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Year 4 Paediatrics > Dermatology > Flashcards

Dermatology Flashcards

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1
Q

Give three red flags for a chronic rash

A

Skin Pain
Mucous Membrane Involvement
Unwell Child

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2
Q

Give three causes of a clear fluid filled rash

A

HSV
Impetigo
Chickenpox

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3
Q

Give three causes of a pus filled rash

A

Acne
Folliculitis
Pustular Psoriasis

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4
Q

Give three causes of a raised rash

A

Urticaria
Viral Warts
Milia

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5
Q

Give three causes of a red and scaly rash without epidermal breakage

A

Psoriasis
Tinea
Sebhorreic Dermatitis

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6
Q

Give a cause of a red and scaly rash with epidermal breakage

A

Atopic Eczema

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7
Q

Give three differentials for a purpuric rash (non blanching)

A

Meningococcal Septicaemia
ITP
Leukaemia

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8
Q

Define Acne Vulgaris. What is the cause?

A

Inflammatory disease of Pilosebaceous Follicles

Under influence of androgens, sebaceous glands produce more sebum and subsequently get blocked

Can become colonised with bacteria - Propionibacterium Acne

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9
Q

Acne Vulgaris commonly affects face/chest/upper back. How does it present?

A

Non Inflammatory (open and closed comedones - black and white heads

Inflammatory (Papules, Postules, Nodules, Cysts)

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10
Q

If Acne is localised then topical therapy can be used. Describe the three different types

A

Benzoyl Peroxide - reduces sebum production and P.Acne growth (may cause skin to peel)

Topical Antibiotics - used in combination with another topical therapy, erythromycin/Tetracycline

Topical Retinoids - Anti Inflammatory effect, contraindicated in pregnancy

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11
Q

If Acne is diffuse then systemic therapy can be used. Describe the three different types

A

Doxycycline (if over 12 - photosensitivity and oesophagitis)

Anti Androgens - COCP

Oral Isotretinoin - Highly effective but toxic so given under consultant supervision

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12
Q

How long does Systemic Acne Therapy take to ‘work’ in theory

A

Allow 3-4 months before review

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13
Q

How can Acne scarring be treated?

A

Laser Resurfacing

Chemical Peels

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14
Q

Define Eczema/Atopic Dermatitis

A

Chronic atopic condition caused by genetic defect in skin barrier function (loss of variants of filaggrin)

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15
Q

Describe the pathophysiology of Eczema

A

Tiny gaps in skin barrier provide entrance for irritants/allergens/microbes , that create an immune response resulting in inflammation

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16
Q

Name three exacerbating factors for Eczema

A

Infections
Allergens
Sweating

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17
Q

How does Eczema typically present?

A

Itchy erythematous dry scaly patches

Infants - Face and Extensor
Children and Adults - Flexor

Nail pitting and ridging

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18
Q

How do Eczema exacerbations present?

A

Erythematous, Vesicular, Weepy

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19
Q

What is the maintenance therapy for Eczema?

A

Emollients (thick layers, should be used as soap substitutes)

Can be thin - E45, Diprobase
Or thick - Hydromol, Cetraben

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20
Q

How are Eczema flares treated?

A

Thicker emollients, Topical Steroids, Wet Wraps

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21
Q

The use of steroids should be the weakest possible for the shortest possible time. Describe the steroid ladder

A

Mild (Hydrocortisone)
Moderate (Eumovate - Clobetasone Diproprionate)
Potent (Betnovate)
Very Potent (Dermovate)

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22
Q

Describe some specialist treatment in resistant eczema

A

Zinc bandages
Topical Tacrolimus
Phototherapy

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23
Q

State three possible infective organisms in Eczema

A

S.Aureus
Eczema Herpeticum
Molluscum Contagiosum

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24
Q

What is Napkin Dermatitis/Nappy Rash?

A

Common due to urine/faeces/friction in the nappy area

Spares the folds and favours the convexities

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25
Q

When would you suspect Candida infection in Nappy Rash?

A

If there are satellite lesions

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26
Q

How is Nappy Rash managed?

A

Frequent nappy changes
Drying after bathing
Hydrocortisone Ointment

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27
Q

If Nappy Rash fails to respond to initial management, what other diagnoses could be considered?

A

Psoriasis
Zinc Deficiency
Langerhans Cell Histiocytosis

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28
Q

Give five causes of Pruritus Ani in infants

A 
Contact dermatitis from faeces/urine/sweat
Allergic Contact Dermatitis 
Threadworms 
Anal Disease (eg Crohns)
Candidiasis
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29
Q

How should Pruritus Ani be investigated?

A

Threadworms are normally visible

Swans of Perianal Skin for MC&S

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30
Q

How should Pruritus Ani be managed?

A

Treat underlying cause
Improve Perianal Hygiene
Mild Steroid Ointment (if infective causes ruled out)

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31
Q

Give three causes of Pruritus Vulvae

A

Contact Dermatitis
Diabetes Mellitus
Threadworms

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32
Q

How should Pruritus Vulvae be managed?

A

Ensure no evidence of lichen sclerosus or diabetes
Void regularly
Change damp underwear
Wipe front to back

Treat acute inflammation with topical steroid until redness settles

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33
Q

Give three common allergens in Allergic Contact Dermatitis (delayed type IV hypersensitivity)

A

Nickel
Plasters
Henna Tattoos

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34
Q

How is Allergic Contact Dermatitis investigated and managed?

A

Ix - Patch test left on for 48hrs and then read on day 5 to 7

Mx - Allergen withdrawal and topical steroids

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35
Q

What is Perioral Lip Lick?

A

Eczema around mouth

Common in mouth breathers

36
Q

How is Perioral Lip Lick managed?

A

Frequent lip balms
Topical steroids

Reduce irritant foods for 2-3 weeks (acidic, vinegar, tomato based)

37
Q

Cutaneous warts are caused by cutaneous infection with HPV. How does it present?

A

Painless form papules with rough hyperkeratoic surface

Typically affects hands/knees/face/feet

Normally resolves within 3 years

38
Q

Cutaneous warts normally don’t require management. If they are painful, or causing psychosocial problems, how can they be managed?

A

Destructive techniques - Keratolytic with Salicyclic, Liquid Nitrogen Cryotherapy, Podophyllotoxin

Immune Based - Immunotherapy

39
Q

What is Impetigo?

A

Superficial bacterial skin infection caused by S.Aureus and less commonly S.Pyogenes characterised by Golden Crust

40
Q

Describe the pathophysiology of Impetigo

A

When bacteria enter via a break in the skin (may be healthy or may be related to dermatitis)
Contagious so children should be kept home from school

41
Q

Impetigo can be Bullous or Non Bullous. How does Non Bullous Impetigo present?

A

Typically occurs around nose and mouth

Exudate dries to form golden crust - unsightly but not unwell

42
Q

How is Non Bullous Impetigo managed?

A

Localised - Topical Fusidic Acid/Hydrogen Peroxide
Widespread - Oral Flucloxacillin

Don’t touch lesions, remain off school until healed/48h of Anitbiotics

43
Q

Impetigo can be Bullous or Non Bullous. How does Bullous Impetigo present?

A

Staphylococcus Aureus produces epidermolytic toxins, breaking down skins structural proteins, causing fluid filled vesicles

Vesicles grow and burst to form golden crust - painful and itchy

May have systemic symptoms
If widespread -Staphylococcal Scalded Syndrome

44
Q

Which form of Impetigo is more common in under 2s?

A

Bullous

45
Q

How is Bullous Impetigo managed?

A

Flucloxacillin (may require IV if severely unwell)

46
Q

Give three complications of Impetigo

A

Cellulitis
Sepsis
Post Strep GN

47
Q

Define Psoriasis and state the four main subtypes

A

Chronic autoimmune condition that causes symptoms of recurrent psoriatic lesions

Plaque, Guttate, Pustular, Erythrodermic

48
Q

How does Chronic Plaque Psoriasis present?

A

Thickened erythematous scabs that can be on extensor surfaces and scalp
1-10cm
More common in adults

49
Q

How does Guttate Psoriasis present?

Note: Most common form in children

A

Small raised papules across trunk and limbs that are mildly erythematous and scaly

Often triggered by Streptococcal throat infections, stress or drugs

Resolves within 3-4 months

50
Q

How does Pustular Psoriasis present?

A

Pustules form under areas of erythematous skin

Can be systemically unwell and initially require hospital admission

51
Q

How does Erythrodermic Psoriasis present?

A

Severe extensive erythematous areas covering most of skins surface
Raw exposed areas
Medical emergency and admission

52
Q

Give three clinical features OE of Psoriasis

A

Auspitz Sign - small points of bleeding when plaques are scraped

Koebner Sign - development of lesions where skin has previously been affected by trauma

Residual pigmentation after resolution

53
Q

Name five nail changes in Psoriasis

A 
Pitting
Thickening
Discolouration
Ridging
Oncholysis
54
Q

Name three management options for Psoriasis

A

Topical (Steroids, Vit D Analogue - Calcipitriol)
UVB Phototherapy

Severe - Systemic Methotrexate/Ciclosporin

55
Q

Eczema Herpeticum is a viral skin infection. Describe the pathophysiology

A

Usually infection with HSV1, but can be with VZV

Normally occurs in a patient with pre-existing skin conditions

Associated with cold sore in patient or close contact

56
Q

How does Eczema Herpeticum typically present?

A

Patient who already suffers eczema presenting with widespread, painful vesicular rash (containing pus)

May have systemic symptoms such as fever/lethargy/irritable

After the vesicular rash bursts - small punched out ulcers with red base

57
Q

Eczema Herpeticum is normally a clinical diagnosis. How is it managed?

A

Aciclovir (oral or IV depending on severity)

Note: very dangerous in those who are immunocompromised

58
Q

Define Erythema Multiforme

A

Erythematous rash caused by hypersensitivity reaction

Caused by viral infection (especially HSV), Mycoplasma Pneumoniae, Drugs (NSAIDs, Penicillins)

59
Q

How does Erythema Multiforme present?

A

May or may not have preceding URTI/Fever/Flu

Widespread itchy rash, characterised by target lesions

Doesn’t normally affect mucous membranes

60
Q

Erythema Multiforme is a clinical diagnosis. How is it managed?

A

Treat any underlying cause

Often mild and resolves spontaneously in 1-4 weeks

If severe - Fluids, Analgesia and Steroids

61
Q

Molluscum Contagiosum is a viral skin infection. How does it present?

A

Small flesh coloured papules with a characteristic control papule

Spread through direct contact/sharing towels or bedding

62
Q

How is Molluscum Contagiosum managed?

A

Normally self resolves within 18 months

Avoid sharing towels and scratching

Any signs of bacterial superinfection - topical fusidic

If immunocompromised/in problem area - Benzoyl Peroxide/Cryotherapy

63
Q

Define Pityriasis Rosea

A

Generalised self limiting rash often occurring in adolescents and young adults. May be caused by HHV6 or HHV7

64
Q

How does Pityriasis Rosea present?

A

May have a prodrome (headache, tiredness, flu)

Herald patch (Red/Pink scaly oval lesion, around 2cm on torso)
Becomes widespread in ‘Christmas Tree Fashion’ along ribs

In darker skin tones it will appear grey

65
Q

How is Pityriasis Rosea treated?

A

Normally resolves without treatment in 3 months

Can cause skin discolouration which will resolves within another 3 months

Not contagious

66
Q

What is Seborrhoeic Dermatitis?

A

Inflammatory condition of sebaceous glands

Affects scalp/nasiolabial folds/eyebrows

Malassezia yeast plays a role

67
Q

How does Infantile Seborrhoeic Dermatitis present?

A

AKA Cradle Cap

Crusty flakey scalp, normally resolving by four months

68
Q

How is Infantile Seborrhoeic Dermatitis (AKA Cradle Cap) treated?

A

Brush scalp with oil then wash off
White petroleum jelly overnight

If fails - topical anti fungal such as Clomitrazole for 4 weeks

69
Q

Seborrhoeic Dermatitis of scalp most commonly occurs in adolescents and young adults, how is it managed?

A

Ketoconazole shampoo left on for five minutes

Often recurs after successful treatment

70
Q

How is Seborrhoeic Dermatitis of Face and body managed?

A

4 weeks Clotrimazole

Localised inflammation can be treated with Hydrocortisone

71
Q

What is Ringworm?

A

Fungal infection of the skin also known as tinea/dermatophytosis

Can be subdivided into: Capitis, Pedis, Cruris, Corporis, Onchomycosis

72
Q

How does Ringworm present?

A

Itchy rash that is erythematous, scaly and well demarcated

Edge of ring is more prominent in colour

73
Q

How does Tinea Capitis present specifically?

A

Well demarcated hair loss

Scalp Dryness

74
Q

How does Tinea Pedis present specifically?

A

White/Red/Flaky itchy patches between toes

More likely if feet are sweaty and damp for long periods

75
Q

How does Onchomycosis present specifically?

A

Thickened discoloured nail

76
Q

Ringworm is normally a clinical diagnosis, describe the different antifungal medications options

A

Topical Clomtrimazole
Ketoconazole Shampoo
Oral Fluconazole/Itraconazole

77
Q

How is Onchomycosis treated?

A

Amorolfine Nail Lacquer

If resistant then Oral Terbinafine

78
Q

Daktacort is also a management option for Ringworm. What is contained within it?

A

Miconazole

Hydrocortisone

79
Q

What is Tinea Incognito?

A

Extensive but less well recognised infection due to steroid use (eg mistakenly diagnosed as dermatitis)

80
Q

What is Erythema Nodosum?

A

Red lumps that appear across patients shins due to inflammation of subcutaneous fat (hypersensitivity reaction)

81
Q

Name five associations with Erythema Nodosum

A 
Strep Throat 
TB
Lymphoma
NSAIDs
IBD
82
Q

What is Staphylococcal Scalded Syndrome?

A

Condition caused by a type of S.Aureus that produces epidermolytic toxins (proteases that break down skin) usually affecting children <5y

83
Q

How does Staphylococcal Scalded Syndrome present?

A

Intitially generalised erythema patches, skin then wrinkles, and then bullae form
When bullae burst it looks like a scald/burn
Systemic symptoms

84
Q

What is Nikolsky sign in Staphylococcal Scalded Syndrome?

A

Rubbing of skin causes it to peel away

85
Q

How is Staphylococcal Scalded Syndrome managed?

A

IV antibiotics

Fluids

Year 4 Paediatrics (15 decks)

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