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YEAR 4 PAEDS > Derm > Flashcards

Derm Flashcards

1
Q

What is Impetigo?

A
  • superficial bacterial skin infection usually caused by either Staphylcoccus aureus or Streptococcus pyogenes
  • can be primary infection or complication of an existing skin condition such as eczema, scabies or insect bites
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2
Q

Who is most likely to get Impetigo?
Where does it typically occur?

A
  • More common in children
  • Particularly during warmer weather
  • Tend to occur on the face, flexures and limbs no covered by clothing
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3
Q

How is Impetigo spread?

A
  • Direct contact with discharge from the scabs of infected person
  • Bacteria enter skin through minor abrasions
  • Infection is spread mainly by hands but can spread via toys, clothing, equipment and the environment may occur
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4
Q

Incubation period for Impetigo?

A
  • Golden crusted lesions, typically found around the mouth
  • Very contagious

4-10 days

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5
Q

Management of limited, localised disease - impetigo?

A
  • 1st line: Hydrogen peroxide 1% creams- for people who are not systemically unwell or at high risk of complication
  • Topical abx creams: Topical fusidic acid, topical mupirocin should be used if fusidic acid resistance is suspected
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6
Q

Management of extensive Impetigo?

A
  • Oral flucloxacillin
  • Oral erythromycin if penicillin allergic
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7
Q

Do children who have Impetigo need to be excluded from school?

A
  • Children should be excluded from school until lesions are crusted and healed
  • OR 48 hours after commencing abx treatment
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8
Q

What is infantile acne?

A
  • < 3months of life,
  • Transient
  • Usually due to maternal androgens
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9
Q

What is the pathophysiology of adolescent acne?

A
  • Increased sebum production: androgenic stimulation of hyper-responsive pilosebaceous units
  • Impaired flow of sebum: Obstruction of the pilosebaceous duct by hyperkeratosis
  • Propionobacterium acnes: gram postive anaerobe is implicated in the inflammation
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10
Q

Risk factors for adolescent acne?

A
  • Puberty
  • May increase pre-menstrually
  • POS
  • Excess cortisol
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11
Q

Presentation of acne?

A
  • Greasy skin- may be painful
  • Open comedones: whiteheads
  • Closed comedones: blackheads
  • Other features: pustules, nodules, cysts, scarring, seborrhoea
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12
Q

Investigations for Acne?

A
  • Usually clinical diagnosis, unless other signs of andorgen excess e.g. pre-pubertal body odour, axillary/pubic hair or genital maturation; postpubertal infrequent menses, hirsuitism, or truncal obesity
  • If androgen excess suspected: Bloods (free testosterone), FSH, LH
  • Urine: 24 hour urinary cortisol (if suspect Cushings)
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13
Q

General Mangement for Acne?

A
  • Non-greasy cosmetics
  • Daily face wash
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14
Q

Complications of Acne treatment?

A
  • Facial scarring
  • Hyperpigmentatio
  • Secondary infection
  • Fistulas
  • Psychosocial: Lack of self-confidence
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15
Q

What are abx available for acne management?

A
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16
Q

What are topical preparations available for acne management?

A
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17
Q

What is atopic Eczema?

A
  • Chronic inflammatory itchy skin condition
  • Same as atopic dermatitis: except atopic dermatitis has more clear trigger
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18
Q

Environmental factors that can trigger atopic ezcema?

A
  • Irritants
  • Infections
  • Contact with food or inhalant allergens
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19
Q

Presentation of Atopic Ezcema?

A
  • Majority begins first year of life
  • Intense itchy skin
  • Chronic relapsing inflammation of skin are cardinal features
  • Infantile: affects face and extensor surfaces and spares the nappy area
  • Older children: Flexural involvement more common
    *
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20
Q

Presentation of ezcema herpeticum rash?

A
  • Widespread, painful, vesicular rash- vesicles filled with pus: when they burst they leave:
  • Small uniform circular ‘punched out erosions’
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21
Q

Investigations of ezcema

A
  • Usually clinical
  • Infants w moderate- severe ezcema w history of immediate reaction to food: Need skin prick testing to common food allergens
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22
Q

What is Ezcema Herpeticum?

A
  • Viral skin infection caused by herpes simplex virus or varicella zoster virus
  • Usually occurs in a pt with pre-existing skin condition e.g. atopic ezcema or dermatitis
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23
Q

Symptoms of Ezcema Herpeticum?

A
  • Rash: widespread- erythematous, painful with pus filled vesicles
  • Systemic symptoms: fever, lethargy, irritability and reduced oral intake
  • Lymphadenopathy
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24
Q

Investigations for Ezcema Herpeticum?

A
  • Can do viral swabs to confirm the diagnosis
  • Usually not needed: clinical diagnosis
25
Q

Management of Ezcema Herpeticum?

A
  • Aciclovir
  • Mild or moderate: oral
  • Severe: IV
26
Q

Complications of ezcema herpeticum?

A
  • Can lead to life-threatening infection: esp if immunocomprised
  • Bacterial superinfection can occur - this will need abx
27
Q

Managment of atopic ezcema?

A
  • Assess eczema severity and quality of life, incl everyday activities and sleep, and psychosocial well-being. Identify and manage any trigger factors. Give advice on prompt recognition and treatment of infection (in particular eczema herpeticum) and provide a written eczema management plan.
  • Emollients: ‘ Total emollient care ’ includes liberal application of creams and ointments, using a soap substitute and bath oil.
  • Topical corticosteroids: Use a stepwise approach to topical steroids depending on the severity of eczema. Use mild steroids for the face. In children with recurrent flares, use a topical steroid for 2 consecutive days/week.
  • Topical calcineurin inhibitors: Can be used as second-line treatment of moderate to severe atopic eczema in children 2 years that is not controlled by topical corticosteroids, or where there are adverse effects to topical steroids.
  • Wet wraps: May be particularly effective for troublesome areas (feet/hands). Not to be used over infected skin, topical potent steroids or calcineurin inhibitors.
  • Dietary manipulation: In bottle-fed infants 6 months with moderate to severe eczema not controlled by optimal treatment, 6 – 8-week trial of an extensively hydrolysed or amino acid formula in place of cow ’ s milk formula.
  • Antihistamine: If children suffer from severe itching, trial a non-sedating antihistamine.
28
Q

Complications of Ezcema?

A
  • Skin infections leading to cellulitis
  • Residual pigmentations
  • Lichenification or skin atrophy related to long- term potent steroid use
  • Psychosocial issues
29
Q

What are the 2 main types of contact dermatitis?

A
  • Irritant
  • Allergic
30
Q

What is irritant contact dermatitis?

A
  • more common
  • non- allergic reaction due to weak acids or alkalis
  • Often seen on hands
  • Erythema is TYPICAL
  • Crusting and vesicles are RARE
31
Q

What is allergic contact dermatitis?

A
  • Type IV hypersensitivity reaction
  • Uncommon
  • Most common: hair following hair dyes
  • Presents as acute, weeping ezcema- affecting margins of hairline rather than hairy scalp
  • Topical treatment with potent steroid is indicated
32
Q

What is Psoriasis?

A

Chronic autoimmune condition that causes symptoms of psoriatic skin lesions

33
Q

Describe psoriatic skin lesions

A
  • Dry, flaky, scaly, faintly erythematous skin lesions
  • Appear raised and rough plaques
  • Commonly over extensor surfaces of the elbows and knees and on the scalp
34
Q

What is the pathophysiology of psoriatic plaques?

A
  • Rapid generation of new skin cells, resulting in an abnormal build up and thickening of the skin in those areas
35
Q

What is plaque psoriasis?

A
  • Most common form in adults
  • Thickened erythematous plaques with silver scales
  • commonly seen on extensor surfaces and scalp
36
Q

What is guttate psoriasis?

A
  • commonly occurs in children
  • small raised papules across trunk and limbs
  • Papules are mildly erythematous and can be lightly scaly
  • Over time the papules can turn into plaques
  • Often triggered by a strep throat infection, stress or medications
  • Often resolves spontaneously within 3-4 months
37
Q

What is pustular psoriasis?

A
  • rare and severe form
  • pustules form underneath areas of erythematous skin
  • Pts can be systemically unwell
  • Treated as medical emergency
  • Need hosp admission
38
Q

What is Erythrodermic Psoriasis?

A
  • rare, severe form of psoriasis
  • extensive erythematous inflamed areas covering most of the surface are of the skin
  • Skin comes away in large patches- exfoliation and results in many exposed areas
  • Medical emergency- pts need admission
39
Q

Child has a throat infection, 2 weeks later they develop small raised papules across they trunk and limbs. What is this?

A
  • Guttate psoriasis
40
Q

How do psoriatic plaques differ in children compared to adults?

A

Plaques are
* smaller
* softer
* less prominent

41
Q

What are the specific signs for psoriasis?

A
  • Auspitz sign- small points of bleeding when the plaques are scraped off
  • Koebner phenomenon- refers to development of psoriatic lesions to areas of skin affected by trauma
  • Residual pigmentation- of the skin after lesions resolved
42
Q

Diagnosis of psoriasis?

A
  • Clinical, based on appearance of lesions
43
Q

Managment of psoriasis in children?

A
  • In children ususally managed and followed up by a specialist
    Treatment options:
  • Topical steroids
  • Topical vitamin D analogues (calcipotriol)
  • Topical dithranol
  • Phototherapy with narrow band ultraviolet B light is particularly useful in extensive guttate psoriasis
    If treatment fails children may be trialled on unlicensed systemic treatment e.g. methotrexate, retinoids

Topical calcineurin inhibitors (tacrolimus) are usually only used in adu

44
Q

Associations with psoriasis?

A
  • Nail psoriasis- can occur at any age: changes incl pitting, thickening, discolouration, ridging and onycholysis
  • Psoriatic arthritis- occurs within 10 years of developing skin changes- usually affects middle age but can occur at any age
  • Psychosocial
45
Q

What is a cutaneous common wart?

A
  • firm, raised papules with a rough surface that resembles a cauliflower
  • Usually asympotmatic but may be tender
46
Q

How do you diagnose cutaneous common warts?

A
  • Usually clinical
  • If doubt, light paring of the wart will reveal a tiny black dots on the surface (thrombosed capillaries)
47
Q

Managment of cutaneous warts?

A
  • Most people not a strong care for treating warts
  • Do not usually cause symptoms and in most cases will resolve within months or at most 2 years
  • Treatments incl:
  • Cyrotherapy
  • Topical salicylic acid
  • Curettage and cautery
48
Q

Adverse affects of cryotherapy for cutaneous common warts?

A
  • Several treatments
  • Can be painful
  • May cause pain, blistering, infection, scarring and depigmentation
49
Q

Adverse effects of topical salicylic acid for cutaneous common warts?

A
  • May require administration for up to 12 weeks
  • Can cause local skin irritation
50
Q

When should you consider treatment for cutaneous common warts?

A
  • Wart is painful
  • Wart is cosmetically unsightly
  • Person requests treatment, and the wart is persisiting
  • Immunosupressed patient
51
Q

What is a viral wart?

A
  • Benign lesion caused by HPV infection
  • Can be classified as cutaneous or mucosal
  • Cutaneous wart are your common warts, verrucas
52
Q

Who gets cutaneous warts?

A
  • School- aged kids
  • Dermatitis
  • Drug induced immunosupression
  • HIV patients
53
Q

What type of virus is HPV?

A
  • Double stranded DNA
54
Q

How does HPV cause cutaneous warts?

A
  • Infection begins in basal layer of epidermis
  • This causes proliferation of keratinocytes and hyperkeratosis and production of infectious viral particles- the wart
55
Q

Most common HPV types affecting the skin?

A
  • 1,2,3,4,10,27,29 and 57
56
Q

How are cutaneous warts spread?

A
  • direct skin-skin contact
  • autoinoculation
57
Q

What is a cutaneous plantar wart?

A
  • Two types:
  • Myrmecial type: Caused by HPV 1: typically tender
  • Mosaic warts: caused by HPV 2
58
Q

What is a cutaneous plane wart?

A
  • Typically multiple flat topped skin coloured papules located most commonly on face, hands and shins
  • Caused by HPV type 3 and 10

YEAR 4 PAEDS (19 decks)

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