Pediatric EOR: Dermatology (Smarty PANCE)
Test Questions with Correct Solutions
What is the pathophysiology of acne vulgaris?
Follicular hyperkeratinization + Propionibacterium acnes colonization + sebum production +
inflammation leading to comedones, papules, pustules
At what age does acne vulgaris typically begin?
Early puberty (ages 10-13) due to increased androgen production stimulating sebaceous gland
activity
What are comedonal vs inflammatory acne lesions?
Comedonal: open (blackheads) and closed (whiteheads) comedones; Inflammatory: papules,
pustules, nodules, cysts
What is first-line treatment for mild comedonal acne?
Topical retinoids (tretinoin, adapalene) - normalize follicular keratinization and prevent
comedone formation
What is first-line treatment for mild to moderate inflammatory acne?
Topical retinoid PLUS topical antibiotic (clindamycin or erythromycin) or benzoyl peroxide
When should oral antibiotics be used for acne?
Moderate to severe inflammatory acne - doxycycline or minocycline (avoid tetracyclines <8
years old)
When should isotretinoin (Accutane) be considered?
,Severe nodulocystic acne, acne resistant to other treatments, or acne causing scarring
What are the major side effects and monitoring for isotretinoin?
TERATOGENIC (iPLEDGE program required), dry skin/lips, elevated triglycerides/LFTs,
depression - monitor lipids, LFTs, pregnancy tests
What patient education is important for topical retinoids?
Apply at night, expect initial irritation/dryness, use sunscreen (photosensitivity), may worsen
before improving (purge period)
What is androgenetic alopecia in pediatric patients?
Rare in children - premature onset typically associated with endocrine disorders, PCOS in
females, or genetic syndromes
What pattern of hair loss is seen in androgenetic alopecia?
Males: receding frontal hairline and vertex thinning; Females: diffuse central scalp thinning with
preserved frontal hairline
What workup is indicated for pediatric androgenetic alopecia?
Endocrine evaluation (testosterone, DHEA-S, prolactin), thyroid function, consider PCOS
workup in females
What is the classic triad of atopic dermatitis?
Eczema, asthma, allergic rhinitis (atopic triad) - often follows “atopic march” progression
What is the age-specific distribution of atopic dermatitis lesions?
, Infants (<2 years): face, scalp, extensor surfaces; Children (2-12): flexural areas (antecubital,
popliteal fossae), neck, wrists
What are the diagnostic criteria for atopic dermatitis?
Pruritus PLUS ≥3 of: onset <2 years, flexural involvement, dry skin, personal/family atopy,
visible eczema
What is the first-line treatment for mild to moderate atopic dermatitis?
Liberal emollients (multiple times daily) + low to mid-potency topical corticosteroids for flares
What is the role of topical calcineurin inhibitors in atopic dermatitis?
Tacrolimus/pimecrolimus - steroid-sparing agents for face/neck, maintenance therapy, or steroid-
resistant areas
What triggers should be avoided in atopic dermatitis?
Harsh soaps, hot water, wool clothing, common allergens (dust mites, pet dander), stress, dry
environments
What are complications of atopic dermatitis?
Bacterial superinfection (S. aureus), eczema herpeticum (HSV), lichenification, sleep
disturbance, psychosocial impact
What is eczema herpeticum and its treatment?
Widespread HSV infection on eczematous skin - presents with clustered vesicles, punched-out
erosions; treat with IV acyclovir
How are pediatric burn depths classified?
Test Questions with Correct Solutions
What is the pathophysiology of acne vulgaris?
Follicular hyperkeratinization + Propionibacterium acnes colonization + sebum production +
inflammation leading to comedones, papules, pustules
At what age does acne vulgaris typically begin?
Early puberty (ages 10-13) due to increased androgen production stimulating sebaceous gland
activity
What are comedonal vs inflammatory acne lesions?
Comedonal: open (blackheads) and closed (whiteheads) comedones; Inflammatory: papules,
pustules, nodules, cysts
What is first-line treatment for mild comedonal acne?
Topical retinoids (tretinoin, adapalene) - normalize follicular keratinization and prevent
comedone formation
What is first-line treatment for mild to moderate inflammatory acne?
Topical retinoid PLUS topical antibiotic (clindamycin or erythromycin) or benzoyl peroxide
When should oral antibiotics be used for acne?
Moderate to severe inflammatory acne - doxycycline or minocycline (avoid tetracyclines <8
years old)
When should isotretinoin (Accutane) be considered?
,Severe nodulocystic acne, acne resistant to other treatments, or acne causing scarring
What are the major side effects and monitoring for isotretinoin?
TERATOGENIC (iPLEDGE program required), dry skin/lips, elevated triglycerides/LFTs,
depression - monitor lipids, LFTs, pregnancy tests
What patient education is important for topical retinoids?
Apply at night, expect initial irritation/dryness, use sunscreen (photosensitivity), may worsen
before improving (purge period)
What is androgenetic alopecia in pediatric patients?
Rare in children - premature onset typically associated with endocrine disorders, PCOS in
females, or genetic syndromes
What pattern of hair loss is seen in androgenetic alopecia?
Males: receding frontal hairline and vertex thinning; Females: diffuse central scalp thinning with
preserved frontal hairline
What workup is indicated for pediatric androgenetic alopecia?
Endocrine evaluation (testosterone, DHEA-S, prolactin), thyroid function, consider PCOS
workup in females
What is the classic triad of atopic dermatitis?
Eczema, asthma, allergic rhinitis (atopic triad) - often follows “atopic march” progression
What is the age-specific distribution of atopic dermatitis lesions?
, Infants (<2 years): face, scalp, extensor surfaces; Children (2-12): flexural areas (antecubital,
popliteal fossae), neck, wrists
What are the diagnostic criteria for atopic dermatitis?
Pruritus PLUS ≥3 of: onset <2 years, flexural involvement, dry skin, personal/family atopy,
visible eczema
What is the first-line treatment for mild to moderate atopic dermatitis?
Liberal emollients (multiple times daily) + low to mid-potency topical corticosteroids for flares
What is the role of topical calcineurin inhibitors in atopic dermatitis?
Tacrolimus/pimecrolimus - steroid-sparing agents for face/neck, maintenance therapy, or steroid-
resistant areas
What triggers should be avoided in atopic dermatitis?
Harsh soaps, hot water, wool clothing, common allergens (dust mites, pet dander), stress, dry
environments
What are complications of atopic dermatitis?
Bacterial superinfection (S. aureus), eczema herpeticum (HSV), lichenification, sleep
disturbance, psychosocial impact
What is eczema herpeticum and its treatment?
Widespread HSV infection on eczematous skin - presents with clustered vesicles, punched-out
erosions; treat with IV acyclovir
How are pediatric burn depths classified?
