Paediatric dermatology Flashcards
1
Q
Eczema
A
- Red, dry, itchy skin eruption
- Flares and settles intermittently
- Familial pattern
- Different pathogens associated
2
Q
Atopc eczema
A
- Most common type
- Widespread diffuse eruption
- Onset → anytime during childhood
- Fluctuates in severity
- Triggers
- Illness
- Stress
- Teething
- Environment → cold air, central heating
3
Q
Pathophysiology of eczema
A
- Increased water loss
- Permeability of irritants and allergens
- Filaggrin mutation predisposition → protein that binds keratin fibres together
4
Q
Management of eczema
A
- Topical steroids
- Moisturisers and emollients → helps symptomatically with itch and reduces steroid use
- Soap substitute for washing
5
Q
Types of topical steroids
A
- Mild → hydrocortisone
- Moderate → eumovate
- Potent → betnovate
- Vert potent → dermovate
6
Q
What are the problems of topical steroid
A
- Steroid phobia
- Conflicting advice
- Skin thinning in prolonged use
7
Q
Alternative management of eczema
A
- Treatment of triggers → allergy, contact allergy, photo aggravation
- Steroid sparing agent → Protopic ointment
- Phototherapy UVB
- Immunosuppression → methotrexate, ciclosporin, mycofenalate, azathioprine
- Biologics
- JAK inhibitor?
8
Q
When to suspect food allergy
A
- Immediate reaction (type 1 hypersensitivity) → lip swelling, facial itching, anaphylactoid symptoms
- Late reaction (type 4 hypersensitivity)
- Worsening eczema 24/48h after ingestion
- GI problems
- Failure to thrive
- Severe eczema
- Severe generalised itch → even when skin is clear
9
Q
Discoid eczema
A
- Scattered annular/ circular patches of itchy eczema
- Pattern as part of atopic eczema or isolated
- Stubborn to treat
- Requires potent topical steroids and antibacterial component
10
Q
Seborrhoeic dermatitis
A
- Mainly scalp and fate
- Associated with proliferation of skin commensal
- Associated with cradle cap
- Treatment
- Emollients → loosen scales
- Daktocort ointment
- Protopic ointment
11
Q
Impetigo
A
- Common
- Acute superficial bacterial infection
- Pustules and honey-coloured crusted erosion
- Staph aureus
- Treatment
- Topical antibacterial (fucidin)
- Oral antibiotic (flucloxacillin)
12
Q
Molluscum contagiosum
A
- Self-limiting and common
- 2 weeks to 6 month incubation
- Transmission via close contact
- Pearly papule, umbilicate centre
- 24 months to clear
- 5% potassium hydroxide → last resort
13
Q
Viral warts
A
- Benign and self-limiting
- Non-cancerous growth caused by HPV infection
- Transmitted by direct skin contact
- Treatment → stimulate own immune system
- Cryotherapy
- Oral zinc
14
Q
Viral exanthema
A
- Reaction to toxin produced by organism, damage to skin by organism or immune response
- Causes fever, malaise and headache
- Viruses: chicken pox, measles, rubella, roseola, erythema infectiosum
14
Q
Viral exanthema
A
- Reaction to toxin produced by organism, damage to skin by organism or immune response
- Causes fever, malaise and headache
- Viruses: chicken pox, measles, rubella, roseola, erythema infectiosum
15
Q
Chicken pox
A
- Varicella zoster infection
- Highly infectious
- Infection causes lifelong immunity
- Immunocompromised susceptible to virus all the time
- Red papules (small bumps) → vesicles (blisters
- Causes itch and viral symptoms
- 1-2 days contagious before e rash
- Self-limiting
16
Q
Parvovirus
A
- Slapped check
- Erythema infectiosum
- Incubation 7-10 days
- Viral symptoms
- Erythematous rash initially, lace-like network rash
- Mild and self-limiting
- Virus targets red cells in bone marrow
- Rare → aplastic crisis
17
Q
Hand foot and mouth
A
- Enterovirus
- Usually coxsakie virus A16
- Blisters on hand, feet and mouth
- Viral symptoms
- Late summer and autumn prevalence
- Self-limiting with supportive treatment
18
Q
Eczema coxackium
A
- Associated with Cocksackie virus
- Associated viral symptoms
- History of eczema
- F
19
Q
Orofacial granulomatosis
A
- Lip swelling and fissuring
- Oral mucosal lesions → ulcers and tags, cobblestone appearance
- Associated with Crohn’s disease
- Check faecal calprotectin if GI
- Patch testing
- Benzoate and cinnamate free diet
20
Q
Clinical features of erythema nodosum
A
- Painful, erythematous subcutaneous nodules
- Over shins and other sites
- Slow resolution, like bruises
- 6-8 weeks
21
Q
Causes of erythema nodosum
A
- Infection → streptococcus and URTI
- Inflammatory bowel disease
- Sarcoidosis
- Drugs → OCP, sulphonamide, penicillin
- Mycobacterial infection
- Idiopathic
22
Q
Dermatitis herpetiformis
A
- Rare but persistent immunobullous disease
- Linked to coeliac disease
- Often symmetrical
- Scalp, shoulder, buttocks, elbow and knees
- Coeliac screen
- Skin biopsy
- Treatment → emollients, gluten free diet, topical steroids, dapsone (antibiotic)
23
Q
Urticaria
A
- Wheals/ hives
- Associated angioedema
- Lasts a few months to 24 hours
- Acute < 6 weeks
- Chronic > 6 weeks
- Causes
- Viral infection
- Bacterial infection
- Food and drug allergy
- NSAIDs, opiates
- Chronic → idiopathic
24
Q
Treatment of urticaria
A
- Identify and withdraw triggers
- Antihistamines
- Ranitidine
- Montelukast
- Ciclopsin
- Omalizumab
25
Q
Treatment of urticaria
A
- Identify and withdraw triggers
- Antihistamines
- Ranitidine
- Montelukast
- Ciclopsin
- Omalizumab
26
Q
Infantile haemangioma
A
- Strawberry spot
- Benign
- Very common vascular birth
- Not present at birth
- Proliferation between 6 weeks to 8 months
- Starts to involute
- Can be superficial or deep
26
Q
Infantile haemangioma
A
- Strawberry spot
- Very common vascular birth
- Not present at birth
- Proliferation between 6 weeks to 8 months
- Starts to involute
- Can be superficial or deep
27
Q
Treatment of infertile haemangioma
A
- No treatment → resolves
- Beta blockers to speed up involution
- Topical timolol
- Orla propanolol
- Particularly for rapidly enlarging, cosmetic sensitive areas and ulcerating sites
