Paediatric dermatology

Question 1

How does eczema come on?

Answer 1

Red, dry itchy skin

Flares and settles quickly

Question 2

Is there a familial tendency for eczema?

Answer 2

Yes

Question 3

What would you suspect if atopic eczema presents prior to 3 months of age?

Answer 3

Cow’s milk protein allergy

Question 4

What is a barrier defect?

Answer 4

Increased permeability of skin to irritants and allergens
Filaggrin mutation/deficiency
E.g. eczema

Question 5

What is the main stay of eczema management?

Answer 5

Topical steroids

Question 6

What are some other parts of eczema management after topical steroids?

Answer 6

Emollient helps with itch

Use non-soap substitute for washing

Question 7

What area does 1 finger tip unit cover?

Answer 7

Surface area of 2 adult hands

About 0.5g

Question 8

How often do you use topical steroids for eczema on body?

Answer 8

Once daily for 1-2 weeks
Reduce to alternate days if improving
Twice per week if persistent

Question 9

What is the topical steroid ladder from mild, through moderate and potent, to very potent?

Answer 9

Hydrocortisone
Eumovate
Betnovate
Dermovate

Question 10

How often do you use topical steroids for eczema on face?

Answer 10

Mild-moderate steroid like eumovate for 3-5 days then repeat if any more flares

Question 11

Which ointment may be used if steroids are being used regularly, especially on the face?

Answer 11

Tacrolimus

Question 12

What are some immunosuppression options if topical steroids don’t work?

Answer 12

Methotrexate
Ciclosporin
Mycofenalate mofetil

Question 13

Name a steroid sparing agent to use if topical steroids aren’t working?

Answer 13

Protopic ointment

Eidel cream

Question 14

What is dupilomab?

Answer 14

Biologic therapy option when topical steroids aren’t working

IL-4 inhibitor

Question 15

When should you suspect a food allergy?

Answer 15

Immediate reaction of lip swelling and face red/itchy

Late onset GI problems, failure to thrive, worsening eczema

Question 16

What does discoid eczema look like?

Answer 16

Scattered circular patches

Question 17

How is discoid eczema treated?

Answer 17

Betnovate

Maybe antibacterial component as well

Question 18

What is seborrheoic dermatitis?

Answer 18

Cradle cap

Proliferation of various species of skin commensal malassezia

Question 19

How is seborrheoic dermatitis managed?

Answer 19

Emollient to loose scale
Daktocort ointment
Protopic ointment

Question 20

What causes impetigo?

Answer 20

Staph aureus

Question 21

How is impetigo treated?

Answer 21

Topical antibiotic fucidin

Oral flucloxacilin

Question 22

What causes molluscum contagiosum?

Answer 22

Molluscipox virus

Question 23

What does molluscum contagiosum look like?

Answer 23

Pearly papules

Umbilicated centre

Question 24

How is molluscum contagiosum managed?

Answer 24

Self limiting

Clears within 24 months so just reassure

Question 25

Are viral warts self limiting?

Answer 25

Yes

Question 26

What causes viral warts?

Answer 26

HPV

Question 27

How are viral warts transmitted?

Answer 27

Direct skin contact

Question 28

What are viral exanthems?

Answer 28

Maculo papular eruption from toxin produced by viral organism Self limiting

Question 29

What are some common causes of viral exanthems?

Answer 29

``` Chicken pox Measles Rubella Roseola Parvovirus B19 ```

Question 30

What causes roseola?

Answer 30

Herpes virus 6

Question 31

What causes chicken pox?

Answer 31

Varicella zoster

Question 32

What is a rare complication of parvovirus?

Answer 32

Aplastic crisis | May cause intrauterine death or hydrops fetalis in pregnant women

Question 33

What is hand foot and mouth?

Answer 33

Coxsackie A16 Blisters on the areas Viral symptoms Self limiting

Question 34

What does eczema herpeticum look like?

Answer 34

Monomorphic punched out lesions

Question 35

How is eczema herpeticum managed?

Answer 35

Withold steroids for 24 hours | Aciclovir

Question 36

What does eczema coxsackium look like?

Answer 36

Flared sites pick out areas of eczema

Question 37

Is eczema coxsackium managed?

Answer 37

Self limiting

Question 38

What has a stuck on appearance?

Answer 38

Seborrhoeic keratosis

Question 39

What does orofacial granulomatosis look like?

Answer 39

Lip swelling Oral mucosal lesions Ulcers and tags Cobblestone appearance

Question 40

How is orofacial granulomatosis managed?

Answer 40

Avoid benzoate and cinnamate

Question 41

What does dermatitis herpetiformis look like?

Answer 41

Blisters over knees, buttocks and elbows

Question 42

How is dermatitis herpetiformis managed?

Answer 42

``` Coeliac screening Skin biopsy Emollients Gluten free diet Topical steroids ```

Question 43

What does urticaria look like?

Answer 43

Wheals/hives | Angioedema

Question 44

How do we treat urticaria?

Answer 44

Remove triggers Antihistamines Ranitidine Ciclosporin

Question 45

What are infantile haemangioma?

Answer 45

Very common vascular birth mark | Not present at birth

Question 46

What causes PHACES?

Answer 46

Haemangioma | Arterial anomalies