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Paediatrics > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is the skin covered with at birth

A

vernix caseosa

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2
Q

Skin in preterm infant

A

thin
Poorly keratinised
Transepiderman water loss is markedly increased

Thermoregulation is impaired as preterm infant lacks subcutaneous fat and is unable to sweat until a few weeks old - unlike in term infant.

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3
Q

Bullous impetigo

A

uncommon but potentially serious blistering form of impetigo

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4
Q

Most common pathogen bullous impetigo

A

S.aureus

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5
Q

Treatment bullous impetigo

A

systemic abx - flucloxacillin

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6
Q

Macule

A

small flat area of altered colour or texture

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7
Q

Patch

A

larger flat area of altered colour or texture

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8
Q

Papule

A

Small raised lesion

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9
Q

Maculopapular

A

Combination of macule and papules

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10
Q

Plaque

A

Larger raised lesion

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11
Q

Nodule

A

Larger raised lesion with a deeper component - involvement of the dermis or subcut fat

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12
Q

Vesicle

A

Small clear blister

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13
Q

Bulla

A

Large clear bluster

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14
Q

Wheal / Weal

A

raised transient lesion due to dermal oedema

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15
Q

Pustule

A

Pus containing blister

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16
Q

Purpura

A

Bleeding into skin or mucosa
Small areas are petechiae
Large are ecchymoses
Do not blanch on pressure

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17
Q

Excoriation

A

Scratch mark, loss of epidermis following trauma

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18
Q

Lichenification

A

Roughening of skin with accentuation of skin marking

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19
Q

Scales

A

Flakes of dead skin

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20
Q

Crust

A

Dry mass of exudates consisting of serum, dried blood, scales and pus

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21
Q

Scar

A

Formation of new fibrous tissue post wound healing

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22
Q

Erosion

A

Loss of epidermis and dermis

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23
Q

Ulcer

A

Loss of epidermis and dermis

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24
Q

Management of melanocytic naevi

A

Reduce prolonged eposure to sunlight and sun protection

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25
Q

Risk of melanoma

A

Positive family
Large number of melanocytic naevi
Fair skin
Repeated episodes of sunburn
Living in hot climate with chronic skin exposure to the sun

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26
Q

Albinism features

A

Defect in biosynthesis and distribution of melanin

Lack of pigment in iris, retina, eyelids and eyebrows results in failure to develop fixation reflex

Pendular nystagmus and photophobia which causes constant frowning

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27
Q

Management Albinism

A

Correction of refractive errors and tinted lenses

Pale skin - suncream and hat

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28
Q

Epidermolysis bullosa

A

genetic conditions characterised by blistering of the skin and mucous membranes

In severe forms fingers and toes may become fused and contracture of limbs results in repeated blistering

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29
Q

Management epidermolysis bullosa

A

Avoiding injury
Treating secondary infection

Maintenance of adequate nutrition and analgesia when dressings are changed

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30
Q

Collodion baby

A

Inherited ichthyoses - skin dry and scaly

Infants born with a taut, shiny parchment like or collodion like membrane

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31
Q

Management of collodion baby

A

Emollients
Hydration
Membrane becomes fissured and separates within a few weeks - usually leaving ichthyotic or far less common normal skin

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32
Q

Nappy rash

A

irritant dermatitis - nappies not changed frequently or if infant has diarrhoea

Can occur even if cleaned regularly

Rash due to irritant effect of urine on the skin of susceptible infants

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33
Q

Where does nappy rash happen

A

convex surfaces of buttocks, perineal region, lower abdomen and top of thighs.

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34
Q

Characteristics in nappy rash

A

erythematous and may have scalded appearance

More severe - erosions and ulcer formation

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35
Q

Management of nappy rash

A

protective emolient
Sevre - mild topical corticosteroids

36
Q

Fungal nappy rash

A

Candida infection

Erythematosus and includes skin flexures and may be satellite lesions

Treatment - topical antifungal

37
Q

Infantile seborrheic dermatitis characteristics

A

Erruption of unknown cause presents in first 3 months

Starts on scale as erythematous scaly eruption

Form a thick yellow adherent layer - cradle cap

May spread to face, behind ears and then extend to flexures and napkin area

It is not itchy and the child is unperturbed by it.

38
Q

Management of infantile seborrheic dermatitis

A

Emollients
Ointment containing low-concentration sulphur and salicylic acid applied to scalp daily for a few hours and then washed off

Widespread body eruption will clear with a mild topical corticosteroid - either alone or mixed with antibacterial and anti fungal agent.

39
Q

Atopic eczema - atopic dermatitis

A

Genetic deficiency of skin barrier function is important to pathogenesis of atopic asthma

First year of life - uncommon in first 2 months

40
Q

RF eczema

A

History of atopic disorders
Asthma
Allergic rhinitis
Eczema

41
Q

Diagnosis of atopic eczema

A

clinically
Immunological changes in atopic disease are secondary to enhanced antigen penetration through a deficient epidermal barrier.

42
Q

Itchy rashes

A

Atopic eczema
Chickenpox
Urticaria - allergic reactions
Contact dermatitis
Insect bites
Scabies
Fungal infections
Pityriasis rosea

43
Q

Symptoms of atopic eczema

A

Itchy main feature
Excoriated areas become erythematous, weeping and crusted

Dry and prolonged scratching and rubbing of the skin may lead to lichenification

44
Q

Complications of eczema

A

Infection - staph or strep

Inflammation increases avidity of skin for s.aureus and reduces expression of antimicrobial peptides which are needed to control microbial infections

Regional lymphadenopathy common when in active eczema and usually resolves when skin improves

45
Q

Management eczema

A

Avoiding irritants and precipitants - cotton clothing avoiding nylon and pure wooden garments

Nails cut short to reduce skin damage from scratching - mittens helpful in very young

Emollients - mainstay managements - moisturising and softening skin - 2-3 x a day and after bath

Topical corticosteroids - 1% hydrocortisone ointment

Immunomodulators - tacrolimus ointment or pimecrolimus cream not controlled by topical corticosteroids

Occlusive bandages - may have zinc paste or zinc and tar paste and worn overnight for 2-3 days at a time

Abx or antiviral / antihistamines

Dietary eliminatiion - food allergy - if IgE suspected

Psychosocial support - national eczema society

46
Q

Viral warts

A

Caused by human papilloma virus

Common in children on fingers and soles

Spontaneously disappear after a few months or years and treatment only indicated if lesions are painful or cosmetic problem

47
Q

Management viral warts

A

daily application of proprietary salicylic acid and lactic acid paint or glutaraldehyde lotion

Cryotherapy with liquid nitrogen is an effective treatment but can be painful and often needs repeated application - reserved for older children

48
Q

Molluscum contagiosum

A

Caused by poxvirus

Lesions are small - skin coloured - pearly papule with central umbilication.

May be single but usually multiple

Widespread but tend to disappear within a year

Topical antibacterial can be applied to prevent or treat secondary bacterial infection

49
Q

Ringworm

A

Fungal infection

Dermatophyte fungi invade dead keratinous structures 0 such as horny layer of skin, nails and hair.

Ringed appearance of skin lesions

50
Q

Kerion

A

Severe inflammatory pustular ringworm patch

51
Q

Tinea capitis

A

Scalp ringworm

Sometimes acquired from dogs and cats

Causes scaling and patchy alopecia with broken hairs

52
Q

Ix ringworm

A

Examination under filtered ultraviolet light may show bright greenish / yellow fluorescence of infected hairs with some fungal species

Microscopic examination of skin scrapings for fungal hyphae

Definitive - culture

53
Q

Treatment ringworm

A

Topical anti fungal

Severe - systemic anti fungal treatment for several weeks.

54
Q

Scabies

A

Parasitic infestations
Caused by infestation mite - Sarcoptes scabiei which burrows down the epidermis along the stratum corner

55
Q

Features of scabies and distribution in ages

A

severe itching 2-6 weeks after infestation
Worse in warm conditions and at night

Older children - burrows, papule, vesicles involve skin between fingers and toes, axillae, flexor aspects of wrists, belt line, and around nipples, penis and buttocks

Younger children - palms, soles and trunk - lesions on soles helpful in making diagnosis

56
Q

Ix Scabies

A

Clinical - itching and characteristic lesions

Burrows - may be hard to identify because of secondary infection due to scratching

Microscopic examination of skin scraping from the lesions to identify mite, eggs and mite faeces.

57
Q

Complications scabies

A

secondary eczematous or urticarial reaction masking true diagnosis

Secondary bacterial infection is common - giving crusted, pustular lesions.

58
Q

Treatment scabies

A

Avoid close Bodily contact

Whole family should be treated regardless of symptoms

Permethrin cream should be applied below the neck to all areas and washed off after 8-12 hours. In babies, the face and scalp should be included.

Benzyl benzoate emulsion applied below the neck only, in diluted form according to age and left on for 12 hours.

Malathion lotion - below neck and left on for 12 hours.

59
Q

Pediculosis Capitis and presentation

A

Head lice infection

Itching of the scalp and nape or from identifying live lice on the scalp or nits (empty egg cases) on hairs.

Louse eggs are cemented to hair close to the scalp and the nits remain attached to the hair shaft as it grows

60
Q

Management Pediculosis

A

Dimeticone 4% lotion or an aqueous solution of malathion 0.5% is tubbed into hair and scalp and left overnight and the hair shampooed the following morning.

Repeated a week later.

Wet combing with a fine tooth comb to remove live lice every 3-4 days for at least 2 weeks.

61
Q

Psoriasis

A

Often follows a strep or viral sore throat or ear infection
Rarely presents before 2yo
Lesions are small, raindrop like, round or oval erythematous scaly patches on the trunk and upper limbs - resolving in 3-4 months

62
Q

Treatment guttae psoriasis

A

bland ointments
Coal tar preparation - plaque psoriasis and scalp involvement

Calcipotriol - vit d analogue - useful for plaque psoriasis in 6YO+

63
Q

Pityriasis Rosea

A

Single round or oval scaly macula, around 2-5cm diameter on the trunk, upper arm, neck or thigh

Numerous small dull pink macule develop over a few days and rash tends to follow line of ribs posteriorly

NO treatment required and resolves in 4-6 weeks

64
Q

Alopecia areata

A

Common form of hair loss
Hairless, single or multiple non-inflamed smooth areas of skin, usually over scalp.
Remenants of broken off hairs visible

Regrowth often occurs within 6-12 months in localised hairloss

65
Q

Granuloma annulare

A

Ringed lesions with a raised flesh coloured non-scaling edge (unlike ringworm)

Can occur anywhere but usually over bony prominences, especially hands and feet.

Tend to disappear spontaneously but may take years to do so

66
Q

Acne Vulgaris pathophysiology

A

1-2 years before onset of puberty following adrenergic stimulation of the sebaceous glands and increased sebum excretion rate

Obstruction to the flow of sebum in follicle initiates acne.

67
Q

Types of acne lesions

A

Open comedones - blackheads
Closed comedones - whiteheads
Progressing to papules, pustules, nodules and cysts

Occur mainly on face, back, chest and shoulders

68
Q

Treatment acne

A

topical treatment - encourage skin to peel using a keratolytic agent - benzoyl peroxide applied 1-2 x daily after washing

Sunshine - in moderation

Topical Abx or retinoids

Oral abx therapy in severe - tetracyclines or erythromycin indicated.

Oral retinoid isotretinoin reserved for severe acne unresponsive to other treatments.

69
Q

Skin rashes associated with systemic disease

A

Facial rash - SLE

Purpura over butt and lower limbs - HSP

Erythema nodosum

Stevens Johnson syndrome

69
Q

Why not use tetracyclines in children under 12 for acne

A

may discolour teeth in younger children

70
Q

Steven Johnson Syndrome

A

severe bullous form of erythema multiforme also involving mucous membranes

Often starting with upper resp tract infecion

71
Q

Features of Steven Johnson syndrome

A

Eye involvement - conjunctivitis, corneal ulceration and uveitis

May be caused by drug sensitivity, infection or both

Sometimes can lead to sepsis or electrolyte imbalance.

72
Q

Causes of erythema nodosum

A

Strep infection
Primary TB
IBD
Drug reaction
Idiopathic

73
Q

Causes of erythema multiform

A

Herpes simplec
Mycoplasma pneumoniae
Infections
Drug reaction
Idiopathic.

74
Q

Urticaria - hives

A

Flesh coloured wheals
Papular urticaria delayed hypersensitivity reaction most commonly seen on legs, following bite from a flea, bedbug, animal or bird mite

74
Q

Symptoms urticaria

A

irritation
vesicles
papules
wheals
Secondary infection due to scratching

74
Q

Hereditary angioedema

A

autosomal dominant disorder caused by deficiency or dysfunction of C1-esterase inhibitor

No urticaria but subcutaneous swellings occur - often with abdo pain

Trigger - physical trauma or psych stress

75
Q

Eczema summary

A

A chronic atopic condition caused by defects in the normal continuity of the skin barrier, leading to gaps which allow irritants, microbes and allergens to enter, creating an immune response and leading to inflammation.
- Some patients will identify environmental triggers such as changes in temperature, certain dietary products, washing powders, cleaning products and emotional events/stress.

Clinical Presentation
- Usually in infancy
- Dry, red, itchy skin with sore patches over the flexor surfaces (elbows, knees) and
face and neck
- Often episodic with flares

Management
- For maintenance, emollients e.g. E45, Diprobase should be used as often as possible, especially after washing and before bed which help create an artificial barrier over the skin
- Flare ups can be treated with thicker emollients such as Cetraben ointment or topical steroids such as Hydrocortisone and Betnovate (beclomethasone) which help keep moisture locked in overnight
- Other specialist treatments include topical tacrolimus, oral corticosteroids and methotrexate.

76
Q

Stevens johnson syndrome summary

A

A disproportional immune response causing epidermal necrosis resulting in blistering and shedding of the top layer of the skin - less than 10% of body surface area affected

Aetiology
1. Medications
- Anti epileptics
- Antibiotics
- Allopurinol
- NSAIDs
2. Infections
- Herpes simplex
- Mycoplasma pneumonia
- Cytomegalovirus
- HIV

Clinical Presentation
- Some cases will be mild whilst others will be severe and potentially fatal
- Non-specific symptoms initially with fever, cough, sore throat, sore mouth, sore
eyes and itchy skin
- Purple/red rash which spreads across the skin and blisters, this then breaks away
and leaves the raw tissue underneath
- Pain, blistering and shedding can also happen to the lips and mucous membranes
- Inflammation and ulceration of the eyes can also happen
- It can also affect the urinary tract, lungs and internal organs

Management
- Medical emergency: supportive care is essential
- Steroids, immunoglobulins and immunosuppressant medications can all be given
with specialist guidance Complications
- Secondary infection such as cellulitis, sepsis
- Permanent skin damage

77
Q

Urticaria summary

A

Also known as hives, these are small itchy lumps which appear on the skin and may be associated with angioedema.
Pathophysiology
- Release of histamine and other pro-inflammatory chemicals by mast cells in the skin
- These may be part of an allergic reaction in acute urticaria or an autoimmune
reaction in chronic idiopathic urticaria
Aetiology
- Allergies to food, medications or animals
- Contact with chemicals, latex or stinging nettles
- Medications
- Viral infections
- Insect bites

Chronic Urticaria
- An autoimmune condition where autoantibodies target mast cells and trigger them to release histamines and other chemicals

Management
Antihistamines
- Fexofenadine is the antihistamine of choice for chronic urticaria
- Oral steroids may be given for flare ups
- Omalizumab which targets IgE

78
Q

Nappy Rash

A

Sore, red, inflamed skin in the nappy areas
- No rash on the creases of the groin
- The rash may be itchy and the infant may be distressed
- Severe and long standing rash can lead to erosion and ulceration

Switching to highly absorbent nappies
- Change the nappy and clean the skin as soon as possible after wetting or soiling
- Use water or gentle alcohol free products
- Ensure the nappy area is dry before replacing the nappy
- Maximise time not wearing a nappy
- Infection requires antifungal/antibiotic cream

79
Q

Differentiating Candida vs Nappy Rash

A

Rash extending into the skin folds
- Large red macules
- Well demarcated scaly border
- Circular pattern to the rash spreading outwards, similar to ringworm
- Satellite lesions - small, similar patches of rash near the main rash

80
Q

Non-blanching rash

A

Caused by bleeding under the skin
- Petechiae are small, non blanching, red spots on the skin caused by burst capillaries
Purpura are larger, non-blanching, red-purple macules or papules caused by leaking of blood from vessels under the skin
- Any child with non-blanching rash needs immediate investigation due to the risk of meningococcal sepsis.

81
Q

Ddx non blanching rash

A

Meningococcal septicaemia: feverish, unwell child which requires immediate antibiotic management due to significant morbidity/mortality.

  • HSP: purpuric rash on the legs and buttocks and may have associated abdominal or joint pain
  • ITP: rash which develops over several days in an otherwise unwell child
  • Leukaemias: gradual development of petechiae with other signs such as anaemia,
    lymphadenopathy and hepatosplenomegaly.
  • HUS: Presents in a child with recent diarrhoea alongside oliguria and signs of
    anaemia.
  • Mechanical: Strong coughing, vomiting or breath holding can product petechiae
    above the neck and most prominently around the eyes
  • Traumatic: Tight pressure on the skin e.g NAI can lead to traumatic petechiae
  • Viral illness can often cause rashes
82
Q

Anaphylaxis

A

85% of this is caused by a food allergy with an IgE mediated response causing significant respiratory/cardiovascular compromise.

  • Other causes include drugs, insect stings, latex, exercise and idiopathic
  • Most occurs in children under 5 due to food allergy however the most fatal is in
    adolescence.
  • Acute management is early administration of adrenaline and long term management
    involves a detailed plan for allergy avoidance and the presence of adrenaline auto-injectors.

Paediatrics (17 decks)

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