Dermatology

Question 1

What is eczema?

Answer 1

Red, dry, itchy skin eruption

Common, affects 1 in 5 children

Question 2

Atopic eczema is thought to be a barrier defect. What does this mean?

Answer 2

There is increased permeability to irritants and allergens, which explains why it is itchy.

There is also water loss, which explains why it is dry.

Question 3

Give an example of a mild topical steroid.

Answer 3

Hydrocortisone

->widely used

Question 4

Give an example of a moderate topical steroid.

Answer 4

Eumovate

Question 5

Give an example of a potent topical steroid.

Answer 5

Betnovate

Question 6

Give an example of a very potent topical steroid.

Answer 6

Dermovate

->rarely used in children

Question 7

Okay summarise the topical steroid ladder.

Answer 7

Very potent- Dermaovate
Potent- Betnovate
Moderate- Eumovate
Mild- Hydrocortisone

Question 8

How long should you use mild-moderate steroids on the face?

Answer 8

3-5 days, then stop and repeat as needed

->using more than required can cause skin thinning in prolonged use

Question 9

If topical steroids don’t help atopic eczema, what should be considered?

Answer 9

Think about triggers, may be a more allergy based response, hence why steroids aren’t helping

Question 10

Alternatives for topical steroids in atopic eczema?

Answer 10

Steroid sparing agents- protopic ointment or Elidel cream
Phototherapy UVB
Immunosuppression- methotrexate, ciclosporin
Biologics- dupilomab

Question 11

If eczema has started at a very young age, what may be the trigger?

Answer 11

Milk

->often GI side effects too and failure to thrive

Question 12

What type of hypersensitivity reaction is eczema?

Answer 12

Either type I or IV

Type I- immediate reactions

Type IV- prolonged reactions

Question 13

What is seen in discoid eczema?

Answer 13

Scattered circular patches of itchy eczema.
Stubborn to treat.

Question 14

I just mentioned that discoid eczema is stubborn to treat, but what can be done?

Answer 14

Requires potent topical steroid, often in combination with an antibacterial component.

e.g. Betnovate C ointment

Question 15

Where on the body is seborrheic dermatitis usually seen?

Answer 15

Face and scalp

->associated with cradle cap in infants

Question 16

What age is seborrheic dermatitis associated with in children?

Answer 16

<3mths, usually resolves by 12mths

Question 17

Treatments of seborrheic dermatitis?

Answer 17

Emollients- to loose scale
Daktocort ointment
Protopic ointment

Question 18

Causative microorganisms of impetigo?

Answer 18

Staph.aureus

Question 19

Appearance of impetigo?

Answer 19

Golden crust and pustules

Very infectious

Question 20

Treatment for impetigo?

Answer 20

Topical antibacterial e.g. fucidin
Oral antibiotic e.g. flucloxacillin if not improving with topical

Question 21

What is seen in molluscum contagiosum?

Answer 21

Pearly papules, umbilicated centre

Question 22

What causes molluscum contagiosum?

Answer 22

Molluscipox virus

Question 23

Is molluscum contagiosum contagious?

Answer 23

Yes, transmission to close direct contacts

Question 24

Treatment of molluscum contagiosum?

Answer 24

Reassurance, self-limiting

Can take 24 mths to clear

->if parents very concerned, can use 5% Potassium Hydroxide as this causes inflammation and turns body’s immune system towards the virus

Question 25

Can viral warts be transmitted?

Answer 25

Yes, by direct skin contact

Question 26

Which virus tends to cause viral warts?

Answer 26

HPV

Question 27

Treatment of viral warts?

Answer 27

No treatment required, stimulate own immune response to them ->if worried, topical treatments such as salicylic acid and paring

Question 28

What causes erythema infectiosum (aka slapped cheek disease)?

Answer 28

Parvovirus B19

Question 29

Which virus causes chickpox?

Answer 29

Varicella zoster

Question 30

What is seen in chickenpox?

Answer 30

Red papules progressing to vesicles (blisters), often starting on the trunk Itchy Associated with viral symptoms

Question 31

What is seen in slapped cheek disease/erythema infectiosom?

Answer 31

Erythematous rash, cheeks initially and then lace like rash on trunk and limbs

Question 32

Treatment of slapped cheek disease/erythema infectiosum?

Answer 32

Usually self-limiting, can take up to 6wks to disappear

Question 33

What can slapped cheek disease result in?

Answer 33

Very rarely, but aplastic crisis ->if patient has haemolytic disorders

Question 34

What can happen in a pregnant woman in infected by erythema infectiosum?

Answer 34

Spontaneous abortion Intrauterine death Hydrops fetalis

Question 35

What is the usual cause of hand, foot and mouth disease?

Answer 35

Enterovirus caused, usually Coxsackie virus A16

Question 36

What is seen in hand, foot and mouth disease?

Answer 36

Blisters on the hands, feet and in the mouth Viral symptoms

Question 37

Treatment of hand, food and mouth disease?

Answer 37

Self limiting Supportive treatment

Question 38

What is the difference is presentation between a child with eczema coxsackium and eczema herpeticum?

Answer 38

Eczema coxsackium- history of eczema, self limitng. Eczema herpeticum- history of eczema, child more unwell and requiring treatment.

Question 39

What is the treatment fir eczema herpetcium?

Answer 39

Withhold steroids for 24hrs Aciclovir- oral or IV ->ophthalmology review if near eye Stop steroids as continuing can make rash spread further

Question 40

What is erythema nodosum associated with?

Answer 40

IBD Sarcoidosis Infections- streptococcus, URTI

Question 41

Treatment of erythema nosodum?

Answer 41

Treat underlying causes NSAIDs

Question 42

What is dermatitis herpetiformis associated with?

Answer 42

Coeliac disease

Question 43

How long is urticaria present for to be classed as chronic urticaria?

Answer 43

>6wks

Question 44

Treatment of urticaria?

Answer 44

Antihistamines Avoid trigger

Question 45

What is meant by infantile haemangioma?

Answer 45

Very common vascular birth mark Not present on skin at birth but there is a proliferative phase between 6wks and 8mths

Question 46

Treatment of infantile haemangioma?

Answer 46

Reassurance ->beta blockers can speed up process of involution