common paeds skin

Question 1

what is eczema?

Answer 1

chronic atopic condition caused by defect in normal continuity of skin barrier leading to inflammation in skin

Question 2

is eczema genetically linked?

Answer 2

yes but not directly

Question 3

how does eczema present?

Answer 3

: 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

Question 4

what is pathophys of eczema?

Answer 4

defect in barrier that skin provides – gaps allow irritants, microbes and allergens to create immune response, resulting in inflammation and associated symptoms

Question 5

what is maintenance managment of eczema?

Answer 5

Maintenance – creates artificial barrier to compensate for defective skin barrier – emollients

Question 6

how should emollients be applied within eczema?

Answer 6

• Thick and greasy as possible after washing and before bed
• Avoid hot baths, body washes that remove natural oils
• Soap substitutes

Question 7

how should eczema pt approach triggers?

Answer 7

identify and avoid

Question 8

what do you do within flares of eczema?

Answer 8

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

Question 9

name some specialist management options of eczema?

Answer 9

zinc impregnated bandages, topical tacrolimus, phototherapy, systemic immunosuppressants – oral corticosteroids, methotrexate, azathioprine

Question 10

how should you use steroids within eczema?

Answer 10

use for weakest steroid for shortest duration to help get skin under control

Question 11

what is moa of steroids in eczema?

Answer 11

• settles immune activity and reduces inflammation

Question 12

what are side effects of steroid use on skin?

Answer 12

can lead to thinning of skin, bruising, tearing, stretch marks and telangiectasia

Question 13

what is telangiectasia?

Answer 13

enlarged blood vessels under surface of skin

Question 14

what areas of body should you avoid with topical steroids?

Answer 14

• avoid thin skin – face, around eyes, genital region

Question 15

should paeds get topical steroids?

Answer 15

not if little
only once old to understand not to touch it

Question 16

what is urticaria?

Answer 16

hives

Question 17

how does urticaria present?

Answer 17

• small itchy lumps that appear on skin
• associated with patchy erythematous rash
• localised to specific area/ widespread

Question 18

what other symptoms may present with hives?

Answer 18

• link to angioedema/ flushing of skin

Question 19

what is pathophy of urticaria?

Answer 19

release of histamine and other pro-inflamm chemicals by mast cells – allergic reaction
- can be acute urticaria / autoimmune reaction or chronic idiopathic

Question 20

what can cause acute urticaria?

Answer 20

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

Question 21

what is dermographism?

Answer 21

rubbing of the skin

Question 22

what can cause chronic idiopathic urticaria?

Answer 22

autoimmune – autoAB target mast cells and trigger them to release histamines and other chemical
- chronic idiopathic: no clear cause

Question 23

what can cause chronic inducible urticaria?

Answer 23

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)

Question 24

what autoimmune conditions are linked to chronic urticaria?

Answer 24

systemic lupus

Question 25

how do you manage chronic urticaria?

Answer 25

fexofenadine in chronic

Question 26

what can be used to manage acute urticaria?

Answer 26

oral pred

Question 27

what management can be used in problematic urticaria?

Answer 27

- problematic: anti-leukotrienes eg montelukast, omalizumab (targets IgE), cyclosporin

Question 28

what are the 6 viral rashes in paeds?

Answer 28

1. measles 2. scarlet fever 3. rubella aka german measles 4. dukes disease 5. parvovirus B19 6. roseola infantum

Question 29

how is measles spread?

Answer 29

highly contagious by resp droplets

Question 30

what symptoms may arise with measles?

Answer 30

- fever, coryzal symptoms and conjunctivitis kolpik spots

Question 31

what are kolpik spots?

Answer 31

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

Question 32

how do you manage measles?

Answer 32

self resolving after 7-10days - need to isolate 4days until symptoms resolve

Question 33

who needs to be notified of measles?

Answer 33

PHE

Question 34

how common are measles complications?

Answer 34

30% of pt develop a complication

Question 35

what complications can arise form measles?

Answer 35

- pneumonia - diarrhoea - dehydration - encephalitis - meningitis - hearing loss - vision loss - death

Question 36

what causes scarlet fever?

Answer 36

group A strep, usually tonsilitis - produced by exotoxin produced by strep.pyogenes

Question 37

how does scarlet fever present?

Answer 37

- 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

Question 38

how do you manage scarlet fever?

Answer 38

phenoxymethylpenicillin (PenV) for 10 days - notifiable disease – needs PHE - children need kept off school until 24hrs after starting AB

Question 39

what are complications of group A strep?

Answer 39

post-strep glomerulonephritis, acute rheumatic fever

Question 40

how does rubella spread?

Answer 40

highly contagious and spread by resp droplets – symptoms 2wks after exposure

Question 41

how does rubella present?

Answer 41

- 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

Question 42

how is rubella managed?

Answer 42

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

Question 43

rubella complications are rare, but what are they?

Answer 43

: are rare - thrombocytopenia and encephalitis - dangerous in preg and can lead to congenital rubella syndrome  triad of blindness, deafness and CHD

Question 44

what is duke's disease?

Answer 44

known as fourth disease - similar to rubella - non-specific viral rah

Question 45

what is roseola infantum?

Answer 45

known as 6th disease caused by human herpesvirus 6 (HHV-6) and less freq by HHV-7

Question 46

how does roseola infantum present?

Answer 46

- 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

Question 47

what are complications of roseola?

Answer 47

febrile convulsions due to high temp - immunocompromised pt may be at risk of myocarditis, thrombocytopenia and GBS

Question 48

what is likely to cause neonatal conjunctivitis?

Answer 48

gonococcal infection from mother

Question 49

what is management of neonatal conjuctivits?

Answer 49

urgent ophthalmology assessment

Question 50

what are complications of neonatal conjunctivitis?

Answer 50

blindness