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paediatric dermatology Flashcards

1
Q

label the skin

A
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2
Q

what is eczema

A

red, dry itchy skin eruption

flares and settles intermittently

varies in severity - mild, moderate, severe

impact on QOL for whole family

familial tendency

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3
Q

how common is eczema

A

1/5 children

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4
Q

what is atopic eczema

A

widespread, diffuse, red scaly eruption

very itchy

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5
Q

pattern of onset of atopic eczema

A

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

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6
Q

triggers for atopic eczema

A

illness

stress

teething

environment - cold air, central heating

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7
Q

what causes atopic eczema

A

barrier defect

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8
Q

eczema - what is a barrier defect

A

increased permeability to irritants and allergens, water loss → dry and itchy, increased risk of irritation and sensitisation

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9
Q

fillagrin and eczema

A

filaggrin mutation identified to predispose to development of eczema → lack of structural integrity and moisturising factor

filaggrin = structural protein which binds keratin fibres together

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10
Q

what is a sign of filaggrin deficiency

A

hyperlinearity on the palms

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11
Q

management of eczema

A

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

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12
Q

finger tip units

A

1 FTU = covers surface area of 2 adult hands (use as a guide to treatment)

1 FTU = 0.5g

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13
Q

finger tip units for 3-6mth old child

A

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
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14
Q

finger tip units for 1-2y/o child

A

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
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15
Q

FTU for 3-5y/o child

A
  1. 5 FTU:
    * entire face and neck

2 FTU:

  • entire arm and hand

3 FTU:

  • entire leg and foot
  • entire front of chest and abdo
  1. 5 FTU:
    * entire back incl buttocks
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16
Q

FTU for 6-10y/o child

A

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
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17
Q

how to use steroids on body for eczema treatment

A
  • 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

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18
Q

topical steroid ladder for eczema

A

vey potent - dermovate, 600x

potent - betnovate, 100x

moderate - eumovate, 25x

mild - hydrocortisone

  • step up potency if not effective enough or severity is increasing
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19
Q

use of topical steroids on face for eczema

A
  • 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
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20
Q

why do parents avoid topical treatment for eczema

A
  • 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

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21
Q

what happens when topical steroids don’t work in eczema

A

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

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22
Q

emollients for eczema

A

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

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23
Q

when to suspect food allergy

A

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)

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24
Q

testing for food allergy and related eczema

A

no specific test

remove suspected agent from diet for 4-6wks

rechallenge to see if symptoms reappear

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25
what is discoid eczema
scattered annular/circular patches of itchy eczema can occur in this pattern as part of atopic eczema or in isolation
26
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
27
what is seborrheoic dermatitis
mainly scalp and face often babies \<3mths, usually resolves by 12mths associated cradle cap in infants
28
organisms in seborrheoic dermatitis
associated w/ proliferation of various species of the skin commensal Malassezia in its yeast form
29
treatment of seborrheoic dermatitis
emollients - to loose scale daktocort ointment protopic ointment
30
what is impetigo
common acute superficial bacterial skin infection staph aureus
31
features of impetigo
pustules and honey coloured crusted erosions typically around mouth and nose
32
treatment of impetigo
topical antibacterial - fucidin oral abx - flucloxacillin (non-responsive. not improving, systemically unwell) separate towels and face cloths for rest of family
33
what is molluscum contagiosum
common benign self limiting infection molluscipox virus
34
features of molluscum contagiousum
2wk-6mth incubation transmission to close direct contacts pearly papules, umbilicated centre
35
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
36
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
37
treatment of viral warts
no treatment stimulate own immune system to respond * topical treatments e.g. salicylic acid and paring * cryotherapy * oral zinc 90% resolve in 24mths
38
what is viral exanthems
common child has associated viral illness - fever, malaise, headache either a reaction to toxin produced by the organism, damage to the skin by the organism or an immune response **chicken pox**, measles, rubella, roseola (HSV 6), erythema infectiosum (parovirus B19, slapped cheek)
39
what causes chicken pox
1y infection w/ varicella zoster virus highly contgious
40
immunity to chicken pox
one infection is thought to confer lifelong immunity immunocompromised individuals are susceptible to the virus at all times
41
features of chicken pox
red papules progressing to vesicles often starts on the trunk itchy associated w/ viral symptoms
42
what condition is this
atopic eczema
43
what condition is this
discoid eczema
44
what condition is this
seborrheoic dermatitis
45
what condition is this
impetigo
46
what condition is this
molluscum contagiosum
47
what condition is this
viral warts
48
vwhat condition is this
viral exanthems
49
what condition is this
chicken pox
50
timeline for chicken pox
incubation period 10-21 days contagious 1-2 days before rash appears and until lesions have crusted self limiting
51
management of chicken pox
self limiting infection control - nursery rarely associated pneumonia, encephalitis
52
slapped cheek causative organism
parvovirus slapped cheek aka fifth disease, erythema infectiosum
53
features of slapped cheek
incubation 7-10 days viral symptoms erythematous rash - cheeks initially, lace like network rash (trunk and limbs) can take 6wks to completely fade usually a mild self limiting illness
54
where to the parvovirus cells target
red cells in bone marrow
55
rare complications from slapped cheek
aplastic crisis (if haemolytic disorders) risk to pregnant women - spontaneous abortion, intrauterine death, hydrops fetalis
56
what condition is this
slapped cheek
57
what causes hand foot and mouth
enterovirus - coxsackie virus A16, can also be due to enterovirus 17 and other coxsackivirus types
58
features of hand foot and mouth
blisters on the hands, feet and in the mouth viral symptoms
59
epidemics of hand foot and mouth
late summer or autumn months
60
treatment of hand foot and mouth
self limiting supportive treatment
61
what condition is this
hand foot and mouth
62
features of eczema coxsackium
associated viral symptoms hx of eczema flared sites picks out areas of eczema self limiting and children are relatively well
63
what condition is this
eczema cosackium
64
treatment for eczema coxsackium
self limiting swab from lesions treat w/ aciclovir if unsure and to err on the side of caution
65
features of eczema herpeticum
unwell child hx of eczema monomorphic punched out lesions
66
what condition is this
eczema herpeticum
67
treatent for eczema herpeticum
withold steroids for 24hrs to prevent areas spreading further aciclovir - oral/IV 50:50 as emollient analgesia ophthalmology review if near eye
68
features of orofacial granulomatosis
lip swelling and fissuring oral mucosal lesions - ulcers and tags, cobblestone appearance
69
management of orofacial granulomatosis
consider crohn's disease - check faecal calprotectin if GI symptoms consider patch testing - benzoate and cinnamate free diet
70
what condition is this
orofacial granulomatosis
71
features of erythema nodosum
painful, erythematous subcutaneous nodules located over shins, sometimes other sites slow resolution, like bruise 6-8wks duration before fading and settling
72
causes of erythema nodosum
infections - streptococcus, URTI, mycobacterial IBD sarcoidosis drugs - OCP, sulphonamides penicillin idiopathic
73
what condition is this
erythema nodosum
74
treatment of erythema nodosum
NSAIDs identify and treat cause sometimes topical steroid - less helpful with deeper inflamamtion
75
what is dermatitis herpetiformis
rare but persistent immunobullous disease linked to coeliac
76
features of dermatitis herpetiformis
itchy blisters, can appear in clusters often symmetry scalp, shoulders, buttocks, elbows and knees
77
management of dermatitis herpetiformis
detailed hx coeliac screening w/ TTG skin biopsy emollients, gluten free diet, topical steroids, dapsone
78
what condition is this
dermatitis herpetiformis
79
what is urticaria
wheals/hives associated angioedema - 10% - important to differentiate from allergy (urticaria - lack of systemic symptoms) areas of rash can last from a few mins -24hrs
80
timing of urticaria
acute \<6wks chronic \>6wks
81
causes of urticaria
viral infection, bacterial infection food/drug allergy NSAIDs, opiates vaccinations chronic - idiopathic
82
what condition is this
urticaria
83
treatment of urticaria
consider possible triggers incl. medications and withdraw antihistamines: non-sedating * off licence doses (3-4x standard) * newer generation e.g desloratadine add on treatments: ranitidine, montelukast for prolonged problems despite high dose anti-histamine: omalizumab, ciclosporin
84
what is infantile haemangioma
very common vascular birth mark not present at birth proliferative phase between 6wks-8mths then starts to involute can be superficial or deep
85
when are infantile haemangiomas more common
premature low birth weight females FHx
86
treatment for infantile haemangioma
no treatment is needed as will resolve **beta blockers** can speed up the process of involution * **topical** - timolol 0.5% gel forming solution tds * **oral** - propanolol solution when to treat: * rapidly enlarging * central face or cosmetically sensitive site * ulcerating: buttocks, genitals, posterior shoulder
86
treatment for infantile haemangioma
no treatment is needed as will resolve **beta blockers** can speed up the process of involution * **topical** - timolol 0.5% gel forming solution tds * **oral** - propanolol solution when to treat: * rapidly enlarging * central face or cosmetically sensitive site * ulcerating: buttocks, genitals, posterior shoulder
87
what condition is this
infantile haemangioma
88
what condition is this
PHACES
89
what is PHACES
pituitary fossa abnormality haemangioma arterial anomalies cardiac anomalies or coarctation of the aorta eyes sternal cleft
90
management of PHACES
low dose propanolol can result in good improvement of segmental haemangioma MDT approach required

Y3 paediatrics (45 decks)

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