14. Paediatric Dermatology Flashcards
What is Eczema?
Itchy, Dry, Inflammatory Skin Disease
What are the 2 Categories of Eczema?
- Endogenous
2. Exogenous
What are the Endogenous Eczemas?
- Atopic - Genetic Barrier Dysfunction
- Seborrheoic Dermatitis
- Discoid Eczema
- Pompholyx Eczema
What are the Features of Atopic Eczema?
- Commonest Eczema in Children - 1:5 Children
2. In with the Atopic Triad - Asthma / Hayfever / Eczema
What occurs due to the Dry Skin in Atopic Eczema?
Impaired Barrier Function:
- Penetration of Irritants and Allergens
- Penetration of Bacteria and Viruses
What is the Inherited Skin “Barrier Defect”?
Abnormality in Filaggrin Expression
Filaggrin Proteins bind Keratin Filaments together, and Help Maintain Moisture
This Results in Trans-Epidermal Water Loss
Where is Atopic Eczema located on Children?
- Flexural Surfaces in Older Children
- Face / Neck / Hands in Infants
- Discoid / Generalised
What can Atopic Eczema Flares be associated with?
- Infections / Viral Illness
- Environment - Central Heating / Cold Air
- Pets - if Sensitised / Allergic
- Teething
- Stress
What are the Features of Seborrheoic Dermatitis?
- Cradle Cap - Scalp / Face + Flexures (Neck / Wrist / ankles)
- Infants - Usually Resolves by 1 year
- Associated with Proliferation of Malassezia (Yeast)
- Treated with:
- a) Emollients
- b) Anti-Fungal Cream and Shampoo
- c) Mild Topical Steroid
What are the Features of Discoid Eczema?
- Scattered Annular / Circular Patches
2. Can occur in Atopic Eczema
What are the Features of Pompholyx Eczema?
- Hand and Foot Eczema
- Vesicles / Bullae
- Intensely Itchy
- Treated with High Potency Steroid
What are the Exogenous Eczemas?
- Allergic Contact Dermatitis
- Irritant Contact Dermatitis
- Photosensitive / Photoaggravated Dermatitis
What are the Features of Allergic Contact Dermatitis (Allergic Allergic Eczema)?
- Type 4 Hypersensitivity - Sensitisation to Allergen
- Associated with uses of Fragrances / Preservatives / Steroids
- Diagnosed using Patch Testing
What are the Features of Irritant Contact Dermatitis (Allergic Allergic Eczema)?
Associated with contact with:
- Water / Saliva
- Soaps - Bubble Baths
- Irritant Foods - Citrus / Tomatoes
- Chemical Irritants
Are Children with Eczema tested for Allergy?
No, the Majority of children with Mild Eczema do not need Allergy Testing
When should a Food Allergy be suspected?
- Immediate Reactions - Angioedema / Facial Rash
- Late Reactions - Worsening of Eczema 24-48 hours after ingestion
- G.I. Symptoms - Vomiting
- Failure to Thrive
- Severe Eczema Unresponsive to Treatment
- Sever Generalised Itching - Even when the Skin Appears Clear
What are the Features of Allergy Testing?
- Blood Tests for Specific IgE Antibodies
- Skin Prick Testing
- Common Dietary - Dairy / Soy / Peanut / Egg / Wheat
- Airborne Allergens - House Dust Mite / Pet Dander / Pollens
What is the Treatment of Eczema?
- Emollients - Creams / Ointments
- Soap Substitutes
- Topical Steroids - Stepwise Strengths (Hydrocortisone - Eumovate - Betnovate - Dermovate)
- Calcineurin Inhibitors
- UVB Light Therapy
- Immunosuppressive Medication
What are the Common Forms of Skin Infection?
- Impetigo
- Molluscum Contagiosum
- Viral Warts & Verrucas
- Viral Exanthems
- Chicken Pox - Varicella Zoster
- Parovirus
- Hand Foot and Mouth
What are the Features of Impetigo?
- Common, Acute Superficial Bacterial Infection - normally Staph. Aureus
- Presents with Pustules / Honey Coloured Crusted Erosions
- Treated with Topical Antibacterial / Oral Antibiotic - Flucloxacillin
What are the Features of Molluscum Contagiosum?
- Common, Benign, Self-Limiting Infection - Molluscipox Virus
- Transmission to Close Direct Contacts
- Presents with Pearly Papules, umbilicated Centre
Note - Can take up to 2 years to clear
What are the Features of Viral Warts / Verrucas?
- Often Skin Coloured
- Common
- Caused by Human Papillomavirus (HPV)
- Transmitted by Direct Skin Contact
What are the Features of Viral Exanthems?
- Common
- Associated with Viral Illness - Checken Pox / Measles / Rubella / Roseola (Herpes 6) / Erythema Infectiosum
- Caused by:
- a) Reaction to a Toxin Produced by the Organism
- b) Skin Damage from the Organism
- c) Immune Response
What are the Features of Chicken Pox?
- Highly Contagious - 1-2 day Pre-Rash until Crusting
- Caused by Varicella-Zoster Virus
- One Infection confers Life-Long Immunity
- Immunocompromised Susceptible at all Times
- Presents as Red Papules - Vesicles - Rupture / Crust
- Lesions appear on Trunk / Extremities
- Itchy and Viral Symptoms
What are the Features of Parvovirus?
- Fifth Disease / Erythema Infectiosum
- Incubation is 7-10 days
- Viral Symptoms / Lace-Like Rash / Red Cheek
- Virus Targets Red Cells in Bone Marrow
- Self Limiting
Note - Very Rarely Aplastic crises in haemolytic disorders
What are the Features of Hand Foot and Mouth?
- Enterovirus - usually Coxsackie Virus A16
- Blisters on Hands / Feet / Mouth + Viral Symptoms
- Self-Limiting / Supportive Treatment
Note - Epidemics = Late Summer / Autumn
What are the Skin Signs of Systemic Disease?
- Orofacial Granulomatosis - Crohn’s Disease
- Dermatitis Herpetiformis - Coeliac Disease
- Eruythema Nodosum - Infections / IBD / Sarcoidosis
