Dermatology

Question 1

What is this rash? In what kids is it commonly seen?

Answer 1

Erythema toxicum - seen in neonates often 2-5d after birth, but up to 2 weeks

Typically transient, quickly appearing and disappearing with no systemic illness

Question 2

What is this rash?

Answer 2

Milia

Question 3

What has this child got? Describe the disease and what is it caused by?

Answer 3

Slapped cheek/fifth disease/erythema infectiosum

Caused by Parvovirus B19 infection

Erythematous rash characteristically starting on cheeks + spreading and lace like, can be mild systemic upset

Question 4

Can you get slapped cheek disease more than once?

Answer 4

No - immune after 1 infection

Question 5

Is slapped cheek disease infectious? When?

Answer 5

Yes - before rash develops

Question 6

In what 2 groups of kids may slapped cheek disease have serious complications?

Answer 6

Anaemias e.g. SCD, thalassaemia

Immunocompromised

Question 7

What could this rash be? What history would make it more likely rubella?

Answer 7

Rubella, measles or roseola

Rubella if also marked lymphadenopathy (suboccipital, postauricular) with headache and Forchheimer spots in soft palate

Question 8

What spots are pathognomonic of rubella and where are they?

Answer 8

Forcheimer spots - petechiae on soft palate

Question 9

What could this rash be? What would make it more likely measles?

Answer 9

Measles, rubella, roseola

Measles more likely if coryzal prodrome, Koplik’s spots on buccal mucosa and rash spreading from hairline behind ears caudally

Question 10

What are these and what are they pathognomonic of?

Answer 10

Koplik spots - Measles

Question 11

What has this child got? What causes it?

Answer 11

Scarlet fever - GAS (pyogenes)

Question 12

What is this characteristic of?

Answer 12

Scarlet fever

Question 13

What has this child got? What are the two most common causes?

Answer 13

Hand foot and mouth disease

Picornaviruses e.g. coxsackie A16 and enterovirus 71

Question 14

What could this child have? What would make it more likely roseola?

Answer 14

Measles, rubella, roseola

More likely roseola if high fever for a few days then macpap rash appearing on chest and spreading to limps as fever subsides

Question 15

What causes roseola? Who gets it? Relatively common complication?

Answer 15

HHV6 infection in kids 6m - under 2

Febrile convulsions quite common

Question 16

What may precede the characteristic lesions of hand foot and mouth?

Answer 16

Oral ulcers

Question 17

Warm CREAM of Kawasaki disease?

Answer 17

Warm - high temp for at least 5d

Conjunctivitis (non purulent)

Rash - polymorphic, non-vesicular

Erythema + oedema of hands and feet (->desquamation)

Adenopathy - usual cervical

Mucosal involvement - erythema, dryness esp of tongue

Question 18

What’s this child got? Treatment and main complications?

Answer 18

Kawasaki disease - high dose aspirin, need echo for coronary artery aneurysm (+/- ECG for carditis)

Question 19

What’s this child got? How can you tell?

Answer 19

Chicken pox - lesions of all stages at same time

Question 20

What’s this child got? What causes it?

Answer 20

Impetigo - usually staph aureus or GAS

Question 21

What’s this?

Answer 21

Molloscum contagiosum

Question 22

What’s this likely to be?

Answer 22

Ringworm

Question 23

What’s this? How can you tell?

Answer 23

Pityriasis rosea - herald patch followed by other little bits

Question 24

Tonsilitis plus red sandpaper rash. Diagnosis?

Answer 24

Scarlet fever

Question 25

What is the proper name for ringworm and what causes it? General management, when would you use oral?

Answer 25

Dermatophytosis - fungal skin infection

Management is with antifungal creams (clotrimazole, miconazole) - oral fluconazole if on scalp

Question 26

What is this rash and distribution typical of?

Answer 26

Childhood eczema