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