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Sarah Paeds > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What % of children are affected by atopic eczema?

A

20%

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2
Q

Lifetime risk subsequent malignant melanoma from congenital pigmented naevi >9cm

A

4-6%

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3
Q

Itchy rashes

A 
Eczema 
Chickenpox 
Urticaria/allergy
Contact dermatitis 
Insect bites 
Scabies 
Pityriasis rosea
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4
Q

Characteristic distribution of nappy rash

A

Buttocks, perineal region, lower abdo, upper thighs

Sparing flexures

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5
Q

Mx nappy rash

A
  • Advise highly absorbent, disposable nappies,
  • Regularly changing, careful drying
  • Nappy off for as much as possible
  • Avoid soaps, lotions, etc.
  • Barrier protection e.g. sudocreme
  • If inflamed - hydrocortisone 1% for 7 days
  • If candida (satellite lesions) - clotrimazole
  • If bacterial - fluclox
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6
Q

Presentation of seborrhoeic dermatitis

A

Cradle cap - thick, yellow, adherent layer
Then break out in erythematous rash similar to nappy rash distribution + flexures

NOT ITCHY (unlike eczema)

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7
Q

What do children with seborrhoeic dermatitis have an increase risk of developing?

A

Atopic eczema

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8
Q

Mx seborrhoeic dermatitis

A

Emollients
Sulphur/salycylic acid ointment
Topic steroids

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9
Q

Differences between atopic eczema and serborrhoeic dermatitis

A

AE - ITCHY, generally not common before 2 mos

SD - not itchy, common before 2 mos. Yellow, scaly cap

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10
Q

When does atopic eczema usually present?

A

First year of life

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11
Q

What % atopic eczema resolved by 16 years

A

75%

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12
Q

Proportion of children with atopic eczema going on to develop asthma

A

1/3

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13
Q

Presentation atopic eczema

A

Itchy rash -
Face and trunk in inftants
Flexures in children

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14
Q

Causes of exacerbations of eczema

A 
Bacterial infection (e.g. staph)
Viral infection (e.g. HSV)
Allergens 
Heat/humidity 
Stress
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15
Q

Mx of eczema

A
  • Avoidance of triggers
  • Cut nails short, loose cotton clothing
  • Emollients (E45, cetraben, dermol500, diprobase) - use liberally and frequently
  • Mild steroids e.g. hydrocortisone
  • Moderate steroids e.g.
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16
Q

Mx of eczema

A
  • Avoidance of triggers
  • Cut nails short, loose cotton clothing
  • Psychosocial support
  • Emollients (E45, cetraben, dermol500, diprobase) - use liberally and frequently
  • Mild steroids e.g. hydrocortisone
  • Moderate steroids e.g. eumovate
  • Calcineurin inhibitors
  • Occlusive bandages (lichenification) w/ zinc and tar
  • Potent steroids e.g. betnovate
  • Very potent steroids e.g. dermovate
  • PO steroids
  • Anti-histamines e.g. cetirizine
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17
Q

Eczema steroid ladder

A

Hydrocortisone
Eumovate
Betnovate
Dermovate

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18
Q

Indications for referral eczema

A

Suspected eczema herpeticum
Severe atopic eczema not responded within 1 week
Failure of bacterial infected treatment
Severe recurrent infections

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19
Q

Eczema treatment w/ lichenifcation

A

Occlusive bandages with zinc and tar

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20
Q

Cause of viral warts

A

HPV

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21
Q

Mx viral warts

A

Daily application salicylic acid paint

Cryotherapy

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22
Q

Which virus causes molluscum contagiosum

A

Pox

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23
Q

Mx molluscum contagiosum

A

Watch and wait (resolves spontaneously after 6-12 months)

Cryotherapy for chronic lesions

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24
Q

Molluscum contagiosum time course

A

6-12 months

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25
Q

Skin coloured pearly papules with central umbilication

A

Molluscum contagiosum

26
Q

Annular lesions with crusted egde. Circular

A

Ringworm

27
Q

Which fungi cause ringworm

A

Dematophytes invade dead keratinous structures

28
Q

Mx ringworm

A

Topical antifungals e.g. terbinafine cream/clotrimazole

Systemic antifungals for severe infection (e.g. terbinafine, itraconazole)

29
Q

Diagnosis ringworm

A

Fungal hyphae on skin scrapings

30
Q

Common cause (source of fungi) ringworm

A

Pets

31
Q

Burrows, vesicles, papules on palms, soles, between fingers and toes.
Severe itching

A

Scabies

32
Q

Mx scabies

A

5% permethrin for WHOLE FAMILY

Washed off after 8-12 hours then reapplied 2 weeks later

Chlorphenamine (drowsy anti-H) for sleep/itchy.

33
Q

Complications of scabies

A

Secondary bacterial infection

Slowly resolving nodular lesions

34
Q

Commonest lice infestation in children

A

Headlice (pediculosis)

35
Q

Itchy scalp/nape

Suboccipital lymphadenopathy

A

Headlice (pediculosis)

36
Q

Mx of headlice

A

Wet combing with fine tooth comb

Dimeticone 4% lotion left in overnight and repeated 1 week later

37
Q

Mx periorbital cellulitis

A

High dose IV abx
- Ceftriaxone
Incision, drainage and culture of peri-ocular abscess

38
Q

Mx tinea capitis

A

Systemic antifungal therapy - PO terbinafine

39
Q

Advice for ringworm infection

A

Loose fitting clothing
Wash affected areas daily and dry thoroughly
Avoid scratching

Do not share towels

Wash clothes and bed linen frequently

40
Q

Commonest psoriasis in childhood

A

Guttate

41
Q

Presentation of guttate psoriasis

A

Raindrop erythematous scaly patches of trunk and upper limbs

Typically follows streptococcal/viral throat or ear infection

42
Q

Mx guttate psoriasis

A

Phototherapy (narrow band UVB)

Emollients
Potent steroids

Vitamin D analogues on plaques

43
Q

Single round scaly macule (Herald’s patch)

A

Pityriasis rosea

44
Q

Origin of pityriasis rosea

A

Viral

45
Q

Mx of pityriasis rosea

A

None - self resolving in 4-6 weeks

46
Q

Pathophysiology of acne

A

Around puberty, increased production of sebum, androgenic stimulation of sebaceous glands.
Obstruction of sebaceous follicles = acne

47
Q

Features of acne

A

Open comedones - blackheads
Closed comedones - whiteheads
Nodules, pustules, cysts

48
Q

Advice for acne

A

Gentle cleansing 2x/day - do not overclean
Avoid squeezing
Healthy diet
Non-comedogenic make up/emollients
(Treatments are effective but may take up to 8 weeks to have desire effect)

49
Q

Mx of acne

A

Conservative advice

  • Topical retinoids or antibiotics (clindamycin)
  • Benzoyl peroxide
  • PO abx (lymecyclin/doxycycline) - change to different abx after 3 months if no improvement
  • Roaccutance (dermatology r/f)
  • COCP (NOT progesterone only)
50
Q

Which contraception should be avoided in girls with acne

A

Prosterone only - with androgenic activity can worsen acne

51
Q

What must be checked for patients on roaccutane

A

Must be on contraception (teratogenic)

Regular LFT checks

52
Q

Mx hand foot and mouth disease

A 
Symptomatic support (hydration, analgesia)
Does not need school exclusion
53
Q

Pathophysiology of milia

A

Keratin trapped under surface of skin

54
Q

Mx milia

A

Most cases clear by themselves

Cosmesis - fine needle, cryotherapy, laser, dermabrasion, chemical peeling

55
Q

Causes erythema nodosum

A

IBD
TB
Drug reaction
Idiopathic

56
Q

Causes erythema multiforme

A

HSV
Mycoplasma pneumonia
Drug reaction

57
Q

Is HSP more common in girls or boys?

A

Boys

58
Q

Erythema nodosum

A

Tender, discrete nodules on the shins

59
Q

Erythema infectiosum

A

Slapped cheeck - parvovirus B19

Erythematous cheek progresses to maculopapular lace-like rash over trunj and limbs

Fever, malaise, headache, myalgia

60
Q

How does PVB19 cause an aplastic crisis?

A

Infects erythroblastoid red cell precursors in the BM

- Paritcularly common in sickle cell

Sarah Paeds (20 decks)

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