Special Patient Populations

Special Patient Populations is further divided into

Neonatal Infections

» What are the TORCHES infections in a neonate?
» Describe the cutaneous findings in neonatal herpes simplex viral (HSV) infections.
» Is neonatal herpes simplex dangerous?
» What percentage of herpes-infected neonates display skin or mucosal lesions?
» What percentage of these lesions are HSV-1, as opposed to HSV-2?
» What tests can be done to diagnose herpes infections? How should material be obtained for these tests?
» What is congenital varicella syndrome?
» What is the average age of onset of lesions in a neonate exposed to varicella perinatally? When is there an increased risk of mortality?
» What is the treatment of neonatal HSV and varicella infection?
» What is a “blueberry muffin baby”? What is the significance of this diagnosis?
» At what time during pregnancy is there the highest risk of congenital rubella following maternal infection?
» List the classic triad of congenital rubella syndrome (CRS).
» Are any precautions necessary for infants with congenital rubella syndrome at the time of hospital discharge?
» Why is human parvovirus infection important to a pregnant woman?
» Are most infants with congenital cytomegalovirus (CMV) infection symptomatic?
» What cutaneous findings are seen in congenital CMV infection?
» What clinical findings are seen in congenital Epstein-Barr virus infection?
» Describe a clinical presentation of congenital human papillomavirus infection.
» What is the risk of HIV infection transmission to an infant born from an HIV-positive mother?
» What is Hutchinson’s triad?
» Are there any other stigmata of late congenital syphilis?
» What are the physical findings of early congenital syphilis?




Pediatric Dermatology

» What is the most common skin disease seen in children?
» Name the papulopustular facial eruption often associated with inappropriate topical steroid use.
» At what age does atopic dermatitis typically begin?
» What is the natural history of atopic dermatitis?
» What organism commonly complicates irritant diaper dermatitis?
» Red, scaly, itchy, weight-bearing skin surfaces of the feet in children are usually not due to tinea pedis, but to what?
» Plant dermatitis, such as poison ivy, is the most prevalent cause of allergic contact dermatitis in children. What are some others?
» One- to 2-mm keratotic papules located on the face, outer upper arms, and thighs are frequently misdiagnosed as folliculitis. What are they really?
» What is the most common cutaneous bacterial infection in children?
» What two organisms are most often responsible for tinea capitis?
» How is tinea capitis treated?
» What is the hypersensitivity reaction to tinea capitis that is commonly mistaken for a bacterial superinfection?
» Name the three conditions most often misdiagnosed as tinea corporis.
» What percentage of children with psoriasis will have guttate psoriasis?
» Describe the rash associated with childhood dermatomyositis.
» A child’s mother tells you that the rash started at one end of her child’s extremity and has now progressed to form a line the entire length of the limb. What is your diagnosis?
» Name the most common sun-induced disease of childhood.
» If it is not sunburn but a photosensitive eruption is suspected, what is it?
» Name the mildly inflammatory tongue eruption with day-to-day changes in appearance.
» Which disease should be considered in a child with easy blistering of the skin?
» Two common nodules are seen in childhood. Name them.
» Crusted purpuric papules and a scaly seborrheic-like eruption in the scalp and groin are seen in what serious disease of childhood?
» Name the skin nodule in childhood that is characterized by frequent bleeding.
» Flesh-colored to brown macules and papules that hive when stroked (Darier’s sign) are diagnostic of what eruption?
» The onset of annular erythema in sun-exposed areas in children less than 6 months of age should make you want to do what test on the infant’s mother?
» Which is the most common type of vasculitis seen in children?
» What is a spider telangiectasia (nevus araneus)?
» Outline the major classes of hair loss in children.
» List the three most common types of acquired circumscribed hair loss in children.
» What are the two most common causes of congenital circumscribed hair loss?
» What should you think of in a 3-year-old who has never required a haircut?
» What are the cutaneous findings seen in tuberous sclerosis complex?
» How many café-au-lait macules must be present on a child to make you worry about neurofibromatosis type 1 (von Recklinghausen’s disease)?
» What is a Mongolian spot (middermal melanocytosis)?
» What are congenital pigmented nevi, and who cares?
» Child abuse is often incorrectly suspected when a young girl presents with what disease?




Geriatric Dermatology

» How common are skin disorders in the elderly population?
» What is intrinsic aging of the skin?
» What is extrinsic aging of the skin?
» How does intrinsically aging human skin vary from young skin under the microscope?
» Why does skin wrinkle as we age?
» Does smoking cigarettes accelerate skin aging?
» What is solar elastosis?
» What is nodular elastosis with cysts and comedones?
» How do liver spots, solar lentigo, and lentigo senilis differ?
» Why do elderly patients frequently develop bleeding into the skin on the dorsum of their hands and arms?
» Advertisements in newspapers and magazines frequently tout products that “rejuvenate” the skin or make the skin younger. Is there truth to these claims?
» What is the difference between superficial, medium, and deep chemical peels?
» Are some sunscreens better than others in preventing wrinkles due to photodamage?
» Which are the most common inflammatory skin diseases in the elderly?
» Why are elderly patients prone to develop xerosis?
» What is the best way to treat xerosis?
» How common is chronic venous insufficiency in the geriatric population?
» Explain the pathogenesis of chronic venous insufficiency.
» How should you manage chronic venous insufficiency?
» What is rosacea? How does it present?
» Is rhinophyma related to alcohol abuse?
» Name the most common types of skin tumors seen in the elderly.
» What are seborrheic keratoses?
» What are stucco keratoses?
» What is sebaceous hyperplasia?
» A 70-year-old man presents to your clinic with the sudden onset of hundreds of seborrheic keratoses. Is there any reason for concern?
» Describe the methods for treating seborrheic keratoses.
» An elderly man presents with a soft blue papule on the helix of his cheek and is concerned about malignant melanoma. What is the most likely diagnosis?
» Is there a future in geriatric dermatology?




Dermatoses of Pregnancy

Specific Dermatoses of Pregnancy
» Name four pregnancy-specific dermatological disorders
» What is pruritic urticarial papules and plaques of pregnancy?
» Does PUPPP have any associated morbidity?
» How is PUPPP treated?
» From which dermatosis of pregnancy must PUPPP be differentiated?
» What is pemphigoid gestationis?
» What are the antigens associated with the development on pemphigoid gestationis?
» Which histocompatibility leukocyte antigen (HLA) types have been associated with pemphigoid gestationis?
» Compare PUPPP and pemphigoid gestationis.
» What is atopic eruption of pregnancy?
» What is intrahepatic cholestasis of pregnancy?
» What is the epidemiology of ICP?
» Are there specific laboratory findings to establish the diagnosis?
» What risks and outcomes are associated with intrahepatic cholestasis of pregnancy?
» How is cholestasis of pregnancy treated?
» Is impetigo herpetiformis a distinct clinical disease?
» Are there lab findings associated with impetigo herpetiformis?
» What is the treatment for impetigo herpetiformis?

Physiologic Skin Changes in Pregnancy
» List the physiologic skin changes that can occur as a normal part of pregnancy.
» What are some of the normal pigmentary changes that can be associated with pregnancy?
» Why do these pigmentary changes occur?
» How does pregnancy affect patients with melanoma?
» Is pregnancy associated with changes in hair growth?
» List the vascular changes that can occur in pregnancy.
» What factors influence the development of striae distensae (commonly known as “stretch marks”)?
» Discuss two cutaneous tumors often associated with pregnancy.
» Do some diseases improve with pregnancy?
» Do some mucocutaneous diseases worsen in pregnancy?
 

Disorders of the Female Genitalia

Nonneoplastic Epithelial Disorders of the Vulva
» What is lichen sclerosus (also known as lichen sclerosus et atrophicus)?
» Describe the clinical signs of lichen sclerosus of the vulva.
» What are the symptoms of lichen sclerosus?
» Is there a need to biopsy lichen sclerosus of the vulva?
» How does one treat lichen sclerosus?
» What is the differential diagnosis of lichen sclerosus of the vulva?
» What is lichen planus?
» Are there different variants of lichen planus that affect the vulva?
» What are the clinical symptoms of vulval lichen planus?
» Is lichen planus associated with malignancy?
» How do you treat lichen planus of the vulva?
» Describe lichen simplex chronicus of the vulva.
» Psoriasis can be present on the vulva. How does it present?
» How is psoriasis of the vulva treated?
» What are other common causes of vulvar pruritus?
» Name some common vulvovaginal infections associated with pruritus?
» Compare and contrast condyloma accuminatum and molluscum contagiosum.


Vasculitic Disease of the Vulva
» What is Behçet’s disease?
» What is the treatment for Behçet’s disease?


Neoplastic Disorders of the Vulva
» What is the most common cancer of the vulva?
» Is squamous cell carcinoma of the vulva associated with a precancerous state?
» How long does it take VIN to progress to squamous cell carcinoma of the vulva?
» How does one treat VIN/SCC of the vulva?
» What is the second most common vulvar malignancy?
» How does melanoma of the vulva present?
» Are melanomas of the vulva more aggressive than other cutaneous melanomas?
» What is the treatment of melanoma of the vulva?
» What is Paget’s disease of the vulva?
» How does Paget’s disease of the vulva present?
» What is the differential diagnosis of Paget’s disease?
» How does one treat Paget’s disease of the vulva?




Special Considerations in Skin of Color

» What is “skin of color”?
» What accounts for differences in color between ethnic and racial groups?
» Do any physiologic differences exist between black skin and that of other racial/ethnic groups?
» Are the brown streaks on the nails of people with skin of color always a cause for concern?
» Is pigmentation of the oral mucosa in people with skin of color invariably concerning?
» Are there other areas of the body where hyperpigmentation represents a normal racial variant?
» What are Futcher’s lines?
» What causes postinflammatory hyperpigmentation?
» What causes postinflammatory hypopigmentation?
» Is pityriasis alba the same thing as postinflammatory hypopigmentation?
» Is vitiligo more common in patients with darker skin?
» Why does tinea versicolor cause hypopigmented spots on dark skin?
» Why is it more difficult to appreciate erythema in darker skin?
» Can any other generalizations be made about common cutaneous reaction patterns in skin of color?
» What is the significance of multiple brown papules often seen on the periorbital area, cheeks, and nose?
» What is cutaneous sarcoidosis?
» What are keloids?
» What are “razor bumps”?
» How is pseudofolliculitis barbae treated?
» Are there other racial differences that may affect the treatment of hair or scalp conditions in blacks?
» Are patients with skin of color particularly susceptible to any life-threatening illnesses?
» Do any special considerations exist when performing skin surgery on patients with skin of color?
» Why is skin cancer less common in skin of color?
» Are there any unique presentations of skin cancer when it does occur in patients with darker skin?
» List skin diseases or conditions that are often considered more common in persons with skin of color.




Cultural Dermatology

» A child from southern India has had a recent decline in school performance and is noted to be anemic. On examination, the child has adorable, dark, mascara-like makeup around her eyes. As an astute cultural dermatologist, you suspect that the makeup is the cause of the difficulties in school and the hematologic profile. What is the name for the traditional Indian eye makeup?
» What is surma made from? How did it affect the child?
» A Vietnamese child is seen in the emergency department with an earache and, on examination, is noted to have several linear ecchymoses on her back. The physician suspects child abuse as the cause of the bruises, but the interpreter says it is not. What caused the marks on the child?
» An older Chinese man is noted to have dozens of fairly uniform round scars on his back. They resemble self-inflicted cigarette burns, only much larger. The patient is unconcerned about the lesions and indicates that someone like you, a doctor perhaps, did this to him. What ancient Chinese medical practice produces burn scars?
» What is moxibustion?
» Can acupuncture cause dermatologic problems?
» Do any Western medical practices cause permanent changes in the skin?
» Where did the practice of tattooing start?
» What does the word tattoo mean?
» What culture has the most elaborate tattoos?
» Why do sailors have tattoos?
» Sailors sometimes have rooster and pig tattoos on their lower legs. Does this have a meaning?
» Who is the Ice Man? Why are his tattoos so important?
» A man from rural Nigeria has several sets of small parallel scars on his face. He says that his village doctor made these with a sharp stone when the man was young. What are ritually placed incisions called?
» Scarification is performed in a number of societies. Why?
» What is an omega brand?
» Name the familiar dark-red spot placed on the central forehead of Hindu women.
» What dermatologic problems can bindi cause?
» While on a surfing trip to an outer island of Fiji, you notice that many of the men have dry, scaly skin. You guess there must be a hyperendemic focus of X-linked ichthyosis. The villagers laugh when you ask if the men are born that way and explain that the skin problem is called kani and is caused by drinking too much yanggona. What is this?
» What is kava?
» Your favorite professor has invited you to accompany her on an assessment of a refugee camp in southern Africa. In the camp, you see hundreds of children and adults with a strikingly similar shiny, slightly erosive eruption along exposed are of their clavicular regions and forearms. What is this eruption?
» Why is pellagra abundant in the refugee camps?
» What is betel nut? Who chews it?
» What dermatologic changes are associated with chewing betel nut?
» The visa of a Somali family living in your town has expired. The mother is fighting deportation because she fears that her daughters will be compelled to undergo circumcision if they return to Mogadishu. What is female circumcision?
» What are the complications of female circumcision?
» What is the most common culturally sanctioned mutilation in the United States?
» What about culturally sanctioned surgical alterations of male genitalia?
» What are artificial penile nodules?
» Your cousin is marrying a woman from Mumbai (Bombay). On the wedding day, the bride’s hands are painted with an intricate filigree-like pattern of reddish-brown pigment. What is this form of ornamentation called?
» Describe the use of henna on the skin.
» Are there any medical problems associated with henna?
» A patient with a referral to the otolaryngology clinic mistakenly arrives in the dermatology clinic. You see that the consultation is to “rule out congenital absence of the uvula.” Sure enough, on your examination, there is no uvula. What gives?
» A 51-year-old Muslim woman from Saudi Arabia is noted to have asymptomatic thickening and hyperpigmentation on the forehead, knees, ankles, and on the dorsa of her feet. What does she have?
» A 22-year-old man from India presents with tinea cruris that involves the penis. What most likely accounts for this highly atypical clinical distribution of infection?

 

 

 

 

 

 

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