Dermatology Flashcards
describe this and what is it?
How do you treat it?
Swelling right occipital region
Erythematous
Loss of hair
Kerion - fungal infection
Treat - Supportive: Simple analgesia e.g. paracetamol 1g PO Q6H PRN
Specific: 6-8 weeks ORAL antifungal (itraconazole, terbinafine, griseofulvin)
Describe this rash
What could it be?
Management
- *multiple vesicles with erythematous base
- crusted
- lower lip and eyelid involvement
- coalescing around cheek
Dx:
Impetigo
eczema herpticum
chicken pox
SJS
HFM with secondary infection
Mx
Analgesia plus dose
treat condition - abx, antiviral eg fluclox 50mg/kg IV
look for complications - shock, dehydration, meningism, systemc infection
describe rash
differentials
widespread erythematous rash, bullae, scolded skin, covers majority of body
Dx
Toxic epidermal necrolysis, SJS, staph scolded skin syndrome, erythematous drug reaction, erythroderma
how do you differentiate TEN and SJS
How do you manage them?
What are the complications?
●SJS – skin detachment of <10 percent of BSA
●TEN – skin detachment of >30 percent of BSA
●SJS/TEN overlap – skin detachment of 10 to 30 percent of BSA
Management:
Supportive:
wound care, analgesia, hydration (electrolyte and nutrition), ocular care, monitor for infections and strict infection control measures
may beed ICU if severe
Complications
* massive fluid loss and hypovolemia and electrolyte imbalnce
* renal failure
* bacteramia
* multi organ failure
* insulin resistance
* * s.aureus infection plus aeriginosa - pneumonia common
What are the common causes of SJS/TEN
Medications:
Allupurinol
Abx - beta lactams
Anticonvulsants - lamotrigine, phenytoin, carbamazepine
analgesics - padanol and oxicam NSAIDS
Omeprazole
Infections
mycoplasma pneumonia
CMV
herpes
What are underlying disease related risk factors for TEN/SJS/Staph scolded skin?
HIV/Aids
Lupus
Lymphoma/leukemia
Describe rash
What is it?
involves palms, macular, target lesions, erythematous - discrete and miultiple sites
Erythema multiforme
What are the causes of erythema multiforme?
MID
- malignancy - lymphoma
- infections - Mycoplasma
- Drugs - Cephalasporins/Carbamazepine
What are some other differentials for erythema multiforme and some distinguising features
- Syphillis - serology, primary chancre
- Gonoccoameia - sexual history, urine PCR, PID
- HFM - Age, lesion elsewhere, source eg daycare
What is this rash?
What features support it?
What are complications?
What would suggest the need for admission?
Facial varicella Zoster
clusters of vesicles, unilateral, confined to one dermatome, surrounding erythema
Complications
* * Added bacterial infections
* * keratitis, uveitis, acute angle glaucoma, optin neuritis, ramsay hunt, cranial nerve palses, meningoencephalitis, post herpetic neuralgia
Admission
severe ocular involvement affecting globe
suspicions of disseminated infection eg cranial
high analgesia requirement eg iv opiates
immunocompromised
What else could TEN/SJS be?
staph scolded skin
bullous pemphigoid
pempigus vulgaris
sunburn
herpes simplex
herpes zoster
mustard gas
insect bites
kawasaki disease
Describe
on both legs, upper things - petichial, multiple discrete erythematous lesions, bruises, purpura
differentials
What is the main indication to consider transfusion in ITP
significant bleeding/intercranial haemorrhage
platelets under 10
describe clinical features
What pathogens can cause this?
Other differentials
child looks unwell - location (arms face torso) petichial and purpuric
n.meningitidis, strep pneumonaie, staph aureus, haemophilus influenzae
SJS/TEN/viral/ lupus/DiC from malignancy
Important investigations and why
initial treatment
complications of meningitis
IV abx ceftriaxone 50mg/kg and vanc 30mg/kg
20ml/kg fluid bolus
complications
DIC
death
brain injury
amputations
ischaemic heptatitis
What can cause petichiae with fever
meningitis/septicaemia
ITP
HSP’
viral infection eg flu
leukemia
any illness causing coughing or vomiting
With petichial rash what would suggest serious bacterial infection?
drowsiness, decreased LOC
abnormal vitals
poor perfusion
rapidly progessive symptoms
describe
differentials
state of child - alert
location - face and shoulders, erythematous, papular, areas of confluence
negatives - not affecting mucous membranes, no conjunctivitis
Differentials;
measles
viral rash
urticaria
scarlet fever
erythema multiforme
kawasaki
list and justify four investigations
measles PCR - nasopharyngeal swab
CRP/ESR for kawasaki
strep- throat cultures
what is the difference in HSV and HZV
HSV - Herpes simplex
HSZ - herpes zoster (shingles and varicella is chicken pox)
