Paeds 3A Flashcards
Which treatment would be recommended for children > 2 years with eczema that has failed to respond to topical steroids?
Topical calcineurin inhibitors (e.g. pimecrolimus)
Under which circumstances do bandages tend to be used in eczema?
For areas of chronically lichenified skin
When are antihistamines used in eczema?
1 month trial of non-sedating antihistamine (e.g. fexofenadine) if severe itching or urticaria
1-2 week trial of sedating antihistamine (e.g. promethazine) if flare is disturbing sleep
How should infected eczema be treated?
Swab the affected area
Advice on good hygiene when using emollients
Flucloxacillin
How is eczema herpeticum managed?
Refer for same-day dermatology advice
Oral aciclovir
Consider ophthalmological review if around the eyes
How are viral warts treated?
Daily administration of salicylic acid, lactic acid paint or glutaraldehyde lotion
Cryotherapy
How is molluscum contagiosum managed?
Spontaneous resolution by 18 months
Avoid squeezing lesions
Avoid sharing towels/clothes
What is the first-line treatment option for mild ringworm?
Topical antifungals (terbinafine cream)
NOTE: hydrocortisone 1% may be added if there is extensive inflammation
How are more severe ringworm infections managed?
Oral antifungals
1st line: terbinafine
2nd line: itraconazole
What is the first-line management option for tinea capitis?
Oral griseofulvin (or oral terbinafine)
NOTE: any animal source of the infection would also need treatment
What is the first line treatment option for scabies?
Topical permethrin 5% cream
Apply on the whole body (chin downwards) and wash off after 8-12 hours
Second application is required 1 week later
2nd line: malathion aqueous 0.5%
What advice should be given to patients with scabies?
Members of the household and close contacts should be treated
Bedding and clothes should be washed at high temperature
Treat post-scabeitic itch with crotamiton 10% cream
Nighttime sedative anti-histamine may be useful to help sleep
How should head lice be treated?
Wet combing with a fine-tooth comb every 3-4 days for 2 weeks
Dimeticone 4% lotion left on overnight and hair shampooed the following morning. repeat after a week
school exclusion not advised
Dimethicone is a common ingredient in some hair products. It kills the lice by blocking the spiracles, which are pores in the side of a louse through which it breathes
guttate psoriasis management
Reassure that it is usually a self-limiting condition that typically resolves within 3–4 months, and reassure that it is not infectious
1st: Phototherapy: narrow band UVB 2-3 times/week (if widespread or unresponsive to topical treatment)
Topical preparation offered:
Emollient to reduce scales and relieve itch (E45, Oilatum, Emulsiderm)
Potent topical corticosteroid with vitamin D preparation +/- salicylic acid if scales are problematic
Refer if lesions are extensive, severe or not responding to treatment
What are the treatment options for mild-to-moderate acne?
Benzoyl peroxide
Duac (benzol peroxide + clindamycin)
Adapalene (topical retinoid - CI in pregnancy and breastfeeding)
Azelaic acid
Outline the treatment options for moderate acne.
Consider oral antibiotics (lymecycline or doxycycline) for a maximum of 3 months
Change to alternative antibiotic after 3 months if no improvement
NOTE: topical benzoyl peroxide or retinoid should be co-prescribed to reduce the risk of antibiotic resistance
What can be used as an alternative to oral antibiotics in girls with acne?
COCP
NOTE: POPs and progestin implants can worsen acne
When might you consider dermatology referral for a patient with acne?
If not responding to 2 courses of antibiotics or if there is scarring, refer to dermatology for consideration of isotretinoin
When should a patient undergoing treatment for acne be reviewed?
At 8-12 weeks
How is heart failure in an infant managed?
Diuretics such as frusemide (reduce preload) Enhance contractility (e.g. dobutamine) Reduce afterload (e.g. ACEi) Improve oxygen delivery (beta-blockers)
How are ASDs managed?
Secundum - percutaneous closure (cardiac catheterisation with insertion of an occlusive device)
Partial AVSD - surgical correction
When are symptomatic ASDs usually treated?
3-5 years
When do large VSDs and AVSD tend to be treated surgically?
3-6 months
How can a PDA be closed?
Medical: indomethacin (or other NSAID)
Surgical: cardiac catheterisation and coil/occlusive device insertion
NOTE: surgical management usually happens at around 1 year
How should a cyanosed neonate presenting within the 1st week of life be managed?
Stabilise the airway, breathing and circulation
Artificial ventilation if necessary
Start prostaglandin infusion
Surgery
