Dermatology in Paediatrics

Question 1

4 year old boy with white patches on forearm and chest. Its not itchy. What is the diagnosis

Answer 1

Pityriasis Versicolor

• common yeast infection of the skin causing flaky discoloured patches to appear on the chest and back
• most frequent in hot humid climates
• affects the trunk, neck and/or arms
• genus malassezia
• diagnosed using a woodlamp examination - yellow-green fluorescence in affected areas
• treatment:
  
  • topical azole cream/shampoo (econazole, ketoconazole)
  • selenium sulfide
  • terbinafine gel
  • apply widely before bedtime as directed (3days to 1 week)
  • only use orals when topical agents fail.

Question 2

5 year old with weepy crusted cheeks and disturbed sleep.

Answer 2

Impetigo secondary to ezcema

• week of ceflaexin

Question 3

A 7 week old girl with red plaque on her right upper eyelid which has developed.

Answer 3

Capillary hemangioma

• they tend to go away, and involute but might have scar
• grow rapidly in first year of life.
• affects vision on of the eye if it grows too much. Bulky and large (‘strawberry hemangioma’)
• Treatment:
  
  • propranolol reduces growth
  • lazer therapy to reduce the size

Question 4

a 12 year old boy with itchy rash with 4 days, target lesions, shapes have changed from yesterday. What is the cause? Management?

Answer 4

Urticaria

• can get target lesions in urticaria
• quickly it changes, other target lesions last.
• itchy, raised, red wheals that move around
• sensitises mast cells, sensitise for some months for a while will get a few sepisodes

Causes:

• viruses is the most common
• allergy to drug or food

Management:

• antihistamines to reduce itch and wheal/flare
• most will settle down, >3 weeks is chronic

Question 5

a 2 year old with rash in the diaper area, screams when he is on the potty.

Answer 5

Infection - Perianal Streptococcal Infection

• red, well demarcated

Treatment

• course of oral antibiotics

Question 6

a 14 month boy with red papules and pustules on face since 7 months old. What look like blackheads on his nose. What is the Diagnosis?

Answer 6

looks like acne - infantile acne

• can happen in kids from 6 months - 3 years
• settles down generally
• might need older kids treatment:
  
  • topical
  • occassionally an antibiotic (no tetracyclins)
• DDx - ensure no virilisation signs elsewhere. (hair growth, body odour).

Question 7

an 8 year old boy with 2nd episode papules and an episode 6 months ago that last for 2 weeks. Dark purple centre and blistered but not itchy. Dad has frequent cold sores. Has some on his lips as well

Answer 7

Erythema Multiforme

• target lesions
• not uncommon
• its not infected, immune mediated
• common triggers:
  
  • drug allergies
  • HSV
  • mycoplasma pneumoniae
• minor and major (if its major its on a SJS reaction - look at mucosa)
• treatment
  
  • steroids

Question 8

5 week old with scaly rash, diarrhoea and irritability. Preterm baby. On diaper area, around the feet and shoulders. What is the management?

Answer 8

Zinc Deficiency

• young infant and someone who is preterm
• particularly if not breastfed its more likely

Treatment:

• get a zinc level, not super helpful
• zinc supplement

DDx - acrodermatitis enterohepatica (congenital condition

Question 9

Types of Rash Description?

Answer 9

• Petechiae = <3mm
• Purpura = 3-10mm
• Vesicular = <5mm
• Bullous = >5mm
• Pustular
• Papule = raised
• Macular = flat