Paeds Flashcards
exanthem
a widespread rash occurring on the outside of the body and usually occurring in children
whats usually used to Rx Neonatal withdrawal (abstinence) syndrome
morphine sulphate
what are the classification groups of Paediatric Dermatological Conditions
infective infestations inflammatory genetic neoplastic
Primary Skin lesions
These are fundamental morphological changes that appear first on formerly unchanged skin
eg of Primary Skin lesions
Macule vesicle Papule Plaque Nodule
Secondary Skin Lesions
lesions that develop from the alteration of primary lesions not on uninvolved skin
eg of Secondary Skin Lesions
Scale Keratosis Fissure Erosion Excoriation
Macule
Circumscribed, flat area of skin different in colour or texture from the surrounding, normal skin
A macule does not exceed 1 cm in greatest diameter
patch
A large macule more than 1cm in diameter
cx of macules and patches
Deposition of endogenous (hemosiderin) or exogenous products (tatooing)
Extravasation of blood (petechiae, purpura, ecchymoses, hematoma)
Changes in melanin content of the epidermis or dermis ( hyper- and hypopigmentation or depigmentation, melanoderma and leukoderma)
Active erythaema and passive hyperaemia (cyanosis)
Deminished blood supply and vasoconstriction
what other features can macules and patches have
may be slightly depressed below the skin surface or
scaling
papule
A circumscribed solid elevation of the skin up to 1 cm in diameter
cx of papule
tissue proliferation
cell infiltration
types of papules
epidermal
dermal
Dermoepidermal
plaque
A circumscribed, superficial, solid elevation of the skin greater than 1 cm in diameter
do Plaques occur as secondary lesions
Plaques may occur as primary lesions but may also result from coalescence of papules and then strictly speaking represent secondary lesions.
nodule
A circumscribed solid lesion of the skin up to 1 cm in size with depth
diff btwn nodule and papule
nodules can always be palpated and have depth
tumour
A solid lesion of the skin greater than 1 cm in diameter with superficial height, palpable depth or both
how do Tumours differ from papules and nodules
by size
may be inflammatory or non-inflammatory
benign or malignant
wheal
Transient dermal oedema, varied in size disappearing within up to 24 hours and typically cause itching
what colours can wheals become
pale red if the capillaries are dilated
whitish if the dermal oedema is heavy enough to compress the blood vessels
vesicle (small blister)
a circumscribed elevation of the skin up to 1 cm in diameter and containing fluid
BULLA (large blister)
a circumscribed elevation of the skin greater than 1 cm in diameter containing a fluid
Types of vesicles and bullae
subcorneal
Intraepidermal
Subepidermal
dermal
what fluids may blisters may house
serum, blood, lymph or a mixture of these fluids
pustules
A circumscribed superficial elevation of the skin filled with pus
name the 9 Morphological characteristics of skin conditions
size shape colour number arrangement
margins
consistency
surface characteristics
contour
give 5 eg of shape
guttate (drop shaped) nummular (coin shaped) annular (ring-like) serpiginous (wavy, snake-like) arcuate (arc-like)
Koebner phenomenon (isomorphic response)
an aspect of psoriasis that’s well-known but not completely understood. It describes the formation of psoriatic skin lesions on parts of the body that aren’t typically where a person with psoriasis experiences lesions
Psoriasis
a skin disorder that causes skin cells to multiply up to 10 times faster than normal. This makes the skin build up into bumpy red patches covered with white scales
psoriasis appears mostly on
scalp, elbows, knees, and lower back
nikolski
When exerting tangential pressure on apparently normal skin, particularly near vesicles, the epidermis or parts of it may be detached in certain bullous diseases eg toxic epidermal necrolysis or epidermolysis bullosa
dermographism/
dermatographism
exaggerated wealing tendency when the skin is stroked
A bright red non-raised line due to vasodilatation occurs after 3-15 seconds
what happens to Dermographism In patients with atopic dermatitis
the respons is para-doxically anaemic (white dermographism)
wha is dermographism the commonest form of
physical or chronic inducible urticaria
cutis marmorata
transient, benign, reticulate, mottled, bluish discolouration of the skin that may last minutes to hours typically when child is cold, usually completely disappears by two months of age
if Cutis marmorata is persistent what syndromes can it indicate
Cornelia de Lange syndrome
trisomy 13
trisomy 18
what is Cornelia de Lange syndrome characterized by
slow growth before and after birth
intellectual disability
abnormalities of bones in the arms, hands, and fingers
skin fragility
Weakened attachments be-tween epidermis & dermis that are easily severed by physical or chemical trauma
peeling skin
Desquamation of neonatal skin most pronounced in infants born 40-42 weeks gestation
Rx an aqueos cream is used No creams with perfume or additives
types of peeling and where they occur
Physiological peeling – hands, ankles and feet
Postmature peeling – extremities and trunk
epsteins pearls
Benign Epidermal inclusion cysts (contain desquamated keratin) occur along the median palatal raphe, most commonly at the junction of the hard & soft palate.
what other skin lesion is similar to epstein pearls
milia
milia
Tiny (1-2mm) globular epidermal inclusion cysts which are white, pearly & firm
Occur on the nose, cheeks, chin and foreheads and usually appear and disappear spontaneously during first month of life
where can Larger milia solitary lesions can be seen on
foreskin, scrotum, areolae and labia majora.
diff btwn pustule and milia
Pustule - more yellow
Milia – more white
Sucking calluses
solitary, oval thickenings on vermilion on the lips and is more common in breast fed, black infants.
Sucking calluses involute spontaneously within a few days to weeks after birth or upon cessation of breastfeeding
Sebaceous Gland Hyperplasia
Multiple, pinpoint, yellowish papules seen at the opening of each pilo-sebaceous follicle in areas where sebaceous glands are abundant, such as the nose that resolve spontaneously.
Sebaceous Gland Hyperplasia Rx
you can use vaseline or an aqueous cream but the latter is preferred
neonatal mastitis
Maternal and placental hormonal effects on the neonate
Secretion of colostrum like substance called “witches milk” late during first week of life
Mongolian Spots
Brownish, blue-gray or blue-black patch usually located over the sacro-gluteal area
Most common of all birthmarks in pigmented races
erythema toxicum facts
Common in term infants (not preterms)
Appear birth to 2 weeks
Erythematous macules, papules, pustules or wheals found on any body surface
Palms and soles rarely affected
Dissapears spontaneously (The rash usually clears within 2 weeks. It is usually completely gone by age 4 months)
Transient Neonatal Pustular Melanosis
Benign condition
Term neonates
Present at birth and resolve within 48 hours
After healing – end up with freckles
Lesions include
vesicles, pustules, crusted lesions, ruptured pustules with scale & pigmented macules –singly or in combination
Miliaria
obstructions of the eccrine duct resulting in rupture of the ducts and sweating into the skin
Fragile 1-2mm clear, non-inflammatory vesicles
Most common in 1st week of life
miliaria types
Miliaria crystalline
Miliaria rubra
Miliaria profunda
Miliaria pustulosa
Miliaria Rubra
secondary local inflammatory response is responsible for the erythema associated with the papules and vesicles
Common sites face neck and trunk
Neonatal acne/Transient Neonatal Cephalic Pustulosis
Common on face, neck, chest & back
Resolves within first 6 months of life
Epidermolysis Bullosa
Neonatal vesicles, bullae and denuded skin, with friction and trauma induced blistering
can cx bleeding and Skin infections
Give morphine
Subtypes of Epidermolysis Bullosa
Simplex
Junctional
Dystrophic
Subcutaneous Fat Necrosis facts
Idiopathic necrosis of the panniculus (subcutaneous fat) Indurated (hardened) plaques or nodules below the skin can become hypocalcaemic self limiting – week or two ass with trauma during labour term babies
aphtha
small ulcer of mucous membranes
cyst
any closed cavity with an epidermal, endothelial or membranous lining containing fluid or soft material
erythroderma
generalized redness associated with infiltra-tion and disquamation of the skin
Gangrene
necrotizing process due to arterial occlusion or infection
Lichenification
thickening of the skin with accentuation and coarsening of the skin markings
milium
tiny white cyst containing keratin
scab
devitalized portion of the skin due to necrosis
impetigo
Round confluent superficial blisters which rupture early and form crusts
impetgo
Round confluent superficial blisters which rupture early and form crusts
erysipelas
Superficial form of cellulitis involving the dermis and upper subcutaneous tissue
Staphylococcal Scalded Skin Syndrome
Cutaneous tenderness and superficial widespread blistering & desquamation
Pityriasis Rosea
Acute self limited, papulo-squamous disorder. Rash is often preceded by a herald patch with collarette of scale
herald patch
erythematous, scaly 2 to 10 centimeter, round to oval patch or plaque with a depressed center and raised border.
Erythema Multiforme Simplex
Acute self-limiting (1-2 weeks) vesicobullous disease with erythematous macules and papules which evolve into “target” lesions
ass with HSV
Stevens-Johnson syndrome
Sudden onset of tender erythematous eruption usually due to a reaction to a medication or an infection
Stevens-Johnson syndrome cx
Antibiotics
Anticonvulsants
NSAIDS
Mycoplasma pneumoniae
Toxic Epidermal Necrolysis
like sjs but faster onset more severe but less common
Early symptoms include fever and flu-like symptoms
Erythema Nodosum
Abrupt onset of tender red subcutaneous nodules on extensor surfaces of lower legs
Scabies
the release of toxic or antigenic secretions of the female mite Sarcoptes scabiei var hominis
Scabies
the release of toxic or antigenic secretions of the female mite Sarcoptes scabiei var hominis
small 1-2mm itching papules with various degrees of crusting and scaling
scabies Most common sites
Hands, palms, wrists, buttocks, feet
Scabies extra facts
Females lay ± 3 eggs/day, requiring ± 4 days to hatch
Time from egg laying to adult mite is 10–14 days
Mites are not blood feeders, but are thought to feed on intercellular fluid
can be acute or chronic (Acute glomerulo-nephritis if infected with Group A Streptococcus)
scabies Rx
Lindane or Quellada lotion (Gamma Benzene hexachloride 1%)
sulphur 2,5%
Tetmosol soap
Benzyl benzoate
Permethrin with 70-80% of ovicidal activity
Cutaneous Larva Migrans (Sandworm)
A creeping erruption caused by Ancylostoma braziliense crawling btwn epidermis and dermis
cx intense pruritis, erythaematous, raised, serpigenous tracts
Cutaneous Larva Migrans (Sandworm) extra facts
secondary infx is common
Topical thiabendazole 10-15%
Albendazole
Major pathogens causing superficial fungal infections in children
Dermatophytes: Trichophyton
Microsporum
Epidermophyton
Yeasts: Candida
Malassezia
Tinea corporis
Active circumscribed raised round or oval scaly margins which spread outwards
Tinea corporis Rx
Imidazoles
Griseofulvin
Pityriasis Versicolor
Caused by malassezia yeast
Lesions on the face are usually hypopigmented, faintly scaling & ovoid
Pityriasis Versicolor Rx
fluconazole
ketoconazole
Scaling skin
the loss of the outer layer of the epidermis in large, scale-like flakes
Pediculosis Capitis facts
human head louse that Infests the scalp and sucks blood
Pruritis is common in long term infestation, but first time infestation may produce no symptoms whatsoever
nits adhering to the hair
Pediculosis Capitis EXTRA FACTS
Infestation most common in children 3-11 yrs
More common in girls than boys
Likes CLEANLINESS – hair but on body – LIKES DIRT
Most head lice products kill the adult lice but not the nits. Thus all topical treatments should be applied twice, 1 week apart
Pediculosis Capitis Rx
Gamma benzene hexachloride
Permethrin
Nitagon
lymphadenopathy common causes
infections
autoimmune diseases
cancers
medications that cause lymphadenopathy
Allopurinol Atenolol Captopril penicillin Quinidine (anti arrythmic)
Epidemiologic Clues to the Diagnosis of Lymphadenopathy
Cat scratch - Cat-scratch disease, toxoplasmosis
Undercooked meat -Toxoplasmosis
Tick bite - Lyme disease, tularemia
Pain in LN is usually the result of an inflammatory process or suppuration, but pain may also result from
hemorrhage into the necrotic center of a malignant node
LN Consistency.
Stony-hard nodes are typically a sign of cancer, usually metastatic
Very firm, rubbery nodes suggest lymphoma. Softer nodes are the result of infections or inflammatory conditions
Suppurant nodes may be fluctuant
dx which cx benign matted LN
TB
sarcoidosis
lymphogranuloma venereum
where do cat scratch dz and infectious mononucleosis cause lymphadenopathy
Cat SD- cervical or axillary adenopathy
Infx M- cervical
Diff diagnosis of lymphadenopathy in Mononucleosis-type syndromes, EBV, leukemia, serum sickness
Mononucleosis-type syndromes: fever, malaise, Fatigue, atypical lymphocytosis
EBV type: Splenomegaly in 50% of patients
Leukemia: Blood dyscrasias, bruising Blood smear, bone marrow
Serum sickness: Fever, malaise, arthralgia, urticaria
Increased hydrostatic pressure cx
High venous pressure - Congestive cardiac failure
- Constrictive pericarditis
Sodium and fluid retention -Glomerulonephritis
-Acute renal failure
Decreased oncotic pressure cx
Decreased protein intake
Impaired absorption
Impaired production
Protein loss
besides Increased hydrostatic pressure
Decreased oncotic pressure what cx oedema
Impaired capillary permeability
• Sepsis/inflammation
Microcytic RBCs cx
Iron deficiency
Sickle-cell disease
Thalassemia
Iron deficiency presentations and Rx
Tired
Koilonychias
Splenomegaly
Rx: ferrous gluconate/sulphate @ 6 mg/kg elemental iron
Thalassaemia facts
Hb rarely < 10g/dl
S Iron normal
HB A2 & HB F increased.
Sickle cell disease facts
Splenomegaly
Hb S & Hb F Increased
Hb A decreased
