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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
acne Px ? (5)
- macules - papules - pustules - comedones (inflamed pilsebacious unit) - blackheads
26
acne Mx ?
- topical benzyl peroxide - topical retinoids - topical Abx - OCP
27
what is the last line acne management ? how does it work ? SE ? (3)
oral retinoids (isthtinoin): reduce seem, reduce inflam and reduce bacterial growth - SE: teratogenic, photosensitivity, depression (+suicidal ideation), stevens Johnson sydnrome
28
What is erythema multiforme? common cause ?
erythematous rash caused by hypersensitivity reaction - common cause: viral infection (HSV or mycoplasma pneoumia)e
29
erythema multiform Px ?
widespread itchy erythematous rash + characters target lesions - stomatitis
30
erythema multiform Mx ?
clinic Dx - usually mild and resolves within 1-4 weeks
31
What is urticaria ? describe appearance ?
(aka hives) - small itchy lumps that appear in skin +/- patchy erythematous rash - may be a associated with angioedema + flushing of skin
32
urticaria pathophys?
release of histamine + other pro inflam chemicals
33
acute urticaria causes ? aetiology ?
acute: (something that triggers mast cells => histamine release) - allergies to food/medications/animals - viral infeciton - insect bite
34
chronic urticaria causes ? aetiology ?
chronic (autoimmune - Ab target mast cells => histamine release from mast cells)
35
urticaria Mx ?
antihistamines (fexofenadine) - severe flare: oral steroids
36
What is seborrhoea dermatitis ? affecting what ? affecting where ?
inflam condition affecting the sebaceous glands (oil producing gland in skin) - affects places with lots of these glands (scalp, nasolabial folds, eyebrows)
37
how dos seborrhoea dermatitis present in infants ? AKA ?
infants => often crusted, dry scalp => aka cradle cap
38
cradle cap Mx ?
(seborrhoeaic dermatitis) - self limiting + resolves in about 4 months - Mx: apply vegetable of olive oil
39
What is ring worm ? most comm causative organism ? how spread ?
fungal infection of the skin (general) - most common type of fungus causing ring own (trichophyton) - spread through contract with infected individuals
40
ringworm Px ? describe the rash ? where look especially ?
- itchy rash, erythematous, clay + well demarcated - often on or several signs of circular shaped areas (well demarcated) - check toenails (thickened, discoloured + deformed nails)
41
ringworm management ?
anti fungal medications (creams, shampoo, oral): clotrimazole
42
What is nappy rash ? caused by ?
contact dermatitis in the nappy area - caused by friction between skin + nappy and contact with urine + faeces
43
nappy rash RF ?
- delayed aching of nappies - irritant soaps - vigorous cleaning - preterm
44
nappy rash Px ? what rash like ?
sore, red + inflamed skin in nappy region (may spare the skin creases)
45
nappy rash similar rash that spreads to skin folds. consider what ? check where else /
more likely candida infection - look for oral thrush
46
nappy rash Mx ?
change nappy and clean asa; after wetting/soiling, - maximise time without nappy
47
Nappy rash complicaitons ?
- candida infeciton - cellulitis
48
What is scabies ? causative organism ? overall sx ?
tiny mites (Sarcoptes scabiei) that burrow under skin => infection + intense itching - lay eggs in skin => further infection + sx
49
scabies Px ? describe rash ? location ?
incredible itchy small red spots + track makes where mites have borrowed - often between finer webs
50
scabies Mx ? describe the treatment regime
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
what is crusted scabies ?
serious infection in immunocomprosmes patient - may need admission for treatment (oral ivervectin + isolation)
52
how are headline transmitted ?
transmission is by head to head contract of sharing equipment (hairbrush, towel)
53
headlice Mx ?
diameticone applied to wet hair + left to dry (repeated 7 days later) - special fine combs - no need to stay off school
54
What is erythema nodosum ? often associated with what ? (3)
condition where red lumps appear across patients kin - often indicated IBD or sarcoidosis or strep throat
55
erythema nodosum Ix ?
looking for underlying cause - inflam markers (IBD, sarcoidosis) - throat swab (strep throat) - faecal calprotectin (IBD)
56
What is impetigo ? caused by what ? transmission ?
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
what are the two types of impetigo ?
- non-bullous - bullous
58
where does non-bulbous typically affect ? presentation ?
typically around mouth/nose - exudate form lesions dry => golden crust
59
non bullous impetigo Mx ? if widespread ?
topical fusidic acid, oral flucloxacillin (if widespread)
60
what is bullous impetigo ? what is the causative organism ? explain
always s.aureus - epidermolytic toxins + breakdown proteins that hold skin otgheter => fluid filled vesicles on skin => grow + burst => golden crust
61
what happens when bullous impetigo is widespread ?
can go to staphylococcus scalded skin syndrome
62
bullous impetigo Mx ?
flucloxacillin - v contagious so should be isolated where possible
63
What is stenes=johnsons syndrome and toxic epidermal necrolysis ? causing what ?
they are a spectrum of the same pathology: disproportional immune response => epidermal necrolysis => blistering and shedding of top layer of skin
64
causes of SJS + TEN ? (2)
- Meds (anti-epileptics, Abx, NSAIDs) - infections (HSV)
65
SJS + TEN Px ? (7)
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
SJS + TEN Mx ?
- steroids - immunoglobbulins - immunosepressants
67
SJS + TEN complications ?
- secondary infection (due to breaks in skin) - permanent skin damage - visual complications (blindness)
68
What is an allergy ? response to what ? causing what ?
hypersensitivity of the immune system to allergens (proteins that the immune system recognises as foreign => allergic immune reaction)
69
What is Atopy ? associated with what conditions ?
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
What is the skin sensitisation theory ? what does it relate to/explain ?
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
what is a type 1 hypersensitivity reaction ? what cell/type involved ? explain it ? give condition examples ?
IgE antibodies to specific allergen => mast cells + basophils release histamines + cytokines => immediate reaction - anaphylaxis, urticaria, allergic rhinitis
72
what is a type 2 hypersensitivity reaction ? what cell/type involved ? explain it ? give condition examples ?
IgG + IgM react to allergen => complement system activation => direct damage to local cells - haemolytic disease of the newborn, transfusion reaction
73
what is a type 3 hypersensitivity reaction ? what cell/type involved ? explain it ? give condition examples ?
Immune complexes accumulate => damage to local tissue - SLE, RA, HSP
74
what is a type 4 hypersensitivity reaction ? what cell/type involved ? explain it ? give condition examples ?
cell mediated caused by T lymphocytes - organ transplants reaction, contact dermatitis
75
Ix for allergies ? gold standard ?
- skin prick - food challenge testing (gold standard)
76
what does a skin prick test test for ?
assess sensitisation not allergy
77
What is allergic rhinitis ? what type of hypersensitivity ? explain a bit
IgE medicated type 1 hypersensitivity reaciton - environment allergens => allergic inflam response in nasal mucosa
78
allergic rhinitis Px ? (3)
- runny, blocked + itchy nose, sneezing, - itchy/red eyes - associated with personal or FHx of atopy
79
allergic rhinitis Mx ?
- avoid triggers (hoover + change pillows + good ventilation) - oral antihistamines: loratedine - nasal antihistamines: in response to a trigger
80
What is a normal amount of resp infection for healthy child per year
up to 4-8
81
when would you consider Ix for recurrent infection in children ? (3)
- chronic diarhoea since infancy - FTT - unusual/persistnat infections
82
What is severe combined immunodeficiency syndrome ?
most severe condition causing immunodeficiency: children have almost no immunity
83
would causes severe combined immunodeficiency syndrome ? aetiology ?
- multiple genetic disorders => absent of dtysfunctioning T + B cells
84
severe combined immunodeficiency syndrome Px ? (3) what age ?
usually present in first few months with: - persisten diarrhoea - FTT - unwell after live vaccinations
85
severe combined immunodeficiency syndrome Mx
- treat underlying infecitons - immunoglobulin therapy - sterile environment - Avoid live vaccines - Haematopoetic stem cell transplantation
86

3a (43 decks)

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