Paeds - Dermatology Flashcards by Joanne McEwan

what is impetigo?

superficial bacterial skin infection usually caused by staph aureus

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characteristic appearence of impetigo?

golden crust

usually on the face

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what causes impetigo?

usually staph aureus

can be strep pyogenes

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should kids be kept off school with impetigo?

yes

v contagious

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2 types of impetigo?

bullous

non-bullous

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features of bullous impetigo?

staph produces epidermolytic toxins that break down proteins holding skin together causing 1-2cm fluid filled blisters to form on the skin
vesicles grow then burst forming a golden crust
lesions can be painful and itchy
may have some systemic symptoms of infection if v bad

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does bullous impetigo leave scars?

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who is bullous impetigo more common in?

neonates and kids under 2

but can occur in older kids and adults

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how is bullous impetigo diagnosed?

swabs of vesicles

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features of non-bullous impetigo?

usually occurs around nose and mouth
exudate from lesions forms golden crust
looks bad but doesnt cause systemic symptoms

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how is non-bullous impetigo managed?

uncomplicated, not unwell or at risk of complications = topical hydrogen peroxide
if hydrogen peroxide unsuitable = topical antibiotic (fusidic acid) for 5 days
if widespread or severe can give oral fluclox

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how is bullous impetigo managed?

oral antibiotics (fluclox)

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what is molluscum contagiosum?

viral skin infection caused by molluscum contagiosum virus (Poxvirus)

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characteristics of molluscum contagiosum?

small, flesh coloured papules (raised) which usually have a central dimple
typically appear in crops of multiple papules in a local area

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how does molluscum contagiosum occur?

spread through direct contact or by sharing towels/bedsheets etc

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course of molluscum contagiosum?

usually resolve without treatment but takes up to 18 months

skin returns to normal afterwards but should advise against picking/scratching them as it may cause scarring

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how is molluscum contagiosum managed?

no real treatment needed
advise against sharing towels or close contact with the lesions etc
may need topical antibiotics if superficial bacterial infections occurs (eg from picking/scratching) but this is rare

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what causes chickenpox?

varicella zoster

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chickenpox rash features?

widespread
erythematous 
raised
vesicular 
blistering
usually starts on trunk or face and spreads outwards affecting whole body over 2-5 days

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is chickenpox contagious?

yes

once lesions have scabbed over though its not contagious

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other symptoms of chickenpox?

fever often first symptom
itch
general fatigue and malaise

how is chickenpox spread?

direct contact with the lesions or infected droplets through cough/sneeze

when do chickenpox symptoms start?

10 days - 3 weeks after exposure

complications of chickenpox?

bacterial superinfection
dehydration
conjunctival lesions
pneumonia
encephalitis (presents as ataxia)
reactivation

how does chickenpox reactivate?

virus lays dormant in sensory dorsal root ganglion cells and cranial nerves reactivate later in life as shingles or ramsey hunt syndrome

how is risk of chickenpox managed in pregnancy?

no risk if immune to chickenpox (already had it) | if not immune (never had it) then they are given varicella zoster immunoglobulins after exposure

what can chickenpox cause in pregnancy?

if before 28 weeks, can cause developmental problems in foetus (congenital varicella syndrome) if around time of delivery can cause life-threatening neonatal infection

how is chickenpox around time of delivery managed?

varicella zoster immunoglobulins and aciclovir

how is chickenpox managed?

usually self limiting and needs no treatment aciclovir sometimes used if immunocompromised, neonates or if over 14 and presenting within 24 hrs itching can be helped with calamine lotion and antihistamines

what causes measles?

measles virus | spreads via resp droplets

symptoms of measles?

``` starts 10-12 days after exposure - fever - coryzal symptoms - conjunctivitis - koplik spots erythematous, macular rash with flat lesions starts on face (classically behind ears) 3-5 days after fever then spreads to rest of body ```

what are koplik spots?

greyish white spots on buccal mucosa appear 2 days after fever pathopneumonic for measles

how is measles managed?

usually self resolves after 7-10 days kids should be isolated until 4 days after symptoms resolve should be notified to public health

what causes scarlet fever?

group A strep (strep pyogenes) caused by exotoxin produced associated with tonsillitis

features of scarlet fever?

``` red/pink blotchy macular rash with rough sandpaper skin starts on trunk and spreads outwards can have red, flushed cheeks fever lethargy sore throat strawberry tongue cervical lymphadenopathy ```

how is scarlet fever managed?

antibiotics for the underlying strep infection (phenoxymethylpenicillin) for 10 days should be reported to public health keep kid off school until 24 hrs after starting antibiotics

other conditions associated with group A strep?

post-strep glomerulonephritis | acute rheumatic fever

how is rubella spread?

rubella virus spread by resp droplets

rubella symptoms?

symptoms start 2 weeks after exposure - erythematous macular rash starting on face and spreading to rest of body - rash usually lasts 3 days - can be associated with mild fever, joint pain and a sore throat - often have enlarged lymph nodes behind ears and back of neck

how is rubella managed?

self limiting notify public health stay off school for 5 days after rash appears avoid pregnant women

complications of rubella?

thrombocytopaenia encephalitis congenital rubella syndrome in babies born to mother with rubella

signs of congenital rubella syndrome?

triad of deafness, blindness and congenital heart disease

other names for slapped cheek?

erythema infectiosum | parovirus B19

what causes slapped cheek?

parovirus B19

symptoms of slapped cheek?

starts with mild fever, coryza and non-specific viral symptoms (lethargy, muscle ache etc) after 2-5 days the rash appears on the face then spreads to trunk and limbs after a few days

describe slapped cheek rash?

diffuse bright red rash on both cheeks appears rapidly a few days after viral symptoms few days later a reticular, mildly erythematous rash on trunk and limbs, can be raised and itchy

what does reticular mean?

net-like

course of slapped cheek?

self limiting and rash/symptoms usually fade over 1-2 weeks

management of slapped cheek?

fluids and simple analgesia self limiting only infectious prior to rash forming so dont need to stay off school once rash has appeared

who is at risk of complications from slapped cheek?

imunocompromised pregnant women people with haematological conditions

how are high risk people managed after expsoure to parovirus B19

require serology testing to confirm parovirus B19 | check FBC and reticulocyte count for aplastic anaemia

possible complications of slapped cheek?

aplastic anaemia encephalitis or meningitis pregnancy complications including foetal death rarely hepatitis, myocarditis or nephritis