14. Dermatology

Question 1

What are the common conditions of paediatric dermatology?

Answer 1

Eczema
Infection- viral and bacterial
Manifestations of systemic disease

Question 2

What are the different layers of the skin?

Answer 2

Dermis- protective barrier
Epidermis- worker part of skin
Subcutaneous tissue- fat, collagen, adherence and support

Question 3

Describe eczema and general?

Answer 3

Itchy, dry and erythematous (red and scaly)

Cheeks common in babies

Question 4

What are the different patterns of eczema?

Answer 4

Atopic eczema- classic eczema (defined or diffuse) barrier dysfunction
Sebprrheoic- greasy, scaly, eyebrows and scalp
Discoid- well defined circular or annular patterns. More topical steroids
Pomphylx- small blisters of palms of hands and soles of feet. V itchy
Varicose- oedema/venous insufficiency

Question 5

Discuss atopic eczema?

What parts of the body does it generally affect?

What causes atopic eczema?

Answer 5

Commonest type of eczema
Part of atopic March- overactive immune responses, linked to eczema, asthma and hay fever

Infants- face,neck and cheeks
Older- spread and becomes more generalised (behind knees and elbows)

Caused by Deficient filagrin expression

Question 6

What causes flares in childhood eczema?

Answer 6

Infections
Environment (central heating, cold air)
Pets
Teething
Stress

Question 7

Discuss suborrheic dermatitis?

How do you treat it?

Answer 7

Greasy scaly dermatitis
Often 3-12 months old

Associated with proliferation of malassezia

Emollients, antifunfals creams, shampoos and steroids used to control

Question 8

Discuss discoid eczema?

Answer 8

Annular circular pattern

Again driven by malasezzia

Need topical steroids and anti fungal creams to treat. Can present as a infectious picture

Question 9

Discuss pomphylx eczema?

Answer 9

Very itchy occurs on hands and feet

Question 10

What are exogenous eczema’s?

Answer 10

Allergic eczema- sensitised to allergens (type IV hypersensitivity)

Irritant eczema- repeated contact with water and soaps, chemicals, foods

Question 11

What is the different between eczema and dermatitis?

Answer 11

No difference they are interchangeable

Allergy and eczema is not the same thing though

Question 12

What is a type I food allergy?

Answer 12

Immediate reaction
Lip swelling
Facial redness
Anaphylactoic symptoms

Question 13

What is the presentation of a type IV hypersensitivity reaction causing eczema?

Answer 13

Worsening of eczema over 24/48 hours after ingestion
GI problems
Failure to thrive
Severe eczema unresponsive to treatment
Severe generalised itching

Question 14

How do you diagnose a Type I good sensitivity?

Answer 14

Skin prick testing
Blood test for specific IgE antibodies

Beware of false positives due to false IgE
Need to have a good idea before hand

Question 15

What are the commonest allergies?

Answer 15

Milk, soy, peanuts and eggs

Airborne- house, dust mites, pets, pollens

Question 16

How do you test for Type IV sensitivities?

Answer 16

No quick test
Suspect a dietary cause, restrict for 6-8 weeks
If eczema subsides, confirm by resting food and conforming as eczema has a relapse and remitting course

Question 17

How do yiu treat eczema?

Answer 17

Emoillents- QV cream

Topical steroids- side effects (thinning in prolonged use)

Calcineurin inhibitors

UVB light therapy

Ilitrucibaps?

Question 18

What is the steroid ladder for eczema?

Answer 18

Mild (hydrocortisone)
Moderate (eumovate)
Potent (betnovate)
Very potent (dermovate)

Question 19

How do you use steroids

Answer 19

Once daily for 1-2 weeks
If improvement then use alternative days for a few more days
Then if stubborn/persistant can use twice weekly in these areas

If at any point the eczema flares go back to dialysis application

Question 20

What is impetigo?

Answer 20

One of the most common bacterial skin infections in children

Honeycoloured crusted areas around nose and mouth, caused my staph aureus

Question 21

How do you treat impetigo?

Answer 21

Topical anti bacterial (fucidin)- increased resistance 
Oral antibiotic (flucloxacillin)

Question 22

What is molluscum contagiosum?

Answer 22

Benign self limiting infections caused by molluscipox virus
Right of passage
Can last for up to three years
Appears as pearly papules with an umbilicated centre

Question 23

How do you treat molluscum contagiousum?

Answer 23

Potassium hydroxide- causes inflammation and allows immune system to recognise and kill virus. Can just treat one and the body gets them

Treat one that’s hard to reach, stops kid scratching

Question 24

What are viral warts?

Answer 24

Common skin coloured non cancerous growths of the skin caused by infection with the human papilloma virus
Also caused a verruca if on the foot
Transmitted by skin contact

If they’re covered watch out for immune deficiency

Question 25

How do you treat viral warts?

Answer 25

Soak once a week
Pair on a daily basis (remove dead skin)
Use salicylic acid
Cryotherapy- kids hate it