Paeds derm

Question 1

Describe a typical measles rash and how it presents

Answer 1

• Erythematous, macular rash with flat lesions
• Fever
• Rash starting on face
• Rash spreads to rest of body

Question 2

Describe a typical Scarlett fever rash and how it presents

Answer 2

• A red-pink, blotchy, macular rash with rough “sandpaper” skin
• Starts on the trunk
• Spreads outwards

Question 3

Describe a typical rubella rash and how it presents

Answer 3

• A erythematous macular rash (milder than in measles)
• The rash starts on the face
• Spreads to the rest of the body.

Question 4

Describe a typical parvovirus B19 rash and how it presents?

Answer 4

• A bright red rash on both cheeks, as though they have “slapped cheeks”
• A few days later a mildly erythematous rash affecting the trunk and limbs appears that can be raised and itchy

Question 5

Describe a typical roseola infantum rash

Answer 5

• Mild erythematous macular rash across the arms, legs, trunk and face
• Rash is not itchy

Question 6

What happens in Stevens-Johnson syndrome?

Answer 6

A disproportional immune response results in epidermal necrosis

Question 7

What medications can cause SJS?

Answer 7

• Anti-epileptics
• Antibiotics
• Allopurinol
• NSAIDs

Question 8

What infections can cause SJS?

Answer 8

• Herpes simplex
• Mycoplasma pneumonia
• Cytomegalovirus
• HIV

Question 9

What is the steroid ladder from weakest to most potent?

Answer 9

Mild: Hydrocortisone
Moderate: Eumovate (clobetasone butyrate)
Potent: Betnovate (betamethasone)
Very potent: Dermovate (clobetasol propionate)

Question 10

What is the most common cause of bacterial skin infection in patients with eczema? What is the abx of choice?

Answer 10

Staph aureus, flucloxacillin

Question 11

What is Eczema herpeticum?

Answer 11

A viral skin infection in patients with eczema caused by the herpes simplex virus (HSV) or varicella zoster virus (VZV)

Question 12

How do you differentiated between infected eczema and eczema herpeticum? What is the treatment of both

Answer 12

• Infected eczema - pain/pus/crusts point to bacterial cause. Tx = antibiotics (normally staph aureus infection so fluclox.)
• Eczema herpeticum - painful vesicles and ‘punched out erosions’. Tx = IV acyclovir

Question 13

What is another name for naves flammeus?

Answer 13

Port wine stain

Question 14

What is another name for cavernous haemangioma?

Answer 14

Strawberry naevus

Question 15

When does cavernous haemangioma typically present?

Answer 15

Within 1 month of life - not present at birth

Question 16

What is impetigo?

Answer 16

Superficial bacterial skin infection caused by staph aureus

Question 17

How can impetigo be classified?

Answer 17

Bullous vs non-bulbous

Question 18

Non-bullous impetigo:
1. Features?
2. Step-wise management?

Answer 18

1. Occurs around nose/mouth, exudate forms golden crust, don’t normally causes systemic symptoms
2. I) Antiseptic cream (hydrogen peroxide 1%)
   II) Topical fusidic acid
   III) Oral flucloxacillin

Question 19

Bullous impetigo:
1. Presentation?
2. Management?
3. What can severe infection cause?

Answer 19

1. 1-2 fluid filled vesicles form on skin, these grow in size then burst -> golden crust, can cause systemic symptoms
2. I) Oral flucloxacillin
   II) IV flucloxacillin
3. Staphylococcus scalded skin syndrome

Question 20

What sign is +ve in scalded skin syndrome?

Answer 20

Nikolsky’s sign (epidermal layer easily comes off with pressure)

Question 21

What is the management of head lice?

Answer 21

• Special fine combs
• Dimeticone 4% lotion -> apply to hair for 8 hrs and wash off, repeat process 7 days later