Paediatric Dermatology Flashcards by Ross Tulloch

What is the commonest form of eczema?

Atopic eczema

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What are the three clinical diagnoses associated with atopy?

Eczema
Hayfever
Asthma

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What is the distribution of atopic eczema?

In infants- typically starts on the face and neck

Older children- flexural pattern predominates (antecubital fossa, popliteal fossa, ankles, wrists, hands)

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Describe the pathophysiology of atopic eczema?

Atopic eczema is associated with a filaggrin expression abnormality. Filaggrin proteins bind keratin filaments together and play a role in producing a natural moisturising factor

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What are the complications of the loss of the barrier function of the skin in atopic eczema?

Loss of water from skin
Irritants (soap, dirt etc) may penetrate
Allergens may penetrate

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What are the causes of flare-ups of childhood eczema?

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

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What is seborrhoeic dermatitis?

Seborrheoic dermatitis mainly affects the scalp and face, often in babies under 3 months. It usually resolves by 12 months. It is associated with proliferation of the skin commensal Malassezia in its yeast form

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How is seborrhoeic dermatitis managed?

Emollients
Antifungal creams
Antifungal shampoos
Mild topical steroids

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What is discoid eczema?

Associated with scattered circular patches and itchy eczema. It can occur as part of atopic eczema or in isolation

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What is pomphlyx eczema?

Affects the hand and feet and is characterised by vesicles. It can be intensely itchy

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What is exogenous eczema?

Allergic eczema associated with type IV hypersensitivity. Irritant eczema occurs following repeated contact, with common allergens including soaps, citrus, tomatoes and chemical irritants

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How is eczema treated?

Emollients
Topical steroids (can cause skin thinning in prolonged use but shouldn’t if used appropriately)
Calcineurin inhibitors (e.g protopic – steroid sparing topical agents)
UVB light therapy
Immunosuppressive medication

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How should steroids be used in eczema?

Always applying a finger tip amount
Use once daily for 1-2 weeks
If improvement seen then reduce to only alternate days
Stubborn areas or flare ups- can go back up to daily use

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What is impetigo?

A common, acute, superficial, bacterial skin infection

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What is the most common causative organism of impetigo?

Staph aureus

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What are the symptoms of impetigo?

Pustules + honey coloured crusted erosions

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How is impetigo treated?

Topical antibiotics- fucidin

Oral antibiotics- flucloxacillin

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What is molluscum contagiosum?

A common, benign, self-limiting condition that is caused by the molluscipox virus

What are the features of molluscum contagiosum?

2 week-6 month incubation period
Transmission to close direct contacts possible.
Presents as pearly papules with an umbillicated centre
Can take up to 24 months to clear
5% potassium hydrochloride can be used to clear the infection

What are viral warts?

Growths of the skin caused by human papillomavirus infection. If present on the sole of the foot they are known as verrucas. They can be transmitted by direct skin-skin contact

How are viral warts treated?

Treatments are topical such as salicylic acid, paring or cryotherapy

What are the features of viral exanthems?

They always have an associated viral illness and usually have fever, malaise and headache present. They can occur either due to a reaction to a toxin produced by the organism, due to damage to the skin or an immune response

What viral infections commonly cause viral exanthems?

Chicken pox
Measles
Rubella
Herpes virus 6
Erythema infectiosum

What is the viral cause of chickenpox?

Varicella zoster virus

What are the symptoms of chickenpox?

Red papules that progress to vesicles, often starting on the trunk. There will be associated viral signs Usually itchy

What is the incubation period of chickenpox and when is it contagious?

Incubation period- 10-21 days | Contagious from 2 days prior to symptom onset until lesions have crusted

What are the possible complications of chickenpox?

Both very rare but can occur: - Pneumonia - Encephalitis

What are the features of parvovirus?

Parvovirus/slapped cheek/erythema infectiosum has an incubation period of 7-10 days and has associated viral signs. There is an erythematous rash initially on the cheeks and then on the trunk and limbs that can take up to six weeks to fade. It is usually a self limiting mild illness

When can parvovirus progress to serious illness?

Aplastic crisis in haemolytic disorders | Can cause difficulty in pregnancy- spontaneous abortion, intrauterine death, hydrops fetalis

What are the causative organisms of hand-foot-mouth?

Enteroviruses, usually coxsackie A16

What are the symptoms of hand-foot-mouth and when does it occur?

Blisters on the hands, feet and in the mouth as well as other viral symptoms There are epidemics in the late summer and early autumn

What are the features of eczema coxsackium?

Associated viral symptoms and a history of eczema and is self limiting

What are the features of eczema herpeticum?

Associated with an unwell child with a history of eczema. There are monomorphic, punched-out lesions.

How is eczema herpeticum treated?

Withhold steroids for 24hrs | Give oral or IV acyclovir

What are the symptoms of orofacial granulomatosis?

Associated with lip swelling and fissuring as well as oral mucosal lesions (ulcers and tags)

How is orofacial granulomatosis investigated and managed?

It can be confused with Crohn’s disease and so fecal calprotectin should be checked. A benzoate and cinnamate free diet can be recommended

What are the clinical features of erythema nodosum?

Painful, erythematous, subcutaneous nodules Common over shins but can affect other sites Slow resolution- 6-8 weeks

What are the causes of erythema nodosum?

``` Infections – Streptococcus, Upper respiratory tract Inflammatory bowel disease Sarcoidosis Drugs – OCP, Sulphonamides, Penicillin Mycobacterial Infections Idiopathic ```

What is dermatitis herpatiformis?

A rare but persistent immunobullous disease. There is a link to coeliac disease

What are the symptoms of dermatitis herpatiformis?

Itchy blisters appear in clusters, with a commonly symmetrical distribution over the scalp, shoulders, buttocks, elbow and knees

How can dermatitis herpatiformis be managed?

``` Detailed history Coeliac screening Skin biopsy Emollients Gluten free diet Topical steroids Dapsone ```

What are the symptoms of urticaria?

Can be acute (<6 weeks) or chronic (>6 weeks) Causes wheals or hives and in some (10%), angioedema Areas of rash can last from a few minutes up to 24hrs

What are the causes of acute and chronic urticaria?

``` Acute: •Viral infection •Bacterial infection •Food or drug allergy •NSAIDS, opiates •Vaccinations Chronic is always idiopathic ```

How is urticaria treated?

Consider possible triggers including medication and withdraw Antihistamines (Newer generation, 3 x daily, ranitidine, montelukast, omalizumab, ciclosporin)