Childhood Dermatological Infections

Question 1

What pathogen causes chicken pox and how does this differ to Shingles?

Answer 1

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

Question 2

Describe the course of illness that occurs with chickenpox in terms of disease presentation.

Where does the rash start?

Answer 2

• Incubation 10-20 days
• Prodome: fever, malaise, myalgia, arthralgia 5 days
• Then a rash (starts nuchally, travels craniocaudally) which becomes widespread.

Question 3

Management of Chicken Pox

Answer 3

• Supportive Cares: Fluid, analgesia, food
• Personal hygiene support
• Crystaderm (H₂O₂) if infected spot (not ABx) as secondary bacterial infection of the lesions is common

Question 4

At what age do we give the chicken pox vaccine?

Answer 4

15 months

Question 5

Should we be worried about chicken pox exposure to a pregnant women? What could happen?

Answer 5

• Yes if she has never had CP before then give immunoglobulin.
• This can lead to immunocompromise and complications such as
  
  • pneumonia
  • Otitis media
  • Encephalotits

Question 6

What is the pathogen behind measles and how is it spread?

Answer 6

RNA paramyxovirus

Spread by droplets!

Question 7

What is the prodrome and features of a measles infection?

Answer 7

• 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

Question 8

Complications of an infection from measles?

Answer 8

• 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

Question 9

Management of Measles infection?

Answer 9

• Supportive Cares
• Addmission if immunocompromised or pregnant
• Offer MMR if not immunised <72 hours

**this is a notifiable disease**

Question 10

What causes Fifth’s Disease or ‘slapped cheek syndrome’

What else is it known as?

Answer 10

Caused by Parovirus B19, it is also called erythema infectiosum.

This virus targets red cells in the bone marrow and spreads via respiratory route

Question 11

How does fifth disease/erythema infectiosum present?

Answer 11

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

Question 12

How is the rash caused by fifth disease/slapped cheek/erythema infectiosum interesting?

Answer 12

• 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

Question 13

Does a child with fifth disease/slapped cheek disease need to be excluded from school?

Answer 13

No because they are no longer infectious by the time the rash occurs

Question 14

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?

Answer 14

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

Question 15

What is the researched complication of pityriasis rosea and pregnancy?

Answer 15

Reported to cause miscarriage in ~1/7 women

Question 16

What is impetigo caused by and what does it look like?

Answer 16

Superficial bacterial skin infection cause by either staph. aureus or strep. pyogenes

Can be either 1^o or 2^o due to eczema/scabies/insect bites

‘golden’ crusted skin lesions around the mouth, flexures and limbs not covered by clothing. ******Very contagious******

Question 17

Management and school exclusion of a child with Impetigo

Answer 17

• Topical Fusidic Acid

If extensive disease

• Oral flucloxacillin
• **erythromycin if penicillin allergic

School exclusion until lesions crusted/healed OR 48hrs post AB tx

Question 18

A boil, also called a furuncle is a deep form of……..

Answer 18

bacterial folliculitis (infection of hair follicle)

Due to staph. aureus from the skin

**if there are multiple heads, it’s called a carbuncle

Question 19

What causes Hand, foot and mouth disease?

Answer 19

Caused by coxsackie A16 and enterovirus 71

**very contagious**

Question 20

Features and management of Hand, foot and mouth disease in children

Answer 20

• 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

Question 21

What causes scabies and why do we react to this?

Answer 21

The mite Sarcoptes scabiei burrows into the skin, laying its eggs.

A delayed type IV hypersensitivity reaction occurs ~30days post this, causing intense pruitis

Question 22

Physical features seen or felt in a scabies infection?

Answer 22

• 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

Question 23

Treatment of Scabies?

Answer 23

• Permethrin 1^st line
  
  • malathion 2nd line
• explain that pruitis persists 4-6 weeks post eradication
• Advise minimal physical contact + cleaning /insectisides all fabrics

Question 24

What is crusted ‘Norwegian’ Scabies from?

Answer 24

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