Free Pediatric Sample Questions

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Your First Free Pediatric Sample Question

After a week-long summer family vacation to an amusement park and water park, a healthy 11-year-old female presents with multiple asymptomatic macules and patches. They are hypopigmented, oval-shaped, and slightly scaly. The macules are on her face and anterior trunk.

Which of the following is the most likely dermatosis?

A. Atopic dermatitis
B. Erythema ab igne
C. Ochronosis
D. Pityriasis alba
E. Solar purpura

Answer and Explanation

Pityriasis alba occurs predominantly in children ages 3 to 16 years of age. It is characterized by patches of hypopigmentation, usually distributed on the face, neck, upper trunk, and proximal extremities. The lesions range from 0.5 to 5 cm in diameter, with well-defined but somewhat irregular borders and fine scale.

They usually are asymptomatic but may be pruritic. Patients often present after sun exposure when the contrast between affected and nonaffected areas is accentuated by tanning. Pityriasis alba is thought to represent nonspecific dermatitis with residual postinflammatory hypopigmentation. It is associated with atopy, sun exposure, and frequency of bathing.

Did you get it right? The correct answer is: D

Incorrect Answer Explanations

Answer A: Atopic dermatitis is a chronic, pruritic, inflammatory skin disease that occurs most frequently in children, but it also affects many adults. Clinical features of atopic dermatitis include skin dryness, erythema, oozing and crusting, and lichenification. Pruritus is a hallmark of the condition and is responsible for much of the disease burden for patients and their families.

Answer B: Erythema ab igne is a reticular erythematous pigmented dermatosis resulting from repeated exposures to moderate heat or infrared radiation. Once common among people who sat near open fires or stoves, it is infrequently seen after the introduction of central heating. However, it is still seen in relation to occupational exposure to heat sources (foundry workers, bakers); use of hot water bottles, heating pads or blankets, or heated car seats; and among laptop users who hold the computer on their thighs. It can occur at any site, more often in an asymmetrical distribution, and is usually asymptomatic. The early skin changes of erythema ab igne usually clear spontaneously in several weeks to months, after the removal of the heat source from the skin. However, longstanding lesions may be associated with permanent hyperpigmentation.

Answer C: Ochronosis is a term used to describe pigment deposition that occurs in the connective tissues of patients with alkaptonuria, an autosomal recessive disorder that results from a deficiency of homogentisic acid oxidase. Brown or blue-gray discoloration of the skin may be seen on the axillary and inguinal areas, face, palms, or soles. In addition, blue-black discoloration can be apparent on skin overlying cartilage in which the pigment is deposited, such as the ears. The sclerae are also typically involved.

Answer E: Solar purpura (also called senile purpura, actinic purpura, or Bateman purpura) is a common form of noninflammatory purpura. It presents as ecchymotic lesions predominantly on the sun-damaged skin of the forearms and dorsum of the hands of older adult individuals. These lesions result from rupture of superficial blood vessels with subsequent extravasation of blood in the dermis following a minor trauma. The incidence and severity of solar purpura are increased in individuals taking anticoagulants or corticosteroids. The ecchymoses may persist for several weeks and resolve spontaneously without undergoing the usual sequential color changes of a normal bruise. Residual hyperpigmentation can be observed.

Bottom Line: Macules are nonpalpable lesions that vary in pigmentation from the surrounding skin. Macules are not raised or atrophic; clinicians must consider other salient features to assist in developing a reasonable differential diagnosis. Often, clinicians state that a dermatologic lesion is “macular-papular,” when in fact the lesion’s morphology involves papules and plaques, not macules.

For more information, see:

Approach to the Patient with Macular Skin Lesions. UpToDate.

Treatment of Atopic Dermatitis (Eczema). UpToDate.

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