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Y5 Paediatrics > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Define Acne Vulgaris.

A

Disorder of pilosebaceous follicles found in the face and upper trunk.

  • An opportunistic bacteria (normal skin flora) plays a role → Propionibacterium acnes
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2
Q

What are the levels of acne?

A
  1. Comedones - follicles impacted and distended by incompletely desquamated keratinocytes and sebum → Blackheads (open) or Whiteheads (closed)
  2. Papules and pustules
  3. Nodulocystic and scarring
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3
Q

What are the signs and symptoms of dermatology?

A
  • Greasy face
  • Comedones, papules, pustules, nodules
  • Psychological impact → low self-esteem
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4
Q

What is the management of acne vulgaris?

A
  • Advice
    • Cleaning face → avoid over-cleaning the skin (twice a day with gentle soap is ok)
    • Make-up → use emollients and cleansers, non-comedogenic preparations
    • Face → avoid picking and squeezing scars due to the risk of scarring
  • Medications = stepwise approach - review every 8-12w
    • Mild to Modeerate
      • Topical retinoid ± benzoyl peroxide (BPO)
      • Topical antibiotic (clindamycin) + benzoyl peroxide (BPO)
      • Azelaic acid 20%
    • Moderate not responding to topicals:
      • Oral antibiotic (max 3m) + BPO / retinoid
        • 1st line = tetracyclines
        • 2nd line = macrolides
      • COCP + BPO / retinoid
    • Severe = Dermatologist referral = Oral isotretinoin = Roaccutane
  • Once cleared, maintain with topical retinoids or azelaic acid (20%)
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5
Q

What are the side effects of roaccutane?

A
  • Dryness
  • Pruritis
  • Conjunctivitis
  • Muscle aches
  • Teratogenic
    • Must be on 2 forms of contraception
  • Deranged LFTs
  • Low mood and Suicidal ideation
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6
Q

What is roaccutane?

A

Synthetic form of Vitamin A.

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7
Q

What are the indications for a dermatologist referral for acne vulgaris?

A
  • Nodulocystic acne / scarring
  • Severe form - acne conglobata, acne fulminans
  • Severe psychological distress
  • Diagnostic uncertainty
  • Failing to respond to medications
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8
Q

Define Milia.

A

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

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9
Q

What are the signs and symptoms of milia?

A
  • Neonatal - affects up to 50% of new-borns
    • Often nose, but also mouth, palate, scalp, face, upper trunk
    • Heal spontaneously within a few weeks
  • Primary:
    • Around eyelids, cheeks, forehead, genitalia
    • Should clear in a few weeks
    • Associated with trauma
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10
Q

What is the management of milia?

A

Self-limiting

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11
Q

Define Molluscum Contagiosum.

A

Common viral infection (molluscum contagiosum / pox virus) transmitted by skin-to-skin transmission.

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12
Q

What are the signs and symptoms of molluscum contagiosum?

A
  • ≥1 small pink skin-coloured or pearly papules, ulcerated/umbilicated
  • Painless but may be itchy occasionally
  • Commonly found on the chest, abdomen, back, armpits, groin, back of knees
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13
Q

What is the management of molluscum contagiosum?

A
  • Acute = Self-resolving → 6-9 months - normally within the year
    • No need to avoid school
    • Wear long-sleeve clothes and don’t share towels
  • Chronic (>2 years) = Cryotherapy
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14
Q

Define Eczema.

A

Chronic, relapsing, inflammatory skin condition characterised by an itchy red rash.

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15
Q

What are the common triggers for eczema?

A
  • Irritants
  • Contact allergens
  • Extremes of temperature
  • Abrasive fabrics
  • Sweating
  • Dietary factors (10%)
  • Inhaled allergens - pollens, dust mite
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16
Q

Where is eczema commonly found?

A
  • Infant = face and trunk
  • Older child = extensors of limbs
  • Young adult = localises to flexures
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17
Q

What is the classification of eczema?

A
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18
Q

What are the appropriate investigations for suspected eczema?

A
  • Consider food allergies → blood or skin prick testing
  • Consider contact dermatitis → patch testing
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19
Q

What is the management of eczema?

A
  • Mild
    • Emollients
    • Mild topical corticosteroids
  • Moderate
    • Emollients
    • Moderate topical corticosteroids
    • Topical calcineurin inhibitors
    • Bandages
  • Severe
    • Emollients
    • Potent topical corticosteroids
    • Systemic therapy
    • Phototherapy
    • Topical calcineurin inhibitors
    • Bandages
  • Antihistamines
    • Severe itching / urticaria = non-sedating antihistamine (e.g. fexofenadine, cetirizine)
    • Sleep disturbance = 7-14-day trial of a sedating antihistamine (e.g. promethazine)
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20
Q

What is the management of infected eczema?

A
  • Skin swab and culture
  • Oral flucloxacillin - erythromycin if pen-allergic
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21
Q

What is the management of eczema herpeticum?

A
  • Oral aciclovir
  • If around eyes = same day referral to ophthalmologist
  • Health education
    • Rapidly worsening eczema, clustered blisters, punched-out erosions = Emergency
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22
Q

What are the indications for a specialist referral for eczema?

A
  • Immediate
    • Eczema herpeticum
  • Urgent referral (<2 weeks)
    • Severe atopic eczema not responded to optimum therapy within 1-week
    • Bacterially infected eczema treatment failure
  • Non-urgent referral (>2 weeks)
    • Diagnosis uncertain
    • Atopic eczema on face not responding
    • Contact allergic dermatitis causing significant social and psychological problems
    • Severe recurrent infections
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23
Q

What counselling should be given to parents with a child with eczema?

A
  • Explain the diagnosis - characterised by dry, itchy skin
  • Explain it is very common and many children grow out of it
  • Explain the management (and use of steroids if necessary)
  • Encourage frequent, liberal use of emollients - and as a soap substitute)
  • Explain the association with other atopic conditions
  • Advise avoidance of triggers - e.g. types of clothes, detergents, soaps, animals
  • Avoid scratching
  • Safety net about signs of infection or eczema herpeticum
  • Information and Support
    • Itchywheezysneezy.co.uk – excellent website demonstrating how to apply emollients
    • British Association of Dermatologists (BAD) – has an information leaflet on atopic eczema
    • National Eczema Society – has fact sheets
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24
Q

What are the causes of impetigo?

A
  • Common skin infection
    • Staphylococcus aureus
    • Streptococcus pneumonia
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25
Q

What are the signs and symptoms of impetigo?

A

Golden-yellow crusted appearance - Honeycomb scab

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26
Q

What is the diagnosis?

A

Impetigo

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27
Q

What is the diagnosis?

A

Milia

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28
Q

What is the diagnosis?

A

Molluscum Contagiosum

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29
Q

What is the management of impetigo?

A
  • Localised, non-bullous = Topical H2O2 1% cream → Topical fusidic acid (2%) antibiotic
  • Widespread, non-bullous = Oral flucloxacillin or Topical fusidic acid (2%) antibiotic
  • Bullous, systemically unwell = Oral flucloxacillin
  • School exclusion - until lesions crusted over or 48 hours after Abx started
30
Q

What is the most common form of nappy rash?

A
  • Most commonly a form of contact dermatitis
    • Babies 3-15 months of age
    • Follows damage to normal skin barrier – urine, faeces, friction, pre-existing conditions, damp predisposition
31
Q

What are the signs and symptoms of irritant nappy rash?

A
  • Erythematous macules and papules in genital area
  • Well-demarcated variety of erythema, oedema, dryness, scaling
  • Sparing skin folds → just skin in contact with nappy is erythematous
32
Q

What are the signs and symptoms of candida albicans nappy rash?

A
  • Erythematous macules and papules in genital area - with small satellite spots or superficial pustules
  • Sharply demarcated erythema
  • Check for oral candidiasis
33
Q

What are the signs and symptoms of seborrhoeic nappy rash?

A
  • Erythematous macules and papules in genital area
  • Cradle cap and bilateral salmon pink patches
  • Desquamating flakes
  • Skin folds
34
Q

What is the management of nappy rash?

A
  • Health education
    • Refer to NHS choices nappy rash leaflet/website)
    • Nappy type → high-absorbency nappies that fit properly, disposable preferable to towel nappies
    • Leave nappy off as much as possible to help skin drying
    • Clean/change every 3-4 hours / ASAP after soiling
      • Use water, or fragrance-free or alcohol-free baby wipes
      • Dry gently after cleaning
      • Bath the child daily (do NOT use soap, bubble bath, lotions or talcum powder)
  • If mild erythema and the child is asymptomatic
    • Advise on the use of barrier preparation at each change (available OTC)
    • Zinc and Castor oil ointment BP, Metanium ointment, white soft paraffin BP ointment
  • If moderate erythema and discomfort
    • If >1-month-old = hydrocortisone 1% cream OD (max 7 days)
  • If rash persists and Candida
    • Advise against the use of barrier protection
    • Topical imidazole cream (clotrimazole, econazole, miconazole)
  • If rash persists and/or Bacterial infection
    • Prescribe oral flucloxacillin (clarithromycin if pen-allergic) for 7 days
    • Arrange to review the child
35
Q

Define Seborrhoeic Dermatitis?

A

Dandruff presents in first 6 weeks - resolves over following weeks.

36
Q

What are the signs and symptoms of seborrhoeic dermatitis?

A
  • Flaking skin on scalp (infants)
  • Erythematous, yellow, crusty, adherent layer (cradle cap) that can spread to behind ears, face, flexures → non-itchy - Pityriasis versicolor (associated with Malassezia yeasts)
37
Q

What is the cause of Pityriasis versicolor?

A

Malassezia furfur

38
Q

What are the appropriate investigations for suspected seborrhoeic dermatitis?

A
  • Clinical diagnosis
  • Skin scrapings for Malassezia
  • Culture of swabs
39
Q

What is the management of seborrhoeic dermatitis?

A
  • Spontaneous resolution (by 8m)
  • 1st line if scalp affected = regular washing with baby shampoo and gentle brushing to remove scales
    • Soaking crusts overnight with white petroleum jelly or slightly warmed vegetable/olive oil, and shampooing in the morning / soften scales with baby oil, gentle brush, wash off with baby shampoo
    • Emulsifying ointment can be used if these measures don’t work
    • If other areas of skin affected, bathe infant ≥1/day using emollient as a soap substitute
  • 2nd line if scalp affected = topical imidazole cream (e.g. clotrimazole, econazole, miconazole)
    • Consider specialist advice if it lasts >4 weeks
  • 3rd line if severe = mild topical steroids (e.g. 1% hydrocortisone)
40
Q

Define Tinea.

A

Fungal infection in which dermatophyte fungi invade dead keratinous structures.

41
Q

What are the signs and symptoms of tinea?

A
  • Ringed appearance ± kerion (severe inflamed ringworm patch), red or silver rash
  • Tinea capitis – scalp
  • Tinea pedis – feet
42
Q

What is the diagnosis?

43
Q

What is the management of Tinea (Faciei, Corporis, Cruris or Pedis)?

A
  • Mild = topical antifungals (e.g. terbinafine cream, clotrimazole)
  • Moderate = hydrocortisone 1% cream
  • Severe = oral antifungals
    • 1st line = oral terbinafine
    • 2nd line = oral itraconazole
  • Advice - very contagious so take steps to prevent spread
    • Wear loose-fitting cotton clothing
    • Wash affected areas of skin daily
    • Dry thoroughly after washing
    • Avoid scratching
    • Do not share towels
    • Wash clothes and bed lined frequently
    • No need for school exclusion
44
Q

What is the management of Tinea Capitis?

A
  • Oral antifungal (e.g. griseofulvin or terbinafine)
  • Advice - very contagious so take steps to prevent spread
    • Wear loose-fitting cotton clothing
    • Wash affected areas of skin daily
    • Dry thoroughly after washing
    • Avoid scratching
    • Do not share towels
    • Wash clothes and bed lined frequently
    • No need for school exclusion
45
Q

What is the cause of scabies?

A

Sarcoptes scabiei

46
Q

What are the signs and symptoms of scabies?

A
  • Intense itching, especially at night
  • Raised rash or spots
47
Q

What is the diagnosis?

48
Q

What is the management of Scabies?

A
  • Antibiotics → Permethrin
  • Advice - very contagious so take steps to prevent spread
    • Wear loose-fitting cotton clothing
    • Wash affected areas of skin daily
    • Dry thoroughly after washing
    • Avoid scratching
    • Do not share towels
    • Wash clothes and bed lined frequently
    • No need for school exclusion
49
Q

What is Mongolian Blue Spot?

A

Blue/black macular discolouration at base of the spine and on buttocks

  • Far more common in Afro-Caribbean or Asian infant
50
Q

What is management of Mongolian Blue Spot?

A

Self-limiting → fade slowly over the first few years (by 4yo)

51
Q

What is Naevus flammeus?

A
  • Vascular malformation which present at birth
  • Port-wine stain in distribution of trigeminal nerve
  • Associated with
    • Sturge-Weber syndrome - GNAQ mutation à intracranial lesions
      • Flat patch → becomes bumpy
      • Epilepsy, contralateral hemiplegia, intellectual disability
    • Parkes Weber syndrome
    • Kippel-Trénaunay syndrome
    • Proteus syndrome
52
Q

What is Naevus simplex?

A
  • Vascular malformation which present at birth
  • Pink or red patch at birth
  • Goes redder when the infant cries
  • AKA: Salmon patches, Stalk bites, Angel’s kiss
53
Q

What are the appropriate investigations for vascular malformations?

A
  • Mainly clinical diagnosis
  • 1st = USS
  • 2nd = MRI (Sturge-Weber)
54
Q

What is the management of vascular malformations?

A
  • Conservative
    • Naevus flammeus = life-long
    • Naevus simplex = usually fade in first few years
55
Q

What are the signs and symptoms 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 the face and spreads to the limbs
56
Q

What are the appropriate investigations for suspected erythema toxicum?

A
  • Exclude congenital infections
57
Q

What is the management of suspected erythema toxicum?

A
  • Self-limiting
    • Benign - affects 50% of new-borns
58
Q

What are the risk factors for Infantile Haemangioma?

A
  • LBW
  • Prematurity
  • Female
  • Multiple gestation
59
Q

What are the signs and symptoms of superficial infantile haemangioma (85%)?

A
  • Bright red area of skin that feels warm
  • Not present at birth → appear in few days/weeks → rapidly grow → regress over 1-2 years
  • Located - upper eyelids, midforehead, nape of neck
60
Q

What are the signs and symptoms of deep infantile haemangioma (15%)?

A
  • Blue in colour that forms a lump
  • Not present at birth → becomes evident after a few weeks
  • May just look like a lump of normal skin
61
Q

What are the signs and symptoms of mixed infantile haemangioma?

A

Bright red area on blue area/lump

62
Q

What are the syndromes associated with infantile haemangiomas?

A
  • Kasabach-Merritt
    • Haemangioma with thrombocytopenia
  • PHACES syndrome
    • Posterior fossa malformations
    • Haemangioma
    • Arterial anomalies
    • Cardiac anomalies / Co-arctation of the aorta
    • Eye anomalies
    • Sternal anomalies
  • LUMBAR syndrome
    • Lower body or lumbosacral haemangioma
    • Urogenital anomalies or ulceration
    • Myelopathy
    • Bony deformities
    • Anorectal and arterial anomalies
    • Renal anomalies
63
Q

What are the appropriate investigations for suspected infantile haemangioma?

A
  • Clinical diagnosis
  • USS → MRI / MRA - gold-standard to diagnose complex vascular tumours if the lesions are:
    • Deep
    • Single large capillary haemangioma
    • Multiple haemangiomas
    • Near the eye
64
Q

What is the management infantile haemangiomas?

A
  • Conservative
    • Try not to catch it
    • Use Vaseline and avoid irritants)
    • Medical photography + review in 3 months
  • Topical or intra-lesional steroid
  • Topical timolol if small and near
    • Eyes
    • Lips (often becomes ulcerated)
    • Nappy area
    • Nasal tip
    • Ear
  • Larger lesions = Oral propranolol
  • Ulceration (10-20%) = Antibiotics and Analgesia
65
Q

What are the reasons for referral of an infantile haemangioma?

A
  • Function threatening - periocular, nasal tip, ear, lips, genetalia
  • Large facial, anogenital, perineal
  • Lumbosacral
  • Ulcerating
  • “Beard” distribution (laryngeal haemangioma) → ENT referral
  • Multiple lesions (>5 = USS liver)
66
Q

What are the types of congenital haemangioma?

A
  • Rapidly involuting congenital haemangiomas (RICH)
    • Maximum size by birth → involute by 12-18 months
  • Non-involuting congenital haemangiomas (NICH)
    • Continue to grow as baby grows
    • Do not shrink after birth (unlike infantile haemangiomas and RICH)
  • Partially involuting congenital haemangiomas (PICH)
    • Combination RICH and NICH types
67
Q

What are the signs and symptoms of congenital haemangioma?

A
  • Present at birth
  • Raised or flat, pink or purple
  • Transient thrombocytopenia
  • Rarer than infantile haemangioma
68
Q

What are the appropriate investigations for suspected congenital haemangioma?

A
  • USS
  • Medical photography
69
Q

What is the management of congenital haemangioma?

A
  • Conservative
  • Embolisation - if they need to be removed
70
Q

What are the complications of haemangiomas?

A
  • Infantile = Ulceration
  • Congenital = Heart failure - if large enough to generate high blood flow
71
Q

What is the grading of acne vulgaris?

A
  • Mild
    • <20 comedones
    • <15 inflammatory lesions
    • Or total lesion count <30
  • Moderate
    • 20-100 comedones
    • 15-50 inflammatory lesions
    • Or total lesion count 30-125
  • Severe
    • >5 pseudocysts
    • >100 comedones
    • >50 inflammatory lesions
    • Or total lesion count >125

Y5 Paediatrics (26 decks)

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