Dermatology Flashcards
Distribution of eczema in infants
In infants, atopic eczema usually involves the face and extensor surfaces of the body as opposed to its classical flexural distribution
What organism is ‘head lice’
Pediculus humanus capitis parasite
What are ‘nits’?
Pediculus humanus capitis parasite egg shells that have hatched or contain unviable embryos and not the lice themselve
What are pediculus humanus capitis parasites?
Head lice are the Pediculus humanus capitis parasite, which causes infestations of the scalp, most commonly in school aged children.
Head lice are commonly known as nits, however nits are egg shells that have hatched or contain unviable embryos and not the lice themselves.
How are head lice transmitted?
Head lice are spread by close contact with someone that has head lice, usually in schools or amongst family members.
Transmission is by head to head contact or by sharing equipment like combs or towels.
Presentation of headlice?
Infestation causes an itchy scalp.
Often the nits (eggs) and even lice themselves are visible when examining the scalp.
Management of headlice?
Dimeticone 4% lotion can be applied to the hair and left to dry.
This is left on for 8 hours (i.e. overnight), then washed off.
This process is repeated 7 days later to kill any head lice that have hatched since treatment.
Special fine combs can be used to systematically comb the nits and lice out of the hair.
They can be used for detection combing to check the success of treatment.
NICE clinical knowledge summaries recommend The Bug Buster kit.
What lotion is used to treat headlice?
Dimeticone 4%
Left on dry hair for 8 hours and then washed off
What is ‘scabies’ and what happens in a scabies infestation?
Scabies are tiny mites called Sarcoptes scabiei that burrow under the skin causing infection and intense itching.
They lay eggs in the skin, leading to further infection and symptoms.
What does the mite sarcoptes scabiei cause?
Scabies
How long does it take for symptoms or a rash to appear after the initial infestation with sarcoptes scabiei to occur?
Up to 8 weeks
How does scabies present?
Scabies presents with incredibly itchy small red spots, possibly with track marks where the mites have burrowed.
The classic location of the rash is between the finger webs, but it can spread to the whole body.
What is seen here?
Sarcoptes scabiei (scabies)
How is scabies managed?
PERMETHRIN CREAM:
Treatment is with permethrin cream. This needs to be applied to the whole body, completely covering skin.
It is best to do this when the skin is cool (i.e. not after a bath or shower) so that a layer of cream remains on top of the skin and does not get absorbed.
The cream should be left on for 8 – 12 hours and then washed off.
This should be repeated a week later to kill all the eggs that survived the first treatment and have now hatched.
ORAL IVERMECTIN
Oral ivermectin as a single dose that can be repeated a week later is an option for difficult to treat or crusted scabies.
CONTACT TREATMENT
Scabies is contagious to all household and close contacts. When one person is diagnosed, all household and close contacts should also be treated in exactly the same way, even if asymptomatic. This is because they may be infected and not yet have symptoms.
All clothes, bedclothes, towels and other materials in contact with scabies need to be washed on a hot wash to destroy the mites. Thorough hoovering of carpets and furniture is also essential.
Itching can continue for up to 4 weeks after successful treatment. Crotamiton cream and chlorphenamine at night at night can help with the itching.
What is an option for difficult to treat or crusted scabies?
Oral ivermectin as a single dose that can be repeated a week later
What is ‘‘crusted scabies” and how is it managed?
Crusted scabies is also known as Norwegian scabies.
It is a serious infestation with scabies in patients that are immunocompromised.
These patient may have over a million mites in their skin. They are extremely contagious.
Rather than individual spots and burrows, they have patches of red skin that turn into scaly plaques.
These can be misdiagnosed as psoriasis.
Immunocompromised patients may not have an itch as they do not mount an immune response to the infestation. They may need admission for treatment as an inpatient with oral ivermectin and isolation.
What causes hand foot and mouth disease?
Coxsackie A virus.
What is the incubation period of Coxsackie A virus?
3 – 5 days.
How does hand foot and mouth disease present?
Starts with URTI symptoms: tiredness, sore throat, dry cough, fever
After 1-2 days:
Small mouth ulcers appear, followed by
Blistering red spots across the body- most notable on hands, feet and around mouth
Painful mouth ulcers, particularly on the tongue are a key feature
Rash is sometimes itchy
What is seen here?
Hand foot and mouth disease - cause by the Coxsackie A virus
Management/infection control of hand foot and mouth disease?
Diagnosis is made based on the clinical appearance of the rash (blistering red spots, most notable on hands, feet and around the mouth)
.
Management is supportive, with adequate fluid intake and simple analgesia such as paracetamol if required. The rash and illness resolve spontaneously without treatment after a week to 10 days
It is highly contagious and advice should be give about measures to avoid transmission, such as avoiding sharing towels and bedding, washing hands and careful handling of dirty nappies.
After how long should the rash and illness resolve spontaneously without treatment in hand foot and mouth disease?
7-10 days
Rarerly, hand foot and mouth disease ( oxsackie A virus) can cause complications - such as?
Dehydration
Bacterial superinfection
Encephalitis
What is seen here?
Infantile seborrhoeic dermatitis (of the face - usually seen on the scalp - cradle cap)
What is seborrhoeic dermatitis, and what does it affect?
Seborrhoeic dermatitis is an inflammatory skin condition that affects the sebaceous glands (the oil producing glands in the skin)
It affects areas that have a lot of these glands, such as the scalp, nasolabial folds and eyebrows.
It causes erythema, dermatitis and crusted dry skin.
In infants it causes a crusted dry flaky scalp, often called cradle cap.
What organism is thought to play a role in seborrhoeic dermatitis and therefore what treatment may improve it?
Malassezia yeast colonisation
Anti-fungal treatment improves the condition
How does infantile seborrhoeic dermatitis usually present?
Infantile seborrhoeic dermatitis (cradle cap) causes a crusted flaky scalp.
By what age infantile seborrhoeic dermatitis has resolved spontaneously?
Usually resolves by 4 months of age, but can last until 12 months.
What is the first line treatment of cradle cap (infantile seborrhoeic dermatitis)
First line treatment is by applying baby oil, vegetable oil or olive oil, gently brushing the scalp then washing off.
Management of cradle cap (infantile seborrhoeic dermatitis)
First line treatment is by applying baby oil, vegetable oil or olive oil, gently brushing the scalp then washing off.
When this is not effective, white petroleum jelly can be used overnight to soften the crusted areas before washing off in the morning.
The next step is a topical anti-fungal cream such as clotrimazole or miconazole, used for up to 4 weeks.
Severe or unresponsive cases may need referral to a dermatologist.
If cradle cap is resitance to first line management (baby oil, and the white petroleum jelly) what anti-fungals can be used?
A topical anti-fungal cream such as clotrimazole or miconazole, used for up to 4 weeks
How does Seborrhoeic Dermatitis of the Scalp present?
Mild seborrhoeic dermatitis of the scalp presents with flaky itchy skin on the scalp (dandruff).
More severe cases cause more dense oily scaly brown crusting.
(This commonly occurs in adolescents and adults rather than children)
What is seen here?
Seborrhoeic Dermatitis of the Scalp
How is seborrhoeic dermatitis of the scalp managed?
First line treatment is with ketoconazole shampoo, left on for 5 minutes before washing off.
Topical steroids may be used if there is severe itching.
It often reoccurs after successful treatment.
How does Seborrhoeic Dermatitis of the Face and Body present?
Seborrhoeic dermatitis of the face and body presents with red, flaky, crusted, itchy skin.
It commonly affects the eyelids, nasolabial folds, ears, upper chest and back.
Where does seborrhoeic dermatitis of the face and body typically affect?
Eyelids
Nasolabial folds
Ears
Upper chest
Back
What is seen here?
Seborrhoeic Dermatitis of the Face
Management of seborrhoeic dermatitis of the face and body?
First line treatment is with an anti fungal cream, such as clotrimazole or miconazole, used for up to 4 weeks.
Localised inflamed areas may benefit from a topical steroids, such as hydrocortisone 1%.
Severe or unresponsive cases should be referred to a dermatologist or paediatrician.
What is seen here?
Ringworm
What is ringworm and what is it also known as?
Ringworm is a fungal infection of the skin.
It is also known as TINEA and DERMATOPHYTOSIS
What is dermatophytosis more commonly known as?
Ringworm/(tinea)
Tinea capitis refers to what?
Tinea capitis refers to ringworm affecting the scalp
Tinea pedis refers to what?
Tinea pedis refers to ringworm affecting the feet, also known as athletes foot
Tinea cruris refers to what?
Tinea cruris refers to ringworm of the groin
Tinea corporis refers to what?
Tinea corporis refers to ringworm on the body
Onychomycosis refers to what?
Onychomycosis refers to a fungal nail infection
What is fungal nail infection known as?
Onychomycosis
What is ringworm on the body known as?
Tinea corporis
What is ringworm affecting the scalp known as?
Tinea capitis
What is athletes foot known as?
Tinea pedis - ringworm affecting the feet
What is the most common type of fungus that causes ringworm/dermatophytosis/tinea?
Trichophyton
What is trichophyton and what does it cause?
dermatophytosis/tinea/ringworm
How is trichophyton spread?
Contact with infected individuals, animals or soil.
Rash in ringworm?
an itchy rash that is:
- erythematous
- scaly
-w ell demarcated
There is often one or several rings or circular shaped areas that spread outwards, with a well demarcated edge.
The edge is more prominent and red and the area in the centre is more faint in colour.
How does tinea capitis present?
Tinea capitis can present with well demarcated hair loss.
There will also be itching, dryness and erythema of the scalp.
(This is more common in children than adults)
What is seen here?
Tinea capitis (ringworm of the scalp)
How does athelets foot (tinea pedis present)?
white or red, flaky, cracked, itchy patches between the toes
The skin may split and bleed.
What makes people prone to tinea pedis?
Athletes foot
This is often the result of sharing changing rooms with someone that has athletes foot and is more likely to occur when feet are sweaty and damp for prolonged periods.
What is seen here?
Tinea pedis (atheltes foot)
What is Onychomycosis?
Onychomycosis
How does onychomycosis present?
Thickened, discoloured and deformed nails.
How is fungal nail infection (onychomycosis) treated?
Amorolfine nail lacquer for 6 – 12 months.
Resistant cases may need oral terbinafine, however the patient will need their LFTs monitoring before and whilst taking this.
What can be used to treat resistant onychomycosis and what must be monitored while this treatment is taken?
Oral terbinafine,
Patient will need their LFTs monitoring before and whilst taking this.
Diagnosis of tinea?
The diagnosis is usually clinical. This is supported by a good response to anti fungal medications. It is possible to scrape some of the scales off and send them for microscopy and culture to identify the causative organism and confirm the diagnosis.
Ringworm is managed with antifungal medications - such as?
Anti-fungal creams such as clotrimazole and miconazole
Anti-fungal shampoo such as ketoconazole for tinea capitis
Oral anti-fungal medications such as fluconazole, griseofulvin and itraconazole
How is dermatophytosis managed?
Anti-fungal creams such as clotrimazole and miconazole
Anti-fungal shampoo such as ketoconazole for tinea capitis
Oral anti-fungal medications such as fluconazole, griseofulvin and itraconazole
A mild topical steroid can help settle the inflammation and itching. A common combination is miconazole 2% and hydrocortisone 1% cream (Daktacort).
Simple advice should be given to help recovery, prevent spread and avoid recurrence. Fungal infections grow best in warm, moist areas. Advise includes:
Wear loose breathable clothing
Keep the affected area clean and dry
Avoid sharing towels, clothes and bedding
Use a separate towel for the feet with tinea pedis
Avoid scratching and spreading to other areas
Wear clean dry socks every day
Advice to prevent spread and recurrence of fungal infection?
Wear loose breathable clothing
Keep the affected area clean and dry
Avoid sharing towels, clothes and bedding
Use a separate towel for the feet with tinea pedis
Avoid scratching and spreading to other areas
Wear clean dry socks every day
What is tinea incognito and when does it occur?
Tinea incognito refers to a more extensive and less well recognised fungal skin infection that results from the use of steroids to treat an initial fungal infection.
This often occurs when the initial presentation of ringworm was misdiagnosed as dermatitis and a topical steroid was prescribed.
The steroid improves the itching and inflammation but accelerates the growth of the fungal infection by dampening the immune response in the local area.
When the steroid is stopped the itchy rash caused by the fungus returns and is much worse than previously.
It may be less recognisable as ringworm due to a less well-demarcated border and fewer scales, giving rise to the incognito name.
What is nappy rash and why does it occur?
Nappy rash is contact dermatitis in the nappy area. It is usually caused by friction between the skin and nappy and contact with urine and faeces in a dirty nappy.
Most babies will get nappy rash at some point, and it is most common between 9 and 12 months of age.
Additionally, the breakdown in skin and the warm moist environment in the nappy can lead to added infection with candida (fungus) or bacteria, usually staphylococcus or streptococcus.
In nappy rash (contact dermatitis in nappy area), the breakdown in skin and the warm moist environment in the nappy can lead to added infection - what organisms are most common?
candida (fungus) or
bacteria, usually staphylococcus or streptococcus.
When is nappy rash most common?
Between 9 and 12 months of age
What is seen here?
Nappy rash (contact dermatitis)
Risk factors for nappy rash?
Delayed changing of nappies
Irritant soap products and vigorous cleaning
Certain types of nappies (poorly absorbent ones)
Diarrhoea
Oral antibiotics predispose to candida infection
Pre-term infants
How does nappy rash present?
Sore, red, inflamed skin in the nappy area.
The rash appears in individual patches on exposure areas of the skin that come in contact with the nappy.
It tends to spare the skin creases, meaning the creases in the groin are healthy.
There may be a few red papules beside the affected areas of skin.
Nappy rash is uncomfortable, may be itchy and the infant may be distressed.
Severe and longstanding nappy rash can lead to erosions and ulceration.
Candida in the nappy area (thrush) is a common finding. Signs that would point to a candidal infection rather than simple nappy rash include what?
Rash extending into the skin folds
Larger red macules
Well demarcated scaly border
Circular pattern to the rash spreading outwards, similar to ringworm
Satellite lesions, which are small similar patches of rash or pustules near the main rash
Check for oral thrush with a white coating on the tongue, as this is likely to indicate a fungal infection in the nappy area.
Management of nappy rash?
Simple measures can be taken to improve skin health and treat nappy rash within a few days:
- Switching to highly absorbent nappies (disposable gel matrix nappies)
- Change the nappy and clean the skin as soon as possible after wetting or soiling
- Use water or gentle alcohol free products for cleaning the nappy area
- Ensure the nappy area is dry before replacing the nappy
- Maximise time not wearing a nappy
Infection with candida or bacteria warrants treatment with an anti-fungal cream (clotrimazole or miconazole) or antibiotic (fusidic acid cream or oral flucloxacillin).
Complications of nappy rash?
Candida infection
Cellulitis
Jacquet’s erosive diaper dermatitis
Perianal pseudoverrucous papules and nodules
What is molluscum contagiosum and what causes it?
Molluscum contagiosum is a viral skin infection caused by the molluscum contagiosum virus, which is a type of poxvirus.
What is seen here?
Molluscum contagiosum
Features of molluscum contagiosum?
Molluscum contagiosum is characterised by small, flesh coloured papules (raised individual bumps on the skin) that characteristically have a central dimple.
They typically appear in “crops” of multiple lesions in a local area.
It is spread through direct contact or by sharing items like towels or bedsheets.
The papules resolve by themselves without any treatment, however this can take up to 18 months.
Once they resolve the skin returns to normal.
Scratching or picking the lesions should be avoided as it can lead to spreading, scarring and infection.
How is molluscum contagiosum spread?
It is spread through direct contact or by sharing items like towels or bedsheets.
How is molluscum contagiosum managed?
No treatment or change in lifestyle is required and children can continue all their normal activities. They should avoid sharing towels or other close contact with the lesions to minimise the risk of spreading the infection. Usually just simple reassurance and education is enough.
Rarely, if bacterial superinfection infection occurs in the lesions as a result of scratching, this may require treatment with antibiotics. Options include topical fuscidic acid or oral flucloxacillin.
Immunocompromised patients and those with very extensive lesions or lesions in problematic areas such as the eyelid or anogenital area may require referral to a specialist. Specialist treatment options include:
Topical potassium hydroxide, benzoyl peroxide, podophyllotoxin, imiquimod or tretinoin
Surgical removal and cryotherapy (freezing with liquid nitrogen) is an option but can lead to scarring
Molluscum contagiosum management: immunocompromised patients and those with very extensive lesions or lesions in problematic areas such as the eyelid or anogenital area may require referral to a specialist. Specialist treatment options include what?
Topical:
Potassium hydroxide
Benzoyl peroxide
Podophyllotoxin
Imiquimod
Tretinoin
Surgical removal and cryotherapy - may lead to scaring
What is pityriasis rosea and what causes it?
Pityriasis rosea a generalised, self limiting rash that has an unknown cause. It often occurs in adolescents and young adults.
It may be caused by a virus such as human herpes virus (HHV-6 or HHV-7), but no definitive causative organism had been established.
What is seen here?
Pityriasis rosea
How does pityriasis rosea present?
There may be prodromal symptoms prior to the rash developing.
These include headache, tiredness, loss of appetite and flu-like symptoms.
The rash starts with a characteristic HERALD PATCH
This is a faint red or pink, scaly, oval shaped lesion that is 2cm or more in diameter, usually occurring somewhere on the torso. It appears 2 or more days prior to the rest of the rash. If you suspect pityriasis, ask and look for a herald patch. Most, but not all, patients have a herald patch.
The rash consists of widespread faint red or pink, slightly scaly, oval shaped lesions, usually less than 2 cm in diameter. On the torso they can be arranged in a characteristic “christmas tree” fashion, following the lines of the ribs.
In dark skinned patients the lesions can be grey coloured, lighter or darker than their skin colour.
Other symptoms may be present:
Generalised itch
Low grade pyrexia
Headache
Lethargy
What is a herald patch, and what type of rash is it seen in?
Occurs in pityriasis rosea
This is a faint red or pink, scaly, oval shaped lesion that is 2cm or more in diameter, usually occurring somewhere on the torso.
It appears 2 or more days prior to the rest of the rash.
If you suspect pityriasis, ask and look for a herald patch. Most, but not all, patients have a herald patch.
What is seen here and when does it occur?
A herald patch
Occurs in pityriasis rosea, 2 or more days prior to the rest of the rash (widespread, faint red or pink, slightly scaly, oval shaped lesions, usually less than 2 cm in diameter. On the torso they can be arranged in a characteristic “christmas tree” fashion, following the lines of the ribs.)
Pityriasis rosea - disease course?
The rash resolves without treatment within 3 months.
It can leave a discolouration of the skin where the lesions were, however these will also resolved within another few months.
Management of pityriasis rosea?
There is no treatment for the rash. It will resolve spontaneously without any long term effects.
Patient education and reassurance is all that is required. It is not contagious and they can continue all their normal activities.
They may require symptomatic treatment if bothered by itching.
This may include emollients, topical steroids or sedating antihistamines at night to help with sleep (e.g. chlorphenamine).
Managing a non-blanching rash in a child
Patients with a non-blanching rash always require urgent referral and investigation unless there is a clear and unconcerning cause. The extent of the investigation depends on the clinical picture. Where there is doubt, patients are usually treated as meningococcal sepsis without waiting for investigations.
Definitive management will depend on the underlying cause.
What investigations may be helpful in a non-blanching rash and why?
FULL BLOOD COUNT
Anaemia can suggest HUS or leukaemia.
Low white cells can suggest neutropenic sepsis or leukaemia.
Low platelets can suggest ITP or HUS.
UREA AND ELECTROLYTES
High urea and creatinine can indicate HUS or HSP with renal involvement.
CRP
This is a non-specific indication of inflammation or infection and can be useful but not definitive in excluding sepsis.
ESR
This is a non-specific indication of inflammatory illness such as a vasculitis (HSP) or infection.
COAGULATION SCREEN including PT, APTT, INR and FIBRINOGEN
Can diagnose clotting abnormalities.
BLOOD CULTURE
This can be useful but not definitive in diagnosing or excluding sepsis.
MENINGOCOCCAL PCR
This can confirm meningococcal disease, although this should not delay treatment.
LUMBAR PUNCTURE
To diagnose meningitis or encephalitis.
BLOOD PRESSURE
Hypertension can occur in HSP and HUS. Hypotension can occur in septic shock.
URINALYSIS
Proteinuria and haematuria can suggest HSP with renal involvement, or HUS.
Typical viral causes of a non-blanching rash
influenza and enterovirus
What is meant by a ‘mechanical’ non-blanching rash?
Strong coughing, vomiting or breath holding can produce petechiae in a “superior vena cava distribution”, above the neck and most prominently around the eyes.
Non blanching rash in a child - differentials?
MENINGOCOCCAL SPETICAEMIA or any other bacterial sepsis
This presents with a feverish unwell child. Any features of meningococcal septicaemia indicate emergency management with immediate antibiotics. This can lead to significant morbidity and mortality if treatment is delayed.
HENOCH-SCHONLEIN PURPURA
This typically presents as a purpuric rash on the legs and buttocks and may have associated abdominal or joint pain.
IDIOPATHIC THROMBOCYTOPENIC PURPURA
This develops over several days in an otherwise well child.
ACUTE LEUKAEMIA
This presents with a gradual development of petechiae, potentially with other signs such as anaemia, lymphadenopathy and hepatosplenomegaly.
HAEMOLYTIC URAEMIC SYNDROME (HUS)
This is associated with oliguria (very low urine output) and signs of anaemia. This often presents in a child with recent diarrhoea.
MECHANICAL
Strong coughing, vomiting or breath holding can produce petechiae in a “superior vena cava distribution”, above the neck and most prominently around the eyes.
TRAUMATIC
Tight pressure on the skin, for example in non-accidental injury, or occlusion of blood in an area of skin can lead to traumatic petechiae.
VIRAL ILLNESS
This is often the explanation when other causes and serious illness are excluded. Typical causes are influenza and enterovirus.
What is seen here?
Purpura are larger (3 – 10mm) non-blanching, red-purple, macules or papules created by leaking of blood from vessels under the skin.
What is seen here?
Petechiae are small (< 3mm), non blanching, red spots on the skin caused by burst capillaries.
What is seen here?
Erythema nodosum
Presentation of erythema nodosum?
Erythema nodosum presents with red, inflamed, subcutaneous nodules across both shins.
The nodules are raised and can be painful and tender.
Over time the nodules settle and appears as bruises.
When you suspect someone has erythema nodosum it is important to look for signs and symptoms of potential triggers and underlying medical conditions.
What is staphylococcal scaled skin syndrome?
Staphylococcal scalded skin syndrome (SSSS) is a condition caused by a type of staphylococcus aureus bacteria that produces epidermolytic toxins.
These toxins are protease enzymes that break down the proteins that hold skin cells together.
When a skin infection occurs and these toxins are produced, the skin is damaged and breaks down.
This condition usually affects children under 5 years. Older children and adults have usually developed immunity to the epidermolytic toxins.
What is chicken pox and what causes it?
Chickenpox is caused by the varicella zoster virus (VZV).
It causes a highly contagious, generalised vesicular rash.
It is common in children.
Once a child has had an episode of chickenpox, they develop immunity to the VZV virus and will not be affected again.
Presentation of chicken pox
Chickenpox is characterised by widespread, erythematous, raised, vesicular (fluid filled), blistering lesions.
The rash usually starts on the trunk or face and spreads outwards affecting the whole body over 2 – 5 days.
Eventually the lesions scab over, at which point they stop being contagious.
Other symptoms:
- Fever is often the first symptom
- Itch
- General fatigue and malaise
What is seen here?
Urticaria
What is urticaria?
Urticaria are also known as hives.
They are small itchy lumps that appear on the skin.
They may be associated with a patchy erythematous rash.
This can be localised to a specific area or widespread.
They may be associated with angioedema and flushing of the skin.
Urticaria can be classified as acute urticaria or chronic urticaria.
What is seen here?
Erythema multiforme
Presentation of erythema multiforme?
Erythema multiforme produces a widespread, itchy, erythematous rash.
WIDESPREAD, ITCHY, ERYTHEMATOUS RASH
CHARACTERISTIC TARGET LESIONS
It does not usually affect the mucous membranes but can cause a sore mouth (stomatitis).
The symptoms come on abruptly over a few days.
It may be associated with other symptoms of:
Mild fever
Stomatitis (sore mouth)
Muscle and joint aches
Headaches
General flu-like symptoms
What are Koplik spots?
Koplik spots
Greyish white spots on the buccal mucosa. They appear 2 days after the fever.
They are pathognomonic for measles
What is seen here?
Koplik spots
Greyish white spots on the buccal mucosa. They appear 2 days after the fever. They are pathognomonic for measles, meaning if a patient has Koplik spots, you can diagnose measles.
Characteristic rash in measles?
The rash starts on the face, classically behind the ears, 3 – 5 days after the fever.
It then spreads to the rest of the body.
The rash is an erythematous, macular rash with flat lesions.
What rash is Scarlet fever characterised by?
It is characterised by a red-pink, blotchy, macular rash with rough “sandpaper” skin that starts on the trunk and spreads outwards.
Patients can have red, flushed cheeks.
Features of rash in rubella?
It presents with a milder erythematous macular rash compared with measles.
The rash starts on the face and spreads to the rest of the body.
The rash classically lasts 3 days.
How does eczema herpeticum present?
A typical presentation is a patient who suffers with eczema that has developed a widespread, painful, vesicular rash with systemic symptoms such as fever, lethargy, irritability and reduced oral intake.
There will usually be lymphadenopathy (swollen lymph nodes).
The rash is usually widespread and can affect any area of the body. It is erythematous, painful and sometimes itchy, with vesicles containing pus. The vesicles appear as lots of individual spots containing fluid. After they burst, they leave small punched-out ulcers with a red base.
What nail changes may be seen in psoriasis?
pitting, thickening, discolouration, ridging and onycholysis (separation of the nail from the nail bed).
What is plaque psoriasis?
Plaque psoriasis features the thickened erythematous plaques with silver scales, commonly seen on the extensor surfaces and scalp.
The plaques are 1cm – 10cm in diameter.
This is the most common form of psoriasis in adults.
What type of psoriasis is seen here?
Plaque psoriasis
thickened erythematous plaques with silver scales, commonly seen on the extensor surfaces and scalp
around 1cm-10cm in diameter
most common tpe in adults
What is guttate psoriasis?
Guttate psoriasis is the second most common form of psoriasis and commonly occurs in children.
It presents with many small raised papules across the trunk and limbs.
The papules are mildly erythematous and can be slightly scaly.
Over time the papules in guttate psoriasis can turn into plaques.
Guttate psoriasis is often triggered by a streptococcal throat infection, stress or medications.
It often resolves spontaneously within 3 – 4 months.
What is seen here?
Guttate psoriasis
Many small raised papules across the trunk and limbs.
The papules are mildly erythematous and can be slightly scaly.
Over time the papules in guttate psoriasis can turn into plaques.
It is the second most common form of psoriasis and commonly occurs in children. Guttate psoriasis is often triggered by a streptococcal throat infection, stress or medications. It often resolves spontaneously within 3 – 4 months.
What is pustular psoriasis?
Pustular psoriasis is a rare severe form of psoriasis where pustules form under areas of erythematous skin.
The pus in these areas is not infectious. Patients can be systemically unwell.
It should be treated as a medical emergency and patients with pustular psoriasis initially require admission to hospital.
What type of psoriasis is seen here?
Pustular psoriasis is a rare severe form of psoriasis where pustules form under areas of erythematous skin. The pus in these areas is not infectious. Patients can be systemically unwell. It should be treated as a medical emergency and patients with pustular psoriasis initially require admission to hospital.
What is erythrodermic psoriasis?
Erythrodermic psoriasis is a rare severe form of psoriasis with extensive erythematous inflamed areas covering most of the surface area of the skin. The skin comes away in large patches (exfoliation) resulting in raw exposed areas. It should be treated as a medical emergency and patients require admission.
What type of psoriasis is seen here?
Erythrodermic psoriasis is a rare severe form of psoriasis with extensive erythematous inflamed areas covering most of the surface area of the skin. The skin comes away in large patches (exfoliation) resulting in raw exposed areas. It should be treated as a medical emergency and patients require admission.
Macule
Macules are flat marks on the skin
Papule
Papules are small lumps on the skin
Pustule
Pustules are small lumps containing yellow pus
Comedomes
Comedomes are skin coloured papules representing blocked pilosebaceous units
Blackheads
Blackheads are open comedones with black pigmentation in the centre
What are ice pick scar
Ice pick scars are small indentations in the skin that remain after acne lesions heal
Hypertrophic scars
small lumps in the skin that remain after acne lesions heal
Rolling scars
Rolling scars are irregular wave-like irregularities of the skin that remain after acne lesions heal
What are salmon patches?
Salmon patches are a vascular birthmark which usually self resolve
. Erythema toxicum neonatorum
- Migratory raised erythematous rash concentrated on the trunk.
- Overlying papules or pustules containing eosinophils.
- Onset at 2-3 days and resolves spontaneously after 3-5 days.
- Pathogenesis unclear.
Atopic dermatitis
- Presents with dry, erythematous itchy skin (note skin breakdown from scratching).
- Distribution differs with age:
- Infants: face, neck, scalp and extensor surfaces. Nappy area is mostly spared.
- Childhood: Flexural surfaces (antecubital and popliteal fossae)
Volar aspect of the wrists; neck and ankles. - Majority of infantile eczema will resolve.
- Eczema more wet and weepy in infants; can be thickened and pigmented in children.
Mila
- Sometimes referred to as ‘milk spots’.
- White papules present at birth found most commonly on the nose and cheeks.
- Caused by build up of sebaceous material in skin follicles.
Transient neonatal pustular melanosus (E).
- Benign idiopathic condition present at birth.
- Distinctive features of vesicles, superficial pustules and pigmented macules.
- Occur on forehead, chin, neck, chest, back and buttocks and less commonly palms
and soles. - Vesicles rupture easily and resolve within 48 hours leaving macules that persist for
several months
Seborrhoiec dermatitis
- Self-limiting eruption of non-inflammatory erythematous greasy plaques.
- Occurs in early infancy (<1 month) and can last to 12 months.
- Distribution favours the scalp (also called ‘cradle cap’), behind the ear, eyebrows and
nasolabial folds as these are rich in sebaceous glands. - Can spread to flexures and napkin area.
- In contrast to eczema it is not itchy and infant is not disturbed
How would this rash be described?
. Morbilliform (B)
- The term morbilliform refers to a rash that looks like measles.
- A morbilliform rash consists of a rose-red flat (macular) or slightly elevated (maculopapular) eruption of circular/elliptical lesions 1-3mm in diameter with intervening
healthy-looking skin.
How would this rash be described?
Petechiae are small (1-2 mm) red, brown or purple sots on the skin (or conjunctivae)
caused by minor bleeding into the skin caused by capillary rupture.
* Usually flat to touch – although classically palpable in Henoch-Schonlein purpura.
* Non-blanching.
* Other terms for cutaneous bleeds are determined by size: purpura 2-10 mm and
ecchymosis > 10 mm.
How would this rash be described?
. Maculopapular (A).
* Macules are flat discoloured areas (usually red) and papules are raised bumps.
* Both variable in size, particularly macules.
Causes of fever + maculopapular rash in a child?
VIRAL
Roseola infantum (Human herpes virus-6 or7)
‘Slapped cheek’ rash of erythema infectiosum (Fifth Disease) (Parvovirus B19)
Enterovirus rash
Measles (morbilliform)
German measles (morbilliform)
BACTERIAL
Scarlet fever (group A streptococcus)
Rheumatic fever – erythema marginatum
Typhoid fever (Salmonella typhi) (Classically rose spots)
Lyme disease – erythema migrans
OTHER
Kawasaki disease
Systemic onset juvenile idiopathic arthritis
