Paediatric Dermatology

Question 1

What are the mx options for acne vulgaris?

Answer 1

a 12-week course of topical combination therapy should be tried first-line e.g. topical benzoyl peroxide with topical clindamycin
Oral tetracyclines e.g. lymecycline
COCP in girls
Oral isotretinoin (Roaccutane) – requires specialist supervision

Question 2

What are the side effects of isotretinoin?

Answer 2

Dry skin and lips
Photosensitivity of the skin to sunlight
Depression, anxiety, aggression and suicidal ideation
Patients should be screened for mental health issues prior to starting treatment
Rarely Stevens-Johnson syndrome and toxic epidermal necrolysis

Question 3

What is impetigo?

Answer 3

a superficial bacterial skin infection, usually caused by staphylococcus aureus - golden crust is characteristic

can be classified as non-bullous or bullous

Question 4

Describe non-bullous impetigo. How should it be managed?

Answer 4

typically occurs around the nose or mouth. The exudate from the lesions dries to form a “golden crust”. They do not usually cause systemic symptoms or make the person unwell.

antiseptic cream (hydrogen peroxide 1% cream)
topical fusidic acid
Oral flucloxacillin is used to treat more widespread or severe impetigo

Question 5

Describe bullous impetigo. How should it be managed?

Answer 5

always caused by staphylococcus aureus
1 – 2 cm fluid filled vesicles form on the skin
exudate dries into golden crust
may be systemically unwell with fever

confirm dx with swabs, can manage with flucloxacillin

Question 6

How long should children with impetigo be off school for?

Answer 6

children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment - highly contagious!!!

Question 7

Complications of impetigo?

Answer 7

Cellulitis if the infection gets deeper in the skin
Sepsis
Scarring
Post streptococcal glomerulonephritis
Staphylococcus scalded skin syndrome
Scarlet fever

Question 8

What is psoriasis?

Answer 8

chronic autoimmune condition

causes dry, flaky, scaly skin lesions that appear in raised and rough plaques, commonly over the extensor surfaces of the elbows and knees and on the scalp

Question 9

Give some signs suggestive of psoriasis

Answer 9

Auspitz sign refers to small points of bleeding when plaques are scraped off
Koebner phenomenon refers to the development of psoriatic lesions to areas of skin affected by trauma
Residual pigmentation of the skin after the lesions resolve

Question 10

Give some mx options in psoriasis

Answer 10

Avoiding triggers like smoking and stress
Regular topical emollients
Potent topical corticosteroid plus Vitamin D analogue once daily (one in morning one in evening, for up to 4 weeks with 4 week break in between courses)
Increase frequency if no improvement after 8 weeks

Secondary care: phototherapy (squamous cell ca.), oral methotrexate

Question 11

Outline the mx of eczema

Answer 11

Avoid triggers

Simple emollients – check how they are using and frequency of use
- if a topical steroid is also being used the emollient should be applied first followed by waiting at least 30 minutes before applying the topical steroid
- creams soak into the skin faster than ointments
- emollients can become contaminated with bacteria - fingers should not be inserted into pots (many brands have pump dispensers)

Topical steroid for flares – be aware that long term use can cause skin thinning
Antihistamines if very itchy

Question 12

Outline the mx of nappy rash

Answer 12

choose nappies with high absorbency and good fit
change nappies every 3-4 hours
keep nappy off for as long as possible
avoid any irritants

Question 13

Outline the mx of scabies

Answer 13

permethrin cream for patient, household, and all close contacts – leave on for 12 hours, then wash off, reapply after 1 week
Avoid close contact with others until end of course
Launder, iron or tumble dry clothing and bedding and towels on first day of tx

Question 14

Outline the mx of head lice

Answer 14

Tx only if living lice found
Malathion, wet combing to remove eggs
Household contacts only treated if affected, school exclusion not advised

Question 15

Outline the mx of hand foot and mouth disease

Answer 15

symptomatic treatment only: general advice about hydration and analgesia
reassurance no link to disease in cattle
children do not need to be excluded from school - kept off school until they feel better

Question 16

What is erythema infectiosum?

Answer 16

also known as fifth disease or ‘slapped-cheek’ syndrome

caused by parvovirus B19

bright red rash on cheeks, spares palms and soles, usually peaks after a week and then fades.

Question 17

Outline the mx of erythema infectiosum

Answer 17

Most children will recover with no specific tx
Rash fades after a week but may come back in heat

Question 18

Outline the mx of chickenpox

Answer 18

keep cool, trim nails
paracetamol for fever, calamine lotion

school exclusion: Advise that the most infectious period is 1–2 days before the rash appears, but infectivity continues until all the lesions are dry and have crusted over

immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG). If chickenpox develops then IV aciclovir should be considered

Question 19

Outline the mx of shingles

Answer 19

remind patients they are potentially infectious
avoid pregnant women and the immunosuppressed
infectious until the vesicles have crusted over, usually 5-7 days following onset
covering lesions reduces the risk

analgesia
paracetamol and NSAIDs first-line
if not responding then use of neuropathic agents (e.g. amitriptyline) can be considered

Question 20

Describe molluscum contagiosum

Answer 20

small, flesh coloured papules (raised individual bumps on the skin) that characteristically have a central dimple. They typically appear in “crops” of multiple lesions in a local area

Question 21

Mx of molluscum contagiosum?

Answer 21

avoid sharing towels or other close contact with the lesions
Topical potassium hydroxide, benzoyl peroxide, podophyllotoxin, imiquimod or tretinoin
Surgical removal and cryotherapy (freezing with liquid nitrogen) is an option

Question 22

Common cutaneous warts look like firm, raised papules with a rough surface that resembles a cauliflower. How can they be managed?

Answer 22

Topical salicylic acid (15–50%) applied daily for up to 12 weeks
Cryotherapy with liquid nitrogen (usually carried out every 2 weeks until the wart is gone, up to a maximum of six treatments).