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LS YEAR 4 Paediatrics > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what Is eczema

and presentation

A

eczema is a chronic relapsing skin condition mostly presenting in infancy
it is characterised by red itchy skin in skin creases such as elbow folds and behind knees
red weepy skin especially on cheeks in infants
hyperpigmentation
lichenficaiton and skin tchiekneing
pruitis
scaling

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2
Q

how many children does it affect

A

20%
with 80% occurring before 5
most regress by teens
but flares throughout childhood is common

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3
Q

risk factors and triggers

A 
family history
hay fever or asthma -atopy
cold weather
infection
sweating 
soap and shampoo
pollen, allergens, pet hair 
dietary food triggers
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4
Q

diagnosis

A

itchy skin and 3 of the following:

  • itching in skin creases/folds
  • family history of atopy or concurrent asthma hayfever
  • dry skin
  • flexural eczema is visble
  • onset in first two years of life
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5
Q

investigations

A

not commonly done but ice

swabs and cultures

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6
Q

management

for mild

A

avoid irritants
cut nails to minimise scratching damage

emollients- to mosturise skin twice daily, oil and greasy ones tend to work better

soap and shampoo substitutes

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7
Q

steroid

A

move onto hydrocortisone steroids and then up the ladder

-hydrocoristone
emuovate
betnaovate /elacon
then dermavate

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8
Q

other options

A

-wet wraps/bandages
-acute if steroid doesn’t work look into tacrolimus
dietary elimination
support from eczema support groups

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9
Q

if at risk of infection or infection what can be given

A

antibiotics

erythromycin and fluxocillin

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10
Q

what is impetigo

A

superficial skin infection

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11
Q

what causes impetigo

A

staphylococcus aureus
or beta haemolytic streptococcus

group A (beta-hemolytic) streptococcus = s pyogenes

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12
Q

how does it present

A

70% cases are non bullous
honey coloured crusted lesions around mouth
satilette lesions
itching
lymph node enlargement
can spread to rest of. body- more commonly in bullous

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13
Q

what increase likeliness of bullous

A

in neonates

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14
Q

diagnosis of impetigo

A

culture /swabs

but commonly clinical diagnosis

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15
Q

management of impetigo

A

fusidic acid/ mucopirin
tds 7 DAYS
if extensive consider pO 7 days flucoxacillin

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16
Q

why is nappy area prone to rash?

A

moist and warm

a simple irritation

17
Q

four types of rashes

A

ammoniacal -irritant, skin fold spared
candida -well demarcated edges, oral thrush may be seen, inguinal folds
seberrhoic -oily thick scales , cradle cap may also be present
psoriatic -fhx often

18
Q

causes

A

exposure prolonged to urine faeces

chemical irritant

19
Q

management

A

change nappy regularly
clean area
nystatin topically for those with candida
use barrier cream and moisturising cream
hydrocortisone

DONT USE TALCUM -not recommended by AAD

20
Q

what is scabies

A

infestation of skin by mites in outer layer of skin

21
Q

what causes scabies

A

sarcoptes scabies

22
Q

presentation of scabies

A

itching
redness of skin
burrowing
affected areas -waist, axilla, webs of fingers and toes, ankle, wrist

23
Q

management of scabies

A

treat with perthemrin or marathion
avoid contact with others
all treated on same day
treat a week later again

24
Q

rf of scabies

A

sexual contacts
crowding
halls and care homes
poverty

25
Q

what is erythema nodosum

A

panniculitis

inflammation of fat under skin causing formation of red nodules under skin commonly on shins

26
Q

key thing about erhtyema nodosum

A

can be seen in systemic disease e.g. IBD

27
Q

causes

A 
mycoplasma 
TB
iBD 
viral
idopahtic 
streptococcal infections (most common)
sulphanides
28
Q

presentation

A 
fever 
itching
arthlagia
rash nodules
swollen ankles
29
Q

Ix

A 
bloods and cultures
throat swabs 
stool samples 
ESR raised 
biospy
xray- for TB and sarcoidosis
30
Q

management

A

treat cause cold compresses NSAIDS

31
Q

what is Steven Johnson syndrome ?

A

immune mediate complex reaction can be mild or severe

32
Q

RF

A

female and hiv

those on meds

33
Q

triggers for SJS

A 
medications -75%
anticonvulsants 
antimicrobials 
infections -25%
HLA-b predisposition
34
Q

presentation of SJS

A 
skin - involvement of face, plans, soles, hands, extensions 
confluent eryhtema 
target lesions
nikolsky sign
other sympotms
URTI
fever
sore throat
chills
headache
nausea and vomiting
diarrhoea 
malasie
PURLUENT COUGH
35
Q

when can tacrolimus be given

A

> 2 year old

36
Q

full eczema mx options

A

o Emollients – apply liberally >2 times/day and after bath; emollient oil as soap substitute
o Topical corticosteroids daily until eczema is clear, then taper off on alternate days for 1wk and then twice weekly before stopping
▪ If eczema returns, resume once daily application until clear and then recommence taper
▪ Ointments > cream
▪ Rx potency depends on severity:
● Mild eczema 🡪 mild potency topical corticosteroid ointment – e.g. 1% hydrocortisone (safe anywhere on body)
● Mild-to-moderate eczema 🡪 moderate potency topical corticosteroid ointment – e.g. clobetasone butyrate 0.05% (face and body, NOT groin)
● Moderate-to-severe eczema 🡪 potent topical corticosteroid ointment – e.g. mometasone furoate (body, NOT face or groin)
▪ Keep to minimum, apply thinly, don’t use on face 🡪 excessive use may cause thinning of skin + systemic S/Es
o Immunomodulators (e.g. tacrolimus) – in children >2yrs when not controlled by short-term steroids
o Occlusive bandages (worn overnight for 2-3 days) – when scratching and lichenification are a problem; may be impregnated with zinc paste or zinc and tar paste
▪ For widespread itching 🡪 wet stockinette wraps; diluted topical steroids with emollient are applied to skin and damp wraps fashioned for trunk and limbs are then applied with overlying dry wraps

37
Q

impetigo exclusion

A
  • HIGHLY contagious 🡪 exclude child from school until lesions are dry OR on Abx for 48hrs
38
Q

barrier cream

A

zinc and castor oil cream

39
Q

tens scoring system

A

SCORTEN score (Score for Toxic Epidermal Necrolysis) and is greater than 90% for people with a SCORTEN score of 5 or more
▪ SCORETEN – 1 point for each of 7 criteria present at time of admission:
● Age >40
● Presence of malignancy
● HR >120 bpm
● Initial percentage of epidermal detachment >10%
● Serum bicarbonate <20 mmol/L
● Serum urea >10 mmol/L
● Serum glucose >14 mmol/L

LS YEAR 4 Paediatrics (24 decks)

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