Dermatology paeds

Question 1

what causes eczema

Answer 1

Eczema is an atopic dermatitis caused by a disturbed epidermal barrier leading to

increased water loss and infiltration of external contents and irritants

these irritants then cause and immune and inflammatory response

further damage to the epidermal barrier and exacerbations of symptoms occur

Question 2

what is the presentation of Eczema

Answer 2

itching

erythetematous skin

weeping and crusted skin

lichenification of skin

regional lymphadenopathy

usually on flexion and friction surfaces

Question 3

if a child younger than 2m comes in and the parents are ?eczema what is the actual diagnosis

Answer 3

seborrheic dermatitis

Question 4

what is seborrhic dermatitis

Answer 4

a skin irritation afecting the seborrhic regions of skin

affecting face and trunk

Question 5

what are complications of eczema

Answer 5

infections of staph, strep, HSV

Question 6

why are staphylococcal infections particularly serious in children with Eczema

Answer 6

inflammatory response of Eczema causes the skin to become acidic

this is ideal for staph which then releases supertoxins and causes severe exacerbations of Eczema

Question 7

describe the management of Eczema

Answer 7

lifestyle advice

emmolients - twie daily, either parafins or ointements

corticosteroids - hydrocortisone

immunomodulators - tacrolimus or pimercolimus

plus:

occlusive bandages which can have zinc or steroids

antibiotics/antivirals

psychological support

Question 8

what is stephen-johnsons syndrome

Answer 8

a severe skin reaction which occurs with toxic epidermal necrosis

is a less sevreform of TEN’s

Question 9

what is the diagnostic difference between stephen-johnsons syndrome and TENs

Answer 9

SJS <10% skin involvement

TEN> 30% skin involvement

Question 10

what causes stephen-johnsons syndrome

Answer 10

abnormal immune reaction to drugs or infections

drugs typically include anticonvulstants or antibiotics

Question 11

what is the presentation of stephen-johnsons syndrome

Answer 11

onset is: 1week post abx or 3w post anticonvulstants

ferer

sore thraot

skin lesions

conjunctivitis

burning eyes (more so in TEN)

painful mouth

burning skin

Question 12

describe the skin lesions of stephen-johnsons syndrome / TEN

Answer 12

ulcerations at mucosa

erythetematous macules and flaccid blisters on skin

Question 13

how do you diagnose stephen-johnsons syndrome

Answer 13

clinical diagnosis and exclusion of staphylococcal infection (which causes scalded skin syndrome)

Question 14

how do you manage stephen-johnsons syndrome

Answer 14

STOP MEDS

iv fluids

enteric feeds

analgesia

opthalmology input

abx if theres a secondary infection

Question 15

what is urticaria

Answer 15

raised red oedematous welts often itchy and are Sx of allergic reactions.

Can be acute or chronic

Question 16

what is angioendema

Answer 16

eye swelling

Question 17

what is the diagnostic criteria for a skin reaction to be acute

Answer 17

under 6 weeks reaction

linked to exposure to allergen or viral infection

Question 18

what is the diagnostic criteria for a skin reaction to be chronic

Answer 18

over 6 weeks

no link to exposure ie non allergic origin

Question 19

what is the pathophysiogy or urticaria

Answer 19

local increase in permeability of cappilaries and venules

Question 20

what are causes of chronic uricaria

Answer 20

cold

heat

sun

aquagenic

cholinergic

Question 21

what is the name of a mark presenting like:

flat red/pink patches on eyelids neck and forehead

Answer 21

salmon patch/stork mark

Question 22

what kind of birth mark is a salmon patch/stork mark

Answer 22

vascular

Question 23

what is the management of salmn patch/stork mark

Answer 23

dissapear on their own mostly within months

but

on forehead and neck can take around 4y

Question 24

what is the name of a mark presenting like:

raised mark on skin which is red or purple

Answer 24

a vascular mark

called strawberry mark / infantile haemangioma

Question 25

what is the management of aninfantile haemangioma

Answer 25

increase rapidly in size at 6 m

but then dissapear around 7 years

suregry in affecting vision or feeding

Question 26

what is the name of a mark presenting like:

flat red/purple marks

can be mm-cm

unilateral

Answer 26

port wine stains

Question 27

what causes port wine stains

Answer 27

capillary malformations

Question 28

describe the course of port wine stains

Answer 28

colour deepends with age and hormonal changes and do not dissapea

Question 29

what is the name of a mark presenting like:

flat light brown patches

Answer 29

cafe au lait spots

Question 30

what does 6+ cafe au lait spots by the age of two indicate

Answer 30

neurofibromatosis

Question 31

what is the name of a mark presenting like:

blue grey bruise like presenting at birth

on L back/buttock

Answer 31

mongolian spots

Question 32

what is the course of mongolian spots

Answer 32

usually dissapear around 4y

Question 33

what is the name of a mark presenting like:

relatively large black or brown mole present at birth

Answer 33

congeital melanocytic nevi

Question 34

what is the course of congenital melanocytic nevi

Answer 34

get smaller w age

Question 35

what causes congenital melanocytic nevi

Answer 35

overgrowth of pigmented cells (melanocytes)

Question 36

what is a risk of congenital melanocytic nevi

Answer 36

skin cancer as an increase in number of miles increases your chances of them becoming cancerous