sajjad -arabic board slide.ppt
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7/18/2019 Sajjad -Arabic board slide.ppt
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Visual DiagnosisVisual Diagnosis
ofofPediatric DisordersPediatric Disorders © ©
Charles M. Ginsburg, M.D.
Marilyn R. Corrigan Distinguished Chair in Pediatric Research
Professor and Chairman of Pediatrics
UT outh!estern Medical Center
Dallas Te"as
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#nde" to Visual Diagnoses of
Pediatric Disorders
Grou$ #% Case &istories '( )*
Grou$ ##% Case &istories )'( +*
Grou$ ###% Case &istories +'( *
Grou$ #V% Case &istories '( -*
Grou$ V% Case &istories -'( '**
Visual tlas
/ou may $roceed through the $rogram in se0uential order
by utili1ing the Right and 2eft cursor arro!s or you may single
clic3 the mouse on the s$ecific Grou$ to go to the first slide in
the res$ecti4e grou$. To return to the #nde", single clic3 the
#nde" button in the u$$er right corner of each slide.
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DEX
Case &istory '
T!o year old !ho has had fe4er and
decreased a$$etite for $ast +- hours5
!as difficult to arouse this .M..
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Cao gio $ic
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DEX
Differential Diagnosis
'. &enoch chonlein Pur$ura
). Child abuse
6. Cao Gio
+. chamberg7s Disease
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DEX
Differential Diagnosis
'. &enoch chonlein Pur$ura
). Child abuse
6. Cao Gio
+. chamberg7s Disease
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DEX
• Cutaneous lesions resembling those seen in
inflicted trauma but $roduced by emotionally
nurturant fol3 $ractices
• Vietnamese fol3 medicine $ractice
• 8ften confused !ith child abuse
• 3in is al!ays intact5 no brea3s in barrier
• R"% counseling
Cao Gio 9:cratch the ;ind7<
9=actitial Dermatitis5 Coin Rubbing<
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DEX
Case &istory )
>ight year old !ho has had rash on!rists and 3nees for se4eral !ee3s5
has no! s$read to $enis. 8ther!ise
!ell. Maternal grandmother has
acti4e tuberculosis.
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2ichen niditus $ic
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DEX
Differential Diagnosis
'. 2ichen ?itidus
). 2ichen Planus
6. 2ichen crofulosorum
+. =lat !arts
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DEX
Differential Diagnosis
'. 2ichen ?itidus
). 2ichen Planus
6. 2ichen crofulosorum
+. =lat !arts
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DEX
2ichen ?itidus
• n uncommon, asym$tomatic chronic eru$tion that onthe arms, legs, $enis and, occasionally on the trun3
• >tiology is not 3no!n
• Characteri1ed by small, shar$ly defined, flesh(colored
locali1ed $a$ules• Common sites%
– e"tensor surface of elbo!, !rists, 3nees
– $enis
– occasionally on trun3R"% Reassurance
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DEX
Case &istory 6
i" !ee3 old !ho had small $ea(si1ed :3not@ on eyebro! at birth5
has increased o4er $ast '* days.
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Dermoid cyst eye $ic
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DEX
Differential Diagnosis
'. 2acrimal gland cyst
). Dermoid cyst
6. >nce$halocoele
+. =ibrosarcoma
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DEX
Differential Diagnosis
'. 2acrimal gland cyst
). Dermoid cyst
6. >nce$halocoele
+. =ibrosarcoma
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DEX
Dermoid Cyst
• Cysts that are lined by an e$idermis that contains 4ariouse$idermal a$$endages
• 8ccur along embryonic fusion lines
• Most common sites%
– lateral one(third of orbital ridge
– nose
– scal$
– midline of nec3
• May be $resent at birth or a$$ear in early childhood
• >"cision5 if on scal$, RA8 intracranial e"tension
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DEX
Case &istory +
=irst(born child of a 6- year oldmother !ith 2u$us. #nfant de4elo$ed
rash on face at B) hours and the rash
:seems to be !orse@.
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>rythema to"icum $ic
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DEX
Differential Diagnosis
'. #nfantile acne
). ?eonatal lu$us
6. ta$hylococcal $ustules
+. >rythema to"icum
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DEX
Differential Diagnosis
'. #nfantile acne
). ?eonatal lu$us
6. ta$hylococcal $ustules
+. >rythema to"icum
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DEX
>rythema To"icum
• Transient blotchy erythema seen in infants during
first !ee3 to ten days of life
• >rythematous macules )(6 cm in diameter !ith '(
)mm $in$oint 4esicles
• Primarily on face but but occurs on trun3 on
trun3 and e"tremities
• 8ccur in a$$ro"imately one(half of neonates• Generally occur in first )+ ( B) days of life
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DEX
Case &istory
i" month old infant !ho has beeninconsolable throughout the night5
!hen changing first morning dia$er,
mother noted that $enis !as s!ollen.
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&air tourni0uet $enis $ic
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DEX
Differential Diagnosis
'. alano$osthitis
). Para$himosis
6. &air tourni0uet syndrome
+. &enoch chonlein Pur$ura
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DEX
Differential Diagnosis
'. alano$osthitis
). Para$himosis
6. &air tourni0uet syndrome
+. &enoch chonlein Pur$ura
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DEX
&air Tourni0uet yndrome
• Rare condition $rimarily occurring in
infants
• May occur on any digit or, rarely, $enis
• trand of hair or strand from an article of
clothing may be res$onsible
• The hair or fiber strand may be difficult to
4isuali1e
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DEX
Case &istory
&ealthy neonate !hose ado$ti4emother noticed lesion on $enis at
the time of the first dia$er change.
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DEX
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Differential Diagnosis
'. &er$es $rogenitalis
). #nclusion cyst
6. >bstein $earl
DEX
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Differential Diagnosis
'. &er$es $rogenitalis
). #nclusion cyst
6. >bstein $earl
DEX
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#nclusion Cyst
• lso called Milium or retention cysts
• May occur at any anatomic site
• Common in ne!borns on $alate 9>bstein7s Pearls<,
on eyelids or on gingi4a
• Distinct, '(6 mm solitary lesions
• u$erficial, globoid, $early(!hite firm $a$ules
• Resol4e s$ontaneously
DEX
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Case &istory B
=i4e day old !hose mother noticedlesions on face this .M.5 is breast(
fed baby !ho has been doing terrific
since birth.
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?eonatal acne $ic
DEX
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Differential Diagnosis
'. Miliaria crystallina
). ta$hylococcal $ustules
6. >rythema to"icum
+. ?eonatal acne
DEX
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Differential Diagnosis
'. Miliaria crystallina
). ta$hylococcal $ustules
6. >rythema to"icum
+. ?eonatal acne
DEX
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?eonatal cne
• Defined as acne that occurs in the first 6* daysafter birth
• Common5 has been estimated to occur in u$ to
*E of all ne!borns
• Rare in immediate neonatal $eriod5 generally
first a$$ears bet!een ) and + !ee3s of age
•8ften has a $ustular a$$earance
• Resol4es s$ontaneously
DEX
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Case &istory -
Rash on thigh of child !ho has had
similar lesions, off and on, in
different $arts of the body in the
$ast. #s asym$tomatic5 classmate
has ring!orm.
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2ichen s$inulosis $ic
DEX
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Differential Diagnosis
'. 2ichen s$inulosis
). Tinea cor$oris
6. 2ichen nitidus
+. 2ichen $lano$ilaris
DEX
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Differential Diagnosis
'. 2ichen s$inulosis
). Tinea cor$oris
6. 2ichen nitidus
+. 2ichen $lano$ilaris
DEX
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2ichen $inulosis
• enign, recurring disorder
• Primarily occurs in mid(childhood
• =emale $redominance• Characteri1ed by grou$s of s$iny(feeling,
3eratotic $a$ules
• Primarily occurs on e"tensor as$ects of
arms, legs, thighs and buttoc3s
DEX
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Case &istory F
do$ted child !ho is brought to you
for $hysical e"am. Parents ha4e
little medical information on child but
ha4e been told that he is !ell e"ce$t
for ha4ing bro3en his arm.
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8to7s ne4us $ic
DEX
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Differential Diagnosis
'. ;ilson7s Disease
). #ncontinentia Pigmenti
6. =rancheschetti(adassohn yndrome
+. ?e4us of 8to
DEX
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Differential Diagnosis
'. ;ilson7s Disease
). #ncontinentia Pigmenti
6. =rancheschetti(adassohn yndrome
+. ?e4us of 8to
DEX
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?e4us of 8to
98culodermal Melanocytosis<
• Congenital, non(hereditary lesion
• Generally $resent at birth but may occur during first fe!
!ee3s of life• =emale $redominance
• Unilateral, flat, blue(blac3 or slate colored lesions in
distribution of the first and second branches of the
Trigeminal ner4e
• Density of the $igment may 4ary
DEX
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Case &istory '*
i" year old !ho has had rash on
face for o4er t!o months5 is slo!ly
getting !orse.
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Pityriasis alba $ic
DEX
ff
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Differential Diagnosis
'. Tinea Versicolor
). Tinea Cor$oris
6. Pityriasis lba
+. ?umular >c1ema
DEX
Diff i l Di i
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Differential Diagnosis
'. Tinea Versicolor
). Tinea Cor$oris
6. Pityriasis lba
+. ?umular >c1ema
DEX
Pityriasis lba
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Pityriasis lba
• 8ne of the &y$omelanosis yndromes5 un3no!n etiology
• enign but esthetically dis$leasing
• 8ccurs $rimarily in young school(aged children5 F*E in children H ')
years
• #nitial lesion is a $in3 to light(bro!n macule !ith indistinct margins5 o4er
time, lesion looses $igment and a fine, fla3y scale a$$ears
• i1e of lesions is highly 4ariable
• 2esions may be multi$le or solitary5 generally there are )(6
• Chee3s, forehead and $erioral regions are the most common sites
• Resol4es s$ontaneously o4er years
• Corticosteroids may be beneficial
DEX
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Case &istory ''
Three !ee3 old !hose mother has
noticed $eriodic :discharge@ from
umbilicus5 during the $ast se4eral
days, the to$ of the dia$ers ha4e had
blood on them.
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Umbilical granuloma $ic
DEX
Diff ti l Di i
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Differential Diagnosis
'. Patent urachus
). Persistent 4itelline duct and $oly$
6. Pyogenic granuloma
+. Umbilical granuloma
DEX
Diff ti l Di i
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Differential Diagnosis
'. Patent urachus
). Persistent 4itelline duct and $oly$
6. Pyogenic granuloma
+. Umbilical granuloma
DEX
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Umbilical Granuloma
• Condition thought to be secondary to lo!(
grade infection andAor e"cessi4e moisture
• Polymor$hic a$$earance5 lesion can be4ascular in a$$earance or ha4e crusted
lesions
• May ha4e serous or serosanguinousdischarge
R"% Drying and sim$le cauteri1ation
DEX
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Case &istory ')
Child has had :sores@ on hands for
se4eral months5 mother thin3s that
they first a$$eared after child !as
bitten by fireants.
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Verruca 4ulgaris $ic
DEX
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Differential Diagnosis
'. =ibrous &istiocytoma
). cro3eratitis 4errucoformis
6. Pyogenic granuloma
+. Verruca 4ulgaris
DEX
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Differential Diagnosis
'. =ibrous &istiocytoma
). cro3eratitis 4errucoformis
6. Pyogenic granuloma
+. Verruca 4ulgaris
DEX
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Verruca Vulgaris
• caly rough $a$ules or nodular lesions
that can be found on any s3in surface
• May be $olymor$hic in a$$earance
• Caused by strains of the Pa$illoma4iruses
• 8ccur $rimarily in children and youngadults5 has been estimated that '*E of
school(age children ha4e !arts
DEX
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Case &istory '6
2esion on face of infant !ho !as
ado$ted on the fifth day of life5ado$tion agency states that they
don7t recall seeing the lesion before
the child !as gi4en to the ado$ti4e$arents.
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?e4us flammeus $ic
DEX
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Differential Diagnosis
'. Port(!ine stain
). ?e4us flammeus
6. turge(;eber yndrome
DEX
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Differential Diagnosis
'. Port(!ine stain
). ?e4us flammeus
6. turge(;eber yndrome
DEX
? =l
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?e4us =lammeus
• 8ther terms% tor3 bite, almon $atch, ca$illaryhemangioma
• 2ight(red flat hemangiomas that most commonly occur on
the eyelids, gabella and na$e of nec35 may be $resent on
any anatomic site
• >"tremely common5 H)*E of ne!borns ha4e a lesion on
the eyelids or gabella and H +*E ha4e one on na$e of nec3
• ll fade to some degree5 lesions on eyelids generally
resol4e com$letely by ' year !hile those on na$e of nec3tend to $ersist into adulthood
DEX
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Case &istory '+
Ten year old !ho has had headache,
fe4er, UR# sym$toms and sore throat
for $ast t!o days. Three days ago,
he ate some $e$$ers that :burned
his tongue@.
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Geogra$hic tongue $ic
DEX
Differential Diagnosis
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Differential Diagnosis
'. Ca$aicin inIury
). carlet fe4er
6. 2ichen $lanus
+. Geogra$hic tongue
DEX
Differential Diagnosis
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Differential Diagnosis
'. Ca$aicin inIury
). carlet fe4er
6. 2ichen $lanus
+. Geogra$hic tongue
DEX
Geogra$hic Tongue
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g $ g
• >stimated to occur in J)E of $o$ulation
• i1arre condition that has areas of de$a$illation
on the dorsal surface of the tongue
• ?ormal mucosa !ith areas of de$a$illation thatare surrounded by areas !ith a !hite rim
• enign, lifelong condition
• $$ro"imately +*E of $atients !ill also ha4e afissured tongue
DEX
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Case &istory '
Mother noted :!hite s$ots@ in mouth
of fi4e day old infant !ho is ha4ing
difficulty breastfeeding.
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>bstein7s $earls $ic
DEX
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Differential Diagnosis
'. >bstein7s Pearls
). Mucocoele
6. Cysts of $heno$alatine =oraminae
+. uction inIury
DEX
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Differential Diagnosis
'. >bstein7s Pearls
). Mucocoele
6. Cysts of $heno$alatine =oraminae
+. uction inIury
DEX
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>bstein7s Pearls
• Milium or retention cysts that occur on
$alate or oral mucosa of ne!borns
• Distinct, '(6 mm solitary lesions
• u$erficial, globoid, $early(!hite firm
$a$ules
• Resol4e s$ontaneously
DEX
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Case &istory '
=irst time 4isit for month old !ho
is other!ise normal. Parents states
that they ha4e al!ays thought that
one e"tremity !as larger than the
other but former $ediatricianassuaged their concerns
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Milroy7s disease $ic
DEX
Diff ti l Di iDifferential Diagnosis
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Differential DiagnosisDifferential Diagnosis
'. =ilariasis
). Milroy7s Disease
6. &emihy$ertro$hy
+. Kli$$el(Trenaunay(;eber syndrome
DEX
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Differential Diagnosis
'. =ilariasis
). Milroy7s Disease
6. &emihy$ertro$hy
+. Kli$$el(Trenaunay(;eber syndrome
DEX
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Milroy7s Disease
• Condition characteri1ed by non($itting edema of the
lo!er e"tremities5 generally unilateral
• =emale $redilection
• May be ina$$arent at birth5 slo!ly $rogressi4e during
infancy
• >tiology not 3no!n but $resumed to be secondary to
a de4elo$mental abnormality of lym$hatic 4essels
• May be familial
DEX
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Case &istory 'B
i" year old !ith :lum$@ on !rist
that Iust :$o$$ed(u$@ se4eral !ee3s
ago. ?ot $ainful but bothers him.
8ther!ise !ell e"ce$t for ha4ing had
ring !orm se4eral months ago thatlasted for se4eral !ee3s.
DEX
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Ganglion cyst $ic
DEX
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Differential Diagnosis
'. 8steogenic sarcoma
). Rheumatoid nodule
6. Ganglion cyst
+. Granuloma nnulare
DEX
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Differential Diagnosis
'. 8steogenic sarcoma
). Rheumatoid nodule
6. Ganglion cyst
+. Granuloma nnulare
DEX
Ganglion Cysts
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Ganglion Cysts
• yno4ial(filled cysts• Generally asym$tomatic
• Dorsal as$ect of the !rist is most common anatomic site
• #n contrast to adults, are not associated !ith
degenerati4e Ioint disease
• Most li3ely the result of trauma
• Most are benign and !ill resol4e o4er time
• hould not be as$irated
DEX
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Case &istory '-
Thirteen year old !ho decided to get
her hair cut short5 has ne4er had hair
cut before. Mother states that she
had a yello!ish rash in scal$ !hen
she !as a baby.
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haddasohns ne4us $ic
DEX
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Differential Diagnosis
'. ?e4us ebaceous of adassohn
). Kerion
6. Condyloma accuminata
+. eborrheic dermatitis
DEX
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Differential Diagnosis
'. ?e4us ebaceous of adassohn
). Kerion
6. Condyloma accuminata
+. eborrheic dermatitis
DEX
?e4us ebaceous of adassohn
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?e4us ebaceous of adassohn
• Predilection for scal$ but may be $resent in any anatomic
site including mucous membranes
• Usually solitary
• /ello! to yello!ish bro!n !a"y(a$$earing lesion duringthe neonatal $eriod5 becomes 4errucoid as child ages
• May increase in si1e and become more 4errucoid during
$uberty
• &as $otential to undergo malignant degeneration
• R"% >"cision
DEX
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Case &istory 'F
dolescent !ith t!o day history of
rash on face that is $ainful and:getting !orse@. ;as on cam$ing tri$
o4er the !ee3end before the rash
de4elo$ed5 one of friends has had coldsores. &as been !ell5 had rashes
during first year of life.
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to$ic dermatitis $ic
DEX
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Differential Diagnosis
'. to$ic dermatitis
). =actitial dermatitis
6. Rhus Dermatitis
+. &er$es sim$le"
DEX
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Differential Diagnosis
'. to$ic dermatitis
). =actitial dermatitis
6. Rhus Dermatitis
+. &er$es sim$le"
DEX
to$ic Dermatitis
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to$ic Dermatitis
• Chronically rela$sing s3in disorder !ith no singledistinguishing characteristic
• Clinical e"$ression is generally age de$endent5 more
generali1ed in infancy and more fle"ural in adolescents
• Pruritis is in4ariable concomitant of disease
• Prurigo, lichenification and ec1emati1ation are
hallmar3s of disease5 e"foliation and
hy$er$igmentation also occur but are more 4ariable
• >tiology is un3no!n
DEX
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Case &istory )*
8ther!ise healthy child !ho has
had :something@ on her tongue for$ast se4eral months that is
:gro!ing@5 doesn7t hurt but :feels
funny@.
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Pa$illoma $ic
DEX
Differential Diagnosis
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'. Condyloma ccuminata
). 2ym$hangioma
6. Rhabdomyosarcoma
+. enign $a$illoma
DEX
Differential Diagnosis
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'. Condyloma ccuminata
). 2ym$hangioma
6. Rhabdomyosarcoma
+. enign $a$illoma
DEX
Pa$illomas
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Pa$illomas
• >"o$hytic, usually small, $a$illary gro!ths
• More common in adolescence and early adulthood
than in childhood
• May occur at any anatomic site
• Generally asym$tomatic
• lmost al!ays the same color and te"ture of the
adIacent mucosa
• >tiology not 3no!n5 relationshi$ to &PV has been
0uestioned but ne4er $ro4en
DEX
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Case &istory )'
=irst 4isit for an eight year old !ho
had been in the care of another$ractitioner. sym$tomatic e"ce$t
for :rash@ on nec3 that has been
$resent since he !as a baby5 therash is asym$tomatic.
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hagreen $atch $ic
DEX
Differential Diagnosis
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Differential Diagnosis
'. =lat !arts
). hagreen $atch
6. Tinea cor$oris
+. 2ichen s$inulosis
DEX
Differential Diagnosis
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Differential Diagnosis
'. =lat !arts
). hagreen $atch
6. Tinea cor$oris
+. 2ichen s$inulosis
DEX
hagreen Patch
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• 8ne of the characteristic cutaneous
manifestations of Tuberous clerosis
• Most often occurs on trun3 or in lumbosacral area
but can occur on any glabrous s3in
• Discrete, usually flesh(colored, flat to slightlyele4ated lesions !ith a :$ig(s3in@ or :orange($eel@
a$$earance
• &ighly 4ariable in si1e
• re $la0ues of sube$idermal fibrosis
DEX
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Case &istory ))
2esion on the bac3 of a si" month
old infant !ho is other!ise normal5there is a dis$ute !ithin the family as
to !hether or not the lesion has been
$resent at birth or first a$$earedse4eral months ago.
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sh leaf s$ot $ic
DEX
Differential Diagnosis
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'. sh(leaf s$ot
). chromic ne4us
6. ?e4us anemicus
+. Vitiligo
DEX
Differential Diagnosis
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'. sh(leaf s$ot
). chromic ne4us
6. ?e4us anemicus
+. Vitiligo
DEX
sh 2eaf $ot
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• 8ne of the characteristic s3in lesions of Tuberous clerosis
• Present in -E( F*E of all $atients !ith Tuberous clerosis
• Present at birth or in early infancy
• Difficult to see in light(s3inned indi4iduals5 ;ood7s light is
hel$ful to 4isuali1e
• &y$omelanotic macules that are in a linear orientation5 4ary in
number
• &a4e a rounded end and a $ointed end 9ash leaf
configuration<
DEX
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Case &istory )6
>ight year old !ho began de4elo$ing
acne se4eral years ago5 slo!ly getting!orse des$ite antibiotics and multi$le
$rescri$tion and o4er(the(counter anti(
acne medications.
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denoma sebaceum $ic
DEX
Differential Diagnosis
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Differential Diagnosis
'. denoma sebaceum
). Cystic acne
6. Multi$le trichoe$itheliomas
+. Rosacea
DEX
Differential Diagnosis
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Differential Diagnosis
'. denoma sebaceum
). Cystic acne
6. Multi$le trichoe$itheliomas
+. Rosacea
DEX
denoma ebaceum
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• 8ne of the characteristic cutaneous lesions of Tuberousclerosis
• Present in a$$ro"imately *Eof $atients !ho are L four
years old5 unusual before + years of age
• >arliest manifestations are erythema that slo!ly$rogresses to flesh(colored to $in3 lesions at nasolabial
folds, malar region, chin, forehead and, sometimes, the
scal$
• 8ften confused !ith acne
• re actually angiofibromas
DEX
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Case &istory )+
i"teen year old child !ith sei1ure
disorder !ho first noticed lesion onhis nail !hen he !as '6 years old5
has slo!ly increased in si1e but
doesn7t hurt.
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Periungual fibroma $ic
DEX
Differential Diagnosis
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g
'. 8nychomycosis
). Periungual =ibroma
6. Charcot(Marie(Tooth yndrome
DEX
Differential Diagnosis
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g
'. 8nychomycosis
). Periungual =ibroma
6. Charcot(Marie(Tooth yndrome
DEX
Periungual =ibroma
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• lso called Koenen tumors
• 8ne of the characteristic cutaneous lesions of
Tuberous clerosis
• May be solitary or multi$le lesions
• 8ccur in $eriungual or subungual regions
• Generally do not manifest until $uberty
• May in4ol4e and e4entually destroy the entire nail
DEX
C &i t )
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Case &istory )
i" month old !ho has been
irritable and crying for $ast )+
hours. Mother noted s!elling on
gums this morning.
> ti t i
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>ru$tion cyst $ic
DEX
Differential Diagnosis
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Differential Diagnosis
'. ngiofibroma
). >$ulis
6. Gumboil
+. >ru$tion cyst
DEX
Differential Diagnosis
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Differential Diagnosis
'. ngiofibroma
). >$ulis
6. Gumboil
+. >ru$tion cyst
DEX
>ru$tion Cysts
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• Common5 $recise incidence not 3no!n
• 8ften o4erloo3ed or not noticed
• Painful
• 8ccasionally, there may be blood in the cyst5
a$$ears as a hematoma of gingi4a
• elf(limited5 sym$tomatic thera$y
• Don7t as$irate
DEX
C &i t )
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Case &istory )
2esion that has been $resent since
birth5 originally thought to besecondary to an infected scal$
electrode site but has ne4er had hair
regro!th.
DEX
l i ti i
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$lasia cutis $ic
DEX
Differential Diagnosis
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'. Pyogenic Granuloma
). ?e4us ebaceus of adassohn
6. $lasia Cutis
+. Tinea Cor$oris
DEX
Differential Diagnosis
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'. Pyogenic Granuloma
). ?e4us ebaceus of adassohn
6. $lasia Cutis
+. Tinea Cor$oris
DEX
$lasia Cutis
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• De4elo$mental failure of s3in closure
• 8ccurs in '%6*** ( '%*** li4e births
• May in4ol4e e$idermis or all s3in layers
• har$ly demarcated, hairless lesion generally in the$osterior midline of scal$ although other anatomic
sites may be in4ol4ed
• May be de$ressed, ulcerated or co4ered by thin
abnormal a$$earing s3in
• May be associated !ith other de4elo$mental defects
DEX
Case &istory )B
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Case &istory )B
Thirteen year old $ost($ubertal
female !ho has noticed that one ofher feet has gro!n larger during the
$ast fe! months5 doesn7t hurt and
tends to get better during the day.
DEX
2ym$hedema $raeco" $ic
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2ym$hedema $raeco" $ic
DEX
Differential Diagnosis
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Differential Diagnosis
'. Milroy7s Disease
). Thrombo$hlebitis
6. 2ym$hedema Praeco"
+. 2ym$hedema Tardum
DEX
Differential Diagnosis
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Differential Diagnosis
'. Milroy7s Disease
). Thrombo$hlebitis
6. 2ym$hedema Praeco"
+. 2ym$hedema Tardum
DEX
2ym$hedema Praeco"
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• Curious condition that $resents around
$uberty5 $rimarily in females
• Generally unilateral
• #nsidious onset
• >arly on the edema is $itting5 edemabecomes non$itting if condition does
not s$ontaneously resol4e
DEX
Case &istory )-
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Case &istory )-
=irst 4isit for child !ho has had life(
long abnormalities of leg. Pre4ious$hysician told them that it !ould go
a!ay o4er time but is no! ha4ing
bac3 and hi$ $ain5 $atient thin3sthat one leg is longer.
Kli$$el treunanay $ic
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Kli$$el treunanay $ic
DEX
Differential Diagnosis
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'. turge(;eber(Dimitri yndrome
). Milroy7s Disease
6. McCune lbright yndrome
+. Kli$$el(Trenauney(;eber yndrome
DEX
Differential Diagnosis
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'. turge(;eber(Dimitri yndrome
). Milroy7s Disease
6. McCune lbright yndrome
+. Kli$$el(Trenauney(;eber yndrome
DEX
Kli$$el(Trenauney(;eber yndrome
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• yndrome characteri1ed by unilateral
abnormal angiomatosis of an e"tremity,
usually a lo!er limb
• Generally $resent at birth
• May result in limb o4ergro!th and
une0ual leg length
• Prone to infection
DEX
Case &istory )F
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Case &istory )F
Three month old !ith t!o !ee3 history
of s!elling of Ia!s, associated !ithmar3ed irritability and fe4er. &ad been
doing !ell since birth.
Caffey7s disease $ic
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Caffey s disease $ic
DEX
Differential Diagnosis
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e e t a ag os s
'. 22
). #nfantile Dermatomyositis
6. Ka!asa3is yndrome
+. Caffey Disease
DEX
Differential Diagnosis
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g
'. 22
). #nfantile Dermatomyositis
6. Ka!asa3is yndrome
+. Caffey Disease
DEX
Caffey Disease
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• lso termed #nfantile Cortical &y$erostosis yndrome
• i1arre condition of un3no!n etiology that has
become rare for reasons that ha4e ne4er been
identified
• Characteri1ed by mar3ed s!elling of soft tissues of Ia!s and soft tissues of face
• Progressi4e cortical thic3ening of long bones of
e"tremities5 characteristic radiogra$hic lesions
• >"acerbations and remissions are common
DEX
Case &istory 6*
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Case &istory 6*
Ten month old !ho has Iust started
:cruising@ !hose mother noticed as!elling in bac3 of 3nee that !as not
$resent the $re4ious day5 does not
seem $ainful and the child isother!ise !ell.
a3ers cyst $ic
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a3ers cyst $ic
DEX
Differential Diagnosis
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'. Dermoid cyst
). a3er7s cyst
6. 2i$oma
+. Disseminated ?euroblastoma
DEX
Differential Diagnosis
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'. Dermoid cyst
). a3er7s cyst
6. 2i$oma
+. Disseminated ?euroblastoma
DEX
a3er7s Cyst
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• Uncommon condition in childhood
• Distention of the gastrocnemius and
semimembranosus bursa along the $osterior
as$ect of the 3nee
• =illed !ith syno4ial fluid
• Generally s$ontaneously resol4e in $re$ubertal
children
• ?ot a surgical condition in $re$ubertal children
DEX
Case &istory 6'
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Case &istory 6'
8bese female !ith Iu4enile Diabetes
Mellitus !ho has noticed increasing:dar3ness@ of s3in under arms and
in groin.
canthosis nigricans $ic
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canthosis nigricans $ic
DEX
Differential Diagnosis
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'. Aspergillus niger infection
). canthosis ?igricans
6. ?ormal
+. Post(inflammatory hy$er$igmentation
DEX
Differential Diagnosis
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'. Aspergillus niger infection
). canthosis ?igricans
6. ?ormal
+. Post(inflammatory hy$er$igmentation
DEX
canthosis ?igricans
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• trange condition manifested by
hy$er$igmentation
• ymmetric 4el4ety gray(bro!n to blac3
$igmentation of locali1ed areas of s3in
• Most common sites% a"illa, groin, base of nec3
and antecubital fossa
• ssociated !ith a 4ariety of disorders% obesity,Diabetes Mellitus, malignancies, 4arious
malignancies
DEX
Case &istory 6)
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Case &istory 6)
i" month old $re4iously health
child !ho has suddenly de4elo$edmulti$le lesions at multi$le anatomic
sites5 lesions are non$ainful, soft
and com$ressible.
DEX
lue Rubber bleb $ic
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lue Rubber bleb $ic
DEX
Differential Diagnosis
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'. acillary ngiomatosis
). Ca$illary &emangiomas
6. Diffuse ?eonatal &emangiomatosis
+. lue Rubber leb ?e4us yndrome
DEX
Differential Diagnosis
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'. acillary ngiomatosis
). Ca$illary &emangiomas
6. Diffuse ?eonatal &emangiomatosis
+. lue Rubber leb ?e4us yndrome
DEX
lue Rubber leb yndrome
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• rare disorder that consists of grou$s of abnormalblood 4essels 9ca4ernous hemangiomas< affecting
the s3in and internal organs of the body
• 8ccurs at birth or !ithin a fe! years after birth
• 2esions seem to gro! !ith body gro!th and rarely
regress
• The lesions are sometimes tender to $al$ation5 can
be $artially em$tied of blood if firm $ressure isa$$lied5 do not s$ontaneously bleed
DEX
Case &istory 66
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y
2esion on the face of an eight year
old !ho has had the lesion sincebirth5 thin3s that it may be enlarging5
asym$tomatic.
Comedone ne4us $ic
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$
DEX
Differential Diagnosis
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'. cne
). 2inear ?e4us
6. Tinea Cor$oris
+. ?e4us Comedonicus
DEX
Differential Diagnosis
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'. cne
). 2inear ?e4us
6. Tinea Cor$oris
+. ?e4us Comedonicus
DEX
?e4us Comedonicus
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• >"tremely uncommon congenital lesion consisting of$ilosebaceous follicles
• #solated linear or o4al lesion that most commonly
occurs on face or scal$
• Characteri1ed by dilated follicular o$enings that are
often $lugged !ith 3eratin
• May ha4e inflammatory res$onse !ith $ustular lesions
R"% e"cision
DEX
Case &istory 6+
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y
Ten !ee3 old infant !ho !as fussy
last e4ening5 a!a3ened multi$letimes throughout night !ith
sometimes inconsolable crying.
Mother noticed s!ollen, red toe this.M.
DEX
&air tourni0uet toe $ic
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0 $
DEX
Differential Diagnosis
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'. listering Distal Dactylitis
). Trauma
6. ubcutaneous =at ?ecrosis
+. &air Tourni0uet yndrome
DEX
Differential Diagnosis
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'. listering Distal Dactylitis
). Trauma
6. ubcutaneous =at ?ecrosis
+. &air Tourni0uet yndrome
DEX
&air Tourni0uet yndrome
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• Rare condition $rimarily occurring in
infants
• May occur on any digit or, rarely, $enis
• trand of hair or strand from an article of
clothing may be res$onsible
• The hair or fiber strand may be difficult to
4isuali1e
DEX
Case &istory 6
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y
Ten year old !ho has been in good
health until last e4ening !hen hesuddenly felt something :funny@ on
his li$ that didn7t really hurt but !as
uncomfortable.
DEX
Mucocoele $ic
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DEX
Differential Diagnosis
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'. Mucocoele
). &emangioma
6. Herpes Simplex
+. Ranula
DEX
Differential Diagnosis
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'. Mucocoele
). &emangioma
6. Herpes Simplex
+. Ranula
DEX
Mucocoele
• ometimes referred to as a :mucous esca$e@ lesion
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• ometimes referred to as a mucous esca$e lesion
• Common
• 8ccur s$ontaneously5 often there is a history of
antecedent trauma
• May occur on any $art of oral mucosa5 mostcommonly occurs on li$s
• Generally $ainless
• Tend to :come and go@ if not e"cised
DEX
Case &istory 6
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?eonate !ith lesion that !as
$resent at birth5 other!ise normal.
>$ulis $ic
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DEX
Differential Diagnosis
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'. Dentiginous eru$tion cyst
). Congenital Rhabdomyosarcoma
6. >$ulis
+. Mucocoele
DEX
Differential Diagnosis
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'. Dentiginous eru$tion cyst
). Congenital Rhabdomyosarcoma
6. >$ulis
+. Mucocoele
DEX
>$ulis
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• lso termed Gingi4al =ibroma
• Rare at birth
• =irm, nonmobile lesion !ith normala$$earing gingi4al mucosa
• Variable in si1e
• Generally secondary to re$eated mildtrauma in older children and adults
DEX
Case &istory 6B
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T!o year old !hose sister had ring
!orm se4eral !ee3s ago5 had onsetof rash on face a$$ro"imately one
!ee3 ago. &as had rashes off and
on on other $arts of body sinceinfancy.
DEX
?umular ec1ema $ic
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DEX
Differential Diagnosis
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'. Tinea Cor$oris
). ?umular ec1ema
6. Granuloma annulare
+. Candidiasis
DEX
Differential Diagnosis
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'. Tinea Cor$oris
). ?umular ec1ema
6. Granuloma annulare
+. Candidiasis
DEX
?umular >c1ema
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• Descri$ti4e term for a $eculiar coin(
sha$ed lesion of ato$ic dermatitis
• May be solitary or multi$le lesions
• 8ften confused !ith Tinea Cor$oris
• Res$onds to to$ical corticosteroids
DEX
Case &istory 6-
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=our month old !ho has had red,
chaffed chee3s off and on since si"!ee3s of age5 se4eral days ago, mother
noted se4eral small blisters on both
sides of the face se4eral hours after
she $laced baby lotion of the red areas.
ibling has &er$es gingi4ostomatitis.
DEX
#nfantile ec1ema $ic
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DEX
Differential Diagnosis
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'. 2ocal reaction to baby lotion
). &er$es Gladiatorium
6. #nfantile >c1ema
+. cabies
DEX
Differential Diagnosis
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'. 2ocal reaction to baby lotion
). &er$es Gladiatorium
6. #nfantile >c1ema
+. cabies
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DEX
Case &istory 6F
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>ight year old !ho has al!ays
com$lained of :funny feeling@ onbac3 of tongue and throat5 not
$ainful and is other!ise normal.
DEX
2ym$hangioma $ic
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DEX
Differential Diagnosis
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'. 2ym$hangioma
). Prominent Circum4allate Pa$illae
6. 2ingual Thyroid
+. &er$es im$le" Glossitis
DEX
Differential Diagnosis
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'. 2ym$hangioma
). Prominent Circum4allate Pa$illae
6. 2ingual Thyroid
+. &er$es im$le" Glossitis
DEX
2ym$hangioma
• Malformation of lym$hatic 4essels that may be
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y $ y
$resent at birth or suddenly become clinicallya$$arent during childhood
• Usually $ainless
• &ighly 4ariable in si1e and any anatomic site may be
in4ol4ed
• ?umerous 4esicle(li3e , sometimes 4errucous
lesions that 4ary in color
• May ha4e 4ascular com$onent
DEX
Case &istory +*
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8ne month old !ho had small, red
:$im$le@ on li$ at the time of birth!hich has $rogressi4ely increased in
si1e5 other!ise !ell.
DEX
&emangioma $ic
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DEX
Differential Diagnosis
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'. Mucocoele
). acillary angiomatosis
6. &emangioma
+. Pyogenic granuloma
DEX
Differential Diagnosis
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'. Mucocoele
). acillary angiomatosis
6. &emangioma
+. Pyogenic granuloma
DEX
&emangioma
b i l f bl d l
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• benign neo$lasm of blood 4essels
• May occur at any anatomic site
• Present at birth but generally enlarge during first ') (
'- months of life
• Ca$illary hemangiomas tend to slo!ly in4olute during
early childhood
• Ca4ernous hemangiomas are dee$er and more
e"tensi4e and generally do not sho! much regression
DEX
Case &istory +'
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=irst(time 4isit for child !ho has not
had longitudinal medical care.
Mil3 teeth $ic
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DEX
Differential Diagnosis
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'. 8steogenesis #m$erfecta
). Tetracycline to"icity
6. =lourosis
+. Mil3(bottle caries
DEX
Differential Diagnosis
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'. 8steogenesis #m$erfecta
). Tetracycline to"icity
6. =lourosis
+. Mil3(bottle caries
DEX
Mil3(ottle Caries
• n e"tensi4e form of dental caries secondary to
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• n e"tensi4e form of dental caries secondary to
slee$ing !ith a nursing bottle that contains
carbohydrates
• Precise incidence is not 3no!n but $articularly
common in medically underser4ed children• #ncidence is mar3edly diminished in infants !ho
are breast(fed or fed !ater at last e4ening feeding
• Clinically a$$arent in second year of life
DEX
Case &istory +)
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8ther!ise healthy t!o year old.
Mother thin3s that the lesion hasbeen $resent since birth.
DEX
Pilondinal sinus $ic
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DEX
Differential Diagnosis
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'. Meningocoele
). Pilonidal sinus
6. Pilomatri"oma
DEX
Differential Diagnosis
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'. Meningocoele
). Pilonidal sinus
6. Pilomatri"oma
DEX
Pilonidal inus
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• Relati4ely common de4elo$mental
anomaly
• 8ften confused !ith a $ilonidal cyst
• Usually asym$tomatic
• Pro$ensity for infection in later life
DEX
Case &istory +6
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=our year old !ho has had a rash on
her face since infancy5 has beentreated !ith a 4ariety of to$ical
agents !ithout a$$reciable change.
Rash is totally asym$tomatic.
DEX
2inear ne4us $ic
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DEX
Differential Diagnosis
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'. 2inear e$idermal ne4us
). 2ichen nitidus
6. 2ichen striaticus
+. to$ic dermatitis
DEX
Differential Diagnosis
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'. 2inear e$idermal ne4us
). 2ichen nitidus
6. 2ichen striaticus
+. to$ic dermatitis
DEX
2inear >$idermal ?e4us
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• Uncommon lesion
• May be $resent at birth5 may enlarge during
early childhood
• May be $olymor$hic5 some ha4e 4errucoid
com$onent
• Usually isolated lesions
• May be $ruritic and ha4e inflammatory
com$onent 9erythema, scaling<
DEX
Case &istory ++
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>ighteen month old !ho has been
healthy e"ce$t for a lot of dia$errashes during the first year of life.
ynechiae 4ul4a $ic
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DEX
Differential Diagnosis
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'. ?ormal
). drenogenital yndrome
6. ynechiae 4ul4a
+. Precocious $uberty
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DEX
ynechiae Vul4a 92abial dhesions<
• Central line of adherence of the labia from the
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fourchette to the inferior as$ect of the clitoris
• lso referred to as labial adhesions
• Generally asym$tomatic
• ?ot rare
• Generally secondary to local inflammation and
hy$oestrogenemia
• May be associated !ith urinary tract infections
DEX
Case &istory +
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=irst(time 4isit for a four year old
!hose mother has lost his medicalrecords. Mother states that child has
had a scaly rash o4er entire body
since birth5 has been treated !ith
multi$le to$ical drugs !ithout much
effect.
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DEX
Differential Diagnosis
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'. to$ic dermatitis
). Refsum7s Disease
6. 2amellar #chthyosis
+. #chthyosis Vulgaris
DEX
Differential Diagnosis
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'. to$ic dermatitis
). Refsum7s Disease
6. 2amellar #chthyosis
+. #chthyosis Vulgaris
DEX
2amellar #chthyosis• 8ne of the more se4ere, life(long forms of ichthyosis
• Presents at birth 9Collodian aby<
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• Characteri1ed by large $archment ty$e scales o4er entire body
surface area5 ha4e e"cessi4e shedding throughout life
• bnormal hair, nails and s!eat glands
• Virtually all ha4e ectro$ion5 distinguishes it from other forms of
ichthyosis• Com$lications%
– recurrent hy$er$yre"ia
– recurrent bacterial infections
– dehydration
DEX
Case &istory +
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Ten year old !ho has had rash on
abdomen for $ast si" months5 hasnot res$onded to the 4arious to$ical
agents that ha4e been a$$lied.
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DEX
Differential Diagnosis
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'. ?umular ec1ema
). cabies
6. to$ic dermatitis
+. llergic contact dermatitis
DEX
Differential Diagnosis
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'. ?umular ec1ema
). cabies
6. to$ic dermatitis
+. llergic contact dermatitis
DEX
llergic Contact Dermatitis
• cute form% erythema, edema, $a$ules, 4esicles, or
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y
bullae
• Chronic form% $a$ular ( $a$ulo4esicular, lichenified,
sometimes scaly
• Rarely in4ol4es $alms and soles
• 84er 6*** en4ironmental sensiti1ers ha4e been
identified5 most are sim$le chemicals that must lin3 to
$roteins before they can sensiti1e
• ?ic3el sulfate is the most common cause of CD inthe U..
DEX
Case &istory +B
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i" month old !ho has been in the
care of neighbor !hile $arents ha4ebeen a!ay. ?eighbor states that the
s!elling Iust a$$eared se4eral hours
before $arents came to $ic3 the child
u$.
#mmersion inIury $ic
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DEX
Differential Diagnosis
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'. Primary irritant dermatitis
). ullous im$etigo
6. K!ashior3or
+. #mmersion inIury
DEX
Differential Diagnosis
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'. Primary irritant dermatitis
). ullous im$etigo
6. K!ashior3or
+. #mmersion inIury
DEX
#mmersion #nIury
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• #nIury that occurs !hen body $art is
e"$osed to $rolonged cold or, most
commonly, !ater that is L ')** =
• May be accidental but child abuse should
al!ays be considered
• May be difficult to initially define the full
e"tent of the inIury !hen the inIury hasbeen caused by hot !ater
DEX
Case &istory +-
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T!o year old !ho has had re$eated
courses of antibiotics for
subma"illary cer4ical adenitis thathas not been associated !ith fe4er
or constitutional signs or sym$toms.
&as no! de4elo$ed drainage fromthe s3in o4er the gland has s!elling
and discoloration in front of the ear.
crofula $ic
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DEX
Differential Diagnosis
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'. Cer4icofacial ctinomycosis
). Cat cratch Disease
6. ?ocardiosis
+. crofula
DEX
Differential Diagnosis
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'. Cer4icofacial ctinomycosis
). Cat cratch Disease
6. ?ocardiosis
+. crofula
DEX
crofula
• Most common e"tra$ulmonic manifestation of M. tuberculosis
infection
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• lo!ly $rogressi4e, non(tender lym$hadeno$athy5 usuallyunilateral
• #n4ol4ed nodes are usually discrete but the o4erlying s3in is
discolored, usually indurated and feels fi"ed to underlying tissues
• T. s3in test is $ositi4e but Chest N( Ray is only abnormal in +*E(BE of cases
• May resol4e s$ontaneously if untreated but generally $rogresses
!ith chronic s3in changes and s$read to adIacent nodes5 often
forms cutaneous fistula !ith chronic drainage
DEX
Case &istory +F
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Rash in an eight month old
un4accinated child !ho has hadgenerali1ed irritability, fe4er and
:3nots@ in the bac3 of the head for
the $ast +- hours.
DEX
Rubella
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DEX
Differential Diagnosis
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'. Rubella
). Measles
6. >ntero4irus B'
+. Ka!asa3i7s yndrome
DEX
Differential Diagnosis
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'. Rubella
). Measles
6. >ntero4irus B'
+. Ka!asa3i7s yndrome
DEX
Rubella
• Vaccine($re4entable acute e"anthematous 4iral
disease
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• #ncubation $eriod% '+ ( )' days
• Mild $rodrome often antedates the fe4er and rash
• Rash begins on face and mo4es ce$halad o4er +- ( B)
hours5 usually macular but may be maculo$a$ular
• deno$athy is an in4ariable concomitant5
subocci$ital lym$h nodes are almost al!ays enlarged
• Resol4es o4er 6( days
DEX
Case &istory *
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>ighteen month old !hose mother is
concerned about the child7s breastde4elo$ment. Child is other!ise
normal5 height and !eight are at
*E, res$ecti4ely and ha4e follo!ed
the gro!th cur4e since birth.
Premature adrenarche $ic
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DEX
Differential Diagnosis
' # l i b
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'. #sose"ual $recocious $uberty
). rain tumor
6. ?ormal 4ariant
+. Premature thelarche
DEX
Differential Diagnosis
' # l i b t
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'. #sose"ual $recocious $uberty
). rain tumor
6. ?ormal 4ariant
+. Premature thelarche
DEX
Premature Thelarche
• enign, s$oradic condition that generally first a$$ears in the
first t!o years of life
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first t!o years of life• Characteri1ed by%
– isolated breast de4elo$ment
– normal gro!th and osseous maturation
– genitalia sho! no e4idence of estrogeni1ation
• reast de4elo$ment is non($rogressi4e and generally
$rogresses after )(6 years
• #f tested, 2& and estradiol are belo! limits of assays5 =& is
normal or slightly ele4ated
DEX
Case &istory '
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=i4e year old !hose mother has
noticed increasing amount of $ubic
hair5 is other!ise normal. Gro!thhas been consistently at the BE and
she has no e4idence of breast
de4elo$ment.
DEX
Premature adrenarche $ic
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DEX
Differential Diagnosis
' # l i b t
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'. #sose"ual $recocious $uberty
). :Missed@ mild congenital adrenal
hy$er$lasia
6. Premature adrenarche
+. rain tumor
DEX
Differential Diagnosis
' # l i b t
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'. #sose"ual $recocious $uberty
). :Missed@ mild congenital adrenal
hy$er$lasia
6. Premature adrenarche
+. rain tumor
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DEX
Case &istory )
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>le4en year old !ho has had some
$ain and redness of u$$er eyelid for$ast se4eral days5 had become
!orse and is no! s!ollen and more
$ainful.
DEX
&ordeolum $ic
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DEX
Differential Diagnosis
' Chala1ion
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'. Chala1ion
). 2acrimal gland abscess
6. Dacrocystitis
+. >"ternal hordeolum
DEX
Differential Diagnosis
' Chala1ion
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'. Chala1ion
). 2acrimal gland abscess
6. Dacrocystitis
+. >"ternal hordeolum
DEX
&ordeolum
• cute, often recurrent, $ainful inflammatory lesion of
eyelid
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• Caused by occlusion of the glands of eiss and Moll
• l!ays at lid margin, in4ol4es eyelashes
• May ru$ture and drain s$ontaneously
• R"%
– !arm com$resses
– e"cision only for recalcitrant lesions
DEX
Case &istory 6
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Child !ho has been in care of father
for $ast '* days. Dro$$ed off by
father !ho is no! una4ailable. Childstates that he has had sore on mouth
for se4eral days and !as ta3en to
doctor by father. Mother has &er$esTy$e ).
DEX
>lectrical cord $ic
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DEX
Differential Diagnosis
' >cthyma gangrenosa
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'. >cthyma gangrenosa
). &er$es sim$le"
6. ?oma
+. >lectrical cord inIury
DEX
Differential Diagnosis
' >cthyma gangrenosa
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'. >cthyma gangrenosa
). &er$es sim$le"
6. ?oma
+. >lectrical cord inIury
DEX
>lectrical Cord #nIury
• #nIury sustained !hen child bites an
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• #nIury sustained !hen child bites anelectrical cord
• #nitial inIury is $ainful and caused by
coagulation necrosis
• leeding may occur at B('* days !hen
eschar falls off
• econdary infection is rare
DEX
Case &istory +
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Toddler !ho has de4elo$ed :!hite@
lesions on chest and arm o4er the$ast fe! months. 2esions began as
small $atches that ha4e become
larger and ha4e coalesced. Mother
thin3s that he can7t feel in area of
lesions.
#ncontinentia achromians $ic
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DEX
Differential Diagnosis
' #ncontinentia Pigmenti chromians
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'. #ncontinentia Pigmenti chromians
). #ncontinentia Pigmenti
6. Tinea Versicolor
+. 2e$rosy
DEX
Differential Diagnosis
' #ncontinentia Pigmenti chromians
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'. #ncontinentia Pigmenti chromians
). #ncontinentia Pigmenti
6. Tinea Versicolor
+. 2e$rosy
DEX
#ncontinentia Pigmenti chromians
• neurocutaneous disorder characteri1ed by
$olymor$hic hy$o$igmented lesions of trun3 and
e"tremities
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e"tremities
• e$arate entity from #ncontinentia Pigmenti
• &y$o$igmented lesions are generally $resent at birth
and slo!ly enlarge and coalesce5 '*E of childrende4elo$ cutaneous lesions after years of age
• 2arge incidence of associated neurologic abnormalities
• Presumed to be a genetic disorder of melanocyte
migration
DEX
Case &istory
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>ight year old !hose mother has
noticed some gradually increasingbald s$ots on scal$ for $ast se4eral
!ee3s. #s other!ise !ell. =riend had
ring !orm on face se4eral !ee3s
ago.
DEX
lo$ecia aereata $ic
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DEX
Differential Diagnosis
' lo$ecia aereata
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'. lo$ecia aereata
). $lasia cutis
6. Tinea ca$itis
+. Traction alo$ecia
DEX
Differential Diagnosis
' lo$ecia aereata
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'. lo$ecia aereata
). $lasia cutis
6. Tinea ca$itis
+. Traction alo$ecia
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DEX
Case &istory
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=our year old !ho had a cold
a$$ro"imately '* days ago but hasother!ise been healthy. !o3e this
.M. !ith ill(defined generali1ed
abdominal $ain, a $ainful ear and
bruises on lo!er leg !hich areasym$tomatic.
DEX
&enoch chonlein $ic
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DEX
Differential Diagnosis
'. Trauma
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'. Trauma
). Meningococcemia
6. #TP
+. &enoch chonlein Pur$ura
DEX
Differential Diagnosis
'. Trauma
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'. Trauma
). Meningococcemia
6. #TP
+. &enoch chonlein Pur$ura
DEX
&enoch chonlein Pur$ura• trange condition of un3no!n etiology that $rimarily effects $reschool(age
children
• Characteri1ed by $ur$uric lesions $rimarily on buttoc3s and lo!er e"tremities
but may in4ol4e any $ortion of body5 lesions are sometimes $al$able
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• Generally $receded by nons$ecific 4iral infection
• May in4ol4e multi$le organ systems%
– G#% *(B*E5 abdominal $ain is most fre0uent
– Renal% 6*(+*E, $rimarily hematuria – Musculos3eletal% )*(6E, arthralgia(arthritis
– C?% rare
• Resol4es s$ontaneously in -*(F*E of $atients
DEX
Case &istory B
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#nfant !ho !as normal at birth !ho
has de4elo$ed a $ersistent :rash@ on
trun3 and abdomen that changes ina$$earance. ?ormally loo3s li3e this
but occasionally gets red and loo3s
li3e hi4es !hich last '*(' minutes
and then disa$$ear lea4ing bro!nish
lesions.
Urticaria $igmentosa $ic
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DEX
Differential Diagnosis
'. Pa$ular urticaria
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'. Pa$ular urticaria
). #ncontinentia Pigmenti
6. &enoch chonlein Pur$ura
+. Urticaria Pigmentosa
DEX
Differential Diagnosis
'. Pa$ular urticaria
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'. Pa$ular urticaria
). #ncontinentia Pigmenti
6. &enoch chonlein Pur$ura
+. Urticaria Pigmentosa
DEX
Urticaria Pigmentosa
• Most common s3in manifestation of Mastocytosis
• Most infants and children ha4e cutaneous form only
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y
unassociated !ith malignancies or malignant disease
• 2esions a$$ear as discrete yello!ish(tan to reddish(bro!n
macules that flare and urticate !hen rubbed
• =ace, scal$, $alms and soles are generally s$ared
• 2esions become $ruritic !hen flared
• #nfants and children rarely ha4e systemic disease
• May res$ond to mast cell stabili1ers 9Cromolyn sodium<
DEX
Case &istory -
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>ighteen month old !ho !as $laying
in yard !ith older siblings !hen he
began to cry. Mother noted that li$s
are s!ollen and child drools and
!on7t ta3e fluids.
DEX
Caustic burn $ic
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DEX
Differential Diagnosis
'. Caustic inIury
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I y
). &er$es gingi4ostomatitis
6. Ka!asa3i7s yndrome
+. >lectrical cord inIury
DEX
Differential Diagnosis
'. Caustic inIury
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I y
). &er$es gingi4ostomatitis
6. Ka!asa3i7s yndrome
+. >lectrical cord inIury
DEX
Caustic #nIury
• Term a$$lied to inIuries caused by chemicals !ith either
4ery lo! 9H< or 4ery high 9L-< $&7s
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• Cause tissue damage on contact
• cids cause coagulation necrosis and al3alis cause
liguification necrosis
• ;hen ingested, the earliest signs are erythema, edema,
drooling and refusal to s!allo!
• Must rule out eso$hageal and laryngeal in4ol4ement if
there is any e4idence of oral burn, regardless of se4erity
DEX
Case &istory F
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=indings on $hysical e"amination of
the abdomen of a si" month old !ho
has had 4omiting and diarrhea for
$ast +( days. &e has had decreased
oral inta3e for $re4ious t!o !ee3s.
DEX
Dehydration $ic
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DEX
Differential Diagnosis
'. Prune elly yndrome
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y y
). Marasmus
6. &y$ertonic dehydration
+. Cutis 2a"a
DEX
Differential Diagnosis
'. Prune elly yndrome
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y y
). Marasmus
6. &y$ertonic dehydration
+. Cutis 2a"a
DEX
Dehydration(3in Changes
• Mild 9HE<% fe!, if any, s3in findings
• Moderate 9('*E<% slight decrease s3in turgor5
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Moderate 9 '*E<% slight decrease s3in turgor5
delayed ca$illary refill
• e4ere 9L'*E<% mar3ed decrease in s3in turgor
9tenting of s3in of the abdomen<5 mar3edly delayedca$illary refill
• Difficult to distinguish dehydration from
malnutrition5 s3in doesn7t tent in malnutrition
unless $atient is also dehydrated
DEX
Case &istory *
t ld h h d h d
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e4enteen year old !ho had had
recurrent bouts of $arotitis since
childhood. Characteri1ed by $ainfuls!elling of $arotid gland, subIecti4e
fe4er that lasts for 6(+ days5 almost
al!ays treated !ith antibiotics !hich
seem to hel$.
DEX
Calculous $arotitis $ic
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DEX
Differential Diagnosis
'. #mmune deficiency
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y
). Recurrent $arotitis
6. Cystic fibrosis
+. 2ym$hosarcoma
DEX
Differential Diagnosis
'. #mmune deficiency
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). Recurrent $arotitis
6. Cystic fibrosis
+. 2ym$hosarcoma
DEX
Recurrent Parotitis
• trange condition of un3no!n etiology
characteri1ed by recurrent bouts of $arotid s!elling
and tenderness !ith or !ithout associated fe4er
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• 8ften $reci$itated by blo!ing !ind instruments,
blo!ing balloons or anything that increases
intraoral $ressure
• May de4elo$ calculi that cause ductal or $arencymal
obstruction
• ?o s$ecific thera$y5 antibiotics of no $ro4en 4alue
DEX
Case &istory '
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=i4e year old !ho has been in good
health de4elo$ed sudden onset of
blisters on legs5 lesions are $ruritic
but not $ainful. ?o mucous
membrane in4ol4ement.
Chronic bullous dermatitis $ic
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DEX
Differential Diagnosis
'. Multi$le insect en4enomations
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). ta$hylococcal calded 3in yndrome
6. ullous Pem$higoid
+. Chronic ullous Disease of Childhood
DEX
Differential Diagnosis
'. Multi$le insect en4enomations
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). ta$hylococcal calded 3in yndrome
6. ullous Pem$higoid
+. Chronic ullous Disease of Childhood
DEX
Chronic ullous Disease of Childhood
• Uncommon condition
• Generally first de4elo$s bet!een 6 and '* years of age
• udden onset of tense, firm bullae that $redominately
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occur on lo!er e"tremities but may in4ol4e any anatomic
site5 mucous membrane in4ol4ement is rare
• Pruritis is a $rominent $art of the disease although not
intense
• 2inear de$osition of #g on bio$sy
• Resol4es s$ontaneously $rior to $uberty
• Ra$id res$onse to Da$sone
DEX
Case &istory )
e4en year old !ho !as in good health
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e4en year old !ho !as in good health
until yesterday !hen he de4elo$ed a red,
$ruritic rash on face and u$$er $ortion
of nec35 he is afebrile and !ithout other
com$laints. ?o e"$osure to sic3
contacts or unusual acti4ities in $ast fe!
days. $$ro"imately one !ee3 ago, hehel$ed father !ith yard !or3.
DEX
Rhus dermatitis $ic
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DEX
Differential Diagnosis
'. #m$etigo
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). Rhus dermatitis
6. #nsecticide burn
+. Pem$higus
DEX
Differential Diagnosis
'. #m$etigo
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). Rhus dermatitis
6. #nsecticide burn
+. Pem$higus
DEX
Rhus 9Poison #4y, 8a3, umac< Dermatitis
• Urushiol is an almost colorless oil that is the $rimary offending
agent5 induces local 9cell mediated< sensiti1ation
• Uncommon in children H years of age
• $$ro"imately -E of the merican $o$ulation of adults can be
sensiti1ed5 4arying degrees of sensiti4ity
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sensiti1ed5 4arying degrees of sensiti4ity
• Re0uires $rimary sensiti1ation5 doesn7t ha$$en on first e"$osure
• Clinical syndrome de$ends on%
• concentration and indi4idual7s sensiti4ity to urushiol
• $re4ious e"$osures
• mechanism of e"$osure
• Clinical sym$toms first a$$ear hours9 -(') < to days 9H '+< after
e"$osure5 de$ends on $rior e"$osure history
• Clinical signs are highly 4ariable% from erythema, edema, 4esicles,
bullae
DEX
Case &istory 6
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i" month old child !hose $arents
ha4e noticed that one of his eyes
seems to be different than the other.
There is disagreement among the
$arents as to !hether or not this has
been $resent since birth or Iusta$$eared.
DEX
2eu3ocoria $ic
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DEX
Differential Diagnosis
'. Toxacara canis
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). Congenital glaucoma
6. Retinoblastoma
+. Cataract
DEX
Differential Diagnosis
'. Toxacara canis
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). Congenital glaucoma
6. Retinoblastoma
+. Cataract
DEX
2eu3ocoria
• ;hite o$acity
• Multi$le causes( 4irtually all bad
– cataracts
– $ersistent 4itreous
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– $ersistent 4itreous
– retrolental fibro$lasia
– retinoblastoma
– Toxacara canis infection
• ometimes difficult to differentiate
• hould be considered as an o$hthalmologic emergency
DEX
Case &istory +
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=our month old !ho had 4esicular
lesions on trun3 in immediate
neonatal $eriod that !as clinically
diagnosed as &er$es sim$le". ;as
treated !ith anti4iral thera$y and
lesions ha4e slo!ly resol4ed butno! has dar3 areas on s3in.
DEX
#ncontinentia $igmenti $ic
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DEX
Differential Diagnosis
'. Congenital sy$hilis
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). Postinflammatory hy$er$igmentation
6. to$ic dermatitis
+. #ncontinentia $igmenti
DEX
Differential Diagnosis
'. Congenital sy$hilis
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). Postinflammatory hy$er$igmentation
6. to$ic dermatitis
+. #ncontinentia $igmenti
DEX
#ncontinentia Pigmenti
9loch(ul1berger yndrome<
Rare N(lin3ed dominant multisytem disease clinically obser4ed in
females5 almost al!ays lethal in males.
Generally $resents as an erythematous linear 4esicular eru$tion
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on fle"or surfaces during the first ) months of life. Vesicles
s$ontaneously clear follo!ed by 4errucous lesions that resol4e
lea4ing areas of hy$er$igmentation or de$igmentation.
– Dental malformations ( E – lo$ecia ( 6E
– 8cular lesions ( 6)E
– C? abnormalities ( 6*E
– Mental retardation ( 'E
DEX
Case &istory
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=irst(time 4isit for a t!el4e year old
!ho has been recei4ing treatment
from another $hysician5 lesions are
tender and slightly $ruritic. Parents
became concerned and re0uested an
emergency a$$ointment !ith you.
DEX
Rabies 4accine $ic
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DEX
Differential Diagnosis
'. Chronic, recurrent giant urticaria
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). Rela$sing $anniculitis
6. Rabies 4accination sites
+. >rythema nodosum
DEX
Differential Diagnosis
'. Chronic, recurrent giant urticaria
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). Rela$sing $anniculitis
6. Rabies 4accination sites
+. >rythema nodosum
DEX
Rabies Vaccine• e4eral different 4accines a4ailable5 &uman di$loid
cell9&DCV< is $referred
• #ntramuscular administration of fi4e doses on days
',6,B,'+Q )-5 #ntradermal administration is no longer
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',6,B,'+Q )-5 #ntradermal administration is no longer
recommended
• d4erse reactions are far less fre0uent !ith &DCV than
!ith older 4accines5 local and systemic9non(allergic<reactions in J)*E and )E of reci$ients, res$ecti4ely
• Chec3 !ith local $ublic health authorities before
ma3ing decision to administer
DEX
Case &istory
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T!o year old !ith history of ato$ic
dermatitis since infancy de4elo$ed
fe4er and 4esicles on face that ha4e
ra$idly $rogressed and become
crusted and !ee$ing during the $ast
)+ hours5 acts :sic3@ .
Ka$osi7s $ic
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DEX
Differential Diagnosis
'. #m$etigo
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). Ka$osi7s 4aricelliform eru$tion
6. econdarily infected 4aricella
+. te4ens ohnson yndrome
DEX
Differential Diagnosis
'. #m$etigo
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). Ka$osi7s 4aricelliform eru$tion
6. econdarily infected 4aricella
+. te4ens ohnson yndrome
DEX
Ka$osi7s Varicelliform >ru$tion
• Primary &er$es 4irus infection of the s3in of$atients !ith chronic s3in disorders, most
l
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commonly ec1ema
• Course is highly 4ariable5 ranges from mild
infection to $otentially life(threateningdisease
• =e4er and systemic to"icity are often $resent
R"% must be indi4iduali1ed
DEX
Case &istory B
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=irst 4isit for a nine year old !ho has
a sei1ure disorder but is other!ise in
good health. &as had :birthmar3@
that has not changed o4er the years.
?e4us unilateris $ic
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DEX
Differential Diagnosis
'. ?e4us unius lateris
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). #ncontinentia $igmenti
6. ?e4us sebaceous of adassohn
+. 2ichen striaticus
DEX
Differential Diagnosis
'. ?e4us unius lateris
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). #ncontinentia $igmenti
6. ?e4us sebaceous of adassohn
+. 2ichen striaticus
DEX
?e4us Unius 2ateris
• Most common form of e$idermal ne4us syndrome
•Uncommon lesion
• Usually $resent at birth
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• May be $resent at any anatomic site
• Characteri1ed by hy$er$igmented, usually 4errucoid lesions in a
linear distribution
• 2arge incidence of associated abnormalities%
– C? 9sei1ures<% '(*E
– s3eletal% '(B*E
– ocular% '*(6*E
DEX
Case &istory -
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>le4en year old !ho feels as though
: something is stuc3@ in the bac3 ofher throat5 other!ise healthy and
!ithout com$laints. &ad difficulty
!ith s!allo!ing as infant and toddler
but :outgre! it@.
2ingual tonsil $ic
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DEX
Differential Diagnosis
'. Rhabdomyosarcoma
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). 2ingual thyroid
6. 0uamous cell carcinoma
+. 2ingual tonsil
DEX
Differential Diagnosis
'. Rhabdomyosarcoma
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). 2ingual thyroid
6. 0uamous cell carcinoma
+. 2ingual tonsil
DEX
2ingual Tonsil
• 8ne of three com$onents of ;aldeyers ring5 the
other t!o are the adenoids and the $alatine tonsils
• re normally $resent but not usually clinically
4isible
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4isible
• May enlarge during u$$er res$iratory and
systemic infections
• Generally, cause no sym$toms
• hould be remo4ed if $atient is sym$tomatic
DEX
Case &istory F
?ine year old !ho has had chronic
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rash on face that first a$$eared
during infancy. &as been treated
!ith to$ical steroids !ith some
res$onse but has fre0uent
recurrences and is beginning to get
more scars. eems to get !orse!hen she goes outdoors.
Por$hyria $ic
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DEX
Differential Diagnosis
'. to$ic dermatitis
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). >rythro$oetic $roto$or$hyria
6. &ydroa aesti4ale
+. =actitious dermatitis
DEX
Differential Diagnosis
'. to$ic dermatitis
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). >rythro$oetic $roto$or$hyria
6. &ydroa aesti4ale
+. =actitious dermatitis
DEX
>rythro$oetic Proto$or$hyria
• utosomal dominant genetic disease
• 8nset in first years of life
• Photosensiti4ity is the hallmar3 of the disease
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• Characteri1ed by burning, stinging and $ruritis of the s3in
on sun e"$osure
• >rythema, edema and sometimes 4esiculation occur !ithin)+ hours of e"$osure
• >ffected s3in undergoes scarring and thic3ening after
re$eated e$isodes
• OA( he$atic in4ol4ement
DEX
Case &istory B*
Three year old !ho has had
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Three year old !ho has had
gradually increasing decrease in
a$$etite and irritability for the $astfe! months. Mother concerned
because stomach is large and his
eyes and feet are $uffy.
K!ashior3or $ic
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DEX
Differential Diagnosis
'. ?e$hrotic yndrome
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). Cystic =ibrosis
6. Menetrier7s Disease
+. K!ashior3or
DEX
Differential Diagnosis
'. ?e$hrotic yndrome
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). Cystic =ibrosis
6. Menetrier7s Disease
+. K!ashior3or
DEX
K!ashior3or • yndrome resulting from se4ere deficiency of $rotein and
caloric inta3e
• Usually occurs after !eaning from the breast
• Characteri1ed by% – decreased gro!th
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– a$athyAirritability
– loss of muscle mass
– edema
– susce$tibility to infection
– hair and s3in changes
– diarrhea
– myriad of metabolic abnormalities
• Treatment consists of $rotein and caloric re$letion
DEX
Case &istory B'
2 i id tifi d d i ti
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2esion identified during routine
$hysical e"amination5 has se4eral
other similar lesions but child is
other!ise normal.
DEX
Caf au lait $ic
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DEX
Differential Diagnosis
'. Postinflammatory hy$er$igmentation
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). Melasma
6. 2entigo sim$le"
+. Caf au 2ait s$ot
DEX
Differential Diagnosis
'. Postinflammatory hy$er$igmentation
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). Melasma
6. 2entigo sim$le"
+. Caf au 2ait s$ot
DEX
Caf au 2ait Macules
• Discrete, !ell(circumscribed uniformly bro!n lesions !ith
irregular border
• ) ( )* mm
• #solated lesions occur in '* ( )*E of $o$ulation5 F-E of
l i di id l h l th th l i
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normal indi4iduals ha4e less than three lesions
• Multi$le lesions occur in a 4ariety of syndromes%
– ?eurofibromatosis
– lbright7s yndrome
– ;atson7s yndrome
– Russell(il4er yndrome
– loom7s yndrome
DEX
Case &istory B)
Genital area of a four year old child
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Genital area of a four year old child
!ho has been other!ise healthy.
Mother first noted small area of $alediscoloration a$$ro"imately si"
months ago5 area has gradually
enlarged and become more :!hite@.
Vitiligo $ic
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DEX
Differential Diagnosis
'. Vitiligo
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). Postinflammatory hy$o$igmentation
6. Pityriasis alba
+. 2e$rosy
DEX
Differential Diagnosis
'. Vitiligo
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). Postinflammatory hy$o$igmentation
6. Pityriasis alba
+. 2e$rosy
DEX
Vitilgo
• Reasonably common ac0uired or genetic disorder
characteri1ed by cutaneous lesions com$letely
de4oid of $igment• May be focal or generali1ed
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• Congenital form is rare5 may occur at any age
• Multi$le etiologies ha4e been $ro$osed
• Multi$le treatment o$tions !ith 4ariable efficacy5
focal lesions may re0uire no thera$y if not
cosmetically disfiguring
DEX
Case &istory B6
ld h h d ti
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e4en year old !ho had an o$eration
during infancy for a :tumor@ in the
nec3. &as been fine until a !ee3 ago
!hen the :tumor@ returned5 is
other!ise healthy.
Thyroglossal Duct Cyst $ic
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DEX
Differential Diagnosis
'. Dermoid cyst
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). Thyroid abscess
6. ranchial cleft cyst
+. Thyroglossal duct cyst
DEX
Differential Diagnosis
'. Dermoid cyst
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). Thyroid abscess
6. ranchial cleft cyst
+. Thyroglossal duct cyst
DEX
Thyroglossal Duct Cyst
• Thyroglossal duct is a remnant of the
connection bet!een the =oramen Cecum and
the thyroid
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• 6E and )E of cysts occur in the infrahyoid
and su$rahyoid regions, res$ecti4ely• lmost al!ays in the midline
• Recurrence rate is large if the fistula is not
totally e"cised at the time of $rimary e"cision
DEX
Case &istory B+
i" year old !hose mother has noticed
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i" year old !hose mother has noticed
gradually increasing hair loss on right
side of head. #s other!ise !ell butmother is concerned that she finds hair
in the child7s bed almost e4ery
morning.
DEX
Trichotillomania $ic
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DEX
Differential Diagnosis
'. Tinea ca$itis
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). lo$ecia aereata
6. Trichotillomania
+. Cou$ de sabre
DEX
Differential Diagnosis
'. Tinea ca$itis
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). lo$ecia aereata
6. Trichotillomania
+. Cou$ de sabre
DEX
Trichotillomania
• yndrome characteri1ed by com$ulsi4e t!istingor $ulling of hair that results in $atchy areas of
hair loss
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• Most common sites are the cro!n and the
tem$oral and $arietal areas
• May also in4ol4e eyelashes and eyebro!s
• cal$ is normal
• Difficult to distinguish from lo$ecia ereata
DEX
Case &istory B
T!o year old !ho has had a rash in
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y
scal$ since infancy that comes and
goes. ;as :bad@ during his first si"months of life but had gone a!ay
until a$$ro"imately three months
ago. Diagnosed as a :fungus@ butdid not res$ond to to$ical thera$y.
eb Derm $ic
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DEX
Differential Diagnosis
'. Tinea ca$itis
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). eborrheic dermatitis
6. 2etterer i!e disease
+. Tinea fa4osum
DEX
'. Tinea ca$itis
Differential Diagnosis
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). eborrheic dermatitis
6. 2etterer i!e disease
+. Tinea fa4osum
DEX
eborrheic Dermatitis
• Common disorder during infancy and early
childhood5 affects )(E of $o$ulation• >tiology not 3no!n5 attributed to increased sebum
$roduction
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$roduction
• cal$, face and ears are the most common sites
in4ol4ed
• Clinical $resentation 4aries from mild to se4ere
• ffected s3in is $in3, sometimes edematous and
co4ered !ith yello! !a"y $la0ue
DEX
Case &istory B
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2esion that de4elo$ed on the chee3
of a t!o !ee3 old, other!ise normalinfant. The child is other!ise
healthy.
=uruncle $ic
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DEX
Differential Diagnosis
'. =uruncle
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). #nclusion cyst
6. Chloroma
+. Pilomatri"oma
DEX
Differential Diagnosis
'. =uruncle
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). #nclusion cyst
6. Chloroma
+. Pilomatri"oma
DEX
=uruncle
• Dee$ necroti1ing form of folliculitis that contains
$us
• =uruncles coalesce to form carbuncles or
b
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abscesses
• Primarily caused by strains of Staphylococcusaureus5 ho!e4er, can be caused by any $us(
forming bacteria
• May indicate nosocomial $roblem in the nursery
!hen they occur in neonates
DEX
Case &istory BB
>le4en year old !ho has had a slo!ly
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increasing mass on ear for a$$ro"imately
si" months. The lesion is not tender butthe child has felt :!ea3@ since the lesion
first a$$eared.
Keloid $ic
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DEX
Differential Diagnosis
'. Pyogenic granuloma
) Pil t i
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). Pilomatri"oma
6. Desmoid tumor
+. Keloid
DEX
Differential Diagnosis
'. Pyogenic granuloma
) Pil t i
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). Pilomatri"oma
6. Desmoid tumor
+. Keloid
DEX
Keloid
• Unchec3ed $roliferation of fibrous tissue that
occurs after trauma to the s3in
• =irm, sometimes slightly tender, mass
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, so et es s g t y te de , ass
• Color 4aries from $in3 to dar3 bro!n
• More fre0uent in dar3(s3inned than in light(
s3inned indi4iduals
• May res$ond to intralesional steroids
DEX
Case &istory B-
=irst(time 4isit for this eight month
old Mother states that he has had a
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old. Mother states that he has had a
:3not@ on his nec3 since birth butshe !as told that it !as nothing
serious and not to !orry about it.
DEX
ranchial Cleft Remnant $ic
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DEX
Differential Diagnosis
'. ranchial arch remnant
) D id t
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). Dermoid cyst
6. Thyroglossal duct cyst
+. ternocleidomastoid fibroma
DEX
Differential Diagnosis
'. ranchial arch remnant
) D id t
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). Dermoid cyst
6. Thyroglossal duct cyst
+. ternocleidomastoid fibroma
DEX
ranchial rch Remnant
• Persistent remnant of branchial arch• Cartilaginous subcutaneous mass
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•Generally lie anterior to thesternocleidomastoid muscle
• 8nly significance is cosmetic
• May be familial
DEX
Case &istory BF
Rash on the chest of an eight year old
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!ho is other!ise !ell e"ce$t for a rash
on the arms, legs and chest that firsta$$eared t!o days ago. Mother thin3s
that his face is :flushed@. The rash is
non($ruritic.
DEX
=ifth7s Disease $ic
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DEX
Differential Diagnosis
'. =ifth7s Disease
) >rythema multiforme
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). >rythema multiforme
6. >rythema chronicum migrans
+. 2yme disease
DEX
Differential Diagnosis
'. =ifth7s Disease
) >rythema multiforme
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). >rythema multiforme
6. >rythema chronicum migrans
+. 2yme disease
DEX
=ifth7s Disease
9>rythema #nfectiosum<
• Classic childhood disease caused by Par4o4irus 'F
• Characteristic clinical a$$earance%
– Mild to no $rodrome
– :la$$ed(chee3@ facial rash !ith circumoral $allor
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la$$ed(chee3 facial rash !ith circumoral $allor
– ymmetric maculo$a$ular laceli3e rash on arms, legs and
trun3
– Rash comes and goes o4er B('* day $eriod5 e"acerbated
by heat and sunlight5 may itch
• rthritis and arthralgia are rare in $re$ubescent children but
common in adolescents and adults
DEX
Case &istory -*
Child is brought to you for a second
o$inion about a :birthmar3@
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o$inion about a :birthmar3@.
Parents ha4e been told that it isnothing serious and !ill $robably go
a!ay as child gets older.
DEX
Giant ?e4us $ic
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DEX
Differential Diagnosis
'. ?e4us of 8to
) Caf au lait macule
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). Caf au lait macule
6. Congenital ne4omelanocytic ne4us
+. Giant lentigo
DEX
Differential Diagnosis
'. ?e4us of 8to
) Caf au lait macule
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). Caf au lait macule
6. Congenital ne4omelanocytic ne4us
+. Giant lentigo
DEX
Congenital ?e4omelanocytic ?e4us
• re al!ays $resent at birth
• 8ccur in J'E of the $o$ulation
• Most are single and small 9F*E H6*mm<
• 2esions may contain hair
f i hi hl i bl f th t bbl t i
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• urface is highly 4ariable from smooth to cobblestone in
a$$earance• Difficult to distinguish from other ne4i
• &a4e malignant $otential% treatment decisions must be
indi4iduali1ed
DEX
Case &istory -'
=our year old !ith sudden onset of
$ainf l lesion on chest ?o histor
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$ainful lesion on chest. ?o history
of trauma but has had lo!(gradefe4er since the lesion first a$$eared.
ranchial cleft cyst $ic
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DEX
Differential Diagnosis
'. #nsect bite
) ranchial cleft cyst infection
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). ranchial cleft cyst infection
6. 8steomyelitis of cla4icle
+. #m$etigo
DEX
Differential Diagnosis
'. #nsect bite
) ranchial cleft cyst infection
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). ranchial cleft cyst infection
6. 8steomyelitis of cla4icle
+. #m$etigo
DEX
ranchial Cleft Cyst
• Generally are secondary to failure to obliterate
the cer4ical sinus of the branchial arches
• May occur at any anatomic site from ear le4el to
b l th l i l
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belo! the cla4icle
• Most common during infancy and early childhood
• 8ften not noticed until infected
• Treatment is surgical e"cision
DEX
Case &istory -)
>le4en year old !ho had rashes in
infancy but has been other!ise
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healthy. Rash first de4elo$ed about
one !ee3 ago and has s$read o4er
trun3, arms and legs. Child states
that the rash is :itchy@.
Pityriasis rosae $ic
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DEX
Differential Diagnosis
'. econdary sy$hilis
) Psorriasis
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). Psorriasis
6. to$ic dermatitis
+. Pitryriasis rosae
DEX
Differential Diagnosis
'. econdary sy$hilis
) Psorriasis
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). Psorriasis
6. to$ic dermatitis
+. Pitryriasis rosae
DEX
Pityriasis Rosae• n acute self(limited s3in eru$tion !ith distincti4e clinical
findings and course5 etiology un3no!n5 $resumably 4iral in origin
• Primary lesion is a o4oid $la0ue that is may be scaly or
$a$ulo4esicular 9herald $atch<5 most commonly on trun3.
=re0uently misdiagnosed as tinea cor$oris
• Ten ('+ days after onset of the $rimary lesion, secondary lesions
a$$ear on trun3 in Nmas tree distribution
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a$$ear on trun3 in Nmas tree distribution
• econdary lesions are diffuse symmetrical often scaly$a$ulos0uamous lesions that follo! clea4age lines of s3in5 are
generally se$arated by normal s3in
• Resol4es !ithout treatment o4er )(6 !ee3s
DEX
Case &istory -6
=our month old !ho has had se4ere
rash on head !hich has im$ro4ed
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$
since mother began a$$lying o4er(the(counter to$ical steroid cream.
Mother is concerned that he is
:going bald@.
DEX
Cradle Ca$ $ic
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DEX
Differential Diagnosis
'. Tinea ca$itis
). Cutis a$lasia
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). Cutis a$lasia
6. eborrheic dermatitis
+. to$ic dermatitis
DEX
Differential Diagnosis
'. Tinea ca$itis
). Cutis a$lasia
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). Cutis a$lasia
6. eborrheic dermatitis
+. to$ic dermatitis
DEX
Cradle Ca$
• Common disorder during infancy and early childhood5
affects )(E of $o$ulation
• >tiology not 3no!n5 attributed to increased sebum
$roduction
• cal$, face and ears are the most common sites in4ol4ed
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cal$, face and ears are the most common sites in4ol4ed
• Clinical $resentation 4aries from mild to se4ere• ffected s3in is $in3, sometimes edematous and co4ered
!ith yello! !a"y $la0ue
• &air loss may occur !ith se4ere disease during infancy5
does not occur in older children
DEX
Case &istory -+
Thirteen year old $ost($ubertal child
!ho has had rash de4elo$ on feet
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!ho has had rash de4elo$ on feet
o4er the $ast t!o !ee3s. Rash isslightly $ainful and some!hat
$ruritic5 other!ise !ell.
DEX
hoe dermatitis $ic
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DEX
Differential Diagnosis
'. Primary irritant dermatitis
). Tinea $edis
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$
6. >rythrasma
+. to$ic dermatitis
DEX
Differential Diagnosis
'. Primary irritant dermatitis
). Tinea $edis
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$
6. >rythrasma
+. to$ic dermatitis
DEX
Primary #rritant Dermatitis
9hoeAandal Dermatitis<
• cute form% erythema, edema, $a$ules, 4esicles, or
bullae• Chronic form% $a$ular ( $a$ulo4esicular, lichenified,
sometimes scaly
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• Caused by rubber in shoes or oils in leather sandals
• Rarely in4ol4es $alms and soles
• 84er 6*** en4ironmental sensiti1ers ha4e been
identified5 most are sim$le chemicals that must lin3
to $roteins before they can sensiti1e
DEX
Case &istory -
i" month old brought in for routine
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!ell child e"am5 mother is concernedthat she has :caught ring !orm@ from
her baby(sitter.
DEX
Traction alo$ecia $ic
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DEX
Differential Diagnosis
'. Tinea ca$itis
). lo$ecia aereata
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$
6. Trichotillomania
+. Traction alo$ecia
DEX
'. Tinea ca$itis
). lo$ecia aereata
Differential Diagnosis
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$
6. Trichotillomania
+. Traction alo$ecia
DEX
Traction lo$ecia
• Peculiar form of alo$ecia that results from
traction induced by hair styling• 2ocali1ed hair loss
• cal$ may ha4e inflammatory $a$ules at site of
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hair follicle
• :Corn ro!@ and :$ony(tail@ are most common
hair styles that induce this syndrome
• &air generally regro!s if traction is not chronic
DEX
Case &istory -
Ten year old !ho a!o3e !ith :blac3(
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eye@5 may ha4e been hit in the eye!ith a tennis ball !hile at recess the
day $rior.
all #nIury $ic
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DEX
Differential Diagnosis
'. ?euroblastoma
). &enoch chonlein Pur$ura
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6. 2eu3emia
+. Tennis ball inIury
DEX
'. ?euroblastoma
). &enoch chonlein Pur$ura
Differential Diagnosis
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6. 2eu3emia
+. Tennis ball inIury
DEX
Pro$ulsion all >ye #nIuries
• 8ne of most common causes of eye inIuries
in children and adolescents
• Male $redominance
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• Ru$tured globe, hy$hema and retinaldetachment are associated !ith $ro$ulsion
eye inIuries
• Protecti4e eye!ear should be encouraged for
children $laying :ball s$orts@
DEX
Case &istory -B
=our month old !hose !or3ing
mother is concerned about a dia$er
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$
rash that :comes and goes@. eemsto clear on the !ee3ends and gets
!orse during !ee3days.
DEX
Primary #rritant Dia$er Derm$ic
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DEX
Differential Diagnosis
'. Candidiasis
). Primary irritant dermatitis
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6. Psorriasis
+. >rythrasma
DEX
Differential Diagnosis
'. Candidiasis
). Primary irritant dermatitis
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6. Psorriasis
+. >rythrasma
DEX
Primary #rritant Dia$er Dermatitis
• 8ften confused !ith Candidal infection
• lightly tender
3i b d
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• 3in may be red
• #n contrast to other forms of dia$er
dermatitis, $rimary irritant dermatitis s$ares
the creases
• Res$onds to good hygienic $ractices
DEX
Case &istory --
e4en month old !ho has had :cradle(
ca$@ for the $ast se4eral months that
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is getting !orse and has s$read to theface and trun3.
#nfantile Psorriasis $ic
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DEX
Differential Diagnosis
'. #nfantile $soriasis
). Tinea ca$itis
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6. eborrheic dermatitis
+. 2etterer(i!e disease
DEX
Differential Diagnosis
'. #nfantile $soriasis
). Tinea ca$itis
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6. eborrheic dermatitis
+. 2etterer(i!e disease
DEX
#nfantile Psoriasis
• imilar to disease in older children and adults5
early onset may $ortend more se4ere $rognosis
• caly $la0ues are the sine qua none
• cal$ in4ol4ement is common and may be the
only early manifestation5 often difficult to
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only early manifestation5 often difficult to
distinguish from seborrheic dermatitis
• Cutaneous lesions are indistinguishable from
those that occur in the adult form of disease
DEX
Case &istory -F
dolescent !ho has had $ruritic
rash on hand for $ast '* days5 too3
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some $enicillin !hich !as in thehouse but there has been no
im$ro4ement
DEX
cabies $ic
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DEX
Differential Diagnosis
'. #m$etigo
). Rhus dermatitis
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6. Dyshidrosis
+. cabies
DEX
Differential Diagnosis
'. #m$etigo
). Rhus dermatitis
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6. Dyshidrosis
+. cabies
DEX
cabies
• #nfection caused by Sarcoptes scabiei
• Clinically manifests as an intensely $ruritic, $a$ulareru$tion caused by the burro!ing of the animal
• More of an intertriginal disease in older children
and adults
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• urro!s are characteristic5 linear, gray(!hitetortuous lines that are usually obliterated by
scratching
• Prone to secondary bacterial infection
DEX
Case &istory F*
=irst 4isit for a nine year old obese
child !ith intellectual retardation.
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Mother is concerned aboutincreasing number of :sores@ on his
arms.
DEX
Pinch Dermatitis $ic
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DEX
Differential Diagnosis
'. Cigarette burns
). Cao Gio
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6. #nsect bites
+. :Pinch dermatitis@
DEX
Differential Diagnosis
'. Cigarette burns
). Cao Gio
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6. #nsect bites
+. :Pinch dermatitis@
DEX
Prader ( ;illi yndrome
• Contiguous gene syndrome is caused by deletion or
disru$tion of a gene or se4eral genes on the $ro"imal long
arm of the $aternal chromosome ' or maternal uni$arental
disomy ', because the gene9s< on the maternal
chromosome9s< ' are 4irtually inacti4e through im$rinting
• yndrome characteri1ed by diminished fetal acti4ity,
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yndrome characteri1ed by diminished fetal acti4ity,
obesity, muscular hy$otonia, mental retardation, shortstature, hy$ogonadotro$ic hy$ogonadism, and small hands
and feet
• ometimes may ha4e $eculiar :$inch lesions@ on s3in
DEX
Case &istory F'
e4en year old !ho has had rash
on arms and legs since infancy. #s
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asym$tomatic and the rash tendsto get better and !orse although
neither he nor the mother 3no!
!hy.
DEX
Keratosis Pilaris $ic
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DEX
Differential Diagnosis
'. Keratosis $ilaris
). ta$hylococcal $ustules
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6. 2ichen s$inulosis
+. cro3eratosis 4erruciformis
DEX
Differential Diagnosis
'. Keratosis $ilaris
). ta$hylococcal $ustules
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6. 2ichen s$inulosis
+. cro3eratosis 4erruciformis
DEX
Keratosis Pilaris
• enign condition of un3no!n etiology
• Keratotic $a$ules of the hair follicles
• Characteri1ed by discrete 3eratotic, follicular
$a$ules !ith surrounding erythema
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$ $ g y
• Primarily on the arms, legs and buttoc3s
• Generally more se4ere !hen s3in is dry
• Res$onds to emollient creams
DEX
Case &istory F)
T!o !ee3 old brought in for !ell
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child e"am5 other!ise healthy andthri4ing.
DEX
2i4edo Reticularis $ic
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DEX
Differential Diagnosis
'. Cutis marmorata
). 2i4edo reticularis
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6. s$hy"ia reticularis
+. 2i4edo annularis
DEX
Differential Diagnosis
'. Cutis marmorata
). 2i4edo reticularis
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6. s$hy"ia reticularis
+. 2i4edo annularis
DEX
2i4edo Reticularis
• trange condition that has many different names
• Most commonly occurs in neonates !ho are
e"$osed to cold
• Characteri1ed by reddish(blue mottling of the
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Characteri1ed by reddish blue mottling of the
s3in in a :fishnet@ reticular $attern
• #n older children and adults, the condition may
be associated !ith systemic disease
DEX
Case &istory F6
8ther!ise healthy child !ho has had
multi$le :birthmar3s@ under her arm
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since birth.
DEX
"illary =rec3les $ic
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DEX
Differential Diagnosis
'. Urticaria $igmentosa
). Caf au lait s$ots
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6. canthosis nigricans
+. "illary frec3les
DEX
Differential Diagnosis
'. Urticaria $igmentosa
). Caf au lait s$ots
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6. canthosis nigricans
+. "illary frec3les
DEX
"illary =rec3ling
• mall 9*.cm< bro!n, !ell(circumscribedmacules
• Cutaneous manifestation of neurofibromatosis
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• Generally go unnoticed
• &igh correlation !ith neurofibromatosis !hen
si" or more frec3les are $resent in the a"illa
DEX
Case &istory F+
e4en year old !ho has had numerous
UR#7s and se4eral e$isodes of sinusitis
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in the the $ast. Doesn7t :feel !ell@.
DEX
llergic hiners $ic
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DEX
Differential Diagnosis
'. ?euroblastoma
). llergic :shiners@
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6. >thmoid sinusitis
+. Ca$illary fragility syndrome
DEX
Differential Diagnosis
'. ?euroblastoma
). llergic :shiners@
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6. >thmoid sinusitis
+. Ca$illary fragility syndrome
DEX
llergic hiners
• Dar3 discoloration belo! the eyes in children
!ho ha4e chronic allergic rhinitis
• 8ften associated !ith other signs of allergy%
– mouth breathing
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– :allergic salute@
– Dennie(Morgan folds 9Dennie lines<
– trans4erse nasal crease
DEX
Case &istory F
T!o !ee3 old !ho had $reci$itous
deli4ery and lo! initial $gar score.
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Res$onded to con4entionalmeasures and had uncom$licated
nursery stay. Mother noted lesions
on leg and buttoc3s a$$ro"imately
three days ago.
DEX
S =at ?ecrosis $ic
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DEX
Differential Diagnosis
'. 2i4edo reticularis
). >rysi$elis
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6. ubcutaneous fat necrosis
+. >rythema nodosum
DEX
ubcutaneous =at ?ecrosis
'. 2i4edo reticularis
). >rysi$elis
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6. ubcutaneous fat necrosis
+. >rythema nodosum
DEX
ubcutaneous =at ?ecrosis
• >rythematous or 4iolaceous firm lesions that
generally de4elo$ in the first fe! !ee3s of life• lmost e"clusi4ely in term infants
• 2ocali1ed but may be multifocal
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• Most common on bac3, buttoc3s, thighs and
chee3
• Resol4e s$ontaneously o4er !ee3s to months
DEX
Case &istory F
Three year old !ho began com$laining
of a :stomach ache@ se4eral hours
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ago. Mother Iust noticed a bulge that!as not $re4iously $resent.
DEX
>$igastric &ernia $ic
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DEX
Differential Diagnosis
'. #nsect bite
). >$igastric hernia
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6. Dermoid cyst
+. 2i$oma
DEX
Differential Diagnosis
'. #nsect bite
). >$igastric hernia
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6. Dermoid cyst
+. 2i$oma
DEX
>$igastric &ernia
• result of a small rent in the linea alba
• l!ays midline
• May be e$isodic
• Can be induced by ha4ing the $atient $erform
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a Valsal4a maneu4er
• Generally only contains fat, not $eritoneal sac
• Generally, are easily reducible
DEX
Case &istory FB
Three !ee3 old !ho has been $erfectly
normal5 mother noted that the :soft(s$ot@
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!as bulging !hen infant a!a3ened thismorning. 8ther!ise asym$tomatic.
ulging =ontanel $ic
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DEX
Differential Diagnosis
'. Meningitis
). 2e$tomeningeal cyst
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6. &ydroce$halus
+. Vitamin to"icity
DEX
Differential Diagnosis
'. Meningitis
). 2e$tomeningeal cyst
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6. &ydroce$halus
+. Vitamin to"icity
DEX
ulging =ontanel• Generally caused by increased intracranial $ressure
• Multi$le causes5 almost all bad
• ome relati4ely benign causes include the
follo!ing%
– le$tomeningeal cyst
b i i t i l h t i
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– benign intracranial hy$ertension – Roseola
– &y$er4itaminosis
DEX
Case &istory F-
Ten year old !ho first noticed
discoloration of tongue se4eral
hours ago. side from the
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discolored tongue, he is other!ise
healthy, feels !ell and is !ithout
com$laints.
2icorice Tongue $ic
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DEX
Differential Diagnosis
'. Aspergillus niger infection
). :Pe$to(ismol@ tongue
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6. ribinofla4inosis
+. :2icorice@ tongue
DEX
Differential Diagnosis
'. Aspergillus niger infection
). :Pe$to(ismol@ tongue
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6. ribinofla4inosis
+. :2icorice@ tongue
DEX
Differential Diagnosis of
lac3 Tongue
'. s$ergillus niger infection
). :2icorice@ tongue
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6. :Pe$tol ( ismol@ tongue
+. ribinofla4inois
DEX
Case &istory FF
Parents returned from 4acation and
found child loo3ing li3e this5
b b itt thi 3 th t h h
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babysitter thin3s that he may ha4e:bum$ed his head@ !hile $laying.
Child is alert, oriented and !ithout
focal neurologic signs.
Dashboard #nIury $ic
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DEX
Differential Diagnosis
'. Child abuse
). ?euroblastoma
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6. :Dashboard@ inIury
+. :Tennis ball@ inIury
DEX
Differential Diagnosis
'. Child abuse
). ?euroblastoma
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6. :Dashboard@ inIury
+. :Tennis ball@ inIury
DEX
Dashboard #nIury
• Characteristic inIury caused during a motor4ehicle im$act or sudden sto$ !hen an
unrestrained child is $ro$elled into
dashboard or rear4ie! mirror
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• Generally associated !ith facial or orbital rim
fractures
• 2arge incidence of retinal detachment
DEX
Case &istory '**
T!el4e year old !ho !as !ell untilyesterday !hen he de4elo$ed fe4er
and some blisters on his face5
blisters ha e s$read to e es mo th
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blisters ha4e s$read to eyes, mouthand the rest of his body. &ad a
:cold(sore@ on li$ a$$ro"imately one
!ee3 ago.
te4ens ohnson yndrome
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DEX
Differential Diagnosis
'. Disseminated &er$es sim$le"
). ta$hylococcal calded 3in yndrome
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6. Polymor$hous light eru$tion
+. te4ens ohnson yndrome
DEX
Differential Diagnosis
'. Disseminated &er$es sim$le"
). ta$hylococcal calded 3in yndrome
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6. Polymor$hous light eru$tion
+. te4ens ohnson yndrome
DEX
te4ens ohnson yndrome
• yndrome characteri1ed by fe4er and blistering
lesions on s3in and mucous membranes
• Must ha4e t!o or more mucous membranes
in4ol4ed to meet criteria
• Multi$licity of $reci$itins5 Herpes simplex has been
associated !ith recurrent disease
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associated !ith recurrent disease
• May be life(threatening
• Re0uires meticulous su$$orti4e care
DEX
Visual Atlas
• Acanthosis Nigricans
• Adenoma Sebaceum• Allergic Dermatitis
• Allergic Shiners
• Alopecia Aereata
• Aplasia Cutis
• !lue #ubber !leb Syndrome
• !ranchial Cleft Cyst• !ranchial Cleft #emnant
• !ulging Fontanel
• Caf$ au Lait %acule
• Caffey Disease
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• Aplasia Cutis
• Ash Leaf Spot
• Atopic Dermatitis
• Axillary Frecles
• !aer"s Cyst
• Caffey Disease• Cao &io
• Caustic 'n(ury
• Chronic !ullous Dermatosis
• Cradle Cap
DEX
Visual Atlas
• Dashboard 'n(ury
• Dehydration• Dermoid Cyst
• )bstein"s *earls
• )c+ema Vaccinatum
• )lectrical Cord 'n(ury
• )rythropoetic *orphyria
• Fifth"s Disease• Furuncle
• &anglion Cyst
• &eographic -ongue
• &iant Ne.us
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• )lectrical Cord 'n(ury• )pigastric ,ernia
• )pulis
• )ruption Cyst
• )rythema -oxicum
• &iant Ne.us• ,air -ourni/uet Syndrome
• ,air -ourni/uet Syndrome
• ,emangioma
• ,enoch Schonlein *urpura
DEX
Visual Atlas
• ,ordeolum
• 'mmersion 'n(ury• 'nclusion Cyst
• 'ncontinentia *igmenti
• 'ncontinentia *igmenti
Achromians
• 03ashioror
• Lamellar 'chthyosis• Leuocoria
• Lichen Nitidus
• Lichen Spinulosis
• Licorice -ongue
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Achromians
• 'nfantile )c+ema
• 0eloid
• 0lippel1-renauney12eb
er Syndrome
• Licorice -ongue• Linear )pidermal Ne.us
• Lingual -onsil
• Li.edo #eticularis
• Lymphangioma
DEX
Visual Atlas
• Lymphedema *raecox
• %il1!ottle Caries• %ilroy"s Disease
• %ucocoele
• Neonatal Acne
N C d i
• Ne.us 6nius Lateris
• Numular )c+ema• *apilloma
• *eriungual Fibroma
• *ilonidal Sinus
• *inch Dermatitis
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• Ne.us Comedonicus
• Ne.us Flammeus
• Ne.us of 4to
• Ne.us Sebaceous of 5adassohn
• *inch Dermatitis• *ityriasis Alba
• *ityriasis #osae
• *remature Adrenarche
• *remature -helarche
DEX
Visual Atlas
• Diaper Dermatitis
• *sorriasis• #abies Vaccination
• #ecurrent *arotitis
• #hus Dermatitis
• #ubella
• Shoe Dermatitis
• Ste.ens 5ohnson Syndrome• Subcutaneous Fat Necrosis
• Synechiae Vul.a
• -ennis !all 'n(ury
• -hyroglossal Duct Cyst
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#ubella• Scabies
• Scrofula
• Seborrheic Dermatitis
• Shagreen *atch
-hyroglossal Duct Cyst• -raction Alopecia
• -richotillomania
• 6mbilical &ranuloma
• 6rticaria *igmentosa
DEX
Visual Atlas
• Verruca Vulgaris
• Vitiligo
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DEX
;eb ite
• Visit the Visual Diagnosis ;eb ite%
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