Paediatric Dermatoloy Flashcards
1
Q
Measles
A
- Caused by measles virus
- Spread by droplets
- 14-day incubation period
Presentation
- Fever, coryza and conjunctivitis
- Day 3 - rash appears on face (discrete, maculopapular, behind ears) then spreads down body and becomes confluent
- Cough present for whole illness
- Koplik spots - pathognomic but rarely seen
Management
- Notifiable disease
- Isolate child and stay off school for 4 days after rash begins
- Supportive treatment
- Safety netting (SOB, altered consciousness, seizures)
- Ribavarin for immunocompromised
- Vaccinate
Complications
- otitis media - most common complication
- Pneumonia
- Encephalitis and SSPE
Encephalitis
- Headaches, seizures and irritability which progresses to seizures and coma
- 15% mortality
- Long term sequelae including deafness, LD
Sub-Sclerosing Pan Encephalitis
- Occurs 7 years after measles infection
- Caused by a variant of measles which persists in the CNS
- Loss of neurological function which progresses to dementia and death
2
Q
Scarlet fever
A
- Characteristic red rash associated with toxin-producing strain of Strep (usually Strep A)
Presentation
- Fine, punctate erythematous rash, most prominent in flexures
- 3 S’s of Scarlet fever:
1. Sparing of perioral area
2. Strawberry tongue
3. deSquamates
Investigations - none
Management
- Erythromycin
- Can return to school 24h after Abx start
Complications
- Rheumatic fever
3
Q
Rubella
A
- Caused by rubella virus
- Incubation period 15-20 days
Presentation
- Red, maculopapular rash begins on face and then spreads centrifugally down torso and arms
- No fever (or low-grade)
- Rash wanes after 3-5 days
Investigations
- Serology - IgM ELISA done on all patients
- Repeat in convalescent phase because of false positives
Management
- No specific management, supportive only
- Should resolve in 7-10 days
- Avoid school for 4 days after rash starts, and avoid pregnant women
Complications
- Thrombocytopenia with haemorrhage
- Encephalitis
4
Q
5th and 6th Disease
A
5th Disease - Erythema Infectiosum
- Caused by PB19 infection, most common in sprint
- 7 day coryza of fever, headache and myalgia
- Maculopapular red rash on cheeks which progresses to lace-like rash on trunk and limbs
6th Disease - Roseola Infantum
- Caused by HHV-6 and HHV-7
- There is 2-3 day coryza
- Generalised maculopapular rash begins as the fever wanes
Management of both
- Supportive care only
- Explain risk of febrile seizures
- No need to stay off school
5
Q
Nappy rash
A
- Usually due to contact dermatitis due to irritant effects of urine
- Can also be atopic eczema, Candida infection
- In contact dermatitis the flexures are spared
Advice for parents
- High absorbency, well-fitting nappies
- Leave nappy off for as long as possible
- Change nappy as soon as possible after child has soiled
- Gently clean the area with water/fragrance free wipes and dry before fixing new nappy
- Use barrier cream e.g. Castor oil ointment (available OTC/in supermarkets)
Management of complications
- Inflammation - 1% hydrocortisone, only for infants >1 months, 7 days use max
- Suspected bacterial infection - oral flucloxacillin
- Suspected Candida infection - topical clomitrazole
6
Q
Cradle cap
A
- Infant sebhorreic dermatitis
- Starts as an erythematous scaly eruption on the head
- There can be a sticky adherent covering on the head (Cradle cap)
- Rash may spread to face, axillae and napkin area
Management
- Advise patients that it is common and usually resolves spontaneously by 8 months
- They can use baby oil on the head, then use a soft brush to loosen the scales and wash with baby shampoo
- If symptoms persist, can give topical clomitrazole to be used 2-3/day until symptoms disappear
7
Q
Eczema
A
- Common in children, usually presents in first year of life
- Itch-scratch cycle - the child feels an itch, scratches it, this exacerbates the rash
- Usually dry skin, excoriations and there can be lichenification
Management
- EMOLLIENTS!!
- Mild - 1% hydrocortisone for 48h
- Moderate - betametasone 0.025% for 48h for flare ups and 1% hydrocortisone for maintenance + non-sedating antihistamine – Follow up – if not better, check compliance, can refer to dermatology
Severe - Betamethasone 0.1% cream for flare ups and Bethamethasone 0.025% for face and flexures
Advice
- Atopic march
- Frequent and liberal use of emollients, even when skin is cleat
- Keep nails short
- If there are bowel symptoms, may refer to food allergy clinic for skin-prick testing
8
Q
Guttate psoriasis
A
- usually presents following a bacteria/viral URTI
- There are red, scaly, drop-like plaques across the trunk and upper limbs
- These resolve over 3-4 months
- Tx with bland ointments
- Can recur in 3-5 years
9
Q
Molluscum contagiosum
A
- Caused by poxvirus
- Presents with skin-coloured pearly papules, with central umbilication
- These are not harmful but can take 18 months to resolve
- No management needed
- Avoid sharing towels, clothing and baths
10
Q
Pityriasis rosea
A
- Cause unknown but thought to be related to HHV infection
- There is an initial herald patch (red, scaly patch) which then develops into a widespread maculopapular rash
- May or may not be itchy
- Self-resolving in 4-6 weeks
11
Q
Tinea
A
- Invasions of dead keratinised structures with dermatophyte fungi
- Can see fungal hyphae on skin scrapings microscopy
- Tinea capitis - systemic antifungals + selenium silphide shampoo
- Can otherwise give topical antifungal
12
Q
Scabies
A
- Caused by Sarcoptes scabei
- Infection of the dermal layers down to the stratum corneum
- Presents with intense itching, 2-6 weeks after exposure
- In older children you may see burrows
- Clinical diagnosis
Treatment
- Permethrin 5% cream
- Apply to whole body, starting at neck and shoulders and then moving downwards
- Allow it to dry before putting on clothes
- After 8-12 hours, wash off
- Repeat treatment after 1 week
- Wash and tumble dry all clothing to decontaminate
- Treat close contacts
13
Q
Pediculosis
A
- Pediculosis capitis = headlice infestation
- Treat with dimeticone 4% - apply and leave overnight, then wash out the next day
- Repeat treatment if symptoms are still there one week later
- Comb hair with fine-tooth comb to remove any live lice
14
Q
Epidermolysis Bullosa
A
- Genetic condition with blistering of the skin and mucous membranes
- Blistering can be spontaneous or after minor trauma
- AD can be fatal whereas AR is milder
- There can be fusing of fingers and toes and limb contractures due to repeated healing and scarring
- Ulceration in mucosal membranes can lead to oesophageal strictures and stenosis
- Manage by avoiding minor trauma and treating secondary bacterial infections
15
Q
Albinism
A
- Failure in the biosynthesis and metabolism of melanin
- Can be ocular, partial or oculocutaneous
- Eye problems - failure to develop fixation reflex, photophobia (constant frowning), pendular nystagmus
- Manage with sun protection and corrective glasses
16
Q
Acne
A
- Generally presents 1-2 years after androgenic stimulation
- Androgens stimulate sebaceous glands to produce sebum
- Open comedones (blackheads) and closed comedones (whiteheads)
- May be related to menstruation
Mild-to-moderate acne
- Topical single agent e.g. benzoyl peroxide
- COCP may help in girls
Moderate acne, not responding to the above treatment
- Abx e.g. Doxycycline
- Give with another agent e.g. topical retinoid, to help prevent resistance
17
Q
Alopecia areata
A
- Non-inflamed hairless areas
- May see exclamation mark hairs (broken hairs)
- Regrowth in 6-12 months
18
Q
Hereditary angioedema
A
- AD condition with deficiency in C1 esterase, resulting in excess bradykinin
- There is severe subcutaneous swelling and abdominal pain with no urticaria or pruritus
- Usually triggered by stress
- Episodes develop over hours and subside over days
- There is risk to the airway, so can treat with purified preparation of C1 esterase inhibitor
19
Q
HSV infections in children
A
GINGIVOSTOMATITIS
- Most common HSV infection in children
- Causes painful, bleeding ulcers in the mouth and hard palate
- High fever
- Clinical diagnosis
- There may be herpetic whitlows (white pustules near the fingers) from autoinoculation
Management
- Mild cases - supportive treatment (anti-pyretics, fluids)
- Severe disease - admission and IV aciclovir
ECZEMA HERPETICUM
- HSV infection on a background of eczema
- Causes crusted ulcer-like lesions
- Mild disease - oral aciclovir
- Moderate-severe disease - IV aciclovir
- Antipyretics, hydration and supportive treatment
20
Q
VZV infection
A
CHICKENPOX
- 14 day incubation period
- Prodrome of 2-day fever, followed by eruptions of red, itchy papules on the head and torso, then spreading to the peripheries
- These develop into vesicles and pustules and then crust over
- Lesions of different stages are present at one time
- Clinical diagnosis
- Usually self-resolving with supportive treatment - hydration, soft cotton clothing, keep nails short
- Can give oral aciclovir if child presents within 24h of rash appearing
- Avoid school for 5-7 days after all lesions have crusted over
- For immunocompromised, there is risk of disseminated infection so give IV aciclovir if affected, VZIG if exposed
- Complications include pneumonia, hepatits, encephalitis
- Chickenpox cerebellitis - chickenpox + ataxia, usually occurs early in illness and resolves in 1 month
SHINGLES
- Reactivation of VZV infection
- Lesions present in sensory dermotomal distribution
- Uncommon in children, so consider an immunodeficiency
21
Q
CMV infection
A
- In immunocompetent children, there is a mild disease resembling EBV mononucleosis
- There is less prominent lymphadenopathy and heterophile monospot test negative
- In immunocompromised children, there is disseminated disease which can present with pneumonia, retinitis, encephalitis, gastroenteritis and bone marrow failure
- This needs treatment with IV ganciclovir
22
Q
Reye Syndrome
A
- Rare complications linked to aspirin use following viral infection e.g. chickenpox
- Presents with acute encephalopathy with sterile CSF, raised transaminases and liver biopsy showing fatty infiltrates
- Can be fatal
23
Q
Hand, Foot and Mouth Disease
A
- Caused by Coxsackie A16 virus
- There are painful vesicles and ulcers on hands, feet, mouth and tongue
- Mild systemic symptoms
- Self-resolving in 3-4 days
- Supportive treatment only
- Can go to school as long as they well
24
Q
Bornholm Disease
A
- Caused by Enterovirus
- There is pleurodynia - chest pain
- Self-resolving
25
Herpangina
- Caused by Coxsackie
- Painful ulcers and vesicles in the mouth and vulval area
- Severe cases may need IV aciclovir
26
HIV in children
- Causes T-cell (CD4+) suppression
- Presents with variable levels of immunocompromise
- Complications included Pneumocystis jiroveci, disseminated candidiasis, recurrent bacterial infections
Detection
- Child <18 months - HIV PCR
- Child >18 months - Serology
Management
- Start ART early
- Give SEPTRIN as PCP prophylaxis
- Vaccinations (not live ones)
- Regular monitoring of CD4 count and development
Advice for pregnant women
- Comply with ART so that CD4 count is undetectable at time of delivery
- Avoid breastfeeding
- Newborns are given PEP
27
Lyme Disease
- Caused by Borellia burgdorferi
- Spread by tick bites, although history is only present in 50% patients
- The is an initial erythematous macule which progresses t erythema migrans (an enlarging lesions with red border)
- There is systemic symptoms e.g. fever (fluctuating), lymphadenopathy and fatigue
- Complications include joint complications, neurological symptoms and myocarditis
Investigations
- Usually clinical diagnosis + serology
- Where the history is unclear you can do ELISA to detect Borellia burgdorferi
Management
- Resolves in weeks-months
- 1st line is Doxycycline
28
Kawasaki Disease
- Vasculitis affecting the coronary arteries
- Presents in children up to 6 years, Japanese children
CRASH + BURN
- Conjunctivitis
- Rash
- Adenopathy
- Strawberry tongue
- Hand and feet involvement - desquamation after 1-2 weeks
- BURN = fever that is difficult to control
Investigations
- Clinical diagnosis
- FBC, CRP
- Thrombocytopenia after 2 weeks
- Urgent echo
Management
- IVIG + high dose aspirin
Complications
- Coronary artery aneurysms
- There can be subsequent scarring and stenosis leading to potential myocardial ischaemia
29
Henoch-Schonlein Purpura
- Vasculitis
- Inflammation of the capillaries
- Usually post-URTI (more common in winter months
Presentation
- Fever
- Tetrad of rash, abdo pain, joint pain and glomerulonephritis
- Rash - palpable purpura, non-blanching, affecting extensor surfaces of limbs and buttocks, trunk-sparing
- Abdominal pain - may be severe colicky pain, intussusception
- Joint pain - there may be joint oedema, swelling of the legs
- Kidney involvement - haematuria/proteinuria
Investigations
- Clinical diagnosis
- Urinalysis
- BP
Management
- Supportive - analgesia, fluids, anti-pyretics
- Steroids can be given for severe abdominal pain or proteinuria
- Acute abdominal pain needs urgent surgical review for possible intussusception
- Monitor BP and kidney function if there is kidney involvement
Usually resolves in 4-6 weeks
