Paediatric dermatitis

Question 1

Where on the body does eczema typically present?

What is the management?

Answer 1

Flexor surfaces - inside elbows and knees

Mx:
Maintenance = emollients
Flares = topical steroids:
1. Hydrocortisone
2. Eumovate
3. Betnovate
4. Dermovate
Staph aureus infection = iv abx

Question 2

What is eczema herpaticum?

What is the typical presentation?

Answer 2

Viral skin infection caused by VZV or HSV1.

widespread, vesicular painful rash in someone who has eczema + fever, lethargy + irritability.
Dx = viral swabs
Mx = Aciclovir

Question 3

What is stephen johnson syndrome and toxic epidermal necrolysis?

Answer 3

SJS and TEN = spectrum of same pathology. A disproportionate immune response causes epidermal necrosis, blistering and shedding

SJS = <10% surface area
TEN = >10% surface area

Question 4

What are the potential causes of SJS / TEN?

Answer 4

Medications
- anti-epileptics, Abx, allopurinol, NSAIDS

Infections
- Herpes, mycoplasma pneumonia, cytomegalovirus, HIV

Question 5

What is the management of SJS / TEN?

Answer 5

• Admit to burns unit
• Steroids
• Immunoglobulins
• Immunosuppressants

Question 6

What is the pathophysiology of urticaria?

Answer 6

Caused by the release of histamine + pro-inflammatory chemicals from mast cells.
May be:
- Allergic reaction
- Acute
- Autoimmune (chronic idiopathic urticaria)

Question 7

What are the 3 classes of chronic urticaria?

Answer 7

1. Chronic idiopathic urticaria - intermittent for >6 weeks, non-allergic
2. Chronic inducible urticaria - clear triggers
3. Autoimmune urticaria - chronic urticaria associated with underlying autoimmune condition (SLE)

Question 8

What is the management for Urticaria?

Answer 8

Antihistamines (Fexofenadine)

• steroids
• anti-leukotrienes
• Omalizumab
• Cyclosporin

Question 9

What is the main causative organism for impetigo?

Answer 9

Staph aureus, less commonly streptococcus pyogenes

Question 10

What is the difference between bullous and non-bullous impetigo?

Answer 10

Non-bullous - exudate –> golden crust typically around nose/mouth, no systemic symptoms

Bullous - always caused by staph aureus, which produce epidermolytic toxins. Fluid filled vesicles grow in size and then burst –> golden crust. Bullous = more common <2 years

Question 11

What is the treatment for impetigo?

Answer 11

Topical fusidic acid for localised non-bullous infection

Flucloxacilin for everything else

Question 12

What is the treatment ladder for acne vulgaris?

Answer 12

1. Topic benzoyl peroxide
2. Toopical retinoids
3. Topical clindamycin
4. Oral abx
5. Oral contraceptive

• Oral retinoids (roaccutane) for severe cases

Question 13

What is angiooedema?

Answer 13

Urticaria that involves deeper tissues, causing swelling (especially lips and around eyes)

Question 14

What is the management of anaphylaxis?

Answer 14

ABCDE
IM/OV adrenaline
Additional:
- antihistamine
- hydrcortisone
- salbutamol if wheeze