Dermatology Flashcards
How to manage seborrheic dermatitis on scalp in an infant
- if doesnt work
- if sx don’t resolve after a certain time
Reassure not serious and that will resolve over a few weeks- by 8 months normally
Massage an emollient into scalp which loosens scales which can then gently brush and then wash off with shampoo
If this doesnt work then apply a topical imidazole cream
- clotrimazole 1% 2-3x up to 4 weeks
- miconazole 2x up to 4 weeks
If haven’t resolved after 4 weeks then seek specialist help
How to manage seborrheic dermatitis in areas other than the scalp
Bathe the child using an emollient instead of soap
Can consider topical imadizole for up to 4 weeks
What drug can be considered in persistent nappy rash over 4 weeks
1% hydrocortisone
Management of seborrheic dermatitis in children
Ketoconazole shampoo 2% twice a week for 4 weeks then 1-2x a week for maintenance or selenium sulphide shampoo
To remove scales can use warm olive oil or salicylic acid and cocunut oil for thicker scales
What can use in children if ketoconazole not appropriate
Shampoos containing zinc, coal tar or salicylic acid
Treatment for necrotising fasciitis
Surgical emergency
Surgical debridement of infected areas and devitalised tissues
IV fluids
Empirical abx-2 or 3 at same time
Can use IVIG
How is atopic eczema assessed (the skin itself)
Clear- normal skin
Mild- areas of dry skin, infrequent itching with or without areas of redness
Moderate- areas of dry skin, frequent itching, redness wuth or without skin thickening or excoriation
Severe- widespread areas of dry skin, incessant itching, with or without excoriation, bleeding, thickening)
How is atopic eczema assessed (QOL)
Clear- no impact
Mild- little impact on everyday activities, sleep, psychosocial wellbeing
Moderate- Moderate impact on everyday
Severe- severe limitation to every day life
Mild atopic eczema treatment
Emollients
Mild topical corticosteroid- 1% hydrocortisone used until 48 hours after flare controlled
Moderate eczema treatment
-2nd line
Emollients
Moderate topical corticosteroid- betamethasone valerate 0.025% used until 48 hours after flare controlled
1 month of non-sedating anti-histamine if severe itching/urticaria
2nd line-topical calcineurin inhbitor
Severe atopic eczema treatment
Emollient
Potent topical corticosteroid- betamethasone valerate 0.1% until 48 hours after flare controlled
Maintenance regime of topical corticosteroids
Occlusive dressing worn for 2-3 days
Wet stockinette wraps with diluted topical steorids and emollients
If severe itching 1 month non-sedating antihistamine
If sleep affected 2 weeks sedating antihistamine
Oral corticoseroids if severe psych distress or severe and extensive
Phototherapy last option
Example of sedating anti-histamine
Chlorphenamine
When are oral corticosteroids used in atopic eczema
Psych distress from severe and extensive
Second line calcineurin inhibitor
Conservative management of atopic eczema
Identify and educate about triggers
Cut nails short
Safety net about eczema herpeticum
Advice for using topical corticosteroids
Only use 1or 2 times a day only on the area
When are bandages used in eczema
Chronic lichenified skin
In short term flares 7-14 days
What is the management of infected eczema
Swab the area
1st line flucloxacillin (oral if systemic, topical if local)
Educate about emollient hygiene so using a spatula and not leaving bottle open
What determines method of administration in infected eczema
Local is topical
Systemic use oral
What to use in recurrent infections for eczema
Chlorhexidine
Treatment for eczema herpeticum
Oral aciclovir and refer for dermatological advice
Management of eczema herpeticum if around the eyes
Refer for same say opthalmological and dermatological advice
How does eczema herpeticum appear
Rapidly worsening painful eczema
Clustered blisters
Punched out erosions
What abx used for infected atopic eczema if penicillin allergic
Erithomycin
Indications for eczema referral
Herpeticum
If severe eczema hasnt responded to tx in a week
If infected hasnt responded to tx
Uncertain diagnosis- maybe contact dermatitis