Title: GZ / The Grenz Zone Season 3 / Ep 38
Tags: GZ DermnetNZ

The mnemonic MYSPACE can be used to remember solitary bumps in a baby or child
M- milia or mastocytosis
Y- yellow tinged lesions (juvenile xanthogranulomas)
S- Spitz nevi
P- pilomatricomas or pyogenic granulomas
A- amelanotic nevi or melanomas
C- calcinosis cutis
E- epidermal inclusion cysts
Back Extra: Milia: May be single or multiple (below)
Mastocytoma: Before and after images featuring Darier sign
JXG
Spitz nevus
Pilomatricoma
Pyogenic granuloma
Amelanotic melanoma
Calcinosis cutis
Epidermal inclusion cyst

If a baby has multiple bumps, the bumps are likely either molluscum, trichoepitheliomas, syringomas, or angiofibromas
Back Extra: Molluscum
Trichoepithelioma
Syringoma
Angiofibroma (may represent (adenoma sebaceum in tuberous sclerosis)

Q: In up to 90% of cases, mastocytomas will exhibit [...], in which rubbing the lesion causes histamine release, erythema and localized swelling
A: Darier’s sign
Back Extra: Mastocytoma: Before and after images featuring Darier sign

Q: Histiocyte actually means "cell of the tissue". There are 3 main cell types that comprise histiocytes in dermatology: These include
[...]
[...]
[...]
A: Langerhans cells; Mononuclear cells and macrophages; Dermal dendritic cells
Back Extra: Type 1 dermal dendritic cells- in
papillary dermis, function like
macrophages; Type 2 dermal dendritic cellsdeeper in the reticular dermis,

Q: [...] is a proliferation of non-langerhans cells tan to red-orange smooth, dome-shaped papules or nodules on head, neck, and trunk that become more yellow over time
A: Juvenile xanthogranuloma (JXG)

Q: What is the triple association with Juvenile xanthogranulomas (JXGs)
[...]
A: JXG's, neurofibromatosis type 1, and juvenile chronic myelogenous leukemia (JCML)
Back Extra: Kids with JXG's and NF1 have a 20-30% higher risk of developing JCML compared to the general population
Key diagnostic clues for NF1: Cafe au lait spots, freckling in the armpit, neurofibromas

Q: Pilomatricomas (calcifying epithelioma of Malherbe) are associated with mutations in [...]
A: beta-catenin

Q: Multiple pilomatricomas may be associated with [...], [...], and [...]
A: myotonic dystrophy; Rubinstein-Taybi disease; Gardner syndrome

Q: Pyogenic granulomas are friable, red papules that grow quickly over weeks to months at trauma-prone sites (gingiva, lips, fingers, face)
Triggers inclue [...], [...], or [...]
A: minor trauma; pregnancy; medications (e.g. isotretinoin, OCPs)
Back Extra: They may leave a collarette of scale at periphery

The ABCDE’s of pediatric melanoma are often cited as
● A- amelanotic
● B- bleeding
● C- single color
● D- small diameter
● E- evolution
Back Extra: In one study, 76% of melanomas under the age of 11 were amelanotic, with over 90% of the melanomas being elevated

The 4 main subtypes of calcinosis cutis
1. Dystrophic - caused by damage (inflammation, trauma) to skin 
2. Idiopathic
3. Metastatic
4. Iatrogenic
Back Extra: Dystrophic - Calcium deposits in juvenile dermatomyositis, CREST syndrome, after heel sticks
Idiopathic - Scrotal or labial calcinosis, subepidermal calcified nodules (SCNs)
Metastatic - patients may have abnormal levels of calcium and/or phosphate (chronic renal failure, calciphylaxis)
Iatrogenic - Extravasation of calcium gluconate from IV site

Q: Epidermal inclusion cysts are rare in prepubertal patients unless they are associated with [...]
A: Gardner Syndrome
Back Extra: Gardner Syndrome is a form of familial adenomatous polyposis (FAP) syndrome
Typically require surgery for treatment

Q: Why are children with atopic dermatitis more susceptible to molluscum contagiosum?
[...]
A: Poor skin barrier allows poxvirus to enter the skin barrier more easily
Back Extra: AD patients may also exhibit more of a Th_2 state, which is not as effective as targeting virally affected cells

Q: After having molluscum contagiosum for months, a patient's mother brings them in to show you that the molluscum lesions have become red, inflamed, and angry
Next step in management?
[...]
A: Reassure
Back Extra: This is a sign that the immune system is working to remove the lesions
Often referred to as the BOTE sign (Beginning Of The End)