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Burns
1  Degree
st
2nd Degree 3rd Degree 4th Degree
Superficial Superficial and Deep partial Full Thickness
Partial Thickness thickness
Depth Epidermis w/ intact  Epidermis+  Epidermis into deep Extends through  Entire skin and 
epidermal barrier superficial portion of  portion of dermis  entire skin underlying fat, 
dermis (papillary) (reticular) muscle, bone
Appearance Erythematous (red),  Erythematous (pink), Red, yellow, pale  Waxy, white Black, charred, 
dry weeping, moist white, dry Leathery, dry eschar
Blistering  Blistering  Dry 
Sensation PAINFUL­ tender to MOST PAINFUL  Not usually  PAINLESS  PAINLESS
touch OF ALL BURNS painful, maybe 
pain w/pressure
Maybe decreased 
2point dismination 
Capillary Refill Refill intact,  Refill intact,  Absent capillary  Absent  Absent
blanches w/ pressure blanches w/ pressure refill
Prognosis  Heals w/in 7 days, no Heals w/in 14­21  3weeks­2months,  Months, does not  Does not heal well, 
scarring days, no scarring but  scarring common spontaneously heal  usually needs 
pigment changes well.  debridement of 
tissues and tissue 
reconstruction 
Rule of 9’s 

Tx: 
- Clean­ w/ mild soap and water, no direct ice. Chemical burns need irrigation for ≥20min
- Debridement­ Escharotomy for circumferential burns. Remove ruptured blisters.
- Pain management­ NSAIDs, Tylenol, opioids as needed 
- ABX­ 
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o Superficial Burns­ bacitracin, no dressing needed
o Silver Sulfadiazine for 2 and 3rd degree burns. CI­ sulfa allergy, pregnancy, <2mo, NOT to be used on face. 
 Dressing­ wrap fingers and toes individually w/ gauze b/t them
- IV Fluids­ Parkland formula LR 4ml/kg/%TSA for first 24 hours 
o ½ in first 8 hours, remaining ½ over next 16 hours. 

Cellulitis
MCC­ S. aureus, and Group A beta­hemolyic strep 
Clinical Manifestations­
- Local­ macular erythema not sharply demarcated, swelling, warmth, tenderness
- Systemic­ NOT COMMON­ fever, chills, tender lymphadenopathy
o (TOPIC) Erysipelas­ MCC GABHS­ well demarcated margins and intensely erythematous­ St. Anthony’s Fire. 
MC involves the face w/ impaired lymphatic drainage 
 Tx: IV PCN, or Vancomycin  if PCN allergy or MRSA suspected 
o Lymphangitis­ spread of infection via lymphatic vessels. Seen as streaking. 
Treatment 
- Cephalexin; Dicloxacillin. If PCN allergy­ Clindamycin, Erythromycin 
- MRSA: IV Vancomycin or Linezolid (best PO med for MRSA), Bactrim (2nd best PO med for MRSA but doesn’t cover 
strep well)  
- Cat Bites (Pasturella Multocieda)­ Amoxicillin/Clavulonate, Doxycycline if PCN allergy. 
- Dog Bites­ Amoxicillin/Clavulonate, 2nd line­ Clindamycin + Ciprofloxacin or Bactrim 
- Human Bites­ Amoxicillin/Clavulonate. 2nd Line­ Clindamycin + Moxifloxacin or Bactrim.
- Puncture Wound through shoe­ Ciprofloxacin  (cover pseudomonas)  

Atopic Dermatitis (Eczema) 
Atopic Triad­ Eczema, Allergic Rhinitis, Asthma 
- Altered immune rxn via T cell mediated immune rxn and increased IgE production 
Triggers­ heat, sweat, allergens, contact irritants 
Clinical Manifestation­ hallmark­ pruritus 
- Acute Lesions­ MC in flexor creases­ antecubital and popliteal folds 
- Nummular eczema­ sharply defined discoid/coin shaped lesions especially on dorsum of hand, feet and extensor surfaces 
(knees, elbows) 
Management­ 
- Acute: topical corticosteroids, antihistamines for itching (diphenhydramine, hydroxyzine). Wet dressing, Abx for secondary 
infection 
o Alternative to topical corticosteroids­ topical calcineurin inhibitors­ tacrolimus 
- Chronic: dry hydration and emollients, oral antihistamines 
- Health Maintenance­ avoid exacerbating factors and irritants. Maintain hydration with skin emollients and tepid baths. 

Contact Dermatitis 
Other Example­ Diaper Rash
Clinical Manifestation­ burning, itching, redness, dry skin, eczematous eruption 
Management­ avoid irritant, wet dressing, eczematous eruption 
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- Diaper Rash­ frequent changes, topical petroleum or zinc oxide 

Drug Eruptions
Pathophysiology­ 
- Type 1­ IgE­ urticarial and angioedema, immediate 
- Type II­ cytotoxic, Ab mediated
- Type III­ immune antibody­antigen complexes. Ex) dug mediated vasculitis and serum sickness
- Type IV­ delayed (cell mediated)­ morbiliform rxn Ex) Erythmea Multiforme 
- Nonimmunoligoic­ cutaneous drug rxn d/t genetic incapability to detox meds (sulfa and anticonvulsants) 
Clinical Manifestations and Tx­ Fever, abdominal pain, joint pain. STOP drug is step 1. 
- Exanthematous/Morbiliform Rash­ MC skin eruption­ bright red macule papules that coalesce to form plaques. Usually 
onset 2­14 days post med initiation­ abx, NSAID, allopurinol, thiazide diuretics 
o Tx: oral antihistamines
- Urticarial/angioedema­ 2nd MC type. w/in minutes of taking drug. MC­ abx, NSAID, opioids, contrast
o Tx: systemic corticosteroids, antihistamines . For anaphylaxis­ IM epi 
- Erythema Multiforme­ target lesions. Sulfa abx, PCN, Phenobarbital, Dilantin 

Urticaria­ Type I HSN (IgE) or complement mediated  d/t mast cell release of histamine vasodilation, edema
- Urticaria­ blanchabe, edematous pink papules, wheals or plaques. Often disappear in 24 hrs .
o Dermatographism­ local pressure to skin may cause wheals in the area
o Angioedema­ painless deeper form of urticaria. May lead to anaphylaxsis. 
- Management­ oral antihistamines 

Infectious Skin Lesions
Impetigo­ Highly contagious superficial vesiculopustular skin infection. MC on face and extremities. 
- RF: warm and humid conditions, poor hygiene 
- Types
o Nonbullous­ Impetigo contagiosa (MC type)­ MCC­ Staph. Aureus, 2nd­ GABHS vesicles, pustules honey colored
crust. Fever, diarrhea, regional lymphadenopathy 
o Bullous­ MCC­ Staph aureus­ vesicles form large bullae rupture thin varnish like crust, fever, diarrhea 
o Ecthyma­ d/t GABHS­ ulcerative pyoderma, heals w/ scarring.
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- Management 
o Mupirocin (Bactroban)­ topical DOC TIDx10 days. Wash area gently, good skin hygiene
o Extensive disease or systemic sx­ systemic abx­ 1st choice­ Cephalexin (Keflix)­ 1st gen cephalosporin. Other 
options­ Dicloxacillin (especially against S. aureus), Clindamycin. Macrolides work too. 

Scabies­ Sarcoptes scabiei (mites) transmitted via skin to skin contact or fomites. Cannot survive off body >4 days. 
- Pruritic lesions, linear burrows MC in intertriginous zones­ web spaces
- Tx: Permethrin topical is DOC, Lindane is cheaper option but causes seizures and CI in pregnancy, breastfeeding and <2yo
o All clothing, bedding, in plastic bad for atleast 72 hours and then washed and dried using heat. 

Lice (Pediculosis)­ transmission via skin to skin contact and fomites. 
- Intense itching, popular urticaria near lice bites
- Nits­ white oval shaped egg capsules at base of hair shaft that can be removed with a comb
- Tx: Permethrin is DOC in shampoo or lotion based on location. 2nd line­ Lindane (neurotocix­ seizure so DON’T use after 
showering). Oral ivermectin in refractory cases. 

Bullous Pemphigoid
- Chronic widespread AI blistering skin disease, MC in elderly (65­75yo)
- Subepidermal blistering d/t Type II HSN IgG AT attack on epithelium basement membrane
o Subepidermal involvement is difference between BP and P. Vulgaris 
- Uritcarial plaques tense bullae that don’t rupture easily as blister roof contains the epidermis. 
o Pruritis
o Lack of Nikolsky sign
- Tx: Systemic corticosteroids, immunosuppressant (Azathioprine) 

Spider Bites
Brown Recluse­ Loxosceles reclusa Black Widow­ Latrodectus Hesperus 
Have a violin pattern on back 
MC­ southwestern and Midwestern US Latrodectism­ local sx­ pain, systemic sx begin in 30min­2hr 
Local effects­ burning and erythema at site for 34­ hours  post bite: muscle pain, spasms, rigidity­ self limited for 1­3days
blanched area “red halo” after 24­72hr hemorrhagic bullae Will appear as a target lesion­ blanched circular patch with 
forms that undergoes eschar formation. Some will proceed to  surrounding red perimeter and central punctum. 
necrosis.  Management 
Management  - Mild­ wound care and pain control 
- Local wound care­ clean, cold packs, elevate - Mod­severe­ opioids and muscle relaxants  (benzo, 
- Pain control­ NSAIDs, opioids, tetanus prophylaxis methocarbamol)
- Dermal necrosis­ debridement, Dapsone, abx if  - Antivenom­ if not responsive to meds. 
cellulitis occurs. 

Herpes zoster
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Pilonidal Disease
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Viral exanthems

Erythema infectiosum (5th disease)

Parvovirus B19. MC<10y. Transmission: respiratory droplets. 4-14d
incubation period
Note from study guide:
 Parvovirus B19, spread by respiratory droplets, 4-14d incubation
period
 Coryza, fever  slapped cheek rash w/ circumoral pallor 2-4d  lacy reticular rash on extremities (sparing palms
and soles) resolves in 2-3w
o Associated with increased fetal loss in pregnancy (fetal hydrops, CHF, spontaneous abortion)
 Tx: supportive, anti-inflammatory
 Complications: arthropathy (in older kids and adults), aplastic crisis w/ SSD or G6PD deficiency

Roseola (6th disease)

 HHV 6&7
 Transmission: spread by respiratory droplets. Occurs MC <5y. 10-12d incubation period
 Clinical Manifestations
o Prodrome of HIGH fever 3-5d  fever resolves before the onset of a rose, pink, maculopapular, blanchable rash on
the trunk/back  face. Rash lasts hours (up to 1-2d).
 Only childhood viral exanthem that STARTS on trunk and spreads to face
o Child appears “well” and alert during the febrile phase. May be irritable during febrile phase.
 Management: supportive, anti-inflammatories, antipyretics (to prevent febrile seizures).
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Measles (Rubeola)

 Paramyxovirus, spread by respiratory droplets, 10-12d incubation period

 URI prodrome: high fever, cough, coryza, conjunctivitis, kolpik spots
(precedes rash 24-48h)
 Clinical Manifestations
o URI prodrome
 High fever
 3C’s: cough coryza, conjunctivitis
 Koplik spots: small red spots in buccal mucosa with
pale blue/white center
 Brick—red rash on face beginning at hairline 
extremities (palms and soles involvement usually seen
last if it occurs) that darkens and coalesces
o Rash usually lasts 7d fading from top to bottom. Fever
concurrent with the rash
 Tx: supportive, ant-inflammatory
o Vitamin A reduces mortality in all children with measles
(decreased M&M)
 Complications: diarrhea, otitis media, pneumonia, conjunctivitis, and encephalitis
Rubella (German Measles)

 Togavirus, spread by respiratory droplets, 2-3w incubation period

 Rash lasts 3d  also called the “3 day rash”
 Clinical Manifestations
o Low fever, cough, anorexia, lymphadenopathy (posterior cervical, posterior auricular)  rash (may see
photosensitivity and joint pains)
o Pink, light-red spotted maculopapular rash on face  extremities (blueberry muffin)
 Note: compared to rubeola, rubella spreads more rapidly and does NOT darken or coalesce
o Forchheimer spots: small red macules or petechiae on the soft palate. (also seen in Scarlet fever).
o Transient photosensitivity and joint pains may be seen (especially in young women)*
 Dx: clinical. Rubella-specific IgM antibody via enzyme immunoassay (MC used)
 Tx: supportive, anti-inflammatory (generally no complications)
 Teratogenic (esp in the 1st trimester), part of TORCH
o Congenital syndrome = sensorineural deafness, cataracts, TTP, mental retardation, heart

Mumps
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 Paramyxovirus, spread by respiratory droplets, 12-14d

incubation period
o Increased incidence in the spring. Patients are usually
infectious 48h prior to and 9d after the onset of partotid
swelling
 Low grade fever, myalgias, headache  PAINFUL parotid
gland swelling
 Dx: serologies, increased amylase. Often a clinical diagnosis.
 Tx: supportive, anti-inflammatory, MMR (sx usually last 7-10d)
 Complications: orchitis (usually unilateral), encephalitis, aseptic
meningitis, deafness, pancreatitis (mumps is the MCC of acute
pancreatitis in children)
 Prevent by giving the MMR vaccine at 12-15m with a second
dose at age 4-6y