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Child Health > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Presentation of atopic eczema

A
  • Association with food allergy, asthma and rhinitis
  • Flexural rash
  • Age <2 years
  • FHx
  • Dry skin
  • Allergic sensitisation (total and sepcific IgE)
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2
Q

Pathogenesis of atopic eczema

A
  • Linked to impaired barrier function of skin
  • Exposure to infection
  • Immune Th1/Th2 imbalance
  • Filaggrin (FLG) mutations
    • Structural - aggregates filaments
    • Breaks down to form a natural moisturiser
    • Dry skin and hyperlinear palms
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3
Q

Treatment of atopic eczema

A
  • Emollients to replace lipids
  • Topical steroids to reduce inflammation
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4
Q

Discoid eczema

A
  • Well demarcated plaques
  • Often crusted and weeping
  • Bacterial superinfection
  • Potent steroid required for 7-14 days
  • Repeat for flares
  • Combine with anti-bacterial (not antibiotic)
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5
Q

Pityriasis alba

A
  • Dry rough skin cheeks
  • Hypopigmentation
  • Asian skin > caucasian
  • Often atopic
  • Treat with emollients and sunscreen
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6
Q

HSV

A
  • Primary infection usually perioral
  • Treat with acyclovir
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7
Q

Impetigo

A
  • Annular erythematous lesions
  • Honey coloured crust
  • Highly contagious
  • Almost always staph aureus (occasionally strep)
  • May become bullous - exfoliative exotoxins
  • Treatment
    • Swabs
    • Hygiene advice (don’t share towels etc)
    • Topical antiseptic
    • Oral antibiotic (flucloxacillin, erythromycin)
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8
Q

Irritant contact napkin dermatitis

A
  • Erythema spares skin folds
  • Moisture and friction disrupt skin barrier
  • Penetration of irritants from urine and faeces
  • Candida overgrowth common
  • Treat with frequent nappy changes, avoid soaps and wipes, emollients and topical steroids
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9
Q

Tinea capitis

A
  • Changing organisms
    • Trichophyton tonsurans
    • Trichophyton violaceum
  • Diagnosis involves scrape from affected site
  • Diffuse scales, patchy alopecia, pustules, black dots, lymphadenopathy and boggy swelling
  • Prevent with ketoconazole shampoo (not a treatment)
  • Treat with topical terbinafine (if head shaved) or oral griseofulvin/terbinafine
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10
Q

Scabies in infants

A
  • Rash with burrows as in adults
  • Soles involved
  • Nodules - axilla, umbilicus, groin, penis
  • Whole family
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11
Q

Acute urticaria

A
  • Itchy papules (hives) and plaques
  • Wheal and flare
  • Lasts 6-8 weeks
  • Multiple triggers (infection, injections, ingestion of food/drugs, inhalation etc)
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12
Q

Chronic urticaria

A
  • Autoimmune
  • May have physical urticaria
  • Manage with chlorpheniramine if <6 months or long acting antihistamine if >6 months
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13
Q

Infantile haemangioma

A
  • 1st 6 weeks of life
  • Superficial, deep and mixed
  • Involute by 50%, 70% and 90% at 5, 7 and 9 years
  • Kaposiform haemangioendothelioma, tufted angioma, rapidly involuting congenital congenitalhaemangioma (RICH) and non-involuting congenital haemangioma (NICH)
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14
Q

Segmental haemangioma

A
  • Occur as plaque
  • Often large
  • Associated visceral lesions
  • Associated with underlying abnormalities (urogenital and cord tethering)
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15
Q

Diffuse neonatal haemangiomatosis

A
  • Multiple haemangiomas with underlying visceral disease
  • Liver, CNS, lungs and GIT
  • Complications include cardiac failure
  • Mortality high
  • Compliations include ulceration, bleeding and infection
  • Can also cause impaired vision
  • Propranalol can be used
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16
Q

Capillary Malformation (CM) and Port Wine Stain (PWS)

A
  • Present at birth
  • Localised or extensive
  • Face, trunk or limbs
  • Bright redin infacny then violaceous with time
  • Risk of Sturge-Weber syndrome if V1
    • Triad of ipsilateral facial V1 CM
    • Pia mater CM (neuro complications)
    • Ocular abnormalities
17
Q

Congenital melanocytic naevi

A
  • Can be small or large
  • Macular pigmentation/slightly elevated
  • May lighten with time
  • Risk of malignant transformation - rare if <10cm
  • Photo-protection important with clothing and high SpF sunscreen
18
Q

Mongolion spot

A
  • Normal finding in black and asian infants
  • Bluish discolouration
  • Lower back and sacrum
  • Histologically deep dermal melanocytes
  • Resolve with time (4 years)
19
Q

Vulvitis

A
  • Occurs in young pre-pubertal firls and represents localised eczema
  • Presents with discharge and stinging/burning when passing urine
  • Pre-pubertal girls do not develop candidiasis as the pH of vulval skin before puberty does not support candida overgrowth
  • Management the same for napkin dermatitis
20
Q

Napkin dermatitis

A
  • Most common skin problem if infancy although declining with the use of disposable napkins
  • Occurs when moisture and friction disrupt the skin barrier allowing penetration from irritants from urine and faeces
  • Contributed to by candida and bacterial overgrowth
  • Management involves frequent nappy changes and avoiding soaps/wipes, greasy emollients and steroid/antifungal cream if very inflamed
21
Q

Lick lip dermatitis

A
  • Peri-oral eczema caysed bt drying the lips of atopic children causing them to lick them which then irritates the skin
  • Worse in winter
  • Manage with greasy emollients and topical steroids when inflammed - also consider tacrolimus if requiring steroids more than once a month
22
Q

Pityriasis alba

A
  • Hypopigmentation usually with dru rough skin on the cheeks of atopic children aged 4-12 years
  • Mainly seen in coloured skin
  • Management involves emollients and sunscreen to prevent the surrounding skin tanning making it more obvious
23
Q

Juvenile plantar dermatosis (JPD)

A
  • Affects plantar surface in children (usually boys) starting around 4-7 years
  • Main trigger is sweating
  • Erythema, hyperkeratosis and fissuring
  • Itch is not a feature
  • Settles spontaneously at puberty
  • Avoidance of occlusive footwear, use synthetic socks or thick towelling socks to improve absrption of sweat
24
Q

Molluscum contagiosum

A
  • Small pearly umbilicated papules on the skin of children
  • Characteristic central dimple
  • Usually affects the 4-9 year age group
  • Generally become inflammed then resolve with the lesions taking around 18 months to resolve
  • Caused by a DNA pox virus
  • They clear quickly if physically irritated
25
Q

Sebaceous hyperplasia

A
  • Seen in over half of full term newborns.
  • Due to hypertrophy of sebaceous glands secondary to maternal androgens and is seen as yellowish white pinpoint lesions clustered around the nose.
  • Resolves spontaneously over the first 4-6 weeks of life.
26
Q

Milia

A
  • Affect 30-50% of neonates.
  • Found on the chin, cheeks and forehead
  • Discrete whitish yellow papules which spontaneously extrude in the first few weeks of life
  • Also seen in the mouth or foreskin/ventral penis and sctorum
27
Q

Miliaria

A
  • Seen in infants nursed in a warm environment such as an incubator
  • Tow forms:
    • Miliaria crystalina due to superficial fuct obstriction and trapping of sweat which leads to clear vesicles
    • Miliaria rubra which are erythematous pustules over the head, neck and trunk
28
Q

Naevus flammeus

A
  • Affects 50% of neonates
  • Nape of neck or overlying the glabella, eyelids, nose or upper lip
  • Those on face tend to fade over time but those on neck tend to persist
29
Q

Epidermal naevi

A
  • Linear plaques of warty pigmented skin orientated along Blashkis lines
  • Most often occur in small area
  • Become darker and more verrucous with age

NB - Can also have a sebaceous component (sebaceous naevus)

30
Q

Sebaceous naevus

A
31
Q

Differential of non-blanching rash

A
  • Meningococcal septicaemia or other bacterial sepsis
  • HSP
  • ITP
  • Acute leukaemias
  • HUS
  • Mechanical - strong coughing, vomiting or breath holding in an SVC distribution
  • Traumatic - NAI
  • Viral illness (i.e. influenza and enterovirus)
32
Q

Hand, foot and mouth disease

A
  • Caused by coxsackie A virus
  • Usually starts with URTI symptoms
  • Clinical diagnosis
  • Supportive management
33
Q

Measles

A
  • Associated fever, corysal symptoms and conjunctivitis
  • Koplik spots (greyish white spots) on buccal mucosa
  • Rash starts on the face, classically behind the ears and then spreads to the rest of the body
  • Erythematous, macular rash with flat lesions
34
Q

Scarlet fever

A
  • Associated with group A streptococcus infection, usually tonsillitis
  • Enterotoxin produced by the streptococcus pyrogenes bacteria
  • Red-pink, blotchy, macular rash with rough ‘sandpaper’ skin that starts on the trunk and spreads outwards
  • Other features include:
    • Fever
    • Lethargy
    • Flushed face
    • Sore throat
    • Strawberry tongue
    • Cervical lymphadenopathy
  • Treat with phenoxymethylpenicillin (penicillin V)
35
Q

Rubella

A
  • Rubella virus
  • Milder erythematous macular rash compared with measles
  • Starts on face and spreads to rest of body
  • Also lymphadenopathy behing ears and at back of neck
  • Complications include thrombocytopenia, encephaitis and congenital rubella syndrome (triad of deafness, blindness and congenital heart disease)
36
Q

Parovirus B19

A
  • Slapped cheek syndrome/erythema infectosum
  • Mild fever, coryxa and non-specific viral symptoms
  • Diffuse bright red rash after 2-5 days on both cheeks
  • Self-limiting
  • Immunocompromised patients and pregnant women most at risk of complications including:
    • Aplastic anaemia
    • Encephalitis or meningitis
    • Fetal death
    • Rarely hepatitis, myocarditis or nephritis
37
Q

Roseola infantum

A
  • Caused by human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7)
  • Presents 1-2 weeks after infection with high fever
  • Mild, erythematous, macular rash across arms, legs, trunk and face
  • Not itchy
  • Main complication is febrile convulsions

Child Health (23 decks)

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