Dermatology Flashcards
Name several common skin conditions affecting infants and children
- Nappy rash/irritant dermatitis
- Atopic eczema
- Seborrheic dermatitis
- Molluscum contagiosum
- Impetigo
Describe the appearance of irritant dermatitis nappy rash. What is the cause? What is a differential and how is this different?
Erythematous macular rash affecting the nappy area, typically sparing the flexor areas
Irritant dermatitis caused by ammonia in urine
Nappy rash can also be caused by Candida infection- this usually affects the flexures, may have satellite lesions
What is the management of nappy rash?
Conservative: time with nappy off for drying, changing nappy as soon as possible after soiling with gentle wipes + drying, daily baths, no soaps/lotions/talcum
- If irritant: emollients (Bepanthen, Sudocrem) after cleaning -> topical corticosteroids
- If Candida: topical antifungals eg clotrimazole
Describe the presentation of seborrheic dermatitis. What is it caused by?
Seborrheic dermatitis is a fungal infection of the stratum corneum. Causes a non-pruritic scaly yellow crust, usually on the scalp (cradle cap). Can also affect the neck folds and just be erythematous.
Caused by Malassezia furfur
Describe the management of seborrheic dermatitis
Cradle cap: Reassure that it is very common, often resolves within months.
- Bath daily with mild baby soap, gently brush the skin
- Olive oil/vaseline can help the scales to soften and come off -> leave overnight and wash in morning
- Antifungal creams eg. clotrimazole can be used if no improvement with conservative measures
Describe the presentation of atopic eczema
Very common - 20% of infants. Often FHx
Itchy, dry, erythematous rash. Usually affects the face + hands in infants -> flexures in children
May cause excoriations due to itching, long term can cause lichenification. Can have bacteria superinfection
What are some complications of eczema
- Bacterial superinfection eg. Staph, Strep
- Viral superinfection eg. HSV (eczema herpeticum)
- Allergen inoculation eg. peanut allergy
Describe the management of atopic eczema
Conservative: avoid irritants, use emollient creams all over body every day + in place of soap/shampoo, wrap to prevent itching, cut nails
Medical:
Mild: emollients + 1% hydrocort
Mod: emollients + 0.025% betamethasone/0.05% clobetasone -> topical calcineurin inhibitor (tacrolimus)
Sev: 0.1% betamethasone -> topical calcineurin i
-Phototherapy
Complications: antibiotics, antivirals
An 8 month old child has just been diagnosed with mild atopic eczema. How would you counsel the parents?
- Explain diagnosis, very common, usually outgrow
- Cons Mx: reduce itching (cut nails), avoid irritants eg. soaps, lotions
- Mainstay of treatment is emollient creams eg. Aveeno, e45 used every day, also in place of soap/shampoo
- During flareups, steroid creams are very helpful in shortening flareup and reducing symptoms. Start with very weak steroid creams, can increase if needed. Only used short-term
- Direct to itchy weezy sneezy for info on applying steroids (fingertip units-FTU)
- Safety net: TCI if rash worsens, not controlled with treatment, or worse red/oozy/blisters
Describe the presentation of warts. What is the cause? What is the management?
Fleshy coloured scaly papules usually on fingers/feet.
Caused by HPV. Need to consider sexual abuse if genital.
Management:
-Topical salicyclates/glutaraldehyde 10% lotion
-Cryotherapy
Describe the presentation of molluscum contagiosum. What is the cause? What is the managment?
Small pearly papules with central umbilication
Caused by poxvirus. Very contagious in young kids
Management: reassure that they usually clear spontaneously within a year. Avoid sharing towels.
Describe the presentation of ringworm. What is the cause and how is it classified?
Itchy, erythematous annular lesions with scaling. May be multiple, grow in size. On scalp can cause alopecia. Can be mistaken for eczema, but will get worse with steroid use.
Can form a boggy pustular infection (kerion)
Caused by dermatophyte fungal infection of the skin. Named by the location eg. Tinea capitis, tinea corporis.
What is the management of ringworm?
Conservative: good hygiene- avoid sharing towels. Daily bathing and dry well. Loose fitting clothing
Mild: topical antifungals eg clotrimazole +/- steroid if inflammation
Severe/scalp: systemic antifungals eg oral terbinafine. Can also use antifungal shampoo for scalp infection
Describe the presentation of scabies. What is the cause?
Very itchy burrows/papules/vesicles, typically on the hands, flexures.
Caused by Sarcoptes scabiei infection (mites)
What is the management of scabies?
Wash bedding + clothing, don’t share towels, household should be treated.
1st line: topical permethrin cream to whole body (except face). Apply and wash off after 8-12 hours.
2nd line: ivermectin cream
