Paediatric Dermatology Flashcards
Describe eczema in children
Red, itchy dry skin eruption
Common affects 1 in 5 children
Flares and settles intermittently
Familial tendency
Different patterns recognised
Describe atopic eczema
Widespread diffuse scaly red eruption which is very itchy
Onset anytime in childhood, fluctuates in severity and commonest pattern is early onset
Prior to 3 months - suspicion of CMPA
What is barrier defect in atopic eczema?
Increased permeability to infection
Water loss
Dry and itchy
Increased risk of irritation and sensitization
Filaggrin mutation identified to predisposition - binds keratin fibres together
What is the management of eczema?
Topical steroids are the mainstay
Moisturiser (emollient) help symptomatically with itch - also helps reduce steroid use
Soap substitutes
1 finger tip unit - 0.5g
How is steroids used on the body when child has eczema?
Use daily for 1-2 weeks on affected areas
Step down to alternative days for further weeks
If stubborn then twice weekly in these areas
Move up again if flaring
Use ointment rather than cream
If face - mild/ moderate steroid for 3-5 days and regular use then protopic ointment
What is the topical steroid ladder?
Very potent - dermovate
Potent - betnovate
Moderate - eumovate
Mild - hydrocortisone
What happens when topical steroids don’t help?
Triggers - allergy, contact allergy and photo-aggravation
Steroid sparing agents - protopic ointment or Elidel cream
Phototherapy UVB
Immunosuppression (methotrexate)
Biologics - Dupilomab
When is food allergy suspected?
If immediate reactions - lip swelling, facial redness/ itching and anaphylactoid symptoms
Late (type IV) - worsening of eczema, GI problems, failure to thrive, severe eczema unresponsive to treatment and severe generalised itching
Describe discoid eczema
Scattered annular/ circular patches of itchy eczema
Stubborn to treat
Requires potent topical steroid, often in combo with antibacterial component ex. Betnovate C ointment
Describe seborrheic dermatitis
Mainly scalp and face
Often babies under 3 months and resolves by 12 months
Associated with proliferation of various species of commensal Malassezia - yeast form
Associated with cradle cap
Emollients, Daktocort ointment and protopic ointment
Describe impetigo
Common acute superficial bacterial skin infection - staph aureus
Pustules and honey-coloured crusted erosions
Topical antibacterial (fucidin) and oral antibiotic (flucloxacillin)
Describe molluscum contagiosum
Common benign self limiting infection
Molluscipox virus
2 week - 6 month intubation
Pearly papules and umbilicated centre
Can take 24hrs to clear
Can use 5% potassium hydroxide
Describe viral warts
Benign self limiting condition
Common non-cancerous growth of the skin caused by infection with HPV
Transmitted by direct skin contact
No treatment
Can use topical treatment (salicylic acid), cryotherapy and oral zinc
Describe viral exanthems
Associated viral illnesses
Common
Fever, malaise and headache
Reaction to a toxin produced by an organism, damage to skin by organism and immune response
Ex. measles, rubella, roseola and erythema infectiosum
What is chicken pox?
Highly infectious disease caused by primary infection with VZV
Red papules progressing to vesicles which often start on the trunk
Itchy and associated with viral symptoms
Describe parovirus (slapped check)
Fifth disease/ erythema infectiosum
Incubation is 7-10 days
Viral symptoms
Erythematous rash cheeks initially and then network rash
Can take 6 weeks to fully fade
Mild self limiting illness
Virus targets red cells in bone marrow
What are the risks of parvovirus?
Can very rarely cause aplastic crisis if haemolytic disorders
Risk to pregnant women - spontaneous abortion, intrauterine death and hydrops fetalis
Describe hand, foot and mouth
Enterovirus
Usually coxsackie virus A16
Blisters on hands, feet and in mouth
Viral symptoms
Late summer and autumn months
Self limiting and supportive treatment
What does eczema coxsackie look like?
Flared sites picks out areas of eczema
History of eczema and self limiting with viral symptoms
Describe eczema herpeticum
Unwell child and history of eczema
Monomorphic punched out lesions
Withhold steroids for 24hrs
Acyclovir - oral or IV
Ophthalmology if near eyes
What is orofacial granulomatosis?
Lip swelling and fissuring
Oral mucosal lesions - ulcers, tags and cobblestone appearance
Chron’s disease - check faecal calprotectin
Benzoate and cinnamate free diet
What are the clinical features of erythema nodosum?
Painful, erythematous and subcutaneous nodules
Over shins, sometimes other sites
Slow resolution - bruise like
6-8 week
What are the causes of erythema nodosum?
Infections (strep and URTIs), IBD, sarcoidosis, drugs (OCP, sulphonamides and penicillin), mycobacterial infections and idiopathic
Describe dermatitis herpetiformis
Rare but persistent immunobullous disease that can be linked to coeliac disease
Itchy blisters can appear in clusters - scalp, shoulder, elbows and knees
Often symmetry
What is the treatment of dermatitis herpetiformis?
Coeliac screening and skin biopsy
Emollients, gluten free diet, topical steroids and dapsone
What are the causes of urticaria?
Viral infection, bacterial infection, food or drug allergy, NSAIDs, opiates and vaccinations
Idiopathic if chronic
What is the treatment of urticaria?
Consider possible triggers like medication and withdrawal
Antihistamines - desloratadine 3x daily
Other options - Ranitidine, montelukast, omalizumab and ciclosporin
What is infantile haemangioma?
Very common vascular birth marks
Not present at skin on birth
Proliferative phase between 6 weeks and up to 8 months
Can be superficial or deep
What is the treatment of infantile haemangioma?
No treatment as will resolve
BB can speed up the process
Topical - timolol and propanol for oral
Used if rapidly enlarging, central face and if ulcerating
What does PHACES stand for?
Pituitary fossa abnormality
Haemangioma
Arterial anomalies
Cardiac anomalies or coarctation of aorta
Eyes
Sternal cleft
What is the management for PHACES?
Low dose propranolol can result in good improvement of segmental haemangioma
MDT approach
