Dermatology Flashcards
What is the skin of a newborn coated with
Vernix caseosa
Chalky white greasy coat
What is impetigo
Yellow gold crust around nose and mouth
Due to staph aureus
How do you treat impetigo
Topical fluclox
What is bullous impetigo
uncommon blistering form of impetigo
How do you treat bullous impetigo
Systemic antibiotics (oral fluclox)
What are melanocytic naevi
moles
What causes albinism
defect in biosynthesis and distribution of melanin
WHat are characteristics of albinism
- failure to develop fixation reflex due to lack of pigment in iris, retina, eyelids, eyebrows
- pendular nystagmus
- photophobia
- visual impairment
What are children with albinism prone to, so what must you give
Skin cancer and sunburn
So give high fa ctor sun creM
What is epidemiolysis bullosa
GENETIC CONDITION (AR/AD) Blistering of skin and mucopus membranes occurring spontaneously / flllowing mild trauma
What is a colloidon baby
rare manifestation of inherited ichthyoses (dry scaly skin)
Skin is taut, shiny, parchment like
Membranes become fissured and separate within a few weeks
Risk of dehydration
What do you give to manage colloidon baby
emollients
What are common causes of naappy rashes
Common causes of nappy rashes:
- irritant contact dermatitis
- infantile seborrhoeic dermatitis
- candida infection
- atopic eczema
Why does irritant dermatitis occur as nappy rash
If nappy is not changed frequently enough
Due to irritant effect of urine on skin
How does irritant dermatitis present
SPARED FLEXURES
Rash is erythematous, scalded appearance
How do you manage irritant dermatitis
protective emollient
Topical steroids
What does a candida nappy rash look like
Includes flexures
Can cause satellite lesions
How do you manage candida naappy rash
topical antifungal (imidazole cream e.g. clotrimazole)
How do you manage nappy rash if it persists / swab is bacterial infection?=
ORAL FLUCLOX 7 days
When does infantile seborrhoeic dermatitis present
First three moths of life
What does infantile seborrhoeic dermatitis present as
Erythematous scaly eruption on scalp
NOT itchy
May involve flexures (neck, axillae, nappy area)
What is a cradle cap
Thick yellow adherent layer to head
Occurs in infantile seborrhoeic dermatitis
What risk is associated ith infantile seborrhoeic dermatitis
later development of ECZEMA
How do you manage infantile seborrhoeic dermatitis
reassure parents
resolves spontaneously over weeks / months
Regular washing with baby shampoo + brushing with soft brush to remove scales
What can you give if cradle cap / infantile seborrhoeic dermatitis is not resolving conservatively
could be due to inflammatory reaction to yeast > give topical imidazole cream (clotrimazole)
What is the pathophysiology of atopic eczem
BARRIER DEFECT OF EPIDERMIS
+
IMMUNE DYSREG OF TH2
How do you diagnose atopic eczema?
clinical
skinprick for T1 hypersensitivity
Elevated plasma IgE
What are clinical features of eczema
ITCHING > scratching, exacerbation of rsh, weepy ad pustular if infected
Dry skin
Lichenification, pigmentation
How does distribution of eczema change with age
In children: cheeks, scalp, extensor surface
in adults: flexor surfaces
What are complications of eczema
overlying infection (bacterial) overlying infection from eczema >eczema herpeticum
What wueestionnaire can you use to assess psych impact of eczema on child?
Children’s Dermatology Life Quality Index Questionnaire
What is mild eczema
dry skin, infrequent itching
What is moderate eczema
dry skin, frequent itching, redness . possible excoriations and localised skin thickening
what is severe eczema
widespread areas of dry skin, incessant itching …
what does infected eczema look like
weeping, crusting, pustules with fevwr and maaise
How do you manage eczema conservatively
emollients
avoid soap
how do you manage eczema topically
corticosteroids (e.g. 1% hydrocortisone)
antihistamine (chlorphenamine)
retinoids
calcineurin inhibitors (tacrolimus)
What non drug management can you give for eeczema
phototherapy (narrowband UVB)
How do you manage mild eczema
emollients mild corticosteroids (e.g. 1% hydrocortisone)
how do you manage moderate eczema
emollient
potent steoid e.g. betamethasone valerate 0.025%
how do you manage severe eczema
emollient
more potent steroid e.g. bethamethasone valerate 0.1%
How do you manage infected eczema
SWAB infected skin
FLucloxacillin (erythromycin if allergic)
How do you treat eczema herpeticum
IV acyclovir
What causes virala warts
HPV
Where are viral warts usually found in children
fingers, soles. called VERRUCAE
When do verrucaes need to be treated
if painful / cosmetic problems
otherwise should disappear spontaneously
How can you remove verrucae
daily salicylic acid, lactic acid
Cryotherapy with liquid nitrogen (painful)
how do you manage molluscum
No treatment if child is immunocompetent
Should resolve independently within 18 months
What is ringworm
DERMATOPHYTE
invcades keratinous structure e.g. skin, nails, hair
Why are dermatophytes caled ringworm
due to annular appearance of skin lesion
what is a kerion
inflamed pustular ringworm patch
How does tinea capitis present
scaling, patchy alopecia with broken hairs
how do you investigiate tinnea capitis
exam under UV light (Wood’s); green/yellow fluorescence of infected hairs
microscopy of skin scraping
culture
What is management for ringworm
topical / systemic antifungal based on severity
e.g. terbinafine, itraconazole
How is ringworm passed on
through cat/dog
What is the cause of scabies
sarcoptes scabei
What are symptoms of scabies
severe itching
worse in warm conditions/at night
burrows, papules, vescicles
What is scabies dx based on
CLINICAL
may use microscopy exam of skin scraping to identify mite, eggs
What is management of scabiees
Topical PERMETHRIN 5% cream (or malathion 0.5%)
Applied to whole body
Wash off after 8-12 hours
Second application after 1 week
Also treat members of household and other close contact
How do you treat post scabetic itch
crotamiton 10% cream
what is pediculosis
head lice infestation
with pediculosis capitis
How do you treat pediculosis
DIMETICONE 4% lotion
OR
MALATHION 0.5%
What does psoriasis present as
scaly plaques on extensor surface
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When does psoriasis present
AFTER AGE OF 2 YEARS OLD
When does guttate psoriasis presents
After sore throat / ear infection
Describe guttate psoriasis lesion
small, raindrop like
oval/round erythematous scaly patches
on trunk / back / upper limbs
Resolves over 3-4 months
How do you treat guttate psoriasis
coal tar preparation
Calcipotriol (vit D agonist)
Phototherapy
Methotrexte
What is PITYRIASIS ROSEA
acute, benign, self limiting
viral origin
what is clinical appeearance of PITYRIASIS ROSEA
begins with herald patch (single round/oval scaly macule), 2-5cm diameter
after few days, several small dull pink macules also develop
Rash follows line of ribs posteriorly: FIR TREE MAATTERN
Is PITYRIASIS ROSEA itchy
occasionalaly
how do you treat PITYRIASIS ROSEA
no treatment required
resolves within 4-6 weeks
What is alopecia areeata
common form of hair loss in children
regrowth aftrr 6-12 months
how does alopecia areata present
hairlss smooth areas of non inflamed skin on scalp
Remnants of broken off hair (exclamation mark hairs)
Describe granuloma annulare
Ringed lesion with raised flesh coloured non scaling edge
How is granuloma annulare different to ringworm
NON SCALING
How do you manage mild-moderatee acne vulgaris
Emollient, cleanser with non-comedogenic preparation
- Benzoyl peroxide
- clindamycin
- Topical retinoid e.g. Adapalene
- Azelaic acid
How do you manage moderate acne vulgaris not responding to topical tx
Consider oral anttibiotic e.g. Lymecycline / Doxyxycline, max 3 months
Co-prescribe topical retinoid or benzoyl peeroxide to prevent antibioptic resistancee
What do you give to acne vulgaris if not responding to antibiotics
Isotrenitoin (Raccutanne)
How often do you review for acne vulgaris
8-12 weeks
Describe erythema nodosum
Tender erythematous nodules over legs
What are triggers of erythema nodosum
Strep infection
TB
IBD
Drug reaction
Descrive erythema multiforme
TARGET LESION (3 colours) - central papule surrounded by erythematous ring
What are causes of erythema multiforme
HSV - omost common!
Mycoplasma pneumoniae
Infection
Drug reaction
WHat is Steven Johnson Syndrome
Severe bullous form of erythema multiforme invading the MUCOUS MEMBRANE
can present with conjunctivitis and mouth ulceration
WHat are triggers for SJS
drug sensitivity
what is management for urticaria
avoid triggers
symptom diary
UAS7 (Urticaria Activity Score) to Assess
tx: non sedating antihistamine
oral corticosteroid if severe
refer if rebound symptoms occur after steroid
Explain UAS7 (Urticaria Activity Score)
Records the severity of disease over 7 days
<7 in one week: control of disease
>28 in one week: SEVEREw
what do you give for acne if not responding to topical therapy=?
Antibiotic (lymecycline/doxycycline) for 3 months + topical retinoid / benzoyl peroxide CO-PRESCRIBED
What do you do for acne patients if not reponding to two courses of antibiotics / are scarring?
refer to dermatology for roaccutane
how do you manage uncomplicated cellulitis
if uncomplicated: at home with antibiotics
HIGH DOSE FLUCLOX 7 DAYS
arrange review in 48h
how does erysipelas present
similarly to cellulitis
but with VERY CLEAR demarcated rash
how do you mange erysipelas
Pen V
How do you manage Guttate Psoriasis
- Cold tar preparation
- Topical emollients (E45)
- Dithranol
- Calcipotriol (vitamin D)
ALSO Phototherapy (narrow band UVB 2-3x weekly)
How do you manage milia?
most clear by themselves
remove if cosmetically displeasing (fine needle, cryotherapy)
how do you manage viral warts in children?
watchful waiting
daily salicyilc acid/ lactic acid and file it down
cryotherapy with liquid nitrogen
