Pediatric EOR Dermatology Exam(Smarty PANCE)
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 Topical retinoid PLUS topical antibiotic (clindamycin or erythromycin) or benzoyl
inflammatory acne? 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 TERATOGENIC (iPLEDGE program required), dry skin/lips, elevated
isotretinoin? 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 Males: receding frontal hairline and vertex thinning; Females: diffuse central
alopecia? scalp thinning with preserved frontal hairline
What workup is indicated for pediatric androgenetic Endocrine evaluation (testosterone, DHEA-S, prolactin), thyroid function,
alopecia? 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 Infants (<2 years): face, scalp, extensor surfaces; Children (2-12): flexural areas
lesions? (antecubital, popliteal fossae), neck, wrists
, Pediatric EOR Dermatology Exam(Smarty PANCE)
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 Liberal emollients (multiple times daily) + low to mid-potency topical
atopic dermatitis? corticosteroids for flares
What is the role of topical calcineurin inhibitors in atopic Tacrolimus/pimecrolimus - steroid-sparing agents for face/neck, maintenance
dermatitis? 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? Superficial (1st degree): epidermis only; Partial thickness (2nd): dermis involved;
Full thickness (3rd): through dermis; 4th: into muscle/bone
What is the Rule of Nines modification for children? Head: 18% (vs 9% adult), each leg: 14% (vs 18% adult) - larger head, smaller
legs proportionally
What burns require transfer to burn center in children? >10% TBSA partial thickness, full thickness burns, face/hands/feet/genitals/joints,
inhalation injury, electrical/chemical burns
What is the Parkland formula for pediatric burn 4 mL × weight (kg) × %TBSA burned in first 24 hours (give half in first 8 hours,
resuscitation? half over next 16 hours)
What are signs of inhalation injury in pediatric burns? Singed nasal hairs, carbonaceous sputum, hoarseness, stridor, facial burns,
history of enclosed space fire
What is the immediate management of minor pediatric Cool (not ice) water for 10-20 minutes, remove clothing/jewelry, assess
burns? depth/extent, clean with soap/water, apply antibiotic ointment
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 Topical retinoid PLUS topical antibiotic (clindamycin or erythromycin) or benzoyl
inflammatory acne? 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 TERATOGENIC (iPLEDGE program required), dry skin/lips, elevated
isotretinoin? 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 Males: receding frontal hairline and vertex thinning; Females: diffuse central
alopecia? scalp thinning with preserved frontal hairline
What workup is indicated for pediatric androgenetic Endocrine evaluation (testosterone, DHEA-S, prolactin), thyroid function,
alopecia? 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 Infants (<2 years): face, scalp, extensor surfaces; Children (2-12): flexural areas
lesions? (antecubital, popliteal fossae), neck, wrists
, Pediatric EOR Dermatology Exam(Smarty PANCE)
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 Liberal emollients (multiple times daily) + low to mid-potency topical
atopic dermatitis? corticosteroids for flares
What is the role of topical calcineurin inhibitors in atopic Tacrolimus/pimecrolimus - steroid-sparing agents for face/neck, maintenance
dermatitis? 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? Superficial (1st degree): epidermis only; Partial thickness (2nd): dermis involved;
Full thickness (3rd): through dermis; 4th: into muscle/bone
What is the Rule of Nines modification for children? Head: 18% (vs 9% adult), each leg: 14% (vs 18% adult) - larger head, smaller
legs proportionally
What burns require transfer to burn center in children? >10% TBSA partial thickness, full thickness burns, face/hands/feet/genitals/joints,
inhalation injury, electrical/chemical burns
What is the Parkland formula for pediatric burn 4 mL × weight (kg) × %TBSA burned in first 24 hours (give half in first 8 hours,
resuscitation? half over next 16 hours)
What are signs of inhalation injury in pediatric burns? Singed nasal hairs, carbonaceous sputum, hoarseness, stridor, facial burns,
history of enclosed space fire
What is the immediate management of minor pediatric Cool (not ice) water for 10-20 minutes, remove clothing/jewelry, assess
burns? depth/extent, clean with soap/water, apply antibiotic ointment
