common paeds skin Flashcards
what is eczema?
chronic atopic condition caused by defect in normal continuity of skin barrier leading to inflammation in skin
is eczema genetically linked?
yes but not directly
how does eczema present?
: in infancy with dry, red, sore patches of skin over flexor surfaces (inside elbows/ knees)
- Can be on face/ neck
- May have periods where it is worse/ better flares
what is pathophys of eczema?
defect in barrier that skin provides – gaps allow irritants, microbes and allergens to create immune response, resulting in inflammation and associated symptoms
what is maintenance managment of eczema?
Maintenance – creates artificial barrier to compensate for defective skin barrier – emollients
how should emollients be applied within eczema?
- Thick and greasy as possible after washing and before bed
- Avoid hot baths, body washes that remove natural oils
- Soap substitutes
how should eczema pt approach triggers?
identify and avoid
what do you do within flares of eczema?
Flares: thicker, topical emollients, topical steroids,
- wet wraps: covering affected areas in thick emollient and applying a wrap to keep moisture locked in overnight
- treating any viral/ bacterial infections
name some specialist management options of eczema?
zinc impregnated bandages, topical tacrolimus, phototherapy, systemic immunosuppressants – oral corticosteroids, methotrexate, azathioprine
how should you use steroids within eczema?
use for weakest steroid for shortest duration to help get skin under control
what is moa of steroids in eczema?
- settles immune activity and reduces inflammation
what are side effects of steroid use on skin?
can lead to thinning of skin, bruising, tearing, stretch marks and telangiectasia
what is telangiectasia?
enlarged blood vessels under surface of skin
what areas of body should you avoid with topical steroids?
- avoid thin skin – face, around eyes, genital region
should paeds get topical steroids?
not if little
only once old to understand not to touch it
what is urticaria?
hives
how does urticaria present?
- small itchy lumps that appear on skin
- associated with patchy erythematous rash
- localised to specific area/ widespread
what other symptoms may present with hives?
- link to angioedema/ flushing of skin
what is pathophy of urticaria?
release of histamine and other pro-inflamm chemicals by mast cells – allergic reaction
- can be acute urticaria / autoimmune reaction or chronic idiopathic
what can cause acute urticaria?
specifically triggered by something that stiulates mast cells to release mast cells:
- allergies to food, medications, animals
- contact with chemicals, latex, stinging nettles
- medications
- viral infections
- insect bites
- dermographism
what is dermographism?
rubbing of the skin
what can cause chronic idiopathic urticaria?
autoimmune – autoAB target mast cells and trigger them to release histamines and other chemical
- chronic idiopathic: no clear cause
what can cause chronic inducible urticaria?
autoimmune – autoAB target mast cells and trigger them to release histamines and other chemical
sunlight, temp changes, exercise, strong emotions, hot/ cold weather, pressure (dermatographism)
what autoimmune conditions are linked to chronic urticaria?
systemic lupus
how do you manage chronic urticaria?
fexofenadine in chronic
what can be used to manage acute urticaria?
oral pred
what management can be used in problematic urticaria?
- problematic: anti-leukotrienes eg montelukast, omalizumab (targets IgE), cyclosporin
what are the 6 viral rashes in paeds?
- measles
- scarlet fever
- rubella aka german measles
- dukes disease
- parvovirus B19
- roseola infantum
how is measles spread?
highly contagious by resp droplets
what symptoms may arise with measles?
- fever, coryzal symptoms and conjunctivitis
kolpik spots
what are kolpik spots?
in measles
- kolpik spots: grey-white spots on buccal mucosa (appear 2days after fever), rash starts on face and then behind ears 3-5days following fever
how do you manage measles?
self resolving after 7-10days
- need to isolate 4days until symptoms resolve
who needs to be notified of measles?
PHE
how common are measles complications?
30% of pt develop a complication
what complications can arise form measles?
- pneumonia
- diarrhoea
- dehydration
- encephalitis
- meningitis
- hearing loss
- vision loss
- death
what causes scarlet fever?
group A strep, usually tonsilitis
- produced by exotoxin produced by strep.pyogenes
how does scarlet fever present?
- red pink, blotchy macular rash with rough sandpaper skin – starts on trunk and spreads outwards
- red flushed cheeks
- other symptoms: fever, lethargy, flushed face, strawberry tongue, cervical lymphadenopathy
how do you manage scarlet fever?
phenoxymethylpenicillin (PenV) for 10 days
- notifiable disease – needs PHE
- children need kept off school until 24hrs after starting AB
what are complications of group A strep?
post-strep glomerulonephritis, acute rheumatic fever
how does rubella spread?
highly contagious and spread by resp droplets – symptoms 2wks after exposure
how does rubella present?
- presents with milder erythematous macular rash, starts on face and spreads to rest of body
- rash lasts 3day
- other symptoms: mild fever, joint pain, sore throat, lymphadenopathy
how is rubella managed?
supportive and self limiting
- need PHE notifying
- children need to stay off school for at least 5days following rash appearing
- children must avoid pregnant women
rubella complications are rare, but what are they?
: are rare
- thrombocytopenia and encephalitis
- dangerous in preg and can lead to congenital rubella syndrome triad of blindness, deafness and CHD
what is duke’s disease?
known as fourth disease
- similar to rubella
- non-specific viral rah
what is roseola infantum?
known as 6th disease caused by human herpesvirus 6 (HHV-6) and less freq by HHV-7
how does roseola infantum present?
- presents 2wks after infection with high fever that comes on suddenly and lasts 3-5dayd then disappears suddenly
- can be coryzal symptoms, sore throat, swollen lymph node, after fever rash appears mild erythematous macular rash on arms and legs, trunk, face and not itchy
what are complications of roseola?
febrile convulsions due to high temp
- immunocompromised pt may be at risk of myocarditis, thrombocytopenia and GBS
what is likely to cause neonatal conjunctivitis?
gonococcal infection from mother
what is management of neonatal conjuctivits?
urgent ophthalmology assessment
what are complications of neonatal conjunctivitis?
blindness
