Derm - Infections & Systemic

Question 1

Try to think of the major childhood infections:

Answer 1

• Impetigo
• Molluscum Contagiosum
• Warts
• Viral Exanthems
  e.g. Chicken pox, slapped cheek and Hand, Foot & Mouth disease

Question 2

Define Impetigo?

Answer 2

An acute superficial bacterial infection caused by Staph Aureus

Question 3

What would impetigo look like?

Answer 3

Honey coloured crusted lesions, often on face
Pustules

Question 4

How would you treat impetigo?

Answer 4

With Abx:
- Topical (Fucidin)
- Oral (Flucloxacillin)

Question 5

What does molluscum Contagiosum look like?

Answer 5

Pearly nodules with umbilicated centre

Question 6

What causes Mollusucum Contagiosum and how do we treat it?

Answer 6

Molluscipox Virus

Self limiting so just reassurance mostly (24 months to clear)

Can use 5% Potassium Hydroxide

Question 7

What causes viral warts?

Answer 7

HPV

Question 8

How do you treat viral warts?

Answer 8

SElf-limiting (24 months avg)

• Reassurance
• Cryotherapy
• Topical paints (Salicylic Acid)

Question 9

What is a viral exanthem?

Answer 9

A widespread rash caused by a viral illness e.g. chicken pox

Question 10

What causes Chiken pox and how is it transmitted?

Answer 10

Primary VZV infection

Contagious from:
- 1-2days before rash appears
- Until lesions have crusted

Question 11

What does chicken pox look like?

Answer 11

Red papules –> Vesicles
Itchy
Starts on trunk

+Viral symptoms e.g. runny nose, fever etc

Question 12

How do you manage chicken pox?

Answer 12

It’s self-limiting so just infection control i.e. keep out of nursery

Question 13

What are the rare complications of chicken pox?

Answer 13

encephalitis
Pneumonia

Question 14

What causes Slapped Cheek?

Answer 14

Parvovirus B19 target Red cells in the marrow

Question 15

What does Slapped Cheek Look like?

Answer 15

A red rash on face
Progresses to a lace-like network rash on the trunk/limbs

+ Viral Symptoms

Question 16

How do we manage Slapped Cheek?

Answer 16

Self-limiting so mostly just reassure (takes up to 6wks to fade)

Question 17

Complications of slapped cheek?

Answer 17

Aplastic Crisis (if haemolytic)

Risk to pregnant women of abortion, IUD & Hydrops Fetalis

Question 18

What causes hand, foot and mouth disease?

Answer 18

Coxsackie Virus A16

Question 19

What does H, F & M look like?

Answer 19

Blisters on the hand, foot and mouth

+ viral symptoms

Question 20

How do we manage H, F & M?

Answer 20

SElf-limiting like the other viral exanthems

Just give supportive therapy

Question 21

What are the major systemic skin conditions in kids?

Answer 21

• Orofacial Granulomatosis ass with crohn’s
• Dermatitis Herpetiformis ass with Coeliac

Erythema Nodosum (ass with IBD)

Urticaria

Question 22

What does Orofacial granulomatosis look like?

Answer 22

Lip swelling + fissuring

Oral Mucosal lesions with a cobblestone appearance

Question 23

What could cause erythema nodosum?

Answer 23

• Inf e.g. Strep, mycobacteria or URTI
• Drugs e.g. Penicillin, OCP & Sulphonamides
• Sarcoid
• IBD
• Idiopathic

Question 24

What does erythema nodosum look like?

Answer 24

Erythematous subcu nodules, mostly on shins

Question 25

What does Dermatitis Herpetiformis look like?

Answer 25

ITchy clusters of blisters

Often symmetrical

Scalp, shoulder, buttock, knee and elbow

Question 26

How do you test for an treat Dermatitis Herpetiformis?

Answer 26

Confirm Coeliac:
- HLA test
- Distal Duodenal Biopsy
- Skin Biopsy

Emollients and topical steroids
Dapsone (abx)
Gluten restriction

Question 27

Finally what does urticaria look like?

Answer 27

Red rash that rises and fall rapidly (minutes up to 24 hours)

+~10% get angioedema

Question 28

What can cause urticoaria?

Answer 28

Chronic is mostly idiopathic (prob autoimmune)

Acute (<6wk) could be:
- Meds e.g. NSAIDs or Opiates
- Food or Med Allergy
- Viral/Bacterial Inf
- Vaccination

Question 29

How do you manage Urticaria?

Answer 29

Try removing triggers e.g. meds or foods

1) Antihistamines
2) H2 receptor antagonist (Ranitidine)
3) Montelukast
4) Omalizumab (mAB)
5) Cyclosporin (Immunosuppresant)