Paed Dermatology Flashcards by Annie Caldwell

What is eczema?

Itchy, dry inflammatory skin disease

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Types of eczema

Endogenous (internal cause)
- Atopic
- Seborrhoeic - face / scalp - scale associated
- Discoid - annular/circular patches
- Pomphylx - vesicles affecting palms/soles
- Varicose - oedema/venous insufficiency
Exogenous (external cause)
- allergic contact dermatitis (sensitised to allergen)
- irritant contact dermatitis (friction, cold, chemicals e.g. acids, alkalis, detergents, solvents)
Photosensitive/photaggravated eczema

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Flares of childhood eczema can be associated with…..

Infections/viral illness
environment 
- central heating
- cold air
Pets if sensitised/allergic 
Teething
Stress 
Sometimes no cause for flare

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What is the most common type of eczema, especially in children?

Atopic eczema

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What is atopy?

Overactive immune response to environmental stimuli

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Pathology of atopic eczema

Immune mediated defects in the skin barrier function - dry inflamed skin
The “skin barrier defect”

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Associations of atopic eczema

Usually 1 or more family members affected

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3 conditions that atopy is often linked to

Asthma
Eczema
Hayfever

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Where is atopic eczema seen in infancy?

Typically starts on face/neck (cheeks common)

Can spread more generally

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Where is atopic eczema seen in older children?

Flexural pattern predominates (antecubital fossae, popliteal fossae, wrists, hands, ankles)
Facial eczema also possible / can recur

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What is there an abnormality in in atopic eczema?

Filaggrin expression

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What is the roles of filaggrin?

Bind the keratin filaments together

Play a role in producing natural moisturing factor

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What is the features of the loss of skin barrier function of atopic eczema?

Loss of water
Irritants may penetrate (soap, detergents, solvents, dirt)
Allergens may penetrate (pollens, dust mite antigens, microbes)

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Who and where is seborrheoic dermatitis mainly seen?

Babies under 3 months

Mainly scalp and face

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When does seborrheic dermatitis usually resolve by?

12 months

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Associations of seborrheoic dermatitis

proliferation of various species of the skin commensal malassezia in its yeast form
Cradle cap in infants

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Treatment of seborrheic dermatitis

emollients
antifungal creams
antifungal shampoos
mild topical steriods

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What is discoid eczema?

Scattered annular/circular patches itchy eczema

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What can discoid eczema also occur as a part of?

Atopic eczema

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Presentation of pomphylx eczema

hand and foot eczema
Characterised by vesicles
Can be intensely itchy

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What does varicose eczema affect?

Legs in association with venous insufficienct

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Associations of varicose eczema

Oedema
varicose veins
chronic leg swelling

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Presentation of varicose eczema

Skin often dry and inflamed

may ulcerate

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Treatment of varicose eczema

emollients
topical steroids
compression stockings

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What is helpful in determining allergic eczema?

Allergic eczema

Causes of irritant eczema

``` Repeated contact water and soaps citrus tomatoes chemical irritants ```

What does eczema =?

Dermatitis

What % of childhood eczema is mild?

80%

Presentation of food allergy

``` Lip swelling facial redness / itching anaphylactoid symptoms Late reactions - worsening of eczema 24/48 hours after ingestion GI problems failure to thrive Severe eczema unresponsive to treatment Severe generalised itching - even when the skin appears clear ```

What can be associated with food allergy?

Atopy

2 ways to test for food allergy

Blood test for specific IgE antibodies to certain foods | Skin prick testing

Commonest food allergies

``` Milk / dairy Soy Peanuts Eggs Wheat Fish ```

Airborne allergens

house dust mite pet dander pollens

How to find out if you are allergic to a food

dietary restrictions / eliminations > 8 weeks

Eczema treatment

``` Emollients - lotions - creams / ointments Topical steroids Calcineurin inhibitors (e.g. protopic - steroid sparing topical agents) UVB light therapy Immunosuppressive medication ```

Features of emollients used for treatment of eczema

Fragrance free | Greasier ointments for effective

S/Es of topical steroids

Skin thinning in prolonged use | Topical steroid phobia

Types of topical steriods

Very potent (dermovate) - 600x Potent (betnovate) 100x Moderate (eumovate) 25x Mild (hydrocortisone)

How much topical steroids should be used?

Finger tip unit

How to use topical steriods

Once daily for 1 - 2 weeks if improvement then use alternate days for a few more days Then if stubborn/persistent areas can use twice weekly in these areas If at any point the eczema starts flaring, go back to daily applications

Treatment of impetigo

``` Topical antibacterial (Fucidin) Oral antibiotic (flucloxacillin) ```

What is molluscum contagiosum caused by?

Molluscipox virus

incubation of molluscum contagiosum

2 weeks to 6 months

Transmission of molluscum contagiosum

close direct contacts

Presentation of molluscum contagiosum

Pearly papules | Umbilicated centre

How long can molluscan contagiousum take to clear?

Up to 24 months

Treatment of molluscan contagiousum

5% potassium hydroxide

Presentation of viral warts

Often skin coloured | Sole of the foot - verruca

What are viral warts?

Common non cancerous growths of the skin caused by an infection with HPV

What do viral warts do?

Stimulate own immune system to respond

Treatment of viral warts

``` cryotherapy Topical paints (salicylic acid) ```

How much of viral warts resolve in 24 months?

90%

Presentation of viral exanthems

Fever Malaise Headache

Pathology of viral exanthems

Either reaction to a toxin produced by the organism, damage to the skin by the organism or an immune response

Associated viral illnesses of viral exanthems

``` chicken pox measles rubella roseola (herpes virus 6) erythema infectiosum (paravirus B19, slapped cheek) ```

What happens once have the varicella zoster infection?

Life long immunity

Who is susceptible to chicken pox at all times?

Immunocompromised

Presentation of chicken pox

``` red papules (small bumps) progressing to vesicles (blisters) often start on trunk itchy associated viral symptoms ```

Incubation period of chicken pox

10-21 days

When is chicken pox contagious?

1-2 days before rash appears and until lesions have crusted

What is chicken pox rarely associated with?

Pneumonia | Encephalitis

Incubation of parvovirus (slapped cheek)

7 - 10 days

Presentation of parvovirus

Erythematous rash cheeks initially and then also lace like network rash (trunk and limbs) viral symptoms mild self limiting illness

How long can parvovirus take to full fade?

6 weeks

What does the virus in parvovirus target?

Red cells in bone marrow

Complications of parvovirus (rare)

``` Aplastic crisis (if haemolytic disorders) Risks to pregnant women - spontaneous abortion - IU death - hydrops fetalis ```

What causes hand foot and mouth disease?

Enterovirus - coxsackie virus A16 - enterovirus 71

Presentation of hand foot and mouth disease

blisters on the hands Feet and in the mouth Viral symptoms

When is there epidemics of hand foot and mouth disease?

Late summer | Autumn months

Treatment of hand foot mouth disease

Supportive

Presentation of orofacial granulomatosis

lip swelling and fissuring oral mucosal lesions - ulcers and tags - cobblestone appearance

Common cause of orofacial granulomatosis

Crohn's disease

Presentation of erythema nodosum

Painful, erythematous subcutaneous nodules Over shins Sometimes other sites

Resolution time of erythema nodosum

Slow resolution like a bruise 6 - 8 weeks

Causes of erythema nodosum

``` infectious - streptococcus - upper resp tract IBD Sarcoidosis Drugs - OCP - Sulphonamides - penicillin Mycobacterial infections Idiopathic ```

What is dermatitis Herpetiformis?

Rare but persistent immunoglobullous disease that has been linked to coeliac disease

What is dermatitis herpetiformis linked to?

Coeliac disease

Presentation of dermatitis herpetiformis

Itchy blisters that can appear in clusters often symmetry scalp, shoulders, buttocks, elbows, knees

Treatment of dermatitis herpetiformis

Emollients Gluten free diet Topical steroids Dapsone

What is urticaria also known as?

Wheals / hives

Associations of urticaria

Angioedema (10%)

How long can urticaria rash last for?

From a few mins up to 24 hours

Types of urticaria

Acute ( < 6 weeks) | Chronic ( > 6 weeks)

Causes of urticaria

``` Viral infection Bacterial infection Food or drug allergy NSAIDs, Opiates Vaccinations Idiopathic ```

Treatment of urticaria

Consider possible triggers, including medication and withdraw Antihistamines - desloratadine

What is joint pain and a salmon pink rash indicative of?

Systemic onset JIA