Paeds DERM Flashcards by Georgia Leggett

What is erythema infectiosum?

Infection by parvovirus B19
“5th disease”
“Slapped-cheek syndrome”

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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

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How does the rash in erythema infectiosum differ from many other rashes?

RARELY effects palms + soles

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Describe the rash in erythema infectiosum

Raised, blotchy red areas + lacy patterns
“Reticular, erythematous eruption”

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What is management for erythema infectiosum?

Self-resolving
No school exclusion (not infectious once rash appears)

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What is roseola infantum?

Infection by human herpes virus 6 (HHV6)
“6th disease”
“Exanthem subitum”

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Which age group are most commonly affected by roseola infants?

6m-2y

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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

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What is the management of roseola infantum?

Self-resolving
No school exclusion

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Describe the levels of acne

Comedones: open (blackheads) or closed (white heads)
Papules/ pustules
Nodulocystic/ scarring

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From what age can acne be managed medically?

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What skin cleaning advice can you give to adolescents with acne?

Don’t over clean: BD with gentle soap

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Why should picking/ squeezing of comedones be avoided?

Risk of scarring

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How long does It take topical medication to start working in acne?

Up to 8w

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How can mild to moderate acne be managed?

Topical retinoid +/- benzoyl peroxide
OR
Topical abx + benzoyl peroxide
Azelaic acid 20%

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How can moderate acne be treated?

Max 3m of oral abx
Add BPO/ retinoid to Abx OR
COCP + BPO/ retinoid

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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

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Where is eczema commonly found?

Flexures

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What 2 differentials should always be considered in suspected eczema?

Contact dermatitis (do patch testing)
Food allergies (blood or skin prick testing)

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What treatment can be used in all severities of eczema?

Emollients

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What other treatments are available in mild eczema?

Mild-potency topical corticosteroids

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What other treatments are available in moderate eczema?

Moderate-potency topical corticosteroids
Topical calcineurin inhibitors
Bandages

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What other treatments are available in severe eczema?

Potent topical steroids
Phototherapy
Topical calcineurin inhibitors
Bandages

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How should infected eczema be managed?

Flucloxacillin

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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

1. Kasabach-Merritt: kaposiform haemangioendothelioma -->thrombocytopaenia --> haemangioma with thrombocytopaenia 2. PHACES syndrome 3. 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