15. Dermatology Part 2

Question 1

What are viral exanthens?

Answer 1

Associated viral illness
Common
Fever, malaise, headache

Can be caused by chicken pox, measles, rubella, roseola (herpes virus 6)
Erythema infectiosum (paravovirus B19, slapped cheek)

Question 2

How do you treat viral exanthens?

Answer 2

Antihistamines and creams if trouble sleeping

Question 3

Discuss chicken pox?

Answer 3

Highly contagious virus caused by infection with the varicella zoster virus

Incubation 10-21 days
Self limiting,
Red papules moving onto vesicles often starting on the trunk

Question 4

What is parvovirus?

Answer 4

Slapped cheek
erythema infectiosum
Viral symptoms
erythematous rash cheeks initially and then also limbs and trunk
Usually a mild self limiting illness
Virus targets red cells in bone marrow
risk to pregnant women (spontaneous abortion, intrauterine death)
aplastic crisis if heamolytic disorders

Question 5

What is hand foot and mouth disease?

Answer 5

Enterovirus, typical Cossacks virus A16
Can also be due to enter virus 71 and other coxsackivirus types
Blisters on the hands, feet and mouth. Viral symptoms
Often occurs in autumn and summer

Question 6

What is eczema coxsackium

Answer 6

Cocksackie A16 virus
Happens in children with history of eczema
Asccoaired viral symptoms and becomes much more widespread
Children still well in themselves

Only treat with symptomatic relief

Question 7

What is eczema herpeticum?

Answer 7

Very unwell well child
History of eczema
Monomorphic punched our lesions
Can be associated with encephalitis in untreated

Question 8

What symptoms define eczema herpaticans

Answer 8

associated viral symptoms
History of eczema
Flared sites picks out areas of eczema
Self limiting

Question 9

What is orafacial granulomatosis?

Answer 9

Lip swelling and fishing
Oral mucosal lesions (ulcers and tags, cobblestone appearance)
May be first incidence of Crohn’s disease- do fadcal calprotectin
Consider patch testing
Benzoate and cinnamate free diet
Topical steroids

Question 10

What is erythema nodosum?

Answer 10

Painful, erythematous subcutaneous nodules
Over shins, sometimes other sites
Slow resolution like bruise (6-8 weeks)

Question 11

What causes erythema nodosum?

Answer 11

Streptococcus
URTI
Inflammatory bowel disease
Sarcoidosis
Drugs (OCP, sulpamides, penicllin)
Mycobacterial infections
Idiopathic

Question 12

How do you treat erythema nodosum?

Answer 12

Gentle compression
Elevate the affected areas
NSAIDS
Topical steroids?

Question 13

What is dermatitis herpetiformis?

Answer 13

Rare but persistant immunobullous disease that has been linked to coeliac disease
Itchy blisters appear in clusters
Often symmetry
Scalp, shoulders, buttocks, elbows and knees

Question 14

What investigations do you do for dermatitis herpetiformis?

Answer 14

Blood tests- low haemoglobin/iron
Detailed history
Coeliac screening
Skin biopsy

Question 15

What is urticaria?

Answer 15

Wheals/hives
Associated with angioedema
Areas of rash can last from a few minutes up to 24 hours

Acute<6 weeks
Chronic over 6 weeks

Question 16

What causes uticaria?

Answer 16

Viral infections
Bacterial infection
Food or drug allergy
NSAIDS, opiates
Vaccinations

Question 17

How do you treat uticaria?

Answer 17

Consider triggers e.g. codeine, ace inhibitors, NSAIDS