Pediatric Dermatology Practice Questions

Q: A neonate presents with a growing skin lesion, as shown in the image provided. The mother reports that the lesion has been increasing in size daily. What is the appropriate management?

Observation. ***Observation*** - The image displays a classic **infantile hemangioma** (strawberry nevus), a benign vascular tumor that typically appears shortly after birth. These lesions characteristically undergo a rapid proliferation phase in the first few months, followed by spontaneous involution over several years. - For uncomplicated hemangiomas that do not obstruct vital functions (like vision or breathing), ulcerate, or cause significant disfigurement, **observation** is the standard management, as most resolve on their own. *Excision and Laser Therapy* - Surgical excision or laser therapy are typically reserved for complicated hemangiomas, such as those that are ulcerated, bleeding, or causing functional impairment. - These invasive procedures carry risks of scarring and are generally avoided for simple lesions that are expected to regress spontaneously. *Immediate Biopsy due to Malignancy Risk* - The clinical presentation is highly characteristic of a benign **infantile hemangioma**, making the risk of malignancy extremely low and a biopsy unnecessary in most cases. - A biopsy is only considered if the lesion has atypical features or if the diagnosis is uncertain, to rule out rare malignant vascular tumors. *Cryotherapy* - Cryotherapy is not a standard treatment for infantile hemangiomas as it may not penetrate deep enough to be effective and carries a high risk of causing scarring, hypopigmentation, and pain. - This modality is more appropriate for smaller, more superficial lesions like warts or actinic keratoses, not for vascular tumors.

Q: A 6-month-old baby presents with a bright red, raised, soft nodule measuring 2 cm in diameter on the forehead. The lesion has well-defined borders, appeared 2 weeks after birth as a small red spot, and has been growing rapidly over the past few months. The surface has a characteristic strawberry-like appearance with a lobulated texture. What is the most likely diagnosis?

Capillary hemangioma. ***Capillary hemangioma*** - Also known as a **strawberry hemangioma**, this is the most common benign vascular tumor of infancy, appearing as a bright red, raised, soft plaque or nodule with sharply defined borders. - These lesions are characterized by an initial rapid **proliferative phase** typically occurring in the first year of life, followed by a slow, eventual **spontaneous involution**. *Portwine stain* - This is a vascular **capillary malformation**, characterized by a flat (**macular**) pink, red, or purple patch that is present at birth. - Unlike hemangiomas, portwine stains **do not involute** spontaneously and persist throughout life; they may thicken and darken over time. *Cavernous hemangioma* - This term is often used for hemangiomas that are **deeper** (involving the reticular dermis and subcutaneous tissue), resulting in a blue, soft, or ill-defined mass. - While they also undergo spontaneous involution, they lack the characteristic superficial, bright red, **raised** appearance seen in typical capillary (strawberry) hemangiomas. *Naevus simplex* - Also known as a **salmon patch** or **stork bite**, this is a common, faint, macular pink-to-red vascular mark typically found on the nape of the neck, eyelids, or glabella. - These lesions are transient and usually **fade completely** before 18 months of age, unlike capillary hemangiomas which are raised and generally take longer to involute.

Q: A neonate presents with blotchy rash on the abdomen as shown in the image. What is the diagnosis?

Erythema toxicum neonatorum. ***Erythema toxicum neonatorum*** - This widespread, **blotchy erythematous rash** with small papules, pustules, or vesicles appearing shortly after birth is characteristic of erythema toxicum neonatorum. - It's a **benign, self-limiting skin condition** common in full-term neonates, often appearing on the trunk and extremities but sparing the palms and soles. *Congenital syphilis* - Congenital syphilis can present with a variable rash, but it often includes **maculopapular or vesicular lesions**, sometimes with involvement of palms and soles, and is typically associated with other systemic signs like **hepatosplenomegaly**, **rhinitis (snuffles)**, or **skeletal abnormalities**. - This image does not show the typical features or additional systemic symptoms commonly seen in congenital syphilis. *Cutis marmorata* - **Cutis marmorata** is a transient, reticulated, **bluish mottling of the skin** that occurs in response to cold exposure due to vasomotor instability. - It appears as a lacy, network pattern and is distinct from the erythematous and papulovesicular rash shown. *Milia* - **Milia** are tiny, **white or yellow papules** that represent keratin-filled cysts and are typically found on the face, especially the nose and cheeks. - They are smaller, white, and do not present as widespread erythematous blotches or pustules like the rash depicted.

Q: A 1-year-old unimmunised child with HbsAg positivity is having following skin lesions. What is the diagnosis?

Gianotti-Crosti syndrome. ***Gianotti-Crosti syndrome*** - This syndrome is characterized by a **papular acrodermatitis** of childhood, typically presenting as monomorphic, erythematous papules on the face, buttocks, and extensor surfaces of the extremities. - It is strongly associated with **viral infections**, particularly **Hepatitis B virus (HBV)** and Epstein-Barr virus (EBV), which aligns with the HbsAg positivity in this unimmunized child. *Erythema infectiosum* - This condition is caused by **Parvovirus B19** and typically presents with a "slapped cheek" rash on the face, followed by a lacy, reticulated rash on the trunk and extremities. - The rash in the image does not demonstrate the characteristic lacy pattern or typical "slapped cheek" appearance. *Pityriasis alba* - This is a common, mild, and often asymptomatic skin condition characterized by **hypopigmented (lighter) patches** with fine scales, predominantly on the face and arms. - The lesions in the image are erythematous (red) and papular, not hypopigmented. *Pityriasis rosea* - This condition typically begins with a single, larger "herald patch" followed by smaller, oval-shaped, pinkish-red patches with a characteristic **"Christmas tree" pattern** on the trunk and proximal extremities. - The rash in the image does not show a herald patch or the distinct distribution and morphology of pityriasis rosea.

Q: An 8-year-old boy who was diagnosed with hypertrophic cardiomyopathy has reddish papules all over the body developing after birth. He also complains of severe pain in hands and feet. Which of the following is correct?

Angiokeratoma, Fabry's disease. ***Angiokeratoma, Fabry's disease*** - The constellation of **hypertrophic cardiomyopathy**, **reddish papules (angiokeratomas)**, and **severe pain in hands and feet (acroparesthesias)** are classic symptoms of **Fabry's disease**. - Fabry's disease is an **X-linked lysosomal storage disorder** caused by a deficiency of **alpha-galactosidase A**, leading to the accumulation of globotriaosylceramide (Gb3). *Actinic keratosis, Xeroderma pigmentosa* - **Actinic keratosis** are precancerous skin lesions caused by sun exposure, typically appearing in older adults, not as widespread papules from birth in a child. - **Xeroderma pigmentosum** is characterized by extreme sensitivity to UV light, leading to a high incidence of skin cancers, freckle-like pigmentation, and ocular abnormalities, but not typically hypertrophic cardiomyopathy or these specific papules. *Pseudoxanthomas, pseudoxanthoma elasticum* - **Pseudoxanthoma elasticum** causes small, yellowish papules, mainly on flexible skin areas, along with angioid streaks in the retina and cardiovascular issues due to calcification of elastic fibers. - While it can involve the heart, it doesn't typically present with the widespread reddish papules (angiokeratomas) or the severe acroparesthesias described. *Angiofibroma, tuberous sclerosis* - **Angiofibromas** are facial papules associated with **tuberous sclerosis**, which is also characterized by brain tubers, renal angiomyolipomas, and hypomelanotic macules. - While tuberous sclerosis can cause cardiac rhabdomyomas (tumors), it is not typically associated with widespread angiokeratomas or acroparesthesias as seen in this case.

Q: An 8-year-old girl has extreme photosensitivity since birth. She has recently been diagnosed with skin cancer. What is the diagnosis?

Xeroderma Pigmentosum. ***Xeroderma Pigmentosum*** - This condition is characterized by an extreme sensitivity to **ultraviolet (UV) light** from birth due to defects in **DNA repair mechanisms**, leading to severe sunburns, pigmentary changes (freckles, hypopigmented macules), and a high risk of developing **skin cancers** at a young age. - The history of extreme photosensitivity since birth and the diagnosis of skin cancer in an 8-year-old girl is highly indicative of Xeroderma Pigmentosum. *Bloom syndrome* - Bloom syndrome is an inherited disorder characterized by **stunted growth**, a **photosensitive facial rash (telangiectatic erythema)**, and a predisposition to **various cancers**, including leukemia and lymphomas. - While photosensitivity and cancer risk are present, the extreme skin damage and early onset of specific skin cancers (as opposed to leukemias/lymphomas often seen in Bloom) make Xeroderma Pigmentosum a more fitting diagnosis. *Griscelli syndrome* - Griscelli syndrome is a rare autosomal recessive disorder characterized by **partial albinism**, immunodeficiency, and neurological impairment. - While it involves pigmentary abnormalities, it does not typically present with the extreme photosensitivity or the very early skin cancer development described in the patient. *Chediak Higashi syndrome* - Chediak-Higashi syndrome is an autosomal recessive disorder characterized by **partial albinism**, recurrent pyogenic infections, and neurological abnormalities, due to defective lysosomal trafficking. - This syndrome is not primarily associated with extreme photosensitivity leading to early skin cancers but rather with immunodeficiency and neurological issues.

Q: A 7-month-old child after weaning develops diarrhea and following skin lesions. The lesions did not respond to topical clotrimazole. All are true about the condition except:

Granulocytes show giant granules. **Granulocytes show giant granules** - This statement is **incorrect** as giant granules in granulocytes are characteristic of **Chédiak-Higashi syndrome**, a distinct immunodeficiency disorder, not acrodermatitis enteropathica. - Chédiak-Higashi syndrome presents with recurrent infections, oculocutaneous albinism, and neurological abnormalities. *Autosomal recessive* - **Acrodermatitis enteropathica** is an **autosomal recessive** genetic disorder caused by a defect in zinc absorption. - The symptoms appear after weaning as breast milk contains zinc-binding ligands that aid absorption, which are absent in other foods. *Eczematous lesions around orifices* - The characteristic rash of acrodermatitis enteropathica includes **eczematous lesions** that are often **periorificial** (around the mouth, anus, and nostrils) and acral (on the hands and feet). - These lesions are typically erythematous, vesiculobullous, and can become pustular or crusted, and do not respond to typical antifungal treatments like clotrimazole. *Diffuse alopecia* - **Hair loss (alopecia)** is a common dermatological manifestation of **zinc deficiency** in acrodermatitis enteropathica, often presenting as diffuse thinning. - Other common features include **diarrhea** and **growth retardation**, as well as immune dysfunction.

Q: All are true about this lesion seen in a child with epilepsy except:

Minor criteria for diagnosis. ***Minor criteria for diagnosis*** - The presented lesion is a **Shagreen patch**, which is considered a **major diagnostic criterion** for **Tuberous Sclerosis Complex (TSC)**, not a minor one. - A definitive diagnosis of TSC requires two major criteria or one major and two minor criteria. *Collagenoma* - A Shagreen patch is a type of dermal **collagenoma**, characterized by an overgrowth of connective tissue, primarily collagen. - These lesions often feel like **roughened or leathery plaques** on the skin. *Peau d'orange appearance* - The Shagreen patch is often described as having a **'peau d'orange'** or orange peel-like texture due to its irregular surface. - This characteristic texture helps in its clinical identification. *Predominantly seen over trunk* - Shagreen patches are typically located on the **trunk**, especially in the lumbosacral region, as seen in the image. - They are one of the distinctive cutaneous manifestations of TSC.

Q: A 6-month-old infant presents with a rash in the diaper area. On examination, erythema and erosions are noted on the convex surfaces (labia and buttocks), while the skin folds are relatively spared. The infant has not grown out of diapers yet. Based on the clinical image, what is the most likely diagnosis?

Irritant diaper dermatitis. ***Irritant diaper dermatitis*** - The image shows **erythema** and **erosions** in the diaper area, particularly on convex surfaces such as the labia and buttocks, while the folds are relatively spared. This pattern is characteristic of irritant diaper dermatitis resulting from prolonged exposure to urine and feces. - The patient, an infant, has not grown out of diapers yet. *Congenital adrenal hyperplasia* - This condition presents with **ambiguous genitalia** in females due to excess androgens, not primarily skin rashes in the diaper area. - While it can cause other symptoms such as salt-wasting crises, skin manifestations are not typically the primary diagnostic feature. *Candidiasis* - **Candidal diaper rash** typically presents with **beefy red plaques** with **satellite pustules** or papules at the periphery, especially in the skin folds (inguinal creases). - The image does not show these characteristic satellite lesions or involvement of the skin folds. *Acrodermatitis enterohepatica* - This is a rare **zinc deficiency disorder** characterized by **periorificial** and acral dermatitis, often with **psoriasiform plaques** and erosions. - While it can involve the perineal area, the distribution and morphology in the image are more consistent with irritant diaper dermatitis rather than the generalized or periorificial pattern of acrodermatitis enterohepatica.

Q: A neonate presents with the condition shown in the image below. This condition has all of the following features EXCEPT:

Satellite lesions. ***Satellite lesions*** - **Satellite lesions** (smaller lesions located near a main rash) are characteristic of certain fungal infections like candidiasis or some viral rashes, but not of **collodion baby/harlequin ichthyosis**, which is suggested by the image. - The image shows features consistent with a severe congenital ichthyosis, where **skin scaling** and **facial deformities** are prominent, not scattered papules or pustules. *Ectropion* - **Ectropion** (eversion of the eyelids) is clearly visible in the image, where the eyelids are pulled outwards, exposing the conjunctiva. - This is a common feature in conditions like **collodion baby** and **harlequin ichthyosis** due to the restrictive outer skin layer. *Eclabium* - **Eclabium** (eversion of the lips) is also distinctly present in the image, with the lips appearing stretched and everted. - This is another characteristic manifestation of severe congenital ichthyosis, resulting from the **tight, hardened skin** around the mouth. *Hard elastic scales over the neck area* - The image shows **thickened, furrowed, and scaly skin** texture, particularly noticeable around the neck area (indicated by the arrow), which aligns with the description of **hard, elastic scales**. - This is a hallmark feature of **ichthyosis**, where there is impaired skin barrier function and excessive scale production.

Question 1

A neonate presents with a growing skin lesion, as shown in the image provided. The mother reports that the lesion has been increasing in size daily. What is the appropriate management?

Accepted Answer

Observation

Answer

Immediate Biopsy due to Malignancy Risk

Answer

Cryotherapy

Answer

Excision and Laser Therapy

Question 2

A 6-month-old baby presents with a bright red, raised, soft nodule measuring 2 cm in diameter on the forehead. The lesion has well-defined borders, appeared 2 weeks after birth as a small red spot, and has been growing rapidly over the past few months. The surface has a characteristic strawberry-like appearance with a lobulated texture. What is the most likely diagnosis?

Accepted Answer

Capillary hemangioma

Answer

Portwine stain

Answer

Naevus simplex

Answer

Cavernous hemangioma

Question 3

A neonate presents with blotchy rash on the abdomen as shown in the image. What is the diagnosis?

Accepted Answer

Erythema toxicum neonatorum

Answer

Congenital syphilis

Answer

Cutis marmorata

Answer

Milia

Question 4

A 1-year-old unimmunised child with HbsAg positivity is having following skin lesions. What is the diagnosis?

Accepted Answer

Gianotti-Crosti syndrome

Answer

Erythema infectiosum

Answer

Pityriasis alba

Answer

Pityriasis rosea

Question 5

An 8-year-old boy who was diagnosed with hypertrophic cardiomyopathy has reddish papules all over the body developing after birth. He also complains of severe pain in hands and feet. Which of the following is correct?

Accepted Answer

Angiokeratoma, Fabry's disease

Answer

Actinic keratosis, Xeroderma pigmentosa

Answer

Pseudoxanthomas, pseudoxanthoma elasticum

Answer

Angiofibroma, tuberous sclerosis

Question 6

An 8-year-old girl has extreme photosensitivity since birth. She has recently been diagnosed with skin cancer. What is the diagnosis?

Accepted Answer

Xeroderma Pigmentosum

Answer

Bloom syndrome

Answer

Griscelli syndrome

Answer

Chediak Higashi syndrome

Question 7

A 7-month-old child after weaning develops diarrhea and following skin lesions. The lesions did not respond to topical clotrimazole. All are true about the condition except:

Accepted Answer

Granulocytes show giant granules

Answer

Autosomal recessive

Answer

Eczematous lesions around orifices

Answer

Diffuse alopecia

Question 8

All are true about this lesion seen in a child with epilepsy except:

Accepted Answer

Minor criteria for diagnosis

Answer

Collagenoma

Answer

Peau d'orange appearance

Answer

Predominantly seen over trunk

Question 9

A 6-month-old infant presents with a rash in the diaper area. On examination, erythema and erosions are noted on the convex surfaces (labia and buttocks), while the skin folds are relatively spared. The infant has not grown out of diapers yet. Based on the clinical image, what is the most likely diagnosis?

Accepted Answer

Irritant diaper dermatitis

Answer

Congenital adrenal hyperplasia

Answer

Candidiasis

Answer

Acrodermatitis enterohepatica

Question 10

A neonate presents with the condition shown in the image below. This condition has all of the following features EXCEPT:

Accepted Answer

Satellite lesions

Answer

Ectropion

Answer

Eclabium

Answer

Hard elastic scales over the neck area

Pediatric Dermatology — MCQs

Pediatric Dermatology — MCQs

On this page

Practice by Chapter

Want unlimited practice?