Paediatric Dermatology Flashcards

1
Q

What is eczema?

A

Itchy, dry inflammatory skin disease.

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2
Q

Different types of endogenous (internal cause) eczema?

A
  • Atopic – ‘genetic barrier dysfunction’ **most common**
  • Seborrheoic – face/scalp – scale associated
  • Discoid – annular/circular patches
  • Pomphylx – vesicles affecting palms/soles
  • Varicose – oedema/venous insufficiency
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3
Q

Different types of exogenous (external cause) eczema?

A
  • Allergic contact dermatitis (sensitised to allergen)
  • Irritant contact dermatitis (friction, cold, chemicals e.g acids,alkalis, detergents, solvents)
  • Photosensitive/photoaggravated eczema
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4
Q

What can eczema flares be associated with?

A
  • Infections/viral illness
  • Environment: central heating, cold air
  • Pets: if sensitised/allergic
  • Teething
  • Stress
  • Sometimes no cause for flare found
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5
Q

What other two conditions are linked with atopic eczema?

A

Asthma and Hayfever

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6
Q

How does atopic eczema present in infants and older children?

A

Infants: typically starts of face and neck, can spread more generally

Older kids: flexural pattern predominates, facial eczema also possible

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7
Q

Brief pathophysiology of eczema?

A
  • Inherited abnormalities in the skin – the skin “barrier defect”
    • loss of water
    • irritants may penetrate skin
  • Abnormality in filaggrin expression.
  • Filaggrin proteins bind the keratin filaments together. Also play a role in producing a natural moisturising factor.
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8
Q

Outline seborrheoic dermatitis: (eczema)

Which commensal?

Rx?

A
  • Scalp and face
  • Often bambinos under 3 months, clears up by 12 months
  • Associated cradle cap in infants
  • Proliferation of commensal Malassezi
  • Rx: emollients, antifungal creams/shampoos
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9
Q

Outline discoid eczema:

A
  • Scattered annular/circular patches itchy eczema
  • Can occur in this pattern as part of atopic eczema or separate entity/diagnosis
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10
Q

What is the hand and foot eczema?

A

Pomphylx

  • Characterised by vesicles
  • Can be intensely itchy
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11
Q

Outline varicose eczema:

A
  • Affects legs in association with venous insufficiency
  • Associated with oedema, varicose veins, chronic leg swelling
  • Skin often dry and inflamed, may ulcerate
  • Rx: emollients, topical steroids, stockings
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12
Q

Briefly outline exogenous eczema:

A
  • Allergic eczema – become sensitised to allergen, patch testing helpful.
  • Irritant eczema – repeated contact; water and soaps, touching irritant foods; citrus, tomatoes, chemical irritants.
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13
Q

Eczema = Dermatitis

Important to remember eczema has many causes and allergy is only one possible cause

A
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14
Q

What reaction would make you suspect a food allergy?

A
  • Immediate reaction: face, lip swelling
  • Late reactions (eczema 24/48 hours after ingestion, particularly if pattern with specific food)
  • GI problems
  • Failure to thrive
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15
Q

How can we test for food allergy?

A
  • Blood test for specific IgE antibodies to certain foods
  • Skin prick testing
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16
Q

What are the various eczema treatments?

A
  • Emollients (Lotions, creams or ointments – fragrance free, greasier ointments more effective)
  • Topical steroids
  • Calcineurin inhibitors (e.g protopic – steroid sparing topical agents)
  • UVB light therapy
  • Immunosuppressive medication
17
Q

How do we use topical steroids?

What are the different types?

What are the risks?

A

Usage

  • One daily for 1-2 wks
  • If improvement then use alternative days for a few more days
  • Then if stubborn areas use 1-2 weekly for a while
  • If starts flaring then once daily

Types

  • Very potent (Dermovate)600x
  • Potent (Betnovate)100x
  • Moderate (Eumovate) 25x
  • Mild (Hydrocortisone)

Risks

  • Skin thinning with prolonged use - but if used correctly this should not occur
18
Q

What is impetigo?

What organism?

How do we treat?

A
  • common acute superficial bacteria skin infection.
  • Pustules and honey-coloured crusted erosions
  • Staph aureus
  • Topical antibacterial (fucidin)
  • Oral antibiotic (flucloxacillin)
19
Q

What is Molluscum contagiosum?

Rx?

A
  • Benign self limiting infection
  • 2 wk - 6 month incubation
  • Pearly papules, umbilicated centre
  • Can take up to 24 months to clear
  • 5% Potassium Hydroxide
20
Q

Viral warts features?

Rx?

A
  • Common non-cancerous growths of the skin caused by infection with human papillomavirus (HPV)
  • Sole foot – verruca
  • Transmitted by skin to skin contact
  • Cryotherapy
  • Topical paints (salicylic acid)
21
Q

What is viral exanthems?

A
  • Associated viral illnesses
  • Common
  • Fever, malaise, headache
22
Q

What is chicken pox?

What virus causes it?

SSx?

A
  • Highly contagious disease caused by primary infection with the varicella-zoster virus
  • One infection thought to confer lifelong immunity
  • Red papules (small bumps) progressing to vesicles (blisters) often start on the trunk
  • Itchy. Associated with viral symptoms.
23
Q

When are children contageous with chicken pox?

A
  • Contagious 1-2 days before rash appears and until lesions have crusted
  • Incubation period: 10-21 days
  • Self limiting.
  • Infection control – nursery
24
Q

What is parvovirus?

A

aka slapped cheek

  • Viral symptoms.
  • Erythematous rash cheeks initially and then also
  • lace like network rash (trunk and limbs). Can take 6w to full fade.
  • Usually a mild self limiting illness
25
Q

Features of hand, foot and mouth?

Which virus?

Rx?

A
  • Enterovirus
  • Blisters on the hands, feet and in the mouth. Viral symptoms.
  • Epidemics late summer or autumn months.
  • Self limiting, treatment supportive
26
Q

Features of orofacial granulomatosis?

A
  • Lip swelling and fissuring
  • Oral mucosal lesions: ulcers and tags, cobblestone appearance
27
Q

Features of erythema nodosum?

Causes?

A
  • Painful, erythematous subcutaneous nodules
  • Over Shins; sometimes other sites
  • Slow resolution - like bruise,
  • 6-8 weeks

Causes

  • Infections: strep, upper resp tract
  • IBD
  • Drugs
  • Sarcoidosis
28
Q

Dermatitis Herpeteformis

A

very rare

  • Itchy blisters can appear in clusters
  • Often symmetry
29
Q

Urticaria features?

Causes?

Rx?

A
  • Wheals/hives
  • Rash that can last a few minutes up to 24hrs
  • Acute <6 wks Chronic >6 wks
  • Causes: many

Rx

  • Consider possible triggers including medication and withdraw
  • Antihistamines