Paediatric Skin conditions and Exanthems Flashcards
What is this?
Superficial Infantile Hemangioma
How do you treat this?
2 main methods (dosing not required)
What if it is refractory?
- Wet combing 40% success
- Topical physical or insecticide treatments
- ivermectin oral.
(adult and child 15 kg or more) 200 micrograms/kg orally with fatty food, as a single dose. Repeat dose in 7 days
What are these an example of?
Salmon Patch also known a naevus simplex
This is a capillary vascular malformation.
Can be more noticeable when the child cries.
will tend to disappear within the first year of life
Name this lesion
And
Name the more serious condition this could be
- Port wine stain
This is a capillary vascular malformation.
Usually occurs on the face.
Don’t usually disappear, though can fade slightly.
- Sturge–Weber syndrome
A mutation in the GNAQ gene on chromosome 9q21 in the vast majority of patients with port-wine stains and Surge-Weber syndrome
This syndrome is a capillary vascular malformation affecting the skin supplied by one branch of the trigeminal nerve of the face with defects in the underlying tissues. These may result in a shrunken brain, calcification inside the skull, seizures, meningeal angioma and eye abnormalities (glaucoma, optic atrophy).
How will you treat this?
Acute first time infection
This is local impetigo
Mupirocin 2% cream applied to crusted lesions, 8 hourly for 5 days
How can you prevent further spread of this?
This is impetigo
- Avoid touching affected area
- Practice good Hand hygiene
- Use a clean cloth each time to clean and dry the different areas
4.
How can you prevent further spread of this?
This is impetigo
- Avoid touching affected area
- Practice good Hand hygiene
- Use a clean cloth each time to clean and dry the different areas
- Do not share towels or flanels
- Ideally change clothes and bedding daily
- Avoid close contact with others
- should be home from school until lesions crust over OR 24 hours of treatment has begun.
Treatment for recurrent Impetigo OR multiple sores…
First:
Cephalexin 25mg/kg (up to 1g), orally, 12 hourly for 7 days or 12.5mg/kg (up to 500mg), 6 hourly, orally for 7 days - stop earlier if cleared
(first line is actually di/fluclox, but the paediatric formulation is more difficult)
If immediate hypersensitivity:
Trimethoprim + sulfamethoxazole 4 + 20mg/kg (160/800mg) orally, 12 hourly for 3 days
In endemic areas (for either local or widespread lesions):
Benzathine benzylpenicillin 1.2 million units Intramuscularly as a single dose
Doses as per sore throat
What can you use to treat cradle cap dermatitis?
Regular washing with baby shampoo
Regular washing with aqueous cream
Gentle brushing to remove scales
White Petrolatum can be useful
Topical anti-fungal agents can be used for extensive rash (ketaconazole 2% cream for 1-2 weeks)
Can use a low potency steroid lotion (hydrocort 1% lotion 1-2 weeks))
Is the MMR vaccine a live vaccine and when is it due?
Yes it is
12 and 18 months in and MMR and MMRV
Measles,mumps, rubella
Measles, mumps, rubella, varicella zoster
Measles can incubate for 10-14 days after initial exposure, hence symptoms develop relatively later on.
What happens once symptoms do develop?
“prodromal phase”
Starts as fever, appetite loss and malaise
Then into conjunctivitis, cough and coryza
Fever can be as high as 40dC
“2-3 days later” Koplik spots appear
“1-2 days later” the rash appears
Cough can last 1-3 weeks
When is a person infectious with measles?
Infectious from when the prodrome starts and up to 4 days after the rash first appears
This rash appeared 5 days after a child started having a fever and loss of appetite and sore muscles.
What infectious disease is this?
Measles
What complications can occur with a measles infection?
A very large variety
Resp- LRTI (which is usually what is fatal), laryngobronchitis
Heart: myocarditis, pericarditis
Kidneys: acute glomerulonerphritis
Conjunctivitis
Otitis Media
GI: nausea, mouth ulceration, appendicitis, hepatitis, mesenteric adenitis and pancreatitis.
Is rubella still a problem in Australia?
What signs might you see in the mouth?
A. Apparently not, it has been eradicated
B. Forchheimer sign- petechaie on the soft palate
What is the difference between the rubella and measles rash?
what is this picture of?
trick question
Essentially none
Both start on the face and spread down
Rubella is less severe as an overall illness, lower fevers, easier recovery.
Koplik spots occur in measles, but petechia in rubella.
More likely to get enlarged LN in rubella.
Picture is rubella, but could just as easily be measles
What rash is this?
How would you tell?
Very hard to tell
This is roseola infantum (6th) disease.
It could be measles, it could be rubella.
Measles and rubella affect the face more
Roseola starts on the trunk and spreads to face - and if the face is affected it’s far less severe
Roseola and rubella are far milder diseases than Measles
- funnily enough though roseola (being even milder than rubella) can have fevers up to 40dC as can measles.
Roseola and measles have a shorter incubation (9-10 and 10-14 days respectively) than Rubella (14 up to 21 days).
Measles and rubella have oral lesions (koplik spots and Forchheimer sign)
What virus causes slapped cheek?
Parvovirus B19
What causes this?
What is the differential?
This is Scarlet Fever caused by Group A strep
It could be slapped cheek - parvovirus b19.
The difference is slapped cheek STARTS on face and can spread down,
whereas Scarlet fever starts on the chest or tummy
Scarlett fever causes the classic strawberry tongue
What is this?
What are common causes?
Nappy Rash
Irritant Dermatitis
Seborrhoeic dermatitis
Candidiasis
Psoriasis
Miliaria
Atopic Dermatitis
What is this?
Treatment?
Napkin Psoriasis
Affects children < 2
May be preceded by a viral or bacterial infection
Usually a fx of psoriasis
Methylprednisolone aceponate 0.1% ointment applied topically to plaques on face and trunk until clear, usually for 2-4 weeks, refer to derm if it persists after this point.
