Childhood Dermatological Infections Flashcards
What pathogen causes chicken pox and how does this differ to Shingles?
Varicella zoster virus.
Shingles is actually a reactivation of the dormant virus in the dorsal root ganglion. **you can catch CP from someone with shingles
Describe the course of illness that occurs with chickenpox in terms of disease presentation.
Where does the rash start?
- Incubation 10-20 days
- Prodome: fever, malaise, myalgia, arthralgia 5 days
- Then a rash (starts nuchally, travels craniocaudally) which becomes widespread.
Management of Chicken Pox
- Supportive Cares: Fluid, analgesia, food
- Personal hygiene support
- Crystaderm (H2O2) if infected spot (not ABx) as secondary bacterial infection of the lesions is common
At what age do we give the chicken pox vaccine?
15 months
Should we be worried about chicken pox exposure to a pregnant women? What could happen?
- Yes if she has never had CP before then give immunoglobulin.
- This can lead to immunocompromise and complications such as
- pneumonia
- Otitis media
- Encephalotits
What is the pathogen behind measles and how is it spread?
RNA paramyxovirus
Spread by droplets!
What is the prodrome and features of a measles infection?
- Prodrome: Irritable, conjunctavitis, fever
- Koplik Spots (before rash): white spots ‘grain of salt’ on buccal mucosa
- Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy and confluent
Complications of an infection from measles?
- otitis media: the most common complication
- pneumonia: the most common cause of death
- encephalitis: typically occurs 1-2 weeks following the onset of the illness)
- subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
- febrile convulsions
- keratoconjunctivitis, corneal ulceration
- diarrhoea
- increased incidence of appendicitis
- myocarditis
Management of Measles infection?
- Supportive Cares
- Addmission if immunocompromised or pregnant
- Offer MMR if not immunised <72 hours
**this is a notifiable disease**
What causes Fifth’s Disease or ‘slapped cheek syndrome’
What else is it known as?
Caused by Parovirus B19, it is also called erythema infectiosum.
This virus targets red cells in the bone marrow and spreads via respiratory route
How does fifth disease/erythema infectiosum present?
In many the illness may be a hardly noticeable feverish illness.
In others a rose-red rash appears on the cheeks and spreads around the body, however it rarely involves the palms and soles. It fades after ~1 week
How is the rash caused by fifth disease/slapped cheek/erythema infectiosum interesting?
- The child feels better as the rash appears
- Months after, a warm bath, sunlight, heat or fever will trigger a recurrence of the red cheeks/rash
Does a child with fifth disease/slapped cheek disease need to be excluded from school?
No because they are no longer infectious by the time the rash occurs
If you get a ‘Herald Patch’ (usually on the truck) followed by erythematous oval scaly patches, what disease are you thinking of?
What is the common way of describing the appearance of that rash?
Pityriasis rosea: acute self-limiting viral rash (6-12/52) usually in teens/adults
The rash follows the lines of Langers, producing a ‘Fir Tree’ appearance
What is the researched complication of pityriasis rosea and pregnancy?
Reported to cause miscarriage in ~1/7 women
What is impetigo caused by and what does it look like?
Superficial bacterial skin infection cause by either staph. aureus or strep. pyogenes
Can be either 1o or 2o due to eczema/scabies/insect bites
‘golden’ crusted skin lesions around the mouth, flexures and limbs not covered by clothing. ******Very contagious******
Management and school exclusion of a child with Impetigo
- Topical Fusidic Acid
If extensive disease
- Oral flucloxacillin
- **erythromycin if penicillin allergic
School exclusion until lesions crusted/healed OR 48hrs post AB tx
A boil, also called a furuncle is a deep form of……..
bacterial folliculitis (infection of hair follicle)
Due to staph. aureus from the skin
**if there are multiple heads, it’s called a carbuncle
What causes Hand, foot and mouth disease?
Caused by coxsackie A16 and enterovirus 71
**very contagious**
Features and management of Hand, foot and mouth disease in children
- Mild systemic upset: sore throat + fever
- Oral ulcers
- Then vesicles on palms and soles of feet
Management
- Symptomatic only
- Reassurance
- ***children don’t need to be kept off school despite contagious nature of disease
What causes scabies and why do we react to this?
The mite Sarcoptes scabiei burrows into the skin, laying its eggs.
A delayed type IV hypersensitivity reaction occurs ~30days post this, causing intense pruitis
Physical features seen or felt in a scabies infection?
- Intense Widespread Pruitis
- Linear burrows on the side of the fingers, interdigital webs amd flexor aspects of the wrist
- Face and scalp of infants
- Exoration and infection from scratching
Treatment of Scabies?
- Permethrin 1st line
- malathion 2nd line
- explain that pruitis persists 4-6 weeks post eradication
- Advise minimal physical contact + cleaning /insectisides all fabrics
What is crusted ‘Norwegian’ Scabies from?
In patients with suppressed immunity the crusted skin will be teeming with 100’s of 1000’s of organisms
Ivermectin is the treatment of choice and isolation is essential
