Paediatric Dermatology Flashcards
Age range of eczema
Atopic eczema worse between ages 2-4
Worse pre-puberty (no sebum production to act as a barrier)
Tends to improve into teen years and beyond
Distribution of atopic eczema in different age groups
Infants: cheeks often first affected
Toddlers: Extensor aspects of joints and genitals
School age on: flexural pattern
Perioral dermatitis cause and treatment
typically occurs after beclamethasone, treatment is to stop using creams on the face +/- oral tetracyclines
Management of eczema
Bathing: lukewarm watern, soap-free cleanser
Dilute K+ permangenate compresses for acute severe patch
Avoid wool
Emolliients after bathing
Topical steroids
Pimecrolis/tacrolimus for severe refractory eczema
Antihistamines may help reduce irritation, e.g. at night
Systemic steroids
MTX, AZA, phototyherapy for severe cases
Steroid creams suitable for facial dermatitis
Hydrocortisone 0.5% or 1%
Suitable for face and other body parts with thin skin
Others are too strong
Common causes of nappy rash
Usually a form of irritant contact dermatitis (due to bile salts and ammonium hydroxide in waste)
Other causes: candida, impetigo, seborrhoeic dermatitis etc.
NOT due to dermatophyte fungal infections (tinea)
Management of nappy rash
Use disposable nappies over cloth
Gently clean with water and soft cloth
Pat dry gently, allow to air dry
Apply protective emollient ointment
give evening fluids early to reduce night time wetting
Observe if certain foods are related to rash (e.g. orange juice increasing stool acidity)
+/- mild topical steroid (e.g. hydrocortisone)
Definition of acne vulgaris
Cutaneous disorder affecting adolescents and young adults involving hyperkeratisation, increased sebum production, infection and inflammation of the pilosebaceous follicles
Predisposing and provoking factors of acne vulgaris
Family history Stress high BMI (in females) PCOS Meds: steroids, hormones, AEDs, EGFR inhibitors Application of occlusive cosmetics (e.g. make up) High environmental humidity Diet high in dairy and high GI foods
pathophysiology of acne vulgaris
increased proliferation and reduced desquamation of keratinocytes lining follicle - partial obstruction of follicle with sebum and keratin- inflammatory cells + sebum acts as growth medium for PROPIONIBACTERIUM ACNES - enzymes produced by bacterium promote degradation and rupture of follicular wall
Sebaceous glands are enlarged and sebum production increased by prepubertal levels of DHEA (androgens)
Pathogen responsible for acne vulgaris
Propionibacterium acnes
Management of acne
Investigate for hyperandrogenism in females (PCOS)
if Mild:
topical benxoyl peroxide (clearasil)
Low dose COCP
Antiseptic washes with salicylic acid
Light/laser therapy
MODERATE: as above plus
tetracycliness for 6 months (or erythromycin or trimethoprim if allergic)
Antiandrogen therapy: COCP, cyproterone acetate + ethinylesrtadiol and/or spironolactone
Isotretinoin (reduces sebum production, only use for 6-12m at a time)
SEVERE:
higher dose antibiotics, oral isotretinoin, referral to derm
Bacteria responsible for impetigo
Strep pyogenes
Bullous impetigo: Staph aureus
Common sites of impetigo
Exposed areas (hands and face) or in skin folds (esp. armpits)
Appearance of impetigo
Round oozing patches of pustules enlarging every day
Clear blisters = bullous impetigo
May be golden yellow crusts
Management of impetigo
Soak with water/whitevinegar mixture
Antiseptic ointment (betadine, hydrogen peroxide, chlorhexadine)
Oral fluclox 7 days
Cover affected areas,avoid close contact with others, stay home from school until crusts dried out, use separate towels and flannels, change ans wash clothes and linen daily
Scalded skin syndrome definition
Red blistering skin that looks like a burn or a scald due to a staphylococcal infection of the skin and the release of epidermolytic toxins A and B
Presentation of scalded skin syndrome
Begins with systemic symptoms: fever, irritability, widespread erythema
Rash develops within 24-48 hours
- tissue paper-like wrinkling of the skin followed by appearance of bullae
- particularly affects armpits, groin, orifices
- top layer of skin peels in sheets, leaving exposed moist, red tender area
- NIKIOLSKY SIGN PRESENT
May be painful and tender around infection site
May have associated weakness and dehydration
Confirm diagnosis with biopsy and bacterial culture
Management of scalded skin syndrome
Hospitalisation
IV antibiotics (fluclox) = oral in several days if respond well
Supportive treatment (paracetamol, maintain fluid and electrolyte intake, skin care)
Usually heal completely within 5-7 days of starting treatment
Copmlications of scalded skin syndrome
If untreated, or if treatment unsuccessful Sepsis Cellulitis Pneumonia Death in severe infection
Scarlet fever definition
A bacterial illness with a distinctive rash of tiny pink-red spots covering the whole body in children who have recently had impetigo or a throat infection caused by strep pyogenes
Age range and risk factors for scarlet fever
4-8y (older kids have developed antibodies against strep toxins, children under 2 still have maternal antibodies)
Risk factors:
- living in overcrowding
- close contact with someone who has a strep infection
Clinical features of scarlet fever
1-4 day incubation
Sudden fever with:
sore throat, swollen neck glands, headache, nausea and vomiting, loss of appetite, strawberry tongue, abdominal pain, body aches, malaise
Characteristic rash (12-48 hours after onset of fever)
- starts below ears, neck, chest, armpits and groin - covers body over 24h
Scarlet spots - boiled lobster appearance
As progresses, looks like sunburn with goosebumps
Rough sandpaper like feel
Pastia lines
fever peaks by day 2 returns to normal in 5-7d
Rash starts to fade and peel like sunburn by day 6
Cause of pastia lines
rupture of fragile blood vessels in skin folds
Occurs in scarlet fever
Cause of scarlet fever
Group A strep (strep pyogenes) exotoxin
Management of scarlet fever
Penicillin/amoxycillin for up to 10 days ADDITIONAL: Paracetamol PRN Eating soft foods, drinking cool liquids Oral antihistamines or calamine lotion for itch Keep fingernails short
Complications of scarlet fever
Rheumatic fever Otitis media Pneumonia Septicaemia Glomerulonephritis Osteomyelitis Death
How contagious is chicken pox
> 90% to non-immune household contacts
Management of alopecia areata
Steroid injections and creams
Psoriasis treatment algorithm
- Emollients, topical vitamin D, coal tar,
- Topical steroids, retinoids or dithranol
- Phototherapy
- Oral MTX, retinoids, cyclosporin
Type of skin condition that sometimes occurs as a sequel to strep throats
Guttate psoriasis
