Paediatric Dermatology Flashcards
What are common presentations in paediatric dermatology?
- Eczema
- Infection – viral and bacterial
- Manifestations of systemic disease
- Vascular birthmarks
Eczema - aetiology
- Familial tendancy
Eczema - epidemiology
- Common, affects 1/5 children
Eczema - severity
- Varies from mild, moderate, severe
Eczema - presentation
- Classically red, dry itchy skin eruption
- Flares and settles intermittently
- Different patterns recognised
- Atopic eczema
- Food allergy
- Discoid eczema
- Seborrheic dermatitis
Atopic eczema - aetiology
- Filaggrin mutation predisposes – structural protein which binds keratin fibres together
Atopic eczema - pathophysiology
- Barrier defect
- Increased permeability to irritants and allergens
- Water loss
Atopic eczema - presentation
- Classic eczema
- Widespread diffuse scaly red eruptions
- Very itchy
- Onset anytime in childhood
Atopic eczema - triggers
- Illness
- Stress
- Teething
- Environment – cold air, central heating
Atopic eczema - management
- Topical steroids (mainstay)
- Strengths and adequate amounts need to be used
- Once daily for 1-2 weeks on affected area, then alternate days and increase again for flare ups
- Moisturiser (emollient)
- Helps symptoms such as itch
- Lighter during day, thicker at night
- Soap substitute
- If topical steroids don’t work
- Steroid sparing agents – protropic ointment or Elidel cream
- Phototherapy UVB
- Immunosuppresion – methotrexate, ciclosporin, mycofenalate mofetil, azathioprine
- Biologics – Dupilomab (IL4 inhibitor)
What is “1 fingertip unit”?
- 1 fingertip unit
- 0.5g
- Roughly covers surface area under 2 adults hands
Describe the topical steroid ladder?
- Very potent
- Dermovate 600x
- Potent
- Betnovate 100x
- Moderate
- Eumovate 25x
- Mild
- Hydrocortisone
When should you suspect food allergy?
- Immediate reactions (type 1 reaction)
- Lip swelling, facial redness/itching, anaphylactoid symptoms
- Late reactions (type IV hypersensitivity)
- Worsening of eczema 24/48 hours after ingestion
- GI problems
- Failure to thrive
- Severe eczema unresponsive to treatment
- Severe generalised itching
Discoid eczema - presentation
- Scattered annular/circular patches of itchy eczema
- Can occur in this pattern as part of atopic eczema or in isolation
Discoid eczema - management
- Stubborn to treat
- Potent topical steroid with antibacterial component
- Such as Betnovate C ointment
Seborrheoic dermatitis - aetiology
- Associated with proliferation of various species of skin commensals
- Malassezia in its yeast form
Seborrheoic dermatitis - presentation
- Mainly scalp and face
- Often babies under 3 months, usually resolves by 12 months
Seborrheoic dermatitis - management
- Emollients
- To loose scalp
- Daktocort ointment
- Protopic ointment
What are common skin infections?
- Impetigo
- Molluscum contagiosum
- Viral warts
- Viral exanthems
- Varicella zoster (chicken pox)
- Parovirus (slapped cheek)
Impetigo - aetiology
- Usually staph aureus
Impetigo - epidemiology
- Common superficial bacterial skin infection
Impetigo - presentation
- Pustules and honey coloured crusted erosions
- Very contagious
Impetigo - treatment
- Topical antibacterial
- Fucidin
- Oral antibiotic
- Flucloxacillin
Molluscum contagiosum - aetiology
- Mulluscipox virus
- Transmissible by close direct contact
Molluscum contagiosum - epidemiology
Common
Molluscum contagiosum - presentation
- Self-limiting condition
- Classically pearly papules, umbilicated centre
Molluscum contagiosum - management
- Reassurance, can take up to 24 months to clear
- 5% potassium hydroxide
Viral warts - aetiology
- Human papillomavirus (HPV)
- Transmitted by direct skin contact
Viral warts - presentation
- Benign self-limiting condition
Viral warts - treatment
- No treatment required
- Stimulate own immune system to respond to presence of virus
- Topical treatments such as salicyclic acid and paring
- Cyrotherapy
- Oral zinc
Viral exanthems - aetiology
- Associated viral illnesses
- Chicken pox
- Measles
- Rubella
- Roseola (herpes virus 6)
- Erythema infectiosum (parovirus B19, slapped cheek)
- Hand foot and mouth
- Eczema coxsackium
- Eczema herpeticum
Viral exanthems - epidemiology
Common
Viral exanthems - pathophysiology
- Either reaction to toxin produced by organism, damage to skin by organism or immune reaction
Viral exanthems - presentation
- Fever
- Malaise
- Headache
Viral exanthems - management
- Self-limiting so only supported treatment
Chicken pox - aetiology
- Varicella-zoster virus
- Highly contagious
- Contagious 1-2 days before rash appears until lesions have crusted over
Chicken pox - presentation
- Red papules (small bumps) progressing to vesicles (blisters) often start on trunk
- Itchy
- Associated with viral symptoms
Chicken pox - management
- Self-limiting
- Infection control
Chicken pox - complications
- Rarely associated with pneumonia, encephalitis
What is parovirus also called?
Also called slapped cheek
Parovirus - presentation
- Often mild, self-limiting illness
- Viral symptoms
- Erythematous rash cheeks initially and then also lace like network rash on trunks and arms
Parovirus - complications
- Virus attacks red cells
- Very rarely aplastic crises (if haemolytic disorders)
- Risk to pregnant woman
- Spontaneous abortion, IUD, hydrops fetalis
Hand foot and mouth disease - aetiology
- Enterovirus
- Usually coxsackie virus A16
- Can also be due to enterovirus 71 and other coxsackivirus types
Hand foot and mouth disease - epidemiology
- Epidemics late summer or autumn months
Hand foot and mouth disease - presentation
- Blisters on hands, feet and in mouth
- Viral symptoms
Hand foot and mouth disease - management
- Self-limiting so treatment is supportive
Eczema coxsackium - presentation
- Self-limiting
- Associated viral symptoms
- History of eczema
- Flared sites picks out areas of eczema
Eczema herpeticum - presentation
- Unwell child
- History of eczema
- Monomorphic punched out lesions
Eczema herpiticum - treatment
- Withhold topical steroids for 24 hours
- Aciclovir
- Oral or IV depending on age and how well
- Opthalmology review if near eye
What are examples of systemic diseases with skin manifestations in children?
- Orofacial granulomatosis
- Erythema nodosum
- Dermatitis herpetiformis
- Urticaria
Orofacial granulomatosis - aetiology
- Can be associated with Crohn’s disease
Orofacial granulomatosis - presentation
- Lip swelling and fissuring
- Oral mucosal lesions
- Ulcers and tags
Orofacial granulomatosis - management
- Check faecal calprotectin if GI symptoms
- Consider patch testing
- Benzoate and cinnamate free diet
Erythema nodosum - aetiology
- Infections
- Streptococcus, upper respiratory tract
- Inflammatory bowel disease
- Sarcoidosis
- Drugs
- OCP, sulphnoamides, penicillin
- Mycobacterial infections
- Idiopathic
Erythema nodosum - clinical features
- Painful, erythematous subcutaneous nodules
- Over shins, sometimes other sites
- Slow resolution like bruise
Erythema nodosum - management
- Painful, erythematous subcutaneous nodules
- Over shins, sometimes other sites
- Slow resolution like bruise
Dermatitis herpetiformis - epidemiology
- Rare but immunobullous disease that has been linked to coeliac disease
Dermatitis herpetiformis - presentation
- Itchy blisters can appear in clusters
- Often symmetry
- Scalp, shoulders, buttocks, elbows and knees
Dermatitis herpetiformis - management
- Coeliac screening
- Skin biopsy
- Emollients
- Gluten free diet
- Topical steroids
- Dapsone
Urticaria - classification
- Acute
- <6 weeks
- Chronic
- >6 weeks
Urticaria - aetiology
- Viral infection
- Bacterial infection
- Food or drug allergy
- NSAIDs, opiates
- Vaccinations
Urticaria - presentation
- Wheals/hives
- Associated angioedema
- Areas of rash can last from few minutes up to 24 hours
Urticaria - treatment
- Consider possible triggers including medication and withdrawal
- Antihistamines
- E.g Desloratadine – 3x daily
What are examples of vascular birthmarks?
- Infantile haemangioma
- PHACES
Infantile haemangioma - epidemiology
- Very common
Infantile haemangioma - presentation
- Not present on skin at birth
- Proliferative phase between 6 weeks up to 8 months
- Then starts to involute
- Can be superficial or deep
- Ulceration of buttocks, genitals or posterior shoulder
Infantile haemangioma - treatment
- No treatment needed as will resolve
- Beta blockers can speed up process of involution
- Topical
- Timolol 0.5% gel
- Oral
- Propranolol solutions
- Topical
What is PHACES?
Syndrome:
- Pituitary fossa abnormality
- Haemangioma
- Arterial anomalies
- Cardiac anomalies or coarctation of aorta
- Eyes
- Sternal cleft
PHACES - management
- Low dose propranolol can result in improvement of segmental haemangioma
- MDT approach
