Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paeds > Derm > Flashcards

Derm Flashcards

1
Q

What is acne vulgaris?

A

Chronic inflammatory dermatosis caused by the obstruction of the pilosebaceous follicles in the face and upper trunk > results in comedones, inflammation and pustules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes of acne vulgaris?

A

Infantile acne (<3m)
Transient and usually due to increase in maternal androgens

Adolescent acne
Increased sebum production / impaired flow of sebum / Propionibacterium acnes

Associations
Puberty, POS, Cushing’s (excess cortisol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the different types of acne lesions?

A

Comedones
Dilated sebaceous follicle

  • Top is closed = whitehead
  • Top is open = blackhead

Papules / pustules
Inflammatory lesions formed from follicles bursting and releasing irritants

Nodules / cysts
Excessive inflammatory response

  • Ice-pick scars and hypertrophic scars
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the S/S of acne?

A
  • Greasy face
  • Lesions
  • Psychological impact > low self-esteem
  • Can be painful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the investigations for acne?

A

Clinical diagnosis
If signs of androgen excess > free testosterone, FSH, LH, 24hr urinary cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the management for acne?

A

Conservative:

  • Cleaning face > avoid over-cleaning
  • Avoid picking / squeezing due to risk of scarring

Medical:
1. Single topical therapy:

  • Topical benzoyl peroxide or topical retinoids (e.g. adapalene)

2. Topical combination therapy:

  • Topical abx (clindamycin 1%) + BPO/adapalene

3a. Oral abx (max 3m) + BPO/adapalene:

  • 1st line = tetracyclines (lymecycline, doxycycline) > avoided in pregnancy
  • 2nd line = macrolides (erythromycin) > can be used in pregnancy

3b. COCP + BPO/adapalene

  • Alternative to oral abx

4. Dermatologist referral & oral isotretinoin

  • Must be on 2 forms of contraception
  • SE > dryness, pruritis, conjunctivitis, muscle aches, deranged LFTs
  • Associated with low mood and suicidal ideation

Support

  • NHS Choices leaflet on acne
  • British Association of Dermatology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is atopic dermatitis (eczema)?

A

Chronic, relapsing, inflammatory skin condition characterised by an itchy, red rash, commonly on flexures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the presentation of eczema in different age groups?

A

Typically presents before 2yrs but clears in ~50% by 5yrs and 75% by 10yrs

Infant = face and trunk
Older child = extensors of limbs
Young adult = localises to flexures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are triggers of eczema?

A
  • Irritants
  • Contact allergens
  • Extremes of temperature (worse in winter)
  • Abrasive fabrics
  • Sweating
  • Dietary factors
  • Inhaled allergens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the S/S of eczema?

A

Mild

  • Areas of dry skin
  • Infrequent itching
  • +/- small areas of redness

Moderate

  • Areas of dry skin
  • Frequent itching
  • Redness
  • +/- excoriation and localised skin thickening

Severe

  • Widespread areas of dry skin
  • Incessant itching
  • Redness
  • +/- excoriation, extensive skin thickening, bleeding, oozing, cracking and alteration of pigmentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the investigations for eczema?

A
  • Infants with moderate/severe eczema + hx of immediate reaction to food = skin prick testing to common food allergens
  • Eczema herpeticum = obs, swabs (bacterial superinfection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the management of eczema?

A

Mild:

  • Simple emollients, large quantities (50/50, Dermol, e45)
  • Mild topical steroids (applied 30 mins after emollients)

Moderate:

  • Emollients
  • Moderate topical steroids (or topical calcineurin inhibitors e.g. Protopic)
  • Wet wraps

Severe:

  • Emollients
  • Potent topical steroids (or topical calcineurin inhibitors)
  • Wet wraps
  • Systemic therapy (oral ciclosporin)
  • Phototherapy

Infected:

  • Oral flucloxacillin (erythromycin if pen allergic)
  • Skin swab and culture

+ antihistamines if severe itching / urticaria
+ Information and support > itchywheezysneezy.co.uk , BAD , National Eczema Society

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the management of eczema herpeticum?

A

Dermatological emergency
Rare but serious viral infection, normally causes by HSV

  • Oral acyclovir
  • If around the eyes > same day ophthalmologist referral
  • Health education
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How are emollients used in eczema?

A
  • Use in large amounts and often
  • Apply on the whole body
  • Use as a soap substitute (also instead of shampoo or use unperfumed shampoos)
  • Examples = e45, cetraben, diprobase, aveeno
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the steroid ladder?

A
  • 1) Hydrocortisone
  • 2) Eumovate
  • 3) Betnovate
  • 4) Dermovate

> SEs = infections, thin skin, stretch marks, systemic SEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Naevus Flammeus?

A

Port-wine stain in distribution of trigeminal nerve
Vivid red/purple macule

  • Sturge-Weber syndrome
  • Parkes Weber syndrome
  • Kippel-Trenaunay syndrome
  • Proteus syndrome

> Mx = pulse dye laser

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Naevus Simplex (salmon patches/stork bites/angel’s kiss)?

A
  • A common, benign capillary vascular malformation
  • Presents at birth as a pink or red patch
  • Most often observed on nape of the neck, eyelid, or forehead
  • Goes redder when the infant cries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the investigations for vascular malformations?

A

Clinical diagnosis
+ Imaging
1st = USS
2nd = MRI (Sturge-Weber)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the management for vascular malformations?

A

Conservative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a haemangioma?

A

Benign tumour made up of blood vessels that typically appear during the first weeks of life as blue or pink macules or patches, then enter a proliferative phase and become elevated above the surrounding skin surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What’s the difference between infantile and congenital haemangioma?

A

Infantile haemangioma = develops a few days/weeks after birth.
Congenital haemangioma = always present at birth. Much rarer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the RFs for haemangioma?

A
  • LBW, prematurity
  • White ethnicity
  • Female
  • Maternal multiple gestation
  • Advanced maternal age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the S/S of haemangioma?

A

Superficial (50-60%)

  • Bright red area of skin and feels warm
  • Upper eyelids, midforehead, nape of neck

Deep (15%)

  • Blue in colour, forms a lump
  • May just look like a lump of normal skin

Mixed

  • Bright red area on blue, forms a lump

Kasabach-Merritt

  • Haemangioma with thrombocytopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the difference between a haemangioma and a vascular malformation?

A

Hemangiomas are vascular tumours that are rarely apparent at birth, grow rapidly during the first 6 months of life, involute with time and do not necessarily infiltrate but can sometimes be destructive.

Vascular malformations are irregular vascular networks defined by their particular blood vessel type, grow slowly throughout life but do not shrink, and usually require treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the investigations for haemangioma?

A

Clinical diagnosis

  • Doppler USS used to distinguish infantile haemangioma from vascular malformation
  • USS > MRI/MRA gold standard to dx complex vascular tumours if lesions are:
    o Deep
    o Multiple haemangiomas
    o Single large capillary haemangioma
    o Near the eye
  • Medical photography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the management for haemangioma?

A

Conservative:

  • Education and reassurance

If functional impairment / cosmetic disfiguration:

  • Topical beta blocker and/or CS
  • Surgical excision as the adjunct

If ulceration:

  • Add astringents and barrier protection
  • Adjunct > topical abx, becaplermin, analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is erythema toxicum?

A
  • Common rash seen in full-term newborns
  • Usually appears in first few days after birth and fades within a week
  • Up to half of all newborns will have it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the S/S of erythema toxicum?

A
  • Maculo-papular-pustular lesions > last for 1 day at a time
  • Wax and wane over the first few days / weeks of life
  • Begins on face and spreads to limbs
  • Must exclude congenital infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the management of erythema toxicum?

A

Self-limiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is Milia?

A

White pimples on nose and cheeks from retention of keratin and sebaceous material of the pilosebaceous follicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is strawberry naevi?

A

= Infantile haemangioma
Common type of birthmark that is usually red or purple

  • Can occur anywhere (usually on face, often on the head and neck areas)
  • Develop shortly after birth (presents ~3m)
  • Complications = ulceration, bleeding, infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Describe neonatal milia

A
  • Affects ~50% of newborns
  • Often nose, but also mouth, palate, scalp, face, upper trunk
  • Heal spontaneously within a few weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe primary milia

A
  • Around eyelids, cheeks, forehead, genitalia
  • Should clear in a few weeks
  • Associated with trauma
34
Q

What is the management for milia?

A

Self-limiting

35
Q

What is molluscum contagiosum?

A

Common viral skin infection caused by molluscum contagiosum virus (MCV) (a poxvirus)

36
Q

How is molluscum contagiosum spread?

A

Not very contagious

  • Skin-to-skin transmission, or
  • Indirect skin contact with fomites such as bath towels / sponges
37
Q

When does molluscum contagiosum occur?

A

Maximum incidence 1-4yrs
Majority of cases in children with atopic eczema

38
Q

What are the S/S of molluscum contagiosum?

A

Characteristic pinkish / pearly white papules with central umbilication

  • Up to 5mm in diameter
  • Lesions appear in clusters in areas anywhere on the body (NOT palms or soles)
  • Commonly seen on trunk and in flexures, or anogenital lesions
  • Painless but itchy occasionally
39
Q

What is the management for molluscum contagiosum?

A

Acute = self-resolving

  • 6-9m, but normally within the year
  • No need to avoid school
  • Long-sleeve clothes
  • Avoid sharing towels, clothing and baths
  • Encourage not to scratch

Chronic (>2yrs) = cryotherapy

  • If eczema or infection develops around the lesions, treat appropriately (e.g. emollients and steroids or antibiotics)
40
Q

What are Mongolian blue spots?

A

Flat bluish- to bluish-gray skin markings commonly appearing at birth or shortly thereafter

  • Commonly at base of spine, buttocks and back
  • Can appear on shoulders
  • Benign and not associated with any conditions or illnesses
  • More common in Afro-Caribbean or Asian infant
41
Q

What is the management of Mongolian blue spot?

A

Self-limiting
Fade slowly after first few years (by 4yrs)

42
Q

What is impetigo?

A

Superficial bacterial skin infection usually caused by staph aureus or strep pyogenes

43
Q

How is impetigo spread?

A

VERY CONTAGIOUS

  • Spread by direct contact with discharge from scabs > bacteria enter skin through minor abrasions then spread to other sites by scratching
  • Spread mainly by hands, but indirect spread via toys, clothing, equipment, and the environment may occur
44
Q

When does impetigo occur?

A
  • Primary infection, or
  • Complication of existing condition e.g. eczema, scabies, insect bites

Common in children, particularly during warm weather

45
Q

What are the S/S of impetigo?

A
  • Golden-yellow, crusted appearance
  • Lesions tend to occur around the mouth, or on the face, flexures and limbs not covered by clothing
46
Q

How is impetigo managed?

A

Conservative:

  • Wash areas with soapy water
  • Wash hands after touching lesions
  • Avoid scratching affected areas and keep nails short
  • Avoid sharing towels/bathwater etc

Medical:
Limited, localised disease:

  • 1st line = topical hydrogen peroxide 1% cream
  • 2nd line = topical fusidic acid (2%) abx
  • > Topical mupirocin if fusidic acid resistance is suspected

Extensive disease / bullous impetigo:

  • Oral flucloxacillin (erythromycin if pen-allergic)

School exclusion:

  • Until lesions are crusted/healed, or
  • 48hrs after commencing abx

Arrange RV if no improvement after 7d:

  • RV diagnosis
  • Check compliance with treatment and hygiene measures
  • Take a swab
  • Consider oral antibiotics if fusidic acid was initially used
47
Q

What is nappy rash?

A

Inflammation of the skin in the area covered by a nappy > most common form of contact dermatitis

48
Q

When does nappy rash occur?

A

Babies 3-15m

49
Q

What irritants cause a nappy rash?

A

Urine, faeces, faecal enzymes, nappy components, friction

50
Q

What are the S/S of a nappy rash?

A

Erythematous macules and papules in genital area

Irritant

  • Well-demarcated variety of erythema, oedema, dryness, scaling
  • Sparing skin folds (just skin in contact with nappy)

Candida albicans

  • Erythematous papules and plaques with small satellite spots or superficial pustules
  • Sharply demarcated redness
  • > check for oral candidiasis

Seborrheic

  • Cradle cap and bilateral salmon pink patches
  • Desquamating flakes
  • In skin folds
51
Q

What is the management of nappy rash?

A

Health education:

  • Nappy type > high absorbency, proper fit, disposable
  • Leave nappy off as much as possible to help skin dry
  • Clean/change every 3-4hrs / ASAP after soiling
  • Use water or fragrance-free or alcohol-free baby wipes
  • Dry gently after cleaning
  • Bath child daily > do NOT use soap, bubble bath, lotions or talcum powder

If mild erythema + child asx:

  • Advise on the use of a barrier preparation (OTC)
  • e.g. Zinc and castor oil ointment

If moderate erythema + discomfort”

  • If >1m then hydrocortisone 1% cream OD (max 7d)

If rash persists and Candidal infection is suspected / confirmed on swab:

  • Advise against use of barrier protection
  • Topical imidazole cream (e.g. clotrimazole, econazole, miconazole)

If rash persists and bacterial infection suspected / confirmed on swab:

  • Oral flucloxacillin 7d (clarithromycin if pen-allergic)
  • Arrange RV
52
Q

What is Seborrhoeic Dermatitis?

A

Relatively common skin disorder seen in children that affects the scalp, nappy area, face, and limb flexures

53
Q

What are the S/S of seborrhoeic dermatitis?

A
  • Dandruff / flaking skin on scalp > presents in first 6w, resolves over following weeks
  • Erythematous, yellow, crusty, adherent layer that can spread to behind ears, face, flexures > Cradle Cap > non-itchy, associated with Malassezia yeasts
54
Q

What are the investigations for seborrhoeic dermatitis?

A
  • Clinical diagnosis
  • Skin scrapings for Malassezia
  • Culture of swabs
55
Q

What is the management of seborrhoeic dermatitis?

A

Conservative:

  • Reassure parents (it is NOT a serious condition)
  • Spontaneous resolution by 8m
  • Regular washing with baby shampoo
  • Gentle brushing to remove scales
  • Baby oils

Mild-moderate:

  • Bathe infant >=1/d using emollient as a soap substitute
  • Topical imidazole cream

Severe:

  • Mild topical steroids e.g. 1% hydrocortisone
56
Q

What is tinea?

A

Tinea is a contagious fungal skin infection

57
Q

What are the 3 types of tinea?

A

Tinea capitis = scalp

Tinea corporis = trunk, legs or arms

Tinea pedis = feet

58
Q

What are the S/S of tinea?

A

Ringed appearance +/- kerion (severe inflamed ringworm patch), red or silver rash

59
Q

What is the management of tinea?

A

Mild:

  • Topical antifungals e.g. terbinafine cream, clotrimazole

Moderate:

  • 1% hydrocortisone

Severe:

  • Oral antifungals e.g. terbinafine or itraconazole

Tinea capitis:

  • Oral antifungal e.g. griseofulvin or terbinafine

Tinea Faciei, Tinea Corporis, Tinea Cruris or Tinea Pedis:

  • Topical antifungal (e.g. terbinafine, naftifine, butenafine)
  • Topical aluminium acetate (in some)

Advice:

  • > VERY contagious so take steps to prevent spread
  • Loose-fitting cotton clothing
  • Dry thoroughly after washing
  • Do not share towels
  • Wash affected areas of skin daily
  • Avoid scratching
  • Wash clothes and bed linen frequently
  • No need for school exclusion
60
Q

What are the red flags for neck lumps?

A
  • Sepsis/unwell
  • Stridor
  • Poor feeding
  • Change in voice
  • Rapid progression
61
Q

Describe a thyroglossal cyst

A
  • Anterior triangle, midline and below the hyoid
  • Derived from remnants of thryoglossal duct
  • Moves with swallowing / rising the tongue
  • Thin walled and anechoic on USS
62
Q

Describe a brachial cyst

A
  • Lateral congenital mass (failure of pharyngeal clefts to involute)
  • Usually located anterior to the sternocleidomastoid near the angle of the mandible
  • Anechoic on USS
  • Cyst, sinus, or fistula, may be infected
63
Q

Describe lymphadenitis

A
  • Transiently enlarged, tender lymph nodes
  • Often multiple small tender bumps
64
Q

What are the investigations for neck lumps?

A
  • Clinical examination
  • Systemic symptoms = FBC and blood film
  • Thyroglossal cyst = USS
  • Atypical lymphadenopathy = TB PPD test, bartonella henselae, EBV, CMV, HIV, toxoplasmosis serology
65
Q

What is the management for lymphadenitis?

A
  • Self-limiting (6w)
  • Secondary ix for atypical lymphadenitis
  • Abx if secondary bacterial infection
66
Q

What is the management for thyroglossal cyst / branchial cleft abnormality?

A

Asx = conservative
Sx = Sistrunk’s procedure (surgical removal)

67
Q

What are the investigations for cellulitis?

A
  • Mark the area of cellulitis
  • FBC
  • Purulent focus culture and molecular diagnostics
  • Do NOT take blood or swabs routinely if mild
68
Q

What is the management for cellulitis?

A

High-dose flucloxacillin for 7d:

  • Penicillin allergy: clarithromycin
  • Arrange RV in 48hrs by phone or in person

Near eyes or nose:

  • Co-amoxiclav

If cellulitis occurring on top of VZV:

  • Flucloxacillin + amoxicillin
  • Penicillin allergy: ciprofloxacin + metronidazole / clarithromycin

Advice:

  • Paracetamol or ibuprofen to relieve pain or discomfort
  • Safety net - seek help if it gets worse or doesn’t improve in 24-48 hours
69
Q

What are the S/S of eczema herpeticum?

A
  • Rapid onset
  • Clusters of itchy and painful blisters
  • They are often blood-stained i.e., red, purple or black
  • They may weep or bleed.
  • Older blisters crust over and form sores (erosions)
  • Fever
  • Swollen local lymph nodes
70
Q

What is Pityriasis Rosea?

A

Reaction to a viral infection (reactivation of HSV6 and HSV7)

71
Q

What are the S/S of pityriasis rosea?

A
  • ‘Herald patch’ - initial truncal, oval, red, scaly, 2-5cm
  • Followed by secondary rash 1-20d later - smaller, scaly patches mostly distributed on chest and back
72
Q

What is the management of pityriasis rosea?

A

Self-limiting, resolves in 6-12 weeks

Conservative:

  • Emollients
  • Bathing/showering with plain water and bath oil, or another soap substitute

Medical:

  • Moderate topical steroid and oral antihistamines may reduce itch
  • If severe itching - treatment with zinc oxide, calamine lotion, and even oral steroids may be helpful
  • Severe cases - 7d course of aciclovir may lead to faster resolution of lesions and help to relieve itching
  • Extensive/persistent cases - phototherapy
73
Q

What is scabies?

A

Rash caused by parasitic mite > hypersensitivity to mite faeces after 4-6wks

74
Q

How is scabies transmitted?

A

Skin-to-skin contact
Bedding / furnishings

75
Q

What are the S/S of scabies?

A
  • Itchy rash
  • Worse at night
  • In web spaces between fingers, on palms and wrists
  • Truncal in infants
76
Q

What is the management of scabies?

A

TREAT WHOLE HOUSE AND CLOSE CONTACTS

  • Permethrin 5% cream
  • Provide information on scabies
  • Advice - wash all bed linen and clothes
77
Q

What is Stevens-Johnson syndrome (SJS)?

A

A rare, serious disorder of the skin and mucous membranes

Usually caused by an allergic reaction to medication or infection

78
Q

What causes SJS?

A

Most commonly associated with anticonvulsants and antibiotics

79
Q

What are the S/S of SJS?

A
  • Prodromal illness for several days (like UTRI)
  • Followed by abrupt onset of tender skin rash
  • Starts on trunk then spreads to face and limbs within hours (scalp, palms, soles = usually spared)
  • Lesions = diffuse erythema / targetoid > becomes flaccid blisters
  • Top layer of affected skin then dies, sheds and begins to heal after several days
  • Nikolsky sign = blisters and erosions appear when skin is slightly rubbed
  • At least 2 mucosal surfaces are affected
80
Q

What is the management of SJS?

A

MEDICAL EMERGENCY, usually requires admission

  • Stop offending drug
  • Supportive care e.g. pain relief, fluids, wound care
  • +/- topical steroids, abx, IVIG
81
Q

Dermoid cyst?

A
  • Multiloculated and heterogeneous
  • Most are located above the hyoid, and their appearances on imaging differentiate them from thyroglossal cysts.
  • Contain variable amounts of calcium and fat
82
Q

Cystic hygroma?

A
  • Soft and transilluminate
  • Most are located in the posterior triangle

Paeds (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions