Eczema
Which feature best differentiates childhood eczema from infantile eczema?
Lichenified plaques in flexural areas
Rationale: Childhood eczema presents with lichenified flexural plaques; infants typically have cheek/extensor involvement.
What are the skin characteristics of molluscum contagiosum?
Dome-shaped, umbilicated papules is molluscum contagiosum
What are the characteristics of a child with pityriasis rosea.
salmon-colored herald patch is seen in patients with pityriasis rosea.
A mother reports that her child scratches constantly at night due to eczema. The provider’s first-line intervention is to:
Hydrocortisone 1% cream
Rationale: For the topical corticosteroid, the first-line treatment is a low- to medium-potency corticosteroid and emollient.
A 6-year-old presents with dome-shaped, umbilicated papules on the trunk. Parents ask about treatment. The best response is:
“These lesions usually resolve within 6–18 months without treatment.”
Rationale: Molluscum contagiosum is benign and self-limited; treatment is rarely needed unless symptomatic/cosmetic concerns…your options after this would be curettage, cantharidin, or topical irritants.
Which of the following must be ruled out when diagnosing pityriasis rosea in a sexually active adolescent?
Secondary Syphilis
Rationale: While tinea corporis needs to also be ruled out, in a sexually active adolescent, secondary syphilis (an STD) can mimic PR and must be excluded in this case.
A 6-year-old child with a history of eczema presents with recurrent wheezing and coughing at night. The parent reports that the symptoms worsen during pollen season. Which of the following best explains the relationship between the child’s skin condition and new respiratory symptoms?
Both conditions are related to underlying allergic inflammation and hyperreactivity
Rationale: Eczema (atopic dermatitis), asthma, and allergic rhinitis are part of the atopic triad, linked by IgE-mediated hypersensitivity and chronic allergic inflammation. Children with eczema often develop asthma due to shared immune pathways
The presence of an eczematous ring around molluscum lesions is known as:
“Beginning of the end” reaction
Rationale: An eczematous reaction around lesions indicates immune-mediated regression.
10-year-old presents with a large, oval “herald patch” on the trunk followed by multiple smaller oval lesions along skin cleavage lines (“Christmas tree” pattern) after a mild viral illness. What is the most appropriate management?
Topical corticosteroids and antihistamines for itching
Rationale: Pityriasis rosea is a self-limited viral exanthem (possibly related to HHV-6/7). The hallmark is a herald patch followed by multiple secondary lesions. The rash resolves within 6–8 weeks without treatment. Management is symptomatic—topical steroids or oral antihistamines for itching. Reassurance is key.
A 4-year-old child presents with worsening eczema on flexural surfaces. The mother reports recent use of bubble baths and scented laundry detergent. What is the best initial recommendation?
Eliminate irritants and use fragrance-free products
Rationale: Atopic dermatitis flares can be triggered by irritants such as soaps, fragrances, and detergents. The first-line management is to remove the trigger and use emollients for skin hydration
An 8-year-old child is diagnosed with molluscum contagiosum. The parent is concerned about the child returning to school and swimming lessons. What should the provider recommend?
The child can attend school and swim if lesions are covered with watertight bandages
Rationale: Molluscum contagiosum is a benign, self-limited viral skin infection caused by a poxvirus, spread through direct skin-to-skin contact or contaminated objects (e.g., towels, pool surfaces). Children do not need to be excluded from school or swimming if lesions are covered. Covering lesions with watertight bandages helps prevent transmission. Routine hygiene (no sharing of towels, clothing, or sports gear) should be reinforced.
A 12-year-old presents with a generalized rash resembling pityriasis rosea. The provider notes lesions on the palms and soles. Which condition should be ruled out before confirming the diagnosis?
Secondary Syphilis
Rationale: Although rare in children, secondary syphilis can mimic pityriasis rosea but is differentiated by involvement of the palms and soles, as well as systemic symptoms. Pityriasis rosea typically spares palms and soles. A RPR (rapid plasma reagin) test is warranted when the rash is atypical to rule out syphilis.