Paeds DERM Flashcards
What is erythema infectiosum?
Infection by parvovirus B19
“5th disease”
“Slapped-cheek syndrome”
What are the symptoms of erythema infectiosum?
Asymptomatic/ mild feverish illness- headache + runny nose
After several days develop red rash on cheeks
Child starts to feel better as rash appears
Rash spreads to trunk, arms + legs
How does the rash in erythema infectiosum differ from many other rashes?
RARELY effects palms + soles
Describe the rash in erythema infectiosum
Raised, blotchy red areas + lacy patterns
“Reticular, erythematous eruption”
What is management for erythema infectiosum?
Self-resolving
No school exclusion (not infectious once rash appears)
What is roseola infantum?
Infection by human herpes virus 6 (HHV6)
“6th disease”
“Exanthem subitum”
Which age group are most commonly affected by roseola infants?
6m-2y
Give 6 signs/ symptoms of roseola infantum
High fever lasting a few days followed later by a
Maculopapular rash
Nagayama spots: papular enanthem on uvula + soft palate
Febrile convulsions (10-15%)
Diarrhoea
Cough
What is the management of roseola infantum?
Self-resolving
No school exclusion
Describe the levels of acne
Comedones: open (blackheads) or closed (white heads)
Papules/ pustules
Nodulocystic/ scarring
From what age can acne be managed medically?
12
What skin cleaning advice can you give to adolescents with acne?
Don’t over clean: BD with gentle soap
Why should picking/ squeezing of comedones be avoided?
Risk of scarring
How long does It take topical medication to start working in acne?
Up to 8w
How can mild to moderate acne be managed?
Topical retinoid +/- benzoyl peroxide
OR
Topical abx + benzoyl peroxide
Azelaic acid 20%
How can moderate acne be treated?
Max 3m of oral abx
Add BPO/ retinoid to Abx OR
COCP + BPO/ retinoid
When should a referral to a dermatologist be made in acne vulgaris?
Nodulocystic acne/ scarring
Severe form (eg acne conglobata/ acne fulminans)
Severe psychological distress
Diagnostic uncertainty
Failure to respond to medications
Where is eczema commonly found?
Flexures
What 2 differentials should always be considered in suspected eczema?
Contact dermatitis (do patch testing)
Food allergies (blood or skin prick testing)
What treatment can be used in all severities of eczema?
Emollients
What other treatments are available in mild eczema?
Mild-potency topical corticosteroids
What other treatments are available in moderate eczema?
Moderate-potency topical corticosteroids
Topical calcineurin inhibitors
Bandages
What other treatments are available in severe eczema?
Potent topical steroids
Phototherapy
Topical calcineurin inhibitors
Bandages
How should infected eczema be managed?
Flucloxacillin
How should eczema herpeticum be managed?
Oral aciclovir
Recall the steroid ladder
Help Every Busy Dermatologist
Hydrocortisone
Eumovate
Betnovate
Dermovate
When should an immediate referral be made in eczema?
Eczema herpeticum
What does eczema herpeticum look very similar to?
Impetigo
What is the fancy medical name for port-wine stain?
Naevus flammeus
Where are port wine stains found?
In trigeminal nerve distribution
What is the cause of port wine stain?
Could be all kinds of syndromes with long names
Most often = Sturge Weber syndrome
Recall 3 alternative names for naevis simplex
Salmon patches/ stalk bites/ angel’s kiss
Describe the appearance of naevus simplex
Pink/ red patch at birth that goes redder when the infant cries
When does infantile haemangioma develop?
A few days/ weeks after birth
How long do infantile haemangiomas last?
6-10m, then they shrink
Where are most infantile haemangiomas found?
Head + neck
Describe the appearance of the different types of infantile haemangioma
Superficial = bright red area of warm skin
Deep = blue lump
Mixed = bright red areas on a blue lump
Recall 3 causes of infantile haemangioma
- Kasabach-Merritt: kaposiform haemangioendothelioma –>thrombocytopaenia –> haemangioma with thrombocytopaenia
- PHACES syndrome
- LUMBAR syndrome
What is PHACES syndrome?
Posterior fossa malformations
Haemangioma
Arterial abnormalities
Cardiac abnormalities
Eye abnormalities
Sternal abnormalities
What is LUMBAR syndrome?
Lower body/ lumbosacral haemangioma
Urogenital anomalies
Myelopathy
Bony deformities
Anorectal/ arterial anomalies
Renal anomalies
When should an MRI be used in investigation of an infantile haemangioma?
If deep/ multiple/ near the eye
How should infantile haemangiomas be managed?
Conservatively: medical photography + review in 3m
If an infantile haemangioma is in a sensitive area, what can be prescribed?
Topical timolol
What is the prevalence of congenital haemangioma?
Very rare
What are the 3 types of congenital haemangioma?
Rapidly involuting congenital haemangiomas (RICH)
Non-involuting congenital haemangiomas (NICH)
Partially-involuting congenital haemangiomas (PICH)
How can rapidly-involuting congenital haemangioma and non-involuting congenital haemangioma be clinicially differentiated?
RICH is at max. size at birth, involutes by 12-18m
NICH continues to grow as baby does: do NOT shrink
Other than the haemangioma itself, what sign might be present in congenital haemangioma?
Transient thrombocytopaenia
If a congenital haemangioma needs to be removed, how should it be done?
Embolisation
What is erythema toxicum?
Benign skin condition present in 50% of newborns
What is the prevalence of erythema toxicum?
50% of newborns
What needs to be excluded in suspected erythema toxicum?
Congenital infection
How does erythema toxicum appear?
Maculo-papular-pustular lesions
Where does erythema toxicum begin and spread to?
Begins on face + spreads to limbs
How does Milia appear?
White pimples on nose + cheeks
What is the cause of milia?
Retention of keratin + sebaceous material of the pilosebaceous follicle
How should milia be treated?
Self-limiting
What is the pathogen in molluscum contagiosum?
Pox virus
What age group does molluscum contagiosum affect?
2-5y
How does molluscum contagiosum appear?
> 1 small pink skin-coloured/ pearly papules, ulcerated/ umbilicated
What are the signs and symptoms of molluscum contagiosum?
Painless usually
occasionally itchy
How long does molluscum contagiosum usually last, and when is it considered chronic?
6-9m
>2y
How is chronic molluscum contagiosum managed?
Cryotherapy
How does mongolian blue spot appear?
Blue/ black maculopapular discolourisation at base of spine + on buttocks
In which infants is mongolian blue spot most likely?
Afro-caribbean or asian infant
How is mongolian blue spot managed?
Self-limiting
What is the most common pathogen in impetigo?
Spathylococcus aureus
How does impetigo appear?
Golden-yellow, crusted appearance
Recall the 3 grades of impetigo
Localised, non-bullous
Widespread, non-bullous
Bullous, systemically unwell
How do you treat each different grade of impetigo?
Localised: topical hydrogen peroxide
Widespread: oral flucloxacillin OR topical fusidic acid
Bullous: PO flucloxacillin
For how long should children with impetigo be excluded from school?
Until lesions crusted over/ 48h after Abx started
What is nappy rash most commonly a form of?
Contact dermatitis
Recall the signs and symptoms of each different type of nappy rash
Irritant: well-demarcated variety of erythema, oedema, dryness + scaling
Candida albicans: erythematous papules + plaques with small satellite spots or superficial pustules
Seborrhoeic: cradle cap + BL salmon pink patches, desquamating flakes
How can mild erythema be managed in nappy rash?
Use of a barrier preparation
How can moderate erythema be managed in nappy rash?
Hydrocortisone 1% cream
How can candidal infection be managed in nappy rash?
DO NOT USE BARRIER
Topical imidazole cream e.g. Clotrimazole
How should bacterial infection be managed in nappy rash?
Oral flucloxacillin
What are the signs and symptoms of seborrhoeic dermatitis
Dandruff: erythematous, yellow, crusty, adherent layer (cradle cap)
What pathogen is seborrhoeic dermatitis associated with?
Malassezia yeasts
After how long should seborrhoeic dermatitis spontaneously resolve?
8 months
Recall the 1st line treatment for seborrhoeic dermatitis
Regular washing with baby shampoo + gentle brushing to remove scales
Can soak crusts overnight in vaseline/ olive oil
When should 2nd line treatment be considered in seborrhoeic dermatitis, and what is it?
If scalp is affected
Topical imidazole cream BD/ TDS
What is the 3rd line treatment for severe seborrhoeic dermatitis?
Mild topical steroids (1% hydrocortisone)
What is the type of pathogen involved in tinea?
Dermatophyte fungi: Trichophytum rubrum
What drug is used to treat scabies?
Permethrin
How does tinea appear?
Ringed appearance +/- kerion
How is tinea capitis treated?
Oral antifungal: terbinafine
How are non-capitis types of tinea treated (mild/ mod/ severe)?
Mild: topical terbinafine
Mod: hydrocortisone 1%
Sev: oral terbinafine
What advice should you give in cases of tinea?
Very contagious so infection control:
Wear loose-fitting cotton clothing
No sharing towels
Dry thoroughly after washing
Avoid scratching
No need for school exclusion
What is the most common cause of neck lumps?
Lymphadenitis
Recall 5 red flags in neck lump to screen for?
Sepsis
Poor feeding
Rapid progression
Stridor
Change in voice
What is the most common midline congenital mass?
Thyroglossal cyst
What is the cause of thyroglossal cyst?
Failure of thyroglossal duct to involute
What is the most common lateral congenital neck mass?
Brachial cleft abnormality
What is the cause of brachial cleft abnormality?
Failure of pharyngeal clefts to involute
How long does lymphadenitis last?
6w: self limiting
How should thyroglossal cyst be managed?
Asymptomatic: conservatively
Symptomatic: Sistrunk’s procedure (surgical removal)
How should brachial cleft abnormality be treated?
Asymptomatic: conservatively
Symptomatic: Sistrunk’s procedure (surgical removal)
Recall the typical distribution of atopic dermatitis in infants, older children and young adults
Infants: face + trunk
Kids: extensor surfaces
YA: localises to flexures
