10- Paediatric Dermatology Flashcards
dermatology history
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
fitzpatric skin types
examining the skin
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
SCAM
- Size and shape – lesion / site and distribution - rash
- Colour
- Associated changes
- Morphology
ABCD
- Asymmetry
- Border
- Colour
- Diameter
macule
Flat and small <1cm
patch
Flat and larger >1cm
papule
Raised <5mm
plaque
- Plaque: Raised with a broad flat top
nodule
- Nodule: Solid raised legion >5mm
fluid filled lesion
- Vesicle <1cm
- Bulla >1cm
- Pustule = filled with purulent fluid
annular
ring shaped lesions
discoid
circular or coined shaped lesion
wheal
well demarcated area of dermal oedema
Comedone
Open- black head
Closed- white heads
summary of skin presentation
Site and distribution
Configuration / border/margin
colour
surface features
atopic eczema
- 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
Pathophysiology of eczema
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.
causes/ RF of eczema
- Genetic influence
- Atopic
- Environmental triggers
o Cold
o Dietary products
o Washing powders
o stress
presentation of eczema
- 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
management of eczema split into
- maintenance
- flares
- specialist treatment
maintenance of eczema
- 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
Emollients
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
eczema flares
- Thicker emollients and “wet wraps’ (applying a wrap to areas covered in emollient overnight)
- Topical steroids (oral if severe)
- Antibiotics to treat infections
topical steroids rules
use lowest dose for shortest period of time to get symptoms under control
moa of steroids for eczema
reduce immune activity in the skin and reducing inflammation
steroid ladder
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%)
side effects of steroids
- 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%)
Eczema and infections
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
examples of different types of eczema
psoriasis background
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
pathophysiology of psoriasis
- 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
Causes/ Risk factors for psoriasis
Triggers
- Injury to skin
- Throat infection- strep
- Medications
- Stress
- Infection
- Smoking and alcohol
Genetic
psoriasis presentation
- 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)
management of psoriasis
- Emollient
- Topical corticosteroids
- Topical Vitamin D analogues (Calcipotriol)
Second line
- Phototherapy (narrow band UV B)
- Methotrexate,
- Cyclosporin
- Retinoids
- Psychosocial counselling
types of psoriasis
plaque
guttate
flexural
pustular
erythroderma
Plaque psoriasis:
the most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp
Guttate psoriasis:
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
flexural psoriasis
: in contrast to plaque psoriasis the skin is smooth
Pustular psoriasis:
commonly occurs on the palms and soles
- Rare
- Pustules form under erythematous skin
- Not infectious
- Medical emergency and usually require hospital admission
erythroderma psoriasis
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
erythroderma psoriasis
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
