Dermatology Flashcards
What are the types of rashes in newborns?
- bullous impetigo
- melanocytic naevi (moles)
- albinism
- epidermolysis bullosa
- colloidon baby
Bullous impetigo?
9
-Uncommon but potentially serious blistering form of impetigo
-its a superficial form of bacterial infection,often caused by staphylococcus aureus and streptococcal infections
-seen particularly in newborns
-treatment-
Systemic antibiotics (cloxacillin,flucloxacillin,fusidic acid,soframycin cream)
Local application is better in treating
Bacteeium might come from nose therefore treat the nasal carriers with mupirocine nasal application
- Auto inoculation is possible
- after few days bullae will rupture and form the crusted lesion
- shouldn’t go schooling until the last lesion is crusted
Melanocytic naevi (moles)?
7
Congenital moles occur in upto 3% and they are usually small.
Involving extensive area (>9 cm) are rare but carry a lifetime risk of 4-6% risk of subsequent malignant melanoma
Require prompt referral to paediatric dermatologist, plastic surgeon and oncologist
Become increasingly common as children gets older and presence of a large number indicates of childhood sun exposure
Prolonged exposure to sunlight should be avoided and sun screem
Malignant melanoma is rare before puberty except giant naevi
Risk factors for malignant melanoma
-positive family history
-large number of melanocyte naevi
-fair skin
-repeated exposure of sunburn
-living in hot climate with chronic skin exposure to the sun
Albinism?
6
A defect in biosynthesis and distribution of melanin
May be occular,occulocutaneous or partial
Lack of pigments in iris,retina,eyelids and eyebrows results in failure to develop fixation reflex
There is pendular nystagmus and photophobia which causes constant frowning
Complications - severe visual impairment,akin ca
Tx- correction of refractive errors,prevent from sunlight
Epidermolysis bullosa?
5 A rare group of genetic conditions with many types characterized by blistering of skin and mucous membranes AD is mild and AR is severe Blistering occurs spontaneously or following minor trauma Tx -avoid injury -treating secondary infection -maintainance of adequate nutrition -amalgesia when changing dressings -MDT approach Complications -fingers and toes fused -contracture of limbs develop from blistering and healing -oral ulceration -stenosis from esophageal erosion
Collodion baby?
4
A rare manifestation of the inherited icthyoses (a group of conditions in which the skin is dry and scaly)
Infants are born with a taut,shiny,parchment like or collodion like membrane
Complications-
-risk of dehydration
-membrane becomes fissured and separated within few weeks
-usually leaving either icthyotic or far Less commonly, normal skin
Treatment
-oniment
-moisturizer
What are the Rashes of infancy (napkin rash)?
Common-
- infantile sebborrhoeic dermatitis
- atopic eczema
- irritant (contact) dermatitis
- candida infection
Rare-
- acrodermatitis enteropathica (associated with Zn def)
- melanocytic naevi
Irritant dermatitis ?
Features - 4
Most common napkin rash
Occur if nappies not changed frequently or if infant has diarrhea
Rash is due to irritant effect of urine on skin of susceptible infants
Urea splitting org in faeces increase the alkalinity
Clinical features- 2
Affect convex surfaces of buttocks,perineal region,lower abd and top of the thigh
Flexures are spared
Mx- 4 Frequent changing of nappies Keep without a nappy Emollient (mild) Topical corticosteroid (severe) 0.5% hydrocortisone
Candida infection?
5 Often complicates nappy rash Erythematous rash linclude skin flexures Satellite lesions may be present Mx- antifungal drugs eg-micanazole
Infantile seborrhoeic dermatitis(cradle cap)?
6
In first 3 months of life
Starts on the scalp as an erythematous scaly eruption
Then scales form a cradle cap
May spread to the face,behind ears and tyen extend to the flexures and napkin area
Incontrast to atopic evzema it is not itchy and the child is unperturbed by it.
Increased risk of subsequently developing atopic eczema
Mx-3
Emollient (mild)
Emolients with low consentration sulphar and salicylic acid (to clear the scales on the scalp)
Topical steroids (widespread body eruptions)
Atopic eczema?
5
Diagnosis-3
Clinical features
-pruritus (results in scratching and exacerbation of the rash)
-excoriated area becomes erythematous,weeping and crusted
Skin is usually dry
-prolonged scratching and rubbing may lead to lichenification
-older children flexion are involved younder extension and face is involved
Causes of exacerbation - 8
Complications- infected usually with staph or strep
Mx- 9
Infections and particular diaseases?
Bacteria - bullous impetigo
Viral- viral warts,molluscum contagiosum
Fungal- ringworm
Parasitic-scabies,pediculosis
Viral warts?
5
Molluscum contagiosum?
8
Ringworm?
7
Scabies?
Caused by an infestation with the 8 legged mite sarcoptes scabiei,which burrows down the epidermis along the stratum corneum
Severe itching occurs 2-6 w after infestation
Worst in warm and at night
Distribution-
-in older-burrows,papules, and vesicles involve the skin between the fingers and toes,axillae
-in younger- palms,soles and trunks
Presence of lesions in the sole can be helpful in making diagnosis
Head,neck,face may be involved in babies but uncommon
Dx- clinical,although burrows are pathognomonic may be hard to identify due to secondary infections due to scratching ,scratching in other family members ,confirm by mic ex of skin scrapping to identify mite eggs and mite feces
Complications- secondary eczematous or utricarial reaction maskind dx,secondary bacterial infection,AGN
MX- premathine cream 5%,benzylbenzoate emulsion 25%,malathion lotion 0.5% aqueous,treat whole family,wash bed linen and keep good hygiene
Pediculosis captitis?
6
What are the other childhood skin disorders?
- psoriasis
- pityriasis rosea
- alopecia areata
- granuloma annulare
- acne vulgaris
Psoriasis?
9
Pityriasis rosea?
8
Alopecia areata?
7
Grabuloma annulare?
6
Acne vulgaris?
9
Rashes and systemic disease?
- facial rash in SLE or dermatomyositis
- purpura over the buttocks,lower limb and elbow in HSP
- Erythema nodosum and erythema multiforme
- steven johnson xd (severe bullous form of erythema multiforme
- petrisis verisicolar (aluham)
- urticaria
Urticaria?
Results from an exposure to an allergen or a viral infection
May involve deeper tissues causing swelling of lips,angioedema and even anaphylaxis
Chronic urticaria is usually non allergic in origin >6 weeks
Results from a local increase in the permeability of capillary and venules
Flesh colored weals
Papular urticaria is delayed hypersensitive reaction most commonly seen on the legs,following a bite from flea,bed bug,or animal ,bird mite,drugs,food
Irritation,vesicles,papules,and weals appear and secondary infection due to scratching is common
May last for months or weeks and maybe recurrent
Mx-antihistamine (clophrenilamine),steroid
Hereditary angioedema?
7
AD
def of dysfunction of C1-esterase inhibitor
No urticaria but subcut swelling occur,often accompanied by abd pain
Trigger is usually trauma
Angioedema may cause res obstruction
Tx in acute attack- purified prep of the inhibitor (C1-esterase),replacement therapy with FFP
Could exacerbate by menstruation
Erythema nodosum.?
Tender nodules over the legs Causes- Strep infection Primary Tb IBD Drug reaction Idiopathic Sarcoidosis (common in adults)
Erythema multiforme?
Target lesions with central papule surrounded by an erythematous ring.lesions may also be vascular or bullous Cause- HSV mycoplasma pneumoniae infection Other infection (strep) Drug reaction Idiopathic
