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Paediatrics > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Common causes nappy rash

A

Irritant (contact) dermatitis: most common, ^ if nappies not changed freq enough/ if infant has diarrhoea
Infantile seborrhoeic dermatitis
Candida infection
Atopic eczema

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2
Q

Characteristics IRRITANT DERMATITIS nappy rash

A

Rash over convex surfaces of buttocks, perineal region, lower abdo and top of thighs.
Characteristically flexures spared (differentiates it from other causes nappy rash)
Rash erythematous, may have erosions + ulcers if severe

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3
Q

Tx IRRITANT DERMATITIS nappy rash

A

Mild: emollient
Severe: mild topical corticosteroids

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4
Q

Characteristics CANDIDA nappy rash

A

Erythematous
Includes skin flexures
May have satellite lesions

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5
Q

Tx CANDIDA nappy rash

A

Topical antifungal

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6
Q

Infantile seborrhoeic dermatitis clin features

A

Starts on scalp as erythematous scaly lesion forming yellow layer
Scaly rash can then extend to face, behind ears and then flexures and nappy area
NOT itchy (unlike atopic dermatitis)
Increased risk baby going on to develop contact dermatitis

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7
Q

Infantile seborrhoeic dermatitis tx

A

Responds to emollients
Scalp: low conc salicylic acid + sulphur-containing ointment
If widespread on body: mild topical corticosteroid +/- antibacterial/ antifungal agents

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8
Q

Scabies definition

A

Infestation with 8-legged mite Sarcoptes scabei, burrows down epidermis

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9
Q

Scabies clinical features

A

Severe itching, worse in warm conditions + at night
Infants + young kids: palms, soles and trunk
Older kids: burrows, papules and vesicles between fingers + toes, axillae, flexor aspect of wrists, belt line, nipple line, penis + buttocks

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10
Q

Dx scabies

A

Clin dx
History of itching
Characteristic lesions
Confirmation can be made by microscopy of skin scrapings from lesions (mite, eggs, mite faeces)

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11
Q

Complications scabies

A

2y eczematous/ urticarial reactions

2y bacterial infection

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12
Q

Tx scabies

A

Tx child + WHOLE FAMILY
Permethrin (insecticide) cream below neck, wash off after 8-12h
Benzoate emulsion below neck only
Malathoin lotion

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13
Q

Head lice definition

A

Pediculosis capitis = head lice infestation

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14
Q

Presentation pediculosis

A 
Itching of scalp/ nape
Live lice on scalp
Nits (empty egg shells) on hairs 
\+/- 2y bacterial infection (often over nape of neck, can be confused w impetigo)
\+/- suboccipital lymphadenopathy
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15
Q

Tx pediculosis

A

0.5% malathion-containing solution applied to hair, left overnight. Shampoo hair, remove lice and nits with fine-tooth comb. Repeat 1 week later OR
Permethrin cream rinse - leave on for 10 mins only OR
Wet combing every 3-4 days for 2 wks

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16
Q

Causes erythema multiforme (HOMID)

A 
Herpes simplex infection
Mycoplasma pneumoniae infection
Other infection
Drug reaction 
Idiopathic
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17
Q

Erythema multiforme rash

A

Target lesions, central papule surrounded by erythematous ring. Lesions may also be vesicular/ bulllous

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18
Q

Impetigo definition

A

Localised, highly contagious, staph aureus and/ or strep pyogenes (group A strep) infection
V CONTAGIOUS

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19
Q

RFs impetigo

A

Pre-existing skin disease e.g. atopic eczema
Infants
Young children

20
Q

Impetigo lesions

A

Lesions on face, neck and hands
Begin as erythematous macules
Can become vesicular/ pustular/ bullous
Characteristic honey-coloured crusted lesions (due to rupture of vesicles with exudation of fluid)

21
Q

Spread of impetigo

A 
Autoinoculation of infected exudate -> infection of other parts of the body 
Nasal carriage (between people)
22
Q

Mx impetigo

A

Mild cases: topical antibiotics e.g. mupirocin
Mod-severe: narrow-spectrum systemic abx, e.g. fluclox
OR broad-spectrum e.g. co-amox
Avoid nursery/ school until lesions dry
Nasal cream containing mupirocin/ chlorhexidene/ neomycin

23
Q

Bullous impetigo

A

Uncommon but potentially serious blistering form of impetigo, caused most commonly by Staph aureus

24
Q

Epidemiology bullous impetigo

A

Seen particularly in newborn

25
Q

Tx bullous impetigo

A

Systemic abx e.g. co-amoxiclav

26
Q

Onset and resulution atopic eczema

A

Usually in 1st year of life, 80% cases present before age 5
Uncommon in 1st 2 months (unlike infant seborrhoeic dermatitis)
Mainly disease of childhood: 50% resolve by age 12, 75% by age 16

27
Q

Prevalence atopic eczema in UK

A

~20%

Prevalence increasing

28
Q

Definition atopic eczema (atopic dermatitis)

A

Chronic, relapsing inflammatory skin condition characterised by itchy red rash that favours skin flexures e.g. in creases of elbows, behind knees

29
Q

Predisposing factors eczema

A

FHx atopic disorders: eczema, asthma, alleric rhinitis

PMHx atopic disorders e.g. asthma

30
Q

Dx atopic eczema

A

Clinical dx
If tested, most kids have ^ IgE level
If hx suggests particular allergic cause, skin-prick and radioallergosorbent tests (RAST)
Exclude immune def disorder if severe/ atypical

31
Q

Clin features atopic eczema

A

Itching = main symptom
Itching -> scratching and exacerbation of the rash
Scratched areas become erythematous, weeping and crusted
Atopic skin usually dry, prolonged scratching can -> lichenification

32
Q

Distribution eczema rash

A

Infant >2 months: mainly face, also trunk

Older child: mainly flexor and friction surfaces

33
Q

Complications eczema

A

2y infection: usually Staph/ Strep
- Herpes simplex: less common, but potentially v serious as can extend rapidly -> extensive vesicular reaction (eczema herpeticum)
Regional lymphadenopathy

34
Q

Mx eczema

A

Avoid soap/ biological detergents, cotton clothing
Avoid any known allergens, e.g. cows milk
Emollients, >=2x day, and after baths
Mild steroids (e.g. 1% hydrocortisone) 2x day if needed
Stronger steroids: acute exacerbations, keep use to minimum

35
Q

Mx severe eczema

A

Immunomodulators e.g. tacrolimus, pimecrolimus: if child >2, not responding to corticosteroids, can use in ST
Occlusive bandages: helpful if scratching and lichenification problems. Apply overnight

36
Q

Definition of squint (stabismus)

A

Misalignment of the visual axes, often reported by parents as misalignment of the eyes

37
Q

Non-pathological squint

A

Newborns usually have transient misalignments up to 3 months old

38
Q

Ix infant with squint

A

Check red reflexes

Refer for specialist ophthalmological opinion if >3 months

39
Q

Classification of squints

A

1) Concomitant (non-paralytic, common)

2) Paralytic (rare) squint varies with gaze direction (due to paralysis of motor nerves)

40
Q

Causes non-paralytic squints

A

Usually due to refractive error in 1 or both eyes

Especially common in children with neurodevelopmental delay

41
Q

Tx non-paralytic squints

A

Often treated by correction with glasses

May need surgery

42
Q

Types non-paralytic squints

A

Squinting eye turns in = convergent (most common)
Eye turns out = divergent
Vertical misalignment

43
Q

Causes paralytic squint

A

Paralysis of motor nerves

Can be sinister: SOL, tumour

44
Q

Corneal light reflex test

A

Used to detect squints
Pen-torch held at distance to produce reflections on both corneas simultaneously
Light reflection should appear on both corneas simultaneously
If doesn’t -> squint

45
Q

Cover test

A

Test to determine presence, type and amount of ocular misalignment
When a squint present and the fixing eye covered, the squinting eye moves to take up fixation
Perform with object (e.g. toy) near and far away (some squints only present at 1 distance)

Paediatrics (7 decks)

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