paediatric dermatology Flashcards
label the skin
what is eczema
red, dry itchy skin eruption
flares and settles intermittently
varies in severity - mild, moderate, severe
impact on QOL for whole family
familial tendency
how common is eczema
1/5 children
what is atopic eczema
widespread, diffuse, red scaly eruption
very itchy
pattern of onset of atopic eczema
any time in childhood
fluctuates in severity
commmonest pattern is early onset and settles by school age
of prior to 3mths - raises suspicion of cow milk protein allergy
triggers for atopic eczema
illness
stress
teething
environment - cold air, central heating
what causes atopic eczema
barrier defect
eczema - what is a barrier defect
increased permeability to irritants and allergens, water loss → dry and itchy, increased risk of irritation and sensitisation
fillagrin and eczema
filaggrin mutation identified to predispose to development of eczema → lack of structural integrity and moisturising factor
filaggrin = structural protein which binds keratin fibres together
what is a sign of filaggrin deficiency
hyperlinearity on the palms
management of eczema
topical steroids - mainstay of treatment, appropriate strength and adequate amounts need to be used
moisturiser (emollient) - itch management, helps to reduce total amount of steroid use over time
soap substitute - soap, shower gel and shampoo can all dry skin and flare eczema
finger tip units
1 FTU = covers surface area of 2 adult hands (use as a guide to treatment)
1 FTU = 0.5g
finger tip units for 3-6mth old child
1 FTU:
- entire face and neck
- entire arm and hand
- entire front of chest and abdo
1.5 FTU:
- entire leg and foot
- enture back incl buttocks
finger tip units for 1-2y/o child
1.5FTU:
- entire face and neck
- entire arm and hand
2 FTU:
- entire leg and foot
- entire front of chest and abdo
3 FTU:
- entire back incl buttocks
FTU for 3-5y/o child
- 5 FTU:
* entire face and neck
2 FTU:
- entire arm and hand
3 FTU:
- entire leg and foot
- entire front of chest and abdo
- 5 FTU:
* entire back incl buttocks
FTU for 6-10y/o child
2FTU:
- entire face and neck
2. 5 FTU: - entire arm and hand
3. 5 FTU: - entire front of chest and abod
4. 5 FTU: - entire leg and foot
5 FTU:
- entire back incl buttocks
how to use steroids on body for eczema treatment
- once daily for 1-2wks to affected areas
- if improvement step down to alternate days for further week
- stubborn/persistent areas - can use 2x wkly in these areas
- if at any point eczema starts flaring, go back to daily applications
use ointment rather than cream - less preservatives, greasier preparations
topical steroid ladder for eczema
vey potent - dermovate, 600x
potent - betnovate, 100x
moderate - eumovate, 25x
mild - hydrocortisone
- step up potency if not effective enough or severity is increasing
use of topical steroids on face for eczema
- more sensitive area and need to limit steroid use
- mild/moderate steroid for 3-5days and then stop and repeat as needed
- if needing to use regularly (3-5 days >3x/mth) - can introduce tacrolimus (protopic ointment)
- helps reduce use of streroids on face
- helps repair skin barrier
why do parents avoid topical treatment for eczema
- topical steroid phobia
- conflicting advice
- skin thinning in prolonged use - shouldn’t cause skin thinning if used appropriately and with clear instructions
if untreated, eczema can impact on QOL and can lead to faltering growth
what happens when topical steroids don’t work in eczema
think about triggers - allergy, contact allergy, photoaggravation
steroid sparing agents - protopic ointment or Elidel cream
phototherapy UVB
immunosuppression - methotrexate, ciclosporin, mycogenalate, mofetil, azathioprine
biologics - dupilomab (IL4 inhibitor)
JAK inhibitors etc
emollients for eczema
the right moisturiser is the one parents are happy to use
ideally lighter emollient for during the day and greasier preparation to use at night
viscous garments can be used alongside
when to suspect food allergy
young onset of eczema - milk as a trigger
immediate reactions (type 1) - lip swelling, facial redness/itching, anaphylactoid symptoms
late reactions (type IV hypersensitivity) - worsening of eczema 24/48hrs after ingestion, GI problems, FTT, severe eczema unresponsive to treatment, severe generalised itching (even when the skin appears clear)
testing for food allergy and related eczema
no specific test
remove suspected agent from diet for 4-6wks
rechallenge to see if symptoms reappear
what is discoid eczema
scattered annular/circular patches of itchy eczema
can occur in this pattern as part of atopic eczema or in isolation
treatment of discoid eczema
stubborn to treat - often re-appears in the same area
requires potent topical steroid, often in combination w/ antibacterial component e.g. betnovate C ointment
- apply for 14 days until area settles then wean down
- problematic areas - 2x/wk maintenance
what is seborrheoic dermatitis
mainly scalp and face
often babies <3mths, usually resolves by 12mths
associated cradle cap in infants
organisms in seborrheoic dermatitis
associated w/ proliferation of various species of the skin commensal Malassezia in its yeast form
treatment of seborrheoic dermatitis
emollients - to loose scale
daktocort ointment
protopic ointment
what is impetigo
common acute superficial bacterial skin infection
staph aureus
features of impetigo
pustules and honey coloured crusted erosions
typically around mouth and nose
treatment of impetigo
topical antibacterial - fucidin
oral abx - flucloxacillin (non-responsive. not improving, systemically unwell)
separate towels and face cloths for rest of family
what is molluscum contagiosum
common benign self limiting infection
molluscipox virus
features of molluscum contagiousum
2wk-6mth incubation
transmission to close direct contacts
pearly papules, umbilicated centre
management of molluscum contagiosum
can take up to 24mths to clear
reassurance
5% potassium hydroxide - causes irritation and directs body towards virus to help clear up, just need to treat up 1-2 areas and rest should speed up recovery
what are viral warts
benign self limiting condition
common non-cancerous growth of skin caused by HPV infection
common on hands and feet
transmitted by direct skin contact