14. Dermatology Flashcards
What are the common conditions of paediatric dermatology?
Eczema
Infection- viral and bacterial
Manifestations of systemic disease
What are the different layers of the skin?
Dermis- protective barrier
Epidermis- worker part of skin
Subcutaneous tissue- fat, collagen, adherence and support
Describe eczema and general?
Itchy, dry and erythematous (red and scaly)
Cheeks common in babies
What are the different patterns of eczema?
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
Discuss atopic eczema?
What parts of the body does it generally affect?
What causes atopic eczema?
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
What causes flares in childhood eczema?
Infections Environment (central heating, cold air) Pets Teething Stress
Discuss suborrheic dermatitis?
How do you treat it?
Greasy scaly dermatitis
Often 3-12 months old
Associated with proliferation of malassezia
Emollients, antifunfals creams, shampoos and steroids used to control
Discuss discoid eczema?
Annular circular pattern
Again driven by malasezzia
Need topical steroids and anti fungal creams to treat. Can present as a infectious picture
Discuss pomphylx eczema?
Very itchy occurs on hands and feet
What are exogenous eczema’s?
Allergic eczema- sensitised to allergens (type IV hypersensitivity)
Irritant eczema- repeated contact with water and soaps, chemicals, foods
What is the different between eczema and dermatitis?
No difference they are interchangeable
Allergy and eczema is not the same thing though
What is a type I food allergy?
Immediate reaction
Lip swelling
Facial redness
Anaphylactoic symptoms
What is the presentation of a type IV hypersensitivity reaction causing eczema?
Worsening of eczema over 24/48 hours after ingestion GI problems Failure to thrive Severe eczema unresponsive to treatment Severe generalised itching
How do you diagnose a Type I good sensitivity?
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
What are the commonest allergies?
Milk, soy, peanuts and eggs
Airborne- house, dust mites, pets, pollens
How do you test for Type IV sensitivities?
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
How do yiu treat eczema?
Emoillents- QV cream
Topical steroids- side effects (thinning in prolonged use)
Calcineurin inhibitors
UVB light therapy
Ilitrucibaps?
What is the steroid ladder for eczema?
Mild (hydrocortisone)
Moderate (eumovate)
Potent (betnovate)
Very potent (dermovate)
How do you use steroids
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
What is impetigo?
One of the most common bacterial skin infections in children
Honeycoloured crusted areas around nose and mouth, caused my staph aureus
How do you treat impetigo?
Topical anti bacterial (fucidin)- increased resistance Oral antibiotic (flucloxacillin)
What is molluscum contagiosum?
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
How do you treat molluscum contagiousum?
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
What are viral warts?
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
How do you treat viral warts?
Soak once a week
Pair on a daily basis (remove dead skin)
Use salicylic acid
Cryotherapy- kids hate it
