Paediatric Dermatology Flashcards
What is eczema?
Itchy, dry inflammatory skin disease.
Different types of endogenous (internal cause) eczema?
- Atopic – ‘genetic barrier dysfunction’ **most common**
- Seborrheoic – face/scalp – scale associated
- Discoid – annular/circular patches
- Pomphylx – vesicles affecting palms/soles
- Varicose – oedema/venous insufficiency
Different types of exogenous (external cause) eczema?
- Allergic contact dermatitis (sensitised to allergen)
- Irritant contact dermatitis (friction, cold, chemicals e.g acids,alkalis, detergents, solvents)
- Photosensitive/photoaggravated eczema
What can eczema flares be associated with?
- Infections/viral illness
- Environment: central heating, cold air
- Pets: if sensitised/allergic
- Teething
- Stress
- Sometimes no cause for flare found
What other two conditions are linked with atopic eczema?
Asthma and Hayfever
How does atopic eczema present in infants and older children?
Infants: typically starts of face and neck, can spread more generally
Older kids: flexural pattern predominates, facial eczema also possible
Brief pathophysiology of eczema?
- 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.
Outline seborrheoic dermatitis: (eczema)
Which commensal?
Rx?
- 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
Outline discoid eczema:
- Scattered annular/circular patches itchy eczema
- Can occur in this pattern as part of atopic eczema or separate entity/diagnosis
What is the hand and foot eczema?
Pomphylx
- Characterised by vesicles
- Can be intensely itchy
Outline varicose eczema:
- 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
Briefly outline exogenous eczema:
- Allergic eczema – become sensitised to allergen, patch testing helpful.
- Irritant eczema – repeated contact; water and soaps, touching irritant foods; citrus, tomatoes, chemical irritants.
Eczema = Dermatitis
Important to remember eczema has many causes and allergy is only one possible cause
What reaction would make you suspect a food allergy?
- Immediate reaction: face, lip swelling
- Late reactions (eczema 24/48 hours after ingestion, particularly if pattern with specific food)
- GI problems
- Failure to thrive
How can we test for food allergy?
- Blood test for specific IgE antibodies to certain foods
- Skin prick testing
What are the various eczema treatments?
- 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
How do we use topical steroids?
What are the different types?
What are the risks?
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
What is impetigo?
What organism?
How do we treat?
- common acute superficial bacteria skin infection.
- Pustules and honey-coloured crusted erosions
- Staph aureus
- Topical antibacterial (fucidin)
- Oral antibiotic (flucloxacillin)
What is Molluscum contagiosum?
Rx?
- Benign self limiting infection
- 2 wk - 6 month incubation
- Pearly papules, umbilicated centre
- Can take up to 24 months to clear
- 5% Potassium Hydroxide
Viral warts features?
Rx?
- 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)
What is viral exanthems?
- Associated viral illnesses
- Common
- Fever, malaise, headache
What is chicken pox?
What virus causes it?
SSx?
- 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.
When are children contageous with chicken pox?
- Contagious 1-2 days before rash appears and until lesions have crusted
- Incubation period: 10-21 days
- Self limiting.
- Infection control – nursery
What is parvovirus?
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
Features of hand, foot and mouth?
Which virus?
Rx?
- Enterovirus
- Blisters on the hands, feet and in the mouth. Viral symptoms.
- Epidemics late summer or autumn months.
- Self limiting, treatment supportive
Features of orofacial granulomatosis?
- Lip swelling and fissuring
- Oral mucosal lesions: ulcers and tags, cobblestone appearance
Features of erythema nodosum?
Causes?
- 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
Dermatitis Herpeteformis
very rare
- Itchy blisters can appear in clusters
- Often symmetry
Urticaria features?
Causes?
Rx?
- 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
