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Paediatrics > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Define vernix caseosa

A

Chalky-whit greasy coat of newborn infants

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2
Q

Skin in preterm infants

A 
Thin
Poorly keratonised
Transepidermal water loss
Lacking subcutaeous fat
Unable to sweat
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3
Q

Features bullous impetigo

A

Uncommon
Blitering form of impetigo
Causes by staphylococcus aureus

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4
Q

Mx Bullous Impetigo

A

Systemic antibiotics .e.g. flucloxacillin

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5
Q

Features congenital pimented naveai

A

Rare
Involve extensive areas of skin (>9cm in diameter)
4-6% risk of malignant melanoma

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6
Q

Features albinism

A 
Defective biosynthesis of melanin
Lack of pigmentation of skin and eye
Failure to develop fixation reflex
Pendular nystagmus
Photophobia (constant frowning)
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7
Q

Mx albinism

A

Correction of refractive errors
Fitting of tinted lenses
Sun protection

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8
Q

Features epidermolysis Bullosa

A

Blistering of the skin and mucous membranes
Blisters occur spontaneously and following minor tauma
Oral ulceration

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9
Q

Mx epidermolysis bullosa

A

Avoidance of minor trauma
Maintenance of adequate nutrition
Analgesia when dressings changed

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10
Q

Cx epidermolysis bullosa

A

fusion of fingers and toes

Limb contractures from repeated blistering and healing

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11
Q

Features collodion baby

A

Dry and scaly skin
Infants born with taut, shiny, parchment like membrane
Risk of dehydration

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12
Q

Mx Collodion baby

A

Application of emmoliants

Membrane fissues and separates within a few weeks

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13
Q

Causes of nappy rash

A 
Irritant contact dermatitis
Infantile seborroeic dermatitis
Candida infection
Atopic eczema
Acrodermatitis enteropathica
Langerhans cell histiocytosis
Wiskott-Aldrich syndrome
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14
Q

Features irritant dermatitis nappy rash

A

Occurs if nappies changed infrequently or in diarrhoea
Irritant affect of urine on the skin
Urea splitting organisms in faeces increase alkalinity
Affects converse surfaces of buttocks, perineal, lower abdo, top of thighs
Sparing of flexures
Erythmatous with scalded appearance
Erosions and ulcer formation present

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15
Q

Features candida nappy rash

A

Erythematous
Includes skin flexures
Satellite lesions

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16
Q

Mx candida nappy rash

A

Topical antifungal

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17
Q

Mx irritant dermatitis nappy rash

A

Mild topical corticosteroid

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18
Q

Features Infantile seborrhooeic dermatitis

A

Present within 3m
Scalp
Erythematous scaly eruption
Scales form a thick yellow adherent layer (cradle cap)
Spread to face, behind ears, flexures and napkin area
Not itchy- child unbothered

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19
Q

Mx Infantile seborrhoeic dermatitis

A

Emollients
Scales cleared with sulfur and salicylic acid ointment
-applied daily for a few hours and washed off
Mild topical corticosteroid- widespread body eruptions
+/- antibacterial and antifungal

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20
Q

Features atopic eczema

A 
Genetic deficiency in the skin barrier
Onset within 1y
Uncommon in first 2m
Associated with atopy (1/3 develop asthma)
Exclusive breastfeeding can delay onset
Usually self resolves
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21
Q

Clinical Diagnosis atopic eczema

A

Itchy rash
Scratching
Excoriated areas become weepy, erythematous and crusted
Dry skin
Linchification from prolonged scratching and rubbing

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22
Q

dDx Itchy rash

A 
Atopic eczema
Chickenpox
Urticaria/allergy
contact dermatitis
Insect bite
Scabies
Fungal infection
Pityriasis rosea
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23
Q

Causes of exacerbation of eczema

A 
Bacterial infection.e.g. strep, staph
Viral infection .e.g. herpes
Ingestion of allergen .e.g. Egg
Contact with irritant or allergen
Environment .e.g. heat, humidity
Change or reduction in medication
Psychological stress
Unexplained
24
Q

Distribution of atopic eczema

A

Infant >2m: predominantly face, also trunk

Older children: flexor and friction surfaces

25
Q

Complications atopic eczema

A

Infection .e.g. staphylococcus, streptococcus
Eczema herpaticum
Regional lymphadenopathy

26
Q

Mx eczema

A 
Avoidance of precipitants
-allergens .e.g. cows milk
-avoiding nylon and woollen garments
-cutting nails and using mittens
Emollients
Topical corticosteroids
Immunomodulators (children >2y): topical tacrolimus ointment or pimecrolimus cream
Occlusive bandages: impregnanted with zinc/tar paste
-worn overnight for 2-3d at a time
Wet stockinette wraps in widespread itching
-diluted topical steroids with emollient
Antibiotics/antiviral/antifungal
Dietary elimination
Psychological support
27
Q

Features viral warts

A

Caused by human papilomavirus
Common in children
Usuaully on fingers and soles (verrucae)
Most disappear spontaneously over a few months

28
Q

Mx viral warts

A

Only indicated for cosmesis and painful lesions
Daily application of proprietary salicylic acid and lactic acid paint / glutaraldehyde lotion
Cryotherapy with liquid nitrogen- only older children

29
Q

Features molluscum contagiosum

A

Caused by poxvirus
Small, skin coloured, pearly papules with central umbilication
Often widespread
Spontaneously regress within a year

30
Q

Mx molluscum contagiosum

A

Topical antibacterial to prevent 2’ infection

Cryotherapy for chronic lesions in older children

31
Q

Features ringworm

A

Dermatophyte fungi invasion f keratinous structures
Annual ring appearance of skin lesions
Kerions: severe inflammatory pustular ringworm
Tinea capitis: scalp, acquired from pets, scaling and patchy alopecia

32
Q

Ix Tinea capitis

A

Examination under filtered UV woods light shows bright greenish yellow flourescence of infected hairs
Microscopic examination of skin scrapings show fungal hyphae
Definitive identification of fungi is by culture

33
Q

Mx ringworm

A

Topical antifungal preparation
Systemic antifungal in severe infection and scalp
Treatment of household animals if infected

34
Q

Features Scabies

A

Infestion by burrowing along stratum corneum
Severe itching occurs 2-6w after infestation
Worse in warm conditions and at night

35
Q

Scabies locations

A 
Older children:
-between fingers and toes
-axillae
-flexor aspect of wrists
-belt line
-nipples,penis, and buttocks
Infants: 
-palms and soles
-trunk
Babies:
-head, face and neck involvement (uncommon)
36
Q

Cx Scabies

A

Excoriation of skin causing eczematous/urticarial reaction
2’ bacterial infection
Norweigan scabies

37
Q

Mx Scabies

A

Treatment of child and household
Primethaprin cream (5%)- applied to all areas and washed off after 8-12h
-In babies face and scalp should be included
Benzyl benzoate emulsion (25%)- applied below neck only, left for 12h
-smells and has irritant action
Malathion lotoin (0.5%)- applied below neck, left 12h

38
Q

Features Pediculosis (Headlice)

A

Typically primary school age
Itching of scalp or nape
Identification of live lice on scalp or nits (egg cases) on hair
Suboccipital lymphadenopathy

39
Q

Mx Head lice

A

Dimeticon 4% lotion / Malathion 0.5% aqeous solution
-rubbed onto hair and scalp and left overnight
-repeated 1w later
Wetcombing with fine tooth comb to remove lice
-repeated every 3-4 days for 2 weeks
No school exclusion necessary

40
Q

Features psoriasis

A

Familial disorder
Presents after 2y
Plaques and annular lesions
Fine pitting of nails in chronic disease

41
Q

Features guttate psoriasis

A

Common in children
Small, raindrop like, oral or round erythematous scaly patches
Trunk and upper limbs
Attack resolves over 3-4m

42
Q

Mx guttate psoriasis

A

Bland ointments

43
Q

Mx Chronic Psoriasis

A

Coal tar preparations
Calcipotriol (vit D analogue) children>6y
Dithranol preparation in resistant plaque psoriasis

44
Q

Features Pityriasis Rosea

A

Acute benign self limiting condition
Single round or oval scaly macule (herald patch)
- 2-5cm in diameter
Trunk, upper arm, neck, or thigh
Numerous smaller dull pink macules develop
Rash follows line of ribs posteriorly (fir tree pattern)
Lesions may be itchy
Resolves within 4-6w

45
Q

Features Alopecia Areata

A

Common form of hair loss in children
Hairless non-inflammed smooth areas of skin, usually over scalp
Remnant of broken hairs (exclamation marks) on edge of active patches

46
Q

Prognosis Alopecia Areata

A

Usually hair growth occurs within 6-12m in localised hair loss
Poorer prognosis is associated with greater hair loss
Prognosis more guarded in children with atopic disorders

47
Q

Features Granuloma Annulare

A 
Ringed lesions
Flesh coloured non scaling edge
Over bony prominences especially hands and feet
Usually 1-3cm in diameter
Disappear spontaneously within 12m
48
Q

Features Acnes Vulgaris

A

Begins 1-2y before onset of puberty
-androgenic stimulation of sebaceous glands
Open and closed comedones, papules, pustules, nodules and cysts
Face, back, chest and shoulders
Cystic and nodular lesions may cause scarring
Exacerbation with menstruation and stress

49
Q

Mx Acne Vulgaris

A 
Topic treatments: 
-benzoyl peroxide (keratolytic agent) 1/2 daily
-sunshine in moderation
-topical antibiotics
-topical retinoids
Systemic therapy
-Oral antibiotics (tetracycline/erythromycin) >12y
-Oral retinoid (isotretinoin)
50
Q

Causes of erythema nodosum

A 
Streptococcal infection
Primary TB
Inflammatory bowel disease
Drug reaction
Idiopathic
51
Q

Causes of erythema multiforme

A 
Herpes simplex
Mycoplasma pneumoniae
Infections
Drug reaction
Idiopathic
52
Q

Features erythema multiforme

A

Target lesion
Central papule surrounded by erythematous ring
Vesicular or bullous lesions

53
Q

Features Steven-Johnson Syndrome

A

Severe bullous form of erythema multiforme
Involvement of mucous membranes
Starts with URTI
Eye involvement: conjunctivitis, corneal ulceration, uveitis

54
Q

Features Urticaria

A 
Flesh coloured wheals
Delayed hypersensitivity reaction
Commonly on legs 
Bite from flea, bedbug, animal/bird mite
Irritation
Vesicles
Papules
Wheals
Secondary infection due to scratching common
55
Q

Features hereditary angioedema

A 
Rare AD
Deficiency or dysfunction of C1-esterase inhibitor
Subcutaneous swelling
Abdominal pain
Physical trauma or stress as a trigger
Lasts a few hours
Can cause respiratory obstruction
56
Q

Mx hereditary angiodema

A

Resolves over few days

Severe acute attack: purified preparation of inhibitor

Paediatrics (22 decks)

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