Paediatric Dermatology

Question 1

What is the pathophysiology of eczema?

Answer 1

Itchy, dry inflammatory skin disease

Can be: atopic, seborrheoic, discoid, pomphylx, varicose, contact allergic, contact irritant, photoaggravated

Atopic is commonest in children thought to be a barrier issue with genetic component - filaggrin expression. Distributes face/neck in infants and then a flexural pattern in older children.

Question 2

What are the principles for managing paediatric eczema?

Answer 2

Emollients - lotions, cream, gel and ointment
Topical steroids - use appropriately, once daily for 1-2 weeks, then alternate days for a few more, if stubborn can use twice weekly in these areas (mild: hydrocortisone, moderate: eumovate, very potent: dermovate)
Calcineurin inhibitors
UVB light therapy
Immunosuppressive medication

Question 3

What are the common skin infections and how are they treated?

Answer 3

Impetigo - pustules and honey coloured crusted erosions, staph aureus - treated with topical antibacterial (fucidin), oral antibiotic (flucloxacillin)

Molluscum contagiosum - 2wk-6mn incubation, pearly papules umbilicated centre, molluscipox virus - self limiting so reassure, can use 5% potassium hydroxide

Viral warts - non cancerous growths by HPV (verruca) - stimulate own immune system, topical TMs eg salicylic acid, paring, cryotherapy

Chicken pox - varicella zoster, red papules progressing to vesicles, itchy, viral syms - self limiting so exposure control

Parvovirus- erythematous rash cheeks then lace trunk and limbs, viral syms - mild self limiting

Hand foot and mouth - enterovirus, usually coxsackie A16, blisters on HFandM, viral syms- supportive TM, self limiting

Eczema coxsackium - viral syms, eczema history, flared sites - self limiting

Eczema herpeticum - unwell, history of eczema, monomorphic punched out lesions - withhold steroids 24hrs, oral or IV aciclovir

Question 4

What are skin manifestations of systemic disease?

Answer 4

Orofacial granulomatosis (crohns disease)
- lip swelling and fissuring, oral mucosal lesions 

Erythema nodosum (strep, urti, IBD, sarcoidosis, drugs, mycobacterium infection, idiopathic)
- painful, erthematous subcutaneous nodules, usually over shins with slow resolution 

Dermatitis herpetiformis (coeliac)
- itchy blisters in clusters, often symmetrical over scalp, shoulders, buttocks, elbows and knees 

Urticaria (infection, food or drug allergy, NSAIDs, opiates, vaccinations)
- wheals/hives, associated angioedema, minutes to hours of rashes