Dermatology

Question 1

A 4-week-old child is brought to clinic with a red rash on her scalp associated with yellow flakes. What is the most likely diagnosis?

Answer 1

Seborrhoeic dermatitis

It typically affects the scalp (cradle cap), nappy area, face and limb flexures

Question 2

A 14-month-old child presents to you in primary care after a convulsion. The parents are very distressed as an uncle has epilepsy and they are concerned their daughter may have it. The child appears alert with a temperature of 38.4C, something which the parents believe she has had for four days. Previously, calpol has helped bring this down from a high of 40.7ºC. You also note a pink, maculopapular rash on the chest with minimal spread to the limbs, something which mum says she noticed this morning. The child has been feeding but has had some diarrhoea and you feel some enlarged glands on the back of her head. There is no rash in the mouth. Given your findings, what do you feel is the most likely underlying cause of the child’s symptoms? State the characteristic features of this illness

Answer 2

Roseola infantum 
Causative organism is herpes virus 6
- 3-5 day high fever (>40)
- Maculopapular rash (as the fever is disappearing)
- Febrile convulsions in 10-15%
- Diarrhoea and cough commonly seen 
- Cervical lymphadenopathy

Question 3

What type of rash is hand foot and mouth disease?
What is the causative organism?
Any other clinical features?

Answer 3

Vesicular rash
Caused by cocksackie A16
Self limiting condition
Clinical features:
- Mild systemic upset: sore throat, fever
- Oral ulcers (red spots on the tongue and inside the mouth progress to yellow-grey ulcers)
- Soon after the mouth ulcers appear vesicles/blisters on the palms and soles of the feet appear

Question 4

What is it important to remember about scarlet fever?

Answer 4

Scarlet fever is a notifiable disease

Children can return to school 24 hours after commencing antibiotics