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Paediatrics (Y4) > 10- Paediatric Dermatology > Flashcards

10- Paediatric Dermatology Flashcards

1
Q

dermatology history

A

Presenting complaint
- Nature e.g. rash (inflammatory) vs lesion
- Site
- Duration

History of presenting complaint
- Initial appearance and evolution
- Any trigger
- Symptoms (particularly itch and pain)
- Aggravating and reliving factors
- Previous and current treatments (effective or not)
- Systemic features: headache, fever, bladder and bowels
- Red flag: weight loss, nights sweats, change in appetite, bleeding

Past medical history
- Systemic disease
- History of atopy (asthma, hay fever, eczema)
- History of skin cancer or pre-cancer
- History of sunburn, sunbathing, sun bed
- Skin type

Family history
- Skin disease
- Atopy
- Autoimmune disease

Drug history
- Regular and recent
- Systemic and topical
- Where? How much? How long for?

Social history
- Occupation
o Sun exposure
o Contactants
- Improvement in OC when away from work

Quality of life- ICE

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2
Q

fitzpatric skin types

A
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3
Q

examining the skin

A

1) Inspect

2) Palpate
- Indurated (SCC)
- Hard (dermatofibroma)
- Soft (skin tag)
- Sclerotic (venous stasis ulcers)

3) Describe
- SCAM
- ABCD

4) Systematic check
- whole skin
- hair
- nails
- mucous membranes

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4
Q

SCAM

A
  • Size and shape – lesion / site and distribution - rash
  • Colour
  • Associated changes
  • Morphology
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5
Q

ABCD

A
  • Asymmetry
  • Border
  • Colour
  • Diameter
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6
Q

macule

A

Flat and small <1cm

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7
Q

patch

A

Flat and larger >1cm

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8
Q

papule

A

Raised <5mm

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9
Q

plaque

A
  • Plaque: Raised with a broad flat top
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10
Q

nodule

A
  • Nodule: Solid raised legion >5mm
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11
Q

fluid filled lesion

A
  • Vesicle <1cm
  • Bulla >1cm
  • Pustule = filled with purulent fluid
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12
Q

annular

A

ring shaped lesions

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13
Q

discoid

A

circular or coined shaped lesion

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14
Q

wheal

A

well demarcated area of dermal oedema

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15
Q

Comedone

A

Open- black head
Closed- white heads

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16
Q

summary of skin presentation

A
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17
Q

Site and distribution

A
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18
Q

Configuration / border/margin

A
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19
Q

colour

A
20
Q

surface features

A
21
Q

atopic eczema

A
  • Chronic, relapsing atopic condition caused by defects in the normal continuity of the skin barrier, leading to inflammation in the skin
  • Significant variation in the severity of the condition
  • Can become infected e.g. cellulitis
22
Q

Pathophysiology of eczema

A

The simplified pathophysiology is that eczema is caused by defects in the barrier that the skin provides. Tiny gaps in the skin barrier provide an entrance for irritants, microbes and allergens that create an immune response, resulting in inflammation and the associated symptoms.

23
Q

causes/ RF of eczema

A
  • Genetic influence
  • Atopic
  • Environmental triggers
    o Cold
    o Dietary products
    o Washing powders
    o stress
24
Q

presentation of eczema

A
  • Presents in infancy
  • Dry, red, itchy and sore patches of skin
  • Flexor surfaces e.g. elbow, knees, face and neck
  • Can appear as flares rather than being constant
25
Q

management of eczema split into

A
  • maintenance
  • flares
  • specialist treatment
26
Q

maintenance of eczema

A
  • Provoking factors avoided
  • Emollients used to create an artificial barrier over the skin to compensate for the defective skin barrier
    –> Used as often as possible, particularly after washing and before bed (3-4 times a day)
  • AVOID
    –>Hot baths
    –>Scratching
    –> Soaps which remove natural oils
27
Q

Emollients

A

Thicker the more effective
Thin creams:
* E45
* Diprobase cream
* Oilatum cream
* Aveeno cream
* Cetraben cream
* Epaderm cream

Thick, greasy emollients:
* 50:50 ointment (50% liquid paraffin)
* Hydromol ointment
* Diprobase ointment
* Cetraben ointment
* Epaderm ointment

28
Q

eczema flares

A
  • Thicker emollients and “wet wraps’ (applying a wrap to areas covered in emollient overnight)
  • Topical steroids (oral if severe)
  • Antibiotics to treat infections
29
Q

topical steroids rules

A

use lowest dose for shortest period of time to get symptoms under control

30
Q

moa of steroids for eczema

A

reduce immune activity in the skin and reducing inflammation

31
Q

steroid ladder

A

mild- face and flexure

  • Mild: Hydrocortisone 0.5%, 1% and 2.5%
  • Moderate: Eumovate (clobetasone butyrate 0.05%)
  • Potent: Betnovate (betamethasone 0.1%)
  • Very potent: Dermovate (clobetasol propionate 0.05%)
32
Q

side effects of steroids

A
  • Mild: Hydrocortisone 0.5%, 1% and 2.5%
  • Moderate: Eumovate (clobetasone butyrate 0.05%)
  • Potent: Betnovate (betamethasone 0.1%)
  • Very potent: Dermovate (clobetasol propionate 0.05%)
33
Q

Eczema and infections

A

Bacterial
- Most commonly staphylococcus aureus
- Oral antibiotics: flucloxacillin
- Severe cases may require admission and IV abx

Eczema herpeticum
- Viral skin infection cause by HSV or VZV

34
Q

examples of different types of eczema

A
35
Q

psoriasis background

A

Background
- Psoriasis is a chronic, autoimmune skin condition that can also affect the nails and joints. It tends to flare up from time to time. (psoriatic arthritis- pitting, onycholysis = nail signs))
- Increases risk of arthritis and CVD- inflammation of vasc

36
Q

pathophysiology of psoriasis

A
  • Occurs due to increased production of skin cells
  • Skin cells normally replaced every 3-4 weeks, however in this chronic condition it only takes 3-7 days
  • Underlying cause not fully understood- to do with immune system mistaking healthy cells
37
Q

Causes/ Risk factors for psoriasis

A

Triggers
- Injury to skin
- Throat infection- strep
- Medications
- Stress
- Infection
- Smoking and alcohol

Genetic

38
Q

psoriasis presentation

A
  • Usually extensor e.g. elbows and knees and scalp region (as opposed to eczema)
  • Erythematous, crusty skin covered with silvery scales
  • Raised and rough plaques
  • Guttate more common in children, may be preceded by strep throat infection
  • Nail psoriasis e.g. pitting, thickening, oncolysis
  • Psoriatic arthritis 10-20% (usually middle age starts)
39
Q

management of psoriasis

A
  • Emollient
  • Topical corticosteroids
  • Topical Vitamin D analogues (Calcipotriol)

Second line
- Phototherapy (narrow band UV B)
- Methotrexate,
- Cyclosporin
- Retinoids
- Psychosocial counselling

40
Q

types of psoriasis

A

plaque
guttate
flexural
pustular
erythroderma

41
Q

Plaque psoriasis:

A

the most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp

42
Q

Guttate psoriasis:

A

transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body –> trunk
o second most common
o children
o small raised papules

43
Q

flexural psoriasis

A

: in contrast to plaque psoriasis the skin is smooth

44
Q

Pustular psoriasis:

A

commonly occurs on the palms and soles
- Rare
- Pustules form under erythematous skin
- Not infectious
- Medical emergency and usually require hospital admission

45
Q

erythroderma psoriasis

A

o Rare form of psoriasis with extensive erythematous inflamed areas covering most of the surface area of the skin
o Skin falls away in large patches resulting in raw exposed areas
o Medical emergency

46
Q

erythroderma psoriasis

A

o Rare form of psoriasis with extensive erythematous inflamed areas covering most of the surface area of the skin
o Skin falls away in large patches resulting in raw exposed areas
o Medical emergency

Paediatrics (Y4) (42 decks)

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