Dermatology - Rashes Flashcards
A child presents with multiple discrete, flat nodule over their lower legs bilaterally.
The nodules are tender and there is accompanying pain in the knee joints.
What is the likely diagnosis?
ERYTHEMA NODOSUM
- Bruise like lesions over the lower limbs associated with arthralgia
What conditions is erythema nodosum associated with?
NO-no cause Drugs (sulfa/penecillins) Oral contraceptives Sarcoidosis/strep infection UC/crohns Micro (TB)
What causes scabies?
MITES - Sarcoptes, scabiei. This mite burrows under the skin into the stratus corneum (epidermis)
How does scabies present?
When the person first becomes infected they will have NO SYMPTOMS AT ALL
Then they will begin to experience INTENSE ITCHING that becomes worse when the person is warm or at night time
What will you see on examination of scabies?
- Can see burrows in the skin and there might be some vesicles and papule
- Commonly lesions are found around the hands (between fingers), around the axilla, flexor portion of wrists, around the nipples, penis and buttocks
How should we diagnose scabies?
It is a clinical diagnosis and should be treated before investigations but could consider SKIN SCRAPING if the clinical picture is slightly more confusing (e.g. if there is secondary infection)
HIGHLY INFECTIOUS - ask about contacts
How should we treat scabies?
PERMETHRIN CREAM (5%) - all areas below the neck and washed off 8-12h later
BENZYL BENZOATE CREAM (only apply below face)
MALATHION LOTION
What secondary infection of eczema is common and potentially harmful in children?
Eczema herpeticum (HSV infection)
How does eczema herpeticum present in children?
- Eczema is painful and there might be discrete fluid filled blisters that break open and leave small open sores
- Sometimes children feel unwell and might have a high temperature?
How is eczema herpeticum treated in children?
Often with oral acyclovir AND fluclox to treat ANY concurrent viral and bacterial secondary infection
What further complication can you get with eczema herpeticum?
Herpes stomatitis - painful lesions in and around the mouth
FEATURES - drooling, not eating and have become systemically unwell
What causes scalded skin syndrome?
How should these children be managed?
- AKA RITTER’S DISEASE - This is a staph aureus infection of the skin
- children are often very very unwell and will need PICU input
A child starts with fever and coryza symptoms that last for around 3-5 days. Just as they start to feel better a maculopapular rash occurs on the trunk. It is not itchy and does not spread anywhere else. What is the likely diagnosis?
ROSEOLA INFANTUM (6th disease)
What causes roseola infantum?
Do they need to be off school?
Human Herpes Virus 6 - HHV-6
Not infectious not time off required
What are some common complications in children with roseola infantum?
About 10-15% of children with roseola will have a febrile convulsion
What is cradle cap known as medically?
Whats the treatment
Seborrhoeic dermatitis 9use baby shampoos and oils)
What is the most common cause of steven johnson syndrome in children?
The most common triggers for Stevens-Johnson syndrome in children are infections, usually viral (URTI prodrome)
(other common infectious triggers include herpes, mumps, flu and the Epstein Barr virus)
Adults: reactions to medicine
What does rash of steven johnsons look like
Initially: ‘target’ with a purple or dark area of skin surrounded by a lighter area.
Then: blisters develop
Then: burst and leave sore areas
** not usually itchy.
Treatment of steven johnsons?
Supportive
- Hydration
- non stick dressings
- topical steroids and antibiotics to prevent further infection
What is the treatment of nappy rash that is inflamed and causing discomfort?
-For children over 1 month of age, consider prescribing topical hydrocortisone 1% cream once a day in addition to barrier ointments until symptoms settle or for a maximum of seven days.
Treatment of nappy rash with bacterial infection?
What about allergies?
Flucoxacilllin
Clarythromycin if allergic
Treatment of nappy rash with suspected or confirmed (swab) candida?
Topical miconazole (also clotrimazole, econazole)
