Paediatric Dermatology

Question 1

Name the different types of eczema

Answer 1

• Atopic
• Seborrheoic
• Discoid
• Pomphylx
• Varicose
• Contact allergic dermatitis
• Contact irritant dermatitis
• Photoaggravated

Question 2

What are the features of atopic eczema?

Answer 2

• Overactive immune response to environmental stimuli
• Atopic march: eczema, asthma and hayfever
• Flexural pattern of distribution
• Found on the face and neck in infants
• Loss of water and penetration of irritants and allergens

Question 3

What can cause flares of childhood eczema?

Answer 3

• Infections/viral illness
• Central heating/cold air
• Pets
• Teething
• Stress
• Sometimes no cause

Question 4

What are the features of seborrheoic dermatitis?

Answer 4

• Mainly on the scalp and face
• Usually on babies under 3 months
• Associated with proliferation of malassezia in its yeast form

Question 5

How can seborrheoic dermatitis be managed?

Answer 5

• Emollients
• Antifungal creams and shampoos
• Mild topical steroids

Question 6

What are the features of discoid eczema?

Answer 6

• Scattered annular/circular itchy patches

- Can occur as part of atopic eczema or in isolation

Question 7

What are the features of pomphylx eczema?

Answer 7

• Hand and foot eczema
• Vesicles
• Intensely itchy

Question 8

How can late reactions to allergens be tested for?

Answer 8

Dietary restrictions/eliminations for 6-8 weeks

Question 9

How can eczema be treated?

Answer 9

• Emollients
• Topical steroids
• Calcineurin inhibitors
• UVB light therapy
• Immunosuppressive therapy

Question 10

Name some commonly used topical steroids (from mild to very potent)

Answer 10

• Hydrocortisone
• Eumovate
• Betnovate
• Dermovate

Question 11

What are the features of impetigo?

Answer 11

• Pustules
• Honey coloured crusted erosions
• Usually caused by staph aureus
• Children are usually well

Question 12

How is impetigo treated?

Answer 12

• Topical antibacterial (fucidin)

- Oral antibiotic (fluclox)

Question 13

What are the features of molluscum contagiosum?

Answer 13

• Self limiting viral infection
• 2wks - 6 months
• Transmission to close direct contacts
• Pearly papules, umbilicated centre
• Can take up to 24 months to clear

Question 14

How can molluscum contagiosum be treated?

Answer 14

-Potassium chloride: molutrex or molludab

Question 15

What are the features of viral warts?

Answer 15

• Skin coloured
• Caused by HPV
• Verrucas on sole of foot
• Transmitted by direct contact

Question 16

How can viral warts be treated?

Answer 16

• Salicylic acid and paring

- Cryotherapy

Question 17

What is a viral exanthems?

Answer 17

A rash caused by a viral illness

Question 18

What are the features of chicken pox infection?

Answer 18

• Varicella-zoster virus
• One infection confers lifelong immunity (not in immunocompromised people)
• Red papules progressing to blisters which often start on the trunk
• Itchy
• Associated with viral symptoms
• Self limiting
• Contagious - avoid nursery etc.

Question 19

What are the features of parvovirus?

Answer 19

• Slapped cheek
• Viral symptoms
• Erythematous rask on cheeks and then a lace like rash on the trunk and limbs
• Can take 6 weeks to fully fade
• Usually mild and self limiting
• Can cause aplastic crisis in patients with haemolytic disorders
• Risk to pregnant women (spontaneous abortion, IUD etc.)

Question 20

What are the features of hand, foot and mouth?

Answer 20

• Coxsackie virus A16
• Blisters on hands, feet and mouth
• Viral symptoms
• Epidemics in late summer and autumn
• Self limiting
• Supportive treatment

Question 21

What is eczema coxsackium?

Answer 21

• Coxsackie A16 infection in a patient with a history of infection
• Flared sites pick out areas of eczema
• Self limiting

Question 22

What are the features of eczema herpeticum and how can it be treated?

Answer 22

• Unwell child
• History of eczema
• Monomophic punched out lesions
• Withhold steroids for 24hrs
• Aciclovir
• Ophthalmology review if near the eye

Question 23

What is orofacial granulomatosis and which disease is it associated with?

Answer 23

• Lip swelling, fissures, ulcers and tags in the mouth

- Crohn’s disease

Question 24

What are the features of erythema nodosum?

Answer 24

• Painful, red SC nodules
• Over shins
• Slow resolution

Question 25

What are the causes of erythema nodosum?

Answer 25

• Infections: strep and URTI
• IBD
• Sarcoidosis
• Drugs: OCP, sulphonamides and penicillin
• Mycobacterial infections
• Idiopathic

Question 26

How can erythema nodosum be treated?

Answer 26

• Rest and elevation
• Compression
• ?topical steroids
• NSAIDs
• Immunosuppression if persistent

Question 27

What are the features of dermatitis herpetiformis and which disease is it associated with?

Answer 27

• Itchy blisters that can appear in clusters
• Often symmetrical
• Affects scalp, shoulders, buttocks, elbows and knees
• Coeliac disease

Question 28

What are the features of urticaria?

Answer 28

• Wheals/hives
• Angioedema
• Can last a few minutes to 24hrs

Question 29

What are the causes of urticaria?

Answer 29

• Viral/bacterial infection
• Food or drug allergy
• NSAIDs/opiates
• Vaccines

Question 30

What are the treatment options for urticaria?

Answer 30

• Consider possible triggers and withdraw them
• Antihistamines
• Ranitidine
• Montelukast
• Omalizumab
• Ciclosporin