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3a > Paediatrics: Dermatology + Allergy > Flashcards

Paediatrics: Dermatology + Allergy Flashcards

1
Q

What is eczema ? defect with what ?

A

chronic atopic condition caused by defects in normal continuity of skin barrier => inflam of the skin (Sx can rly vary)

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2
Q

eczema presentation ? located where ?

A

usually in infancy
- dry, red, itchy + sore patches
- on flexor surfaces (inside of elbows + knees) and face + neck
- periods where it is well controlled + then periods when worse (flares)

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3
Q

eczema pathophys ?

A

Defects in barrier that skin provides => tiny gaps => entrance for irritants/microbes/allergens => immune response => inflam

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4
Q

eczema overall Mx ?

A

maintenance + Mx of flares

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5
Q

desceirb eczema maintenance Mx ?

A

create arterial barrier over skin to compensate for defective one (emollient)
- avoid scratching/scrubbing skin, harsh soaps

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6
Q

eczema flares Mx ?

A
  • use thicker emollients
  • wet wraps
  • topical steroids
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7
Q

describe the emolients used in eczema Mx ? examples ?

A

use as thick as tolerated to maintain healthy skin
- thin creams (E45)
- thick greasy (50:50)

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8
Q

describe the use of topical steroids in eczema Mx ? examples ?

A

use weakest steroid for shortest period
- mild (hydrocortisone)
- v potent (dermovate)

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9
Q

how does eczema increase risk of bacterial infection ? what is most common causative organism ? how managed ?

A

skin barrier breakdown => entry point for infective organism (s.aureus)
- Mx: oral Abx (flucloxacillin)

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10
Q

What is Eczema herpeticum ? causative organism ?

A

viral skin infection in patients with eczema caused by HSV (most common) or VZV

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11
Q

patient with eczema has developed widespread, painful, vesicular rash. what is this ? what other Sx associated ?

A

eczema herpeticum
- plus systemic Sx: fever, lethargy, irritability, reduced oral intake, lymphadenopathy

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12
Q

eczema herpeticum Mx ?

A

viral swab of vesicles
- Aciclovir (HSV1 most common causative organism)

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13
Q

complications of eczema herpeticum ?

A

children can be v unwell
- bacterial super infection => more severe illness

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14
Q

What is psoriasis ?

A

chronic autoimmune ocnditon => recurrent Sx of psoriatic skin lesions

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15
Q

describe patches of psoriasis ? located where ?

A

dry, flakey, rough, faintly erythematous lesions
- usually extensors surfaces 9elbows, knees), scalps

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16
Q

what causes psoriatic lesions ?

A

caused by rapid generation of new cells => abnormal buildup + skin thickening

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17
Q

what are the different types of psoriasis ? most common in adults ? most common in kids ?

A
  • Plaque psoriasis (most common type in adults)
  • guttate (common in kids)
  • Pustular (rare and severe)
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18
Q

describe plaque psoriasis ?

A

thicken erythematous plaques with silver scales
(most common type in adults)

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19
Q

describe guttate psoriasis ? often associated with what ?

A

common in kids
- many small raised pauses across trunk + limbs (slightly scaled) (can turn into plaques)
- often triggered by throat infection

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20
Q

what Ix for psoriasis ?

A

clinical appearance of lesions is diagnostic

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21
Q

psoriasis Mx ? (2)

A
  • topical steroids
  • topical vit D analogues
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22
Q

name some associations of psoriasis ? (complications) (3)

A
  • nail psoriasis: pitting, thickening, discolouration, onycholysis
  • psoriatic arthritis (10-20%)
  • psychosocial
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23
Q

what is acne vulgarisms ? common when ?

A

extreme common condition during puberty + adolescence (can vary from mild - severe)

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24
Q

acne pathophys ? increased production of what ?

A

caused by chronic inflam +/- local infeciton
- acne results form increase production of sebum, trapping of keratin + blocking of pilosebavious unit => swelling + inflam of pilsebacious unit (comedones)

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25
Q

acne Px ? (5)

A
  • macules
  • papules
  • pustules
  • comedones (inflamed pilsebacious unit)
  • blackheads
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26
Q

acne Mx ?

A
  • topical benzyl peroxide
  • topical retinoids
  • topical Abx
  • OCP
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27
Q

what is the last line acne management ? how does it work ? SE ? (3)

A

oral retinoids (isthtinoin): reduce seem, reduce inflam and reduce bacterial growth
- SE: teratogenic, photosensitivity, depression (+suicidal ideation), stevens Johnson sydnrome

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28
Q

What is erythema multiforme? common cause ?

A

erythematous rash caused by hypersensitivity reaction
- common cause: viral infection (HSV or mycoplasma pneoumia)e

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29
Q

erythema multiform Px ?

A

widespread itchy erythematous rash + characters target lesions
- stomatitis

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30
Q

erythema multiform Mx ?

A

clinic Dx
- usually mild and resolves within 1-4 weeks

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31
Q

What is urticaria ? describe appearance ?

A

(aka hives)
- small itchy lumps that appear in skin +/- patchy erythematous rash
- may be a associated with angioedema + flushing of skin

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32
Q

urticaria pathophys?

A

release of histamine + other pro inflam chemicals

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33
Q

acute urticaria causes ? aetiology ?

A

acute: (something that triggers mast cells => histamine release)
- allergies to food/medications/animals
- viral infeciton
- insect bite

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34
Q

chronic urticaria causes ? aetiology ?

A

chronic (autoimmune - Ab target mast cells => histamine release from mast cells)

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35
Q

urticaria Mx ?

A

antihistamines (fexofenadine)
- severe flare: oral steroids

36
Q

What is seborrhoea dermatitis ? affecting what ? affecting where ?

A

inflam condition affecting the sebaceous glands (oil producing gland in skin)
- affects places with lots of these glands (scalp, nasolabial folds, eyebrows)

37
Q

how dos seborrhoea dermatitis present in infants ? AKA ?

A

infants => often crusted, dry scalp => aka cradle cap

38
Q

cradle cap Mx ?

A

(seborrhoeaic dermatitis)
- self limiting + resolves in about 4 months
- Mx: apply vegetable of olive oil

39
Q

What is ring worm ? most comm causative organism ? how spread ?

A

fungal infection of the skin (general)
- most common type of fungus causing ring own (trichophyton)
- spread through contract with infected individuals

40
Q

ringworm Px ? describe the rash ? where look especially ?

A
  • itchy rash, erythematous, clay + well demarcated
  • often on or several signs of circular shaped areas (well demarcated)
  • check toenails (thickened, discoloured + deformed nails)
41
Q

ringworm management ?

A

anti fungal medications (creams, shampoo, oral): clotrimazole

42
Q

What is nappy rash ? caused by ?

A

contact dermatitis in the nappy area
- caused by friction between skin + nappy and contact with urine + faeces

43
Q

nappy rash RF ?

A
  • delayed aching of nappies
  • irritant soaps
  • vigorous cleaning
  • preterm
44
Q

nappy rash Px ? what rash like ?

A

sore, red + inflamed skin in nappy region (may spare the skin creases)

45
Q

nappy rash similar rash that spreads to skin folds. consider what ? check where else /

A

more likely candida infection
- look for oral thrush

46
Q

nappy rash Mx ?

A

change nappy and clean asa; after wetting/soiling,
- maximise time without nappy

47
Q

Nappy rash complicaitons ?

A
  • candida infeciton
  • cellulitis
48
Q

What is scabies ? causative organism ? overall sx ?

A

tiny mites (Sarcoptes scabiei) that burrow under skin => infection + intense itching
- lay eggs in skin => further infection + sx

49
Q

scabies Px ? describe rash ? location ?

A

incredible itchy small red spots + track makes where mites have borrowed
- often between finer webs

50
Q

scabies Mx ? describe the treatment regime

A

pernitrim cream (to whole body), left on for 8-12 hours)
- then washed off
- repeat 1 week later
- v contagious so treat all household members the same
- stay off work/school until 24hrs after first treatment

51
Q

what is crusted scabies ?

A

serious infection in immunocomprosmes patient
- may need admission for treatment (oral ivervectin + isolation)

52
Q

how are headline transmitted ?

A

transmission is by head to head contract of sharing equipment (hairbrush, towel)

53
Q

headlice Mx ?

A

diameticone applied to wet hair + left to dry (repeated 7 days later)
- special fine combs
- no need to stay off school

54
Q

What is erythema nodosum ? often associated with what ? (3)

A

condition where red lumps appear across patients kin
- often indicated IBD or sarcoidosis or strep throat

55
Q

erythema nodosum Ix ?

A

looking for underlying cause
- inflam markers (IBD, sarcoidosis)
- throat swab (strep throat)
- faecal calprotectin (IBD)

56
Q

What is impetigo ? caused by what ? transmission ?

A

superficial skin infection usually caused by s. aureus
- contagious and kids should be kept off school
-occurs when bacteria enter via a break in the skin

57
Q

what are the two types of impetigo ?

A
  • non-bullous
  • bullous
58
Q

where does non-bulbous typically affect ? presentation ?

A

typically around mouth/nose
- exudate form lesions dry => golden crust

59
Q

non bullous impetigo Mx ? if widespread ?

A

topical fusidic acid, oral flucloxacillin (if widespread)

60
Q

what is bullous impetigo ? what is the causative organism ? explain

A

always s.aureus
- epidermolytic toxins + breakdown proteins that hold skin otgheter => fluid filled vesicles on skin => grow + burst => golden crust

61
Q

what happens when bullous impetigo is widespread ?

A

can go to staphylococcus scalded skin syndrome

62
Q

bullous impetigo Mx ?

A

flucloxacillin
- v contagious so should be isolated where possible

63
Q

What is stenes=johnsons syndrome and toxic epidermal necrolysis ? causing what ?

A

they are a spectrum of the same pathology: disproportional immune response => epidermal necrolysis => blistering and shedding of top layer of skin

64
Q

causes of SJS + TEN ? (2)

A
  • Meds (anti-epileptics, Abx, NSAIDs)
  • infections (HSV)
65
Q

SJS + TEN Px ? (7)

A

can be mild or severe/life threatening
- fever, cough, sore throat, sore eyes, itchy skin
- then purple red rash: that starts to blister => skin breakdown and shed

66
Q

SJS + TEN Mx ?

A
  • steroids
  • immunoglobbulins
  • immunosepressants
67
Q

SJS + TEN complications ?

A
  • secondary infection (due to breaks in skin)
  • permanent skin damage
  • visual complications (blindness)
68
Q

What is an allergy ? response to what ? causing what ?

A

hypersensitivity of the immune system to allergens (proteins that the immune system recognises as foreign => allergic immune reaction)

69
Q

What is Atopy ? associated with what conditions ?

A

predisposition to having hypersensitivity reactions to allergens
- tendency to develop: eczema, asthma, allergic rhinitis + food allergies
- tends to run in families and likely to come together

70
Q

What is the skin sensitisation theory ? what does it relate to/explain ?

A

origin of allergies
- there is break in infants skin (eczema or infection) that allows allergens to enter PLUS
- child does not the contact with allergen in GI tract

71
Q

what is a type 1 hypersensitivity reaction ? what cell/type involved ? explain it ? give condition examples ?

A

IgE antibodies to specific allergen => mast cells + basophils release histamines + cytokines => immediate reaction
- anaphylaxis, urticaria, allergic rhinitis

72
Q

what is a type 2 hypersensitivity reaction ? what cell/type involved ? explain it ? give condition examples ?

A

IgG + IgM react to allergen => complement system activation => direct damage to local cells
- haemolytic disease of the newborn, transfusion reaction

73
Q

what is a type 3 hypersensitivity reaction ? what cell/type involved ? explain it ? give condition examples ?

A

Immune complexes accumulate => damage to local tissue
- SLE, RA, HSP

74
Q

what is a type 4 hypersensitivity reaction ? what cell/type involved ? explain it ? give condition examples ?

A

cell mediated caused by T lymphocytes
- organ transplants reaction, contact dermatitis

75
Q

Ix for allergies ? gold standard ?

A
  • skin prick
  • food challenge testing (gold standard)
76
Q

what does a skin prick test test for ?

A

assess sensitisation not allergy

77
Q

What is allergic rhinitis ? what type of hypersensitivity ? explain a bit

A

IgE medicated type 1 hypersensitivity reaciton
- environment allergens => allergic inflam response in nasal mucosa

78
Q

allergic rhinitis Px ? (3)

A
  • runny, blocked + itchy nose, sneezing,
  • itchy/red eyes
  • associated with personal or FHx of atopy
79
Q

allergic rhinitis Mx ?

A
  • avoid triggers (hoover + change pillows + good ventilation)
  • oral antihistamines: loratedine
  • nasal antihistamines: in response to a trigger
80
Q

What is a normal amount of resp infection for healthy child per year

A

up to 4-8

81
Q

when would you consider Ix for recurrent infection in children ? (3)

A
  • chronic diarhoea since infancy
  • FTT
  • unusual/persistnat infections
82
Q

What is severe combined immunodeficiency syndrome ?

A

most severe condition causing immunodeficiency: children have almost no immunity

83
Q

would causes severe combined immunodeficiency syndrome ? aetiology ?

A
  • multiple genetic disorders => absent of dtysfunctioning T + B cells
84
Q

severe combined immunodeficiency syndrome Px ? (3) what age ?

A

usually present in first few months with:
- persisten diarrhoea
- FTT
- unwell after live vaccinations

85
Q

severe combined immunodeficiency syndrome Mx

A
  • treat underlying infecitons
  • immunoglobulin therapy
  • sterile environment
  • Avoid live vaccines
  • Haematopoetic stem cell transplantation
86
Q
A

3a (43 decks)

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