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Paeds > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Nappy rash advice

A

High absorbency nappy well fitted
Leave nappy off as much as possible to help skin drying
Clean skin and change nappy every 3-4hrs or as soon as wetting/soiling
Use water or fragrance+alcohol free baby wipes
gently dry after cleaning
bath daily NOT using soap, bubblebath, lotions or talc
NHS choices leaflet

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2
Q

Nappy rash w/mild erythema or child asymptomatic

A 
Barrier preparation (OTC)
Apply thinly after nappy change
(Zn or castor oil ointment, white soft paraffin)
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3
Q

Nappy rash that is inflamed or causing discomfort

A

If >1m hydrocortisone 1% cream OD max 7d

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4
Q

If nappy rash persists and candidal infection suspected/detected

A

Advise against barrier
prescribe topical imidazole (eg clotrimazol, econazole, miconazole)
Preparation determines frequency

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5
Q

If nappy rash persists or bacterial infection suspected/confirmed

A

PO fluclox 7d (clari if allergy)

arrange r/v

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6
Q

Summary of nappy rash

A

Disposable nappies better than towel
Expose area to air where possible
Barrier eg subocrem
Mild steroid 1% hydrocort. in severe cases
Candida: imidazole and cease barrier until candida settled

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7
Q

Seborrhoeic dermatitis in children

A

NOT serious
will resolve in wks/months (usually by 8m)
If scalp affected:
-Regular washing + brushing
- soften w/baby oil and then wash with baby shampoo
- soak crusts overnight in white petroleum jelly or slightly warmed oil and shampoo in morning
If conservative ineffective: topical imidazole cream 2-3 times/day
Specialist if lasting 4wks
If non scalp advise bathing and using emollient and soap substitute
if severe 1% hydrocort

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8
Q

Atopic eczema skin/physical severity

A

Clear: normal skin
Mild: areas of dry skin, infreq. itch
mod: mild+redness
Sev: widespread areas odf dry skin, incessant itch, redness, skin thickening

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9
Q

Atopic eczema impact on life and psychosocial wellbeing

A

none: no impact
mild: little impact
mod:mod impact+disturbed sleep
Sev: severe limitation and nigthtly loss of sleep

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10
Q

Atopic eczema Ix

A

Identify triggers

Consider diagnosis of food allergy

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11
Q

Atopic eczema mild Mx

A

emollients

mild potency topical CS

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12
Q

Atopic eczema moderate Mx

A

emollients
moderate potency topical CS
topical calcineurin inhibitors
bandages

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13
Q

Severe eczema Mx

A 
Emollient
potent topical CS
topical calcineurin inhibitors
bandages
Phototherapy
systemic therapy
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14
Q

how long to treat flares in eczema

A

treat as soon as identified and until 48 hrs after

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15
Q

Emollients in Atopic eczema

A

Large amounts and often
E45, cetraben, diprobase, aveeno
should be applied on whole body
use as soap substitute

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16
Q

Topical CS in Atopic eczema

A

use O/BD
only apply to active eczema
dont use potent CS <12m w/o specialist advise
In areas prone to flares use for 2 consecutive days/wk r/v at 3-6mo
If TCS ineffective use different steroid of same potency before increasing potency

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17
Q

Potency of steroid in eczema

A

Mild: hydrocortisone 1%
mod: betamethasone valerate 0.025% or clobetasone butyrate 0.05%
Potent: betamethasone valerate 0.1%, mometasone
If very severe and extensive consider PO steroids

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18
Q

Topical calcineurin inhibitors Atopic eczema

A

topical tacrolimus 2L in mod-sev eczema (alt. pimecrolimus)
Apply only to active eczema
NOT under occlusive bandages

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19
Q

Bandages in Atopic eczema

A

Can be used w/emollients for areas of lichenified skin
short term flares 7-14d
whole body occlusive may be used by specialists

20
Q

Antihistamines in atopic eczema

A

1 month trial of nonsedating antihistamone (fexofenadine, certirizine) if sev. itching or urticaria r/v every 3mo
Consider 7-14d of sedating antihistamine (promethazine, chlorphenamine) if causing sleep disturbance

21
Q

Infected eczema

A

Swab area
Advise maintaining good hygiene (use spatula, dont leave it open)
First line: flucloxacillin (PO if extensive topical if local)
penicillin allergy: erythro/clarithromycin use Abx for no longer than 2w

22
Q

Eczema herpeticum

A

Oral aciclovir
If widespread start aciclovir immediately and refer for same day derm
if around eyes: opthalmology r/v
Educate parents of signs: rapidly worsening/painful, clustered blisters

23
Q

Alternative treatments in eczema

A

phototherapy

homeopathy, herbal medicine, food supplements

24
Q

Indication for specialist referral in eczema

A

Eczema herpeticum (immediate)
Urgent if severe atopic has not responded to optimum therapy within 1wk or treating bacterial eczema has failed
If diagnosis uncertain, atopic on face is not responding, ?contact allergic dermatitis, causing significant impact on life, severe of recurrent infections

25
Q

PACES counselling of Atopic eczema

A 
Dx: dry itchy skin 
very common many will grow out 
Encourage regular liberal emollients and use as soap substitutes
Steroids if necessary
A/w atopy
avoid triggers: clothes, detergents, soaps, antivirals
Avoid scratching if possible (nails short/mittens)
Safety net: oozing, red, fever
Info+support:
itchywheezysneeze.co.uk
BAD
national eczema society
26
Q

Viral warts

A

daily administration of proprietary salicylic acid or lactic acid paint or glutaraldehyde
cryotherapy w/liquid nitrogen

27
Q

Molluscum contagiosum

A

NOT Rx if immmunocompetent
Resolution within 18m
Advise agaisnt squeezing mollusca to avoid spreading and superinfections
Avoid towel/clothing/bath sharing
If eczema or infection develops give emollients/steroids
chemical or physical destruction can be done by a specialist

28
Q

Ringworm

A

Mild: topical antifungal (terbinafine cream, clotrimazole)
If marked inflammation consdier 1% hydrocortisone
Severe: systemic Afx
1L: terbinafine, 2L itraconazole

29
Q

Tinea capitis:

A
  • systemic Afc (griseofulvin or terbinafide) 2L:itra/fluconazole
    topical Af shampoo in some patients (ketoconazole)
30
Q

Tinea Faciei, Tinea Corporis, Tinea Cruris or Tinea Pedis

A 
topical Afx (terbinafine, naftifine, butenafine)
topical aluminium acetate
31
Q

Tinea infections

A 
Loose fitting cotton cothing
wash affected areas of skin daily
dry thoroughly after washing
Avoid scratching
Do not share towels
Wash clothes and bed linen frequently
No need for school exclusion
32
Q

Scabies

A 
Topical permethrin 5%
- whole body from chin and ears down
- particularly between fingers
- apply to cool/dry skin and let dry before dressing
- wash off after 8-12h
- second application 1wk after first
2L: malathion 0.5%
Babies: face and scalp included
Alternative: benzylbenzoate solution applied below neck but smells bad and had irritant reaction
33
Q

Scabies advise

A

members of household traced and treated
bedding, clothing, towels of patient and any potential contacts should be decontaminated by washing at a high temp and drying in a hot dryer
Patients whose Sx persist beyond 1m after Rx should be retreated
Treat post-scabietic itch w/crotimiton 10% cream or topical hydroc.)
Night time sedative antihistamine
Seek specialist help: crusted scabies, <2m old

34
Q

Pediculosis (head lice)

A

wet combing with fine tooth every 3-4d for 2 wees
Dimeticone 4% or aqueous 0.5% malathion rubbed into sclap and left overnight
shampoo next morning
Repeat Rx after 1wk

35
Q

Guttate psoriasis

A

Coal tar preps useful in plaque psoriasis >6yr
Dithranol: resistant plaque psoriasis
Calcipotriol: plaque psoriasis >6
occasionally may develp into psoriatic arthritis
Psoriasis association

36
Q

Acne vulgaris Advice

A

Avoid over cleaning (twice daily w/gentle soap adequate)
Non-comedogenic products w/pH close to skin
Avoid picking/squeezing
Rx can take up to 8wks
Healthy diet
NHS choices
BAD

37
Q

Mild-moderate acne

A 
Topical:
benzoyl peroxide
benzoyl peroxide + clindamycin
Adapalene (topical retinoid CI in preg/bf)
Azelaic acid 20%
- creams/lotions preferable of dry skin
38
Q

Moderate acne not responding to topical Rx

A

consider PO Abx:
Lymecycline/Doxycycline
for MAX 3mo
NB. Topical retinoid or benzoyl peroxide should be co-prescribed w/PO abx to reduce risk of Abx resistance
Change to alternative after 3m if no improvement
If no response to 2 cycles or if scarring send to derm ?isotretinoin
COCP in combination w/ topicals in girls (avoid POP)

39
Q

Refer to specialist: Acne

A 
severe variant
severe with (risk of) scarring
multiple failed treatments
psychological distress
diagnostic uncertainty
40
Q

Follow up of moderate/severe acne

A

R/v each step at 8-12wks
if adequate continue Rx for 3m
if acne nearly cleared consider maintenance w/topical retinoids or azelaic acid
if NO response: consider adherence/moving up ladder

41
Q

Hand foot and mouth disease

A

Sx Mx only
no link to Dx in cattle
do NOT need exclusion

42
Q

Insect bites and stings

A 
If stinger visible remove by scraping sideways with a finger nail or credit card 
Clean area
Specifics:
- bedbugs: pest control
- fleas: a/w pets
- Lice: check head lice
- Scabies
43
Q

Transient localised reaction to Insect bites and stings

A

simple analgesia
oral anti-histamine or topical steroids (1%Hydrocort)
OTC: crotamiton, topical antihistamines, topical anaesthetics
secondary bacterial infection can be treated as cellulitis

44
Q

Animal and human bite

A

Check risk if tetanus
Co-amox 7d
(metro/doxy 7d if allergic)
Safety net for signs of infection

45
Q

Neck masses

A

Branchial cyst: anterior to SCM near angle of mandible, anechoic
Dermoid cyst: midline, suprahyoid, heterogenous on USS
Cystic hygroma: posterior to SCM, painless fluid filled, hyperechoic on USS

Paeds (23 decks)

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