she be aware of? Severe/ Refractory acne
Tx: Isotretinoin
AE: dry skin/lips (M/C), TERATOGENIC (put on birth control ) increased TG and Cholesterol, In rare cases
Hepatitis.
What is the androgen responsible for Androgenetic Alopecia? DHT
,18 yoM is concerned after he noticed hair thinning around his temples and a receding hair line. He
mentions his father is bald. What is the first line medication? How long until changes are seen? Dx:
Androgenetic Alopecia
Topical Minoxidil 5% can be used indefinitely
Requires 4-6 months before improvements
18 YoF noticed her hair is thinning between the frontal and vertex of the scalp. What work up is needed?
In females, Alopecia needs to be investigates with labs:
DHEAS, Testosterone levels, CBC, Iron, TIBC, TSH, Vit D
18 yoM is on topical minoxidil after noticing hair thinning, but after 1 year it is only getting worse. He has
a family Hx of baldness. What medication should be added on? What AE must he be aware of? Dx:
Androgenetic Alopecia
Tx: 2nd line is Oral Finasteride
Because its a 5-a-reductase inhib it decreases androgen activity = low libido, sexual dysfunction, risk of
prostate Ca
5 yo boy with hx of Asthma is brought by parents for pruritic skin on arms and legs. Skin is dry,
erythematous, with scaly lesions found in the AC and popliteal fossa. What is the pathophysiology of this
condition? Atopic Dermatitis
Caused by filaggrin mutation, causing a skin barrier disruption, leading to dry and irritated skin
What is the atopic triad? Atopic dermatitis, allergic rhinitis, and asthma
Where does Atopic Dermatitis present in infants? On their face and EXTENSOR part of extremities (from
crawling and rubbing on skin)
, What labs would you expect to be elevated in patients with Atopic Dermatitis? IgE and EOSINOPHILS
pointing to an allergic origin
5 yo boy with hx of Asthma is brought by parents for pruritic skin on arms and legs. Skin is dry,
erythematous, with scaly lesions found in the AC and popliteal fossa. What is the first line tx? Low
potency topical Corticosteroids!
Ex. Mometasone, Triamcinolone, Fluticasone, Betamethasone
Patient with atopic dermatitis is having adverse reaction to topical steroids with skin atrophy, what
alternative can be given? Topical Calcineurin Inhibitors: Tacrolimus/ Pimecrolimus
6 yoF with hx of allergic rhinitis and atopic dermatitis complains of itchiness on arms. Her parents are
having a hard time getting her to stop scratching herself. What medication class can help with the
pruritis? Antihistamines like Cetrizine, Fexofenadine, Loratidine
What advice can you give to parents for children with atopic dermatitis to decrease symptoms?
Maintain skin hydration! Moisturize BID and within 3 min after shower
AVOID drying out skin!
No hot showers, keep house humid, no irritating soaps or detergents
10 yoF c/o of itchiness and burning on her neck and chest. Exam shows a red and edematous band
around her neckline with papules. Mom mentions she got a new necklace for Christmas but she had to
take it off bc of the itching. What is the first line tx? Dx: Contact Dermatitis (NIckel is a common irritant)
Tx: Topical Corticosteroids
Patient shouldn't wear that necklace....
15 yoF presents with comendomes and a few papules on face. How is this treated? Mild Acne Vulgaris
Tx: BPO wash + retinoid
14 yoM presents with comedones and erythematous papules. his mother is concerned about his
appearance but he doesnt seem to mind. How is this treated? No treatment! Only if patient wants to
treat.
17 yoM presents with comedones with erythematous skin and multiple pustules and papules. He's
already tried a retinoid and BPO wash with minimal improvement. Tx? Moderate Acne Vulgaris
ADD ON: Oral Abx (Minocycline / Doxycycline) and consider SPironolactone
18 yoF is frustrated with her acne after oral Abx with retinoids and BPO wash have not helped. Patients
face has papules > 5mm and cystic lesions scattered amongst pustules on erythematous skin. A new
medication is to be started , What adverse effects must she be aware of? Severe/ Refractory acne
Tx: Isotretinoin
AE: dry skin/lips (M/C), TERATOGENIC (put on birth control ) increased TG and Cholesterol, In rare cases
Hepatitis.
What is the androgen responsible for Androgenetic Alopecia? DHT
,18 yoM is concerned after he noticed hair thinning around his temples and a receding hair line. He
mentions his father is bald. What is the first line medication? How long until changes are seen? Dx:
Androgenetic Alopecia
Topical Minoxidil 5% can be used indefinitely
Requires 4-6 months before improvements
18 YoF noticed her hair is thinning between the frontal and vertex of the scalp. What work up is needed?
In females, Alopecia needs to be investigates with labs:
DHEAS, Testosterone levels, CBC, Iron, TIBC, TSH, Vit D
18 yoM is on topical minoxidil after noticing hair thinning, but after 1 year it is only getting worse. He has
a family Hx of baldness. What medication should be added on? What AE must he be aware of? Dx:
Androgenetic Alopecia
Tx: 2nd line is Oral Finasteride
Because its a 5-a-reductase inhib it decreases androgen activity = low libido, sexual dysfunction, risk of
prostate Ca
5 yo boy with hx of Asthma is brought by parents for pruritic skin on arms and legs. Skin is dry,
erythematous, with scaly lesions found in the AC and popliteal fossa. What is the pathophysiology of this
condition? Atopic Dermatitis
Caused by filaggrin mutation, causing a skin barrier disruption, leading to dry and irritated skin
What is the atopic triad? Atopic dermatitis, allergic rhinitis, and asthma
Where does Atopic Dermatitis present in infants? On their face and EXTENSOR part of extremities (from
crawling and rubbing on skin)
, What labs would you expect to be elevated in patients with Atopic Dermatitis? IgE and EOSINOPHILS
pointing to an allergic origin
5 yo boy with hx of Asthma is brought by parents for pruritic skin on arms and legs. Skin is dry,
erythematous, with scaly lesions found in the AC and popliteal fossa. What is the first line tx? Low
potency topical Corticosteroids!
Ex. Mometasone, Triamcinolone, Fluticasone, Betamethasone
Patient with atopic dermatitis is having adverse reaction to topical steroids with skin atrophy, what
alternative can be given? Topical Calcineurin Inhibitors: Tacrolimus/ Pimecrolimus
6 yoF with hx of allergic rhinitis and atopic dermatitis complains of itchiness on arms. Her parents are
having a hard time getting her to stop scratching herself. What medication class can help with the
pruritis? Antihistamines like Cetrizine, Fexofenadine, Loratidine
What advice can you give to parents for children with atopic dermatitis to decrease symptoms?
Maintain skin hydration! Moisturize BID and within 3 min after shower
AVOID drying out skin!
No hot showers, keep house humid, no irritating soaps or detergents
10 yoF c/o of itchiness and burning on her neck and chest. Exam shows a red and edematous band
around her neckline with papules. Mom mentions she got a new necklace for Christmas but she had to
take it off bc of the itching. What is the first line tx? Dx: Contact Dermatitis (NIckel is a common irritant)
Tx: Topical Corticosteroids
Patient shouldn't wear that necklace....
