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)
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
3
Q
Treatment of atopic eczema
A
- Emollients to replace lipids
- Topical steroids to reduce inflammation
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)
5
Q
Pityriasis alba
A
- Dry rough skin cheeks
- Hypopigmentation
- Asian skin > caucasian
- Often atopic
- Treat with emollients and sunscreen
6
Q
HSV
A
- Primary infection usually perioral
- Treat with acyclovir
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)
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
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
10
Q
Scabies in infants
A
- Rash with burrows as in adults
- Soles involved
- Nodules - axilla, umbilicus, groin, penis
- Whole family
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)
12
Q
Chronic urticaria
A
- Autoimmune
- May have physical urticaria
- Manage with chlorpheniramine if <6 months or long acting antihistamine if >6 months
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)
14
Q
Segmental haemangioma
A
- Occur as plaque
- Often large
- Associated visceral lesions
- Associated with underlying abnormalities (urogenital and cord tethering)
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
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
