Paediatric Dermatology

Question 1

describe atopic eczema, what causes it?

Answer 1

• most common type of eczema, particularly in children
• atopy - over active immune response to environmental stimuli
• association with asthma and hayfever
• abnormality in filaggrin expression.
• loss of skin barrier function: loss of water, irritants and allergens may penetrate

Question 2

what is the distribution of atopic eczema in infancy, and older children?

Answer 2

• infancy: typically starts on the face/neck (cheeks common), can spread more generally
• older children: flexural pattern predominated i.e. antecubital fossae, popliteal fossae, wrists, hands, ankles

Question 3

what does filaggrin do?

Answer 3

• fillagrin proteins bind the keratin filaments together, also play a role in producing a natural moisturising factor.
• abnormality in filaggrin expansion in atopic eczema

Question 4

childhood eczema flares can be associated with:

Answer 4

• infections/viral illness
• environment: central heating, cold air
• pets: if sensitised/allergic
• teething
• stress
• sometimes no cause for flare found

Question 5

Describe seborrheoic dermatitis: distribution, who does it affect? cause?

Answer 5

• mainly scalp and face
• often babies under 3 months, usually resolves by 12 months
• associated with proliferation of various species of the skin commensal Malassezia in its yeast form
• associated cradle cap in infants

Question 6

Seborrheoic dermatitis treatment

Answer 6

• emollients
• antifungal creams and shampoos
• mild topical steroids

Question 7

describe discoid eczema

Answer 7

• scattered annular/circular patches itchy eczema
• can occur in this pattern as part of atopic eczema or in insolation.

Question 8

describe pomphylx eczema

Answer 8

• hand and foot eczema
• characterised by vesicles
• can be intensely itchy

Question 9

eczema treatment

Answer 9

• emollients
• topical steroids
• calcineurin inhibitors (e.g. protopic - steroid sparing topical agents)
• UVB light therapy
• immunosuppressive medication

Question 10

name some topical steroids: mild, moderate, potent and very potent

Answer 10

• mild: hydrocortisone
• moderate: eumovate
• potent: betnovate
• very potent: dermovate

Question 11

how should topical steroids be used for eczema?

Answer 11

• finger tip unit, once daily for 1-2 weeks
• if improvement then use alternate days for a few more days
• then if stubborn/persistent areas can use twice weekly in there areas
• if at any point the eczema starts flarin, go back to daily applications

Question 12

describe impetigo

Answer 12

• a common acute superficial bacteria skin infection
• pustules and honey-coloured crusted erosions
• staph aureus causative organism

Question 13

impetigo treatment

Answer 13

• topical antibacterial (fucidin)
• oral antibiotic (flucloxacillin)

Question 14

viral warts treatment

Answer 14

• salicylic acid and paring
• cryotherapy

Question 15

eczema herpeticum treatment

Answer 15

• withold steroids for 24 hours
• aciclovir oral or IV
• opthamology review if near eye

Question 16

erythema nodosum clinical features

Answer 16

• painful, erythematous subcutaneous nodules
• over shins, sometimes other sites
• slow resolution: like bruise, 6-8 weeks

Question 17

erythema nodosum causes

Answer 17

• infections: streptococcus, URTI
• IBD
• sarcoidosis
• drugs: OCP, sulphonamides, penicillin
• mycobacterial infections
• idiopathic

Question 18

describe dermatitis herpetiformis

Answer 18

• rare but persistent immunobullous disease that has been linked to coeliac disease
• itchy blisters can appear in clusters
• often symmetry
• calp shoulders, buttocks, elbows and knees