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Finals > Paeds: Dermatology > Flashcards

Paeds: Dermatology Flashcards

1
Q

Eczema

what is it

A

a chronic atopic condition caused by defects in the normal continuity of the skin barrier, leading to inflammation in the skin

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2
Q

Eczema

how does it present in infancy

A

dry, red, itchy and sore patches of skin over the FLEXOR surfaces and on the face and neck

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3
Q

Eczema

pathophysiology

A

defective skin barrier: tiny gaps in the skin barrier provide an entrance for irritants, microbes and allergens that create an immune response

resulting in inflammation and the associated symptoms

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4
Q

Eczema

maintenance mnx aim

A

create an artificial barrier over the skin to compensate for the defective skin barrier

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5
Q

Eczema

maintenance mnx

A
  • emollients as often as possible
  • avoid bathing in hot water, scratching or scrubbing as they break down the skin barrier
  • soap substitutes
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6
Q

Eczema

name some environmental factors which could cause a flare

A
  • changes in temp
  • certain dietary products
  • washing powders
  • cleaning products
  • emotional events or stresses
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7
Q

Eczema

what can flares be treated with

A
  • thicker emollients
  • topical steroids
  • ‘wet wraps’: thick emollient and applying wrap to keep moisture locked in overnight
  • treat complications eg bacterial or viral infections
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8
Q

Eczema

what can be used to treat very severe flares

A

IV abx or oral steroids

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9
Q

Eczema

other specialist trx in severe eczema

A
  • zinc impregnated bandages
  • topical tacrolimus
  • phototherapy
  • systemic immunosuppressants eg: corticosteroids, methotrexate + azathioprine
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10
Q

Eczema

thin creams

A
  • E45
  • Diprobase
  • Oilatum cream
  • Aveeno cream
  • Cetraben cream
  • Epaderm cream
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11
Q

Eczema

thick greasy emollients

A
  • 50:50 ointment (50% liq paraffin)
  • hydromol ointment
  • diprobase ointment
  • cetraben ointment
  • epaderm ointment
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12
Q

Eczema

what is the general rule for topical steroids

A

use the weakest steroid for the shortest period required to get the skin under control

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13
Q

Eczema

SEs of topical steroids

A
  • thinning of the skin

which can make the skin more prone to flares, bruising, tearing, stretch marks and telangiectasia

  • systemic absorption
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14
Q

Eczema

which areas to avoid topical steroids in children

A

face, around eyes and in the genital region

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15
Q

Eczema

what is the steroid ladder from the weakest to most potent

A

HEBDO

mild: Hydrocortisone 0.5, 1 and 2.5%
moderate: Emuvate (clobetasone butyrate 0.05%)
potent: Betnovate (betamethasone 0.1%)

very potent: Dermovate (clobetasol propionate 0.05%)

oral

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16
Q

Eczema

why are opportunistic bacterial infections of the skin common in eczema

A

the breakdown in the skin’s protective barrier allow an entry point for infective organisms

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17
Q

Eczema

what is the most common organism in opportunist bacterial infections

A

staphylococcus aureus

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18
Q

Eczema

trx for bacterial infection

A

oral abx (flucloxacillin)

more severe cases may require admission + IV abx

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19
Q

Eczema Herpeticum

what is it

A

a viral skin infection caused by herpes simplex virus (HSV) or varicella zoster virus (VZV)

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20
Q

Eczema Herpeticum

what is the most causative organism

A

HSV-1

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21
Q

Eczema Herpeticum

what may infection of HSV-1 be associated with

A

a coldsore in the patient or a close contact

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22
Q

Eczema Herpeticum

RFs

A

pts with a pre-existing skin condition eg atopic eczema or dermatitis

where the virus is able to enter the skin and cause an infection

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23
Q

Eczema Herpeticum

presentation

A

a pt who suffers with eczema that has developed:

  • widespread, painful, vesicular rash
  • systemic sx: fever, lethargy, irritability + reduced oral intake
  • lymphadenopathy
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24
Q

Eczema Herpeticum

describe the rash

A

widespread and affect any area

erythematous, painful and sometimes itchy

vesicles containing pus which later burst leaving small punched-out ulcers with a red base

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25
Q

Eczema Herpeticum

confirm dx

A

viral swabs of the vesicles although trx is usually started based on the clincial appearance

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26
Q

Eczema Herpeticum

trx

A

mild/mod: PO aciclovir

severe: IV aciclovir

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27
Q

Eczema Herpeticum

complications

A

can be life threatening esp in immunocompromised children

bacterial superinfection leads to more severe illness. Needs abx trx

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28
Q

Viral Exanthemas

what is exanthem

A

an eruptive widespread rash

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29
Q

Viral Exanthemas

what are the 6 viral exanthemas

A 
first disease: measles
second disease: scarlet fever
third disease: rubella
fourth disease: Dukes' disease 
fifth disease: parvovirus B19
sixth disease: roseola infantum
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30
Q

Measles

what is it caused by

A

the measles virus

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31
Q

Measles

how is it spread

A

resp droplets

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32
Q

Measles

when do sx start after exposure and with what

A

10-12d

fever
coryzal sx
conjunctivitis

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33
Q

Measles

what is the pathognomonic feature

A

Koplik spots: greyish white spots on the buccal mucosa that appear 2d after the fever

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34
Q

Measles

describe the rash

A

erythematous, macular rash with flat lesions

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35
Q

Measles

where and when does the rash start

A

starts classically behind the ears

3-5d after the fever

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36
Q

Measles

mnx

A
  • notifiable disease- report to PHE
  • self resolving after 7-10d
  • children should isolate until 4d after their sx resolve
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37
Q

Measles

complications

A 
Pneumonia
Diarrhoea
Dehydration
Encephalitis
Meningitis
Hearing loss
Vision loss
Death
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38
Q

Scarlet Fever

what is it associated with

A

group A strep infection, usually tonsillitis

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39
Q

Scarlet Fever

what is it caused by

A

an exotoxin produced by the streptococcus pyogenes (group A strep)

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40
Q

Scarlet Fever

describe the rash

A

red-pink, blotchy, macular rash

with rough sandpaper skin

that starts on the trunk and spreads outwards

pts can have red, flushed cheeks

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41
Q

Scarlet Fever

other features apart from the rash

A
  • strawberry tongue
  • sore throat
  • cervical lymphadenopathy
  • flushed face
  • lethargy
  • fever
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42
Q

Scarlet Fever

mnx

A
  • notifiable disease
  • phenoxymethylpenicillin (penicillin V) for 10d
  • keep child off school until 24h after starting abx
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43
Q

Scarlet Fever

what other conditions can pts have associated with group A strep infection

A
  • post-strep glomerulonephritis

- acute rheumatic fever

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44
Q

Rubella

what is it caused by

A

the rubella virus

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45
Q

Rubella

how is it spread

A

resp droplets

highly contagious

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46
Q

Rubella

when do sx start after exposure

A

2w

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47
Q

Rubella

describe the rash

A

milder erythematous macular rash

starts on face and spreads to rest of body

lasts 3d

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48
Q

Rubella

what other sx apart from rash may they have

A
  • mild fever, joint pain, sore throat

- lymphadenopathy behind ears and back of neck

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49
Q

Rubella

mnx

A
  • notifiable disease
  • self limiting
  • child stay off school for at least 5d after the rash disappears
  • avoid pregnant women
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50
Q

Rubella

complications

A
  • thrombocytopenia

- encephalitis

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51
Q

Rubella

why is it dangerous in pregnancy

A

can lead to congenital rubella syndrome:

  1. deafness
  2. blindness
  3. congenital heart disease
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52
Q

what is Duke’s disease

A

aka fourth disease with no organism found and non-specific ‘viral rashes’

disagreement whether this actually exists

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53
Q

what is fifth disease also known as

A
  • Parvovirus B19
  • slapped cheek syndrome
  • erythema infectiosum
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54
Q

Parvovirus B19

what is it caused by

A

Parvovirus B19 lol

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55
Q

Parvovirus B19

what do symptoms start as

A
  • mild fever
  • coryza
  • non-specific viral sx: muscle aches, lethargy
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56
Q

Parvovirus B19

when does the rash appear

A

after 2-5d after initial sx

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57
Q

Parvovirus B19

describe the rash

A

diffuse bright red rash on both cheeks

a few days later: reticular (net like) mildly erythematous rash affecting the trunk and limbs

can be raised and itchy

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58
Q

Parvovirus B19

mnx

A
  • self limiting within 1-2w
  • supportive with plenty of fluids and analgesia
  • don’t need to stay off school once rash has formed as no longer infectious
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59
Q

Parvovirus B19

who is at risk of complications

A
  • immunocompromised
  • pregnant women
  • haem conditions
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60
Q

Parvovirus B19

why do those at risk of complications need serology testing for parvovirus

A

to confirm dx and check FBC + reticulocyte count for aplastic anaemia

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61
Q

Parvovirus B19

complications

A
  • APLASTIC ANAEMIA
  • encephalitis or meningitis
  • pregnancy complications: fetal death
  • rarely hepatitis, myocarditis or nephritis
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62
Q

Roseola Infantum

aka

A

roseola

sixth disease

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63
Q

Roseola Infantum

what is it caused by

A

HHV-6 (common)

HHV-7

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64
Q

Roseola Infantum

what is the typical pattern of illness

A

1-2w after infection: sudden high fever for 3-5d then stops suddenly

then rash appears for 1-2d

may be coryzal symptoms, sore throat and swollen lymph nodes

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65
Q

Roseola Infantum

describe the rash

A

mild erythematous macular rash

across the arms, legs, trunk and face

not itchy

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66
Q

Roseola Infantum

mnx

A
  • full recovery within a week

- do not need to be kept off nursery if they are well enough to attend

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67
Q

Roseola Infantum

main complication

A

febrile convulsions due to high temp

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68
Q

Roseola Infantum

what may immunocompromised pts be at risk of

A
  • myocarditis
  • thrombocytopenia
  • Guillain-Barre syndrome
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69
Q

rose-pink macular rash with surrounding pale halos and febrile seizures. What does child have

A

Roseola Infantum caused by HHV6

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70
Q

Hand, Foot and Mouth Disease

what is it caused by

A

coxsackie A virus

71
Q

Hand, Foot and Mouth Disease

incubation period

A

3-5d

72
Q

Hand, Foot and Mouth Disease

presentation

A

initially: URTI

1-2d later: mouth ulcers –> blistering red spots across body

most notable on hands, feet and mouth

painful tongue mouth ulcers

rash may be itchy

73
Q

Hand, Foot and Mouth Disease

dx

A

based on the clinical appearance of the rash

74
Q

Hand, Foot and Mouth Disease

mnx

A

supportive

resolves spontaneously 7-10d later

highly contagious: avoid sharing towels and bedding, washing hands and careful handling of dirty nappies

75
Q

Hand, Foot and Mouth Disease

complications (3)

A
  • dehydration
  • bacterial superinfection
  • encephalitis
76
Q

Erythema Multiforme

what is it

A

an erythematous rash caused by a hypersensitivity reaction

77
Q

Erythema Multiforme

common causes

A
  • viral infections
  • medications
  • herpes simplex virus (causing coldsores)
  • mycoplasma pneumonia
78
Q

Erythema Multiforme

presentation of rash

A
  • widespread, itchy, erythematous rash

- “target lesions”: red rings within larger red rings, with the darkest red at the centre

79
Q

Erythema Multiforme

other symptoms (excluding rash)

A
  • stomatitis
  • mild fever
  • muscle and joint aches
  • headaches
  • general flu-like sx
80
Q

Erythema Multiforme

mnx if severe (esp if it affects oral mucosa)

A
  • admit

- IV fluids, analgesia and steroids (systemic or topical).

81
Q

Erythema Multiforme

mnx if not severe

A

resolves spontaneously within one to four weeks without any treatment

82
Q

Scabies

what are they

A

tiny mites called Sarcoptes scabiei that burrow under the skin causing infection and intense itching.

They lay eggs in the skin, leading to further infection and symptoms

83
Q

Scabies

how long can it take for any sx or rash to appear after the initial infestation

A

8 weeks

84
Q

Scabies

presentation

A
  • incredibly itchy small red spots

- possible track marks where the mites have burrowed

85
Q

Scabies

where is the classic location of the rash

A

between the finger webs, but it can spread to the whole body.

86
Q

Scabies

trx

A

permethrin cream

87
Q

Scabies

instructions for applying permethrin cream

A
  • apply to whole body
  • when skin is cool
  • leave on for 8-12h then wash off
  • repeat a week later
88
Q

Scabies

trx for difficult to treat or crusted scabies

A

single dose PO ivermectin , repeated a week later

89
Q

Scabies

mnx for all household and close contacts

A

treated in exactly the same way, even if asymptomatic (permethrin)

90
Q

Scabies

hygiene mnx

A
  • All clothes, bedclothes, towels and other materials in contact with scabies need to be washed on a hot wash
  • Thorough hoovering of carpets and furniture is also essential.
91
Q

Scabies

how long can itching continue for after trx

A

up to 4w

92
Q

Scabies

trx for itching

A

Crotamiton cream and chlorphenamine at night

93
Q

Scabies

what is crusted scabies aka

A

Norwegian scabies

94
Q

Scabies

what is crusted scabies

A

a serious infestation with scabies in patients that are immunocompromised

95
Q

Scabies

presentation of crusted scabies

A

Rather than individual spots and burrows, they have patches of red skin that turn into scaly plaques

often misdiagnosed as psoriasis

96
Q

Scabies

what may immunocompromised pts not have an itch in crusted scabies

A

they do not mount an immune response to the infestation

97
Q

Scabies

mnx for immunocompromised pts

A

may need admission

PO invermectin + isolation

98
Q

Urticaria

aka

A

hives

99
Q

Urticaria

presentation

A
  • small itchy lumps
  • may have patchy erythematous rash
  • can be localised or widespread
100
Q

Urticaria

presentation other than rash

A
  • angioedema and flushing of skin
101
Q

Urticaria

what can it be classified into

A
  • acute urticaria

- chronic urticaria

102
Q

Urticaria

acute urticaria pathophysiology

A
  • allergic reaction

- mast cells release histamine and other inflammatory chemicals

103
Q

Urticaria

chronic urticaria pathophysiology

A
  • autoimmune reaction

- mast cells release histamine and other inflammatory chemicals

104
Q

Urticaria

causes of acute urticaria

A
  • Allergies to food, medications or animals
  • Contact with chemicals, latex or stinging nettles
  • Medications
  • Viral infections
  • Insect bites
  • Dermatographism (rubbing of the skin)
105
Q

Urticaria

how can chronic urticaria be sub-classified depending on the cause

A
  • Chronic idiopathic urticaria
  • Chronic inducible urticaria
  • Autoimmune urticaria
106
Q

Urticaria

what is chronic inducible urticaria

A

episodes of chronic urticaria that can be induced by certain triggers:

  • Sunlight
  • Temperature change
  • Exercise
  • Strong emotions
  • Hot or cold weather
  • Pressure (dermatographism)
107
Q

Urticaria

what is autoimmune urticaria

A

chronic urticaria associated with an underlying autoimmune condition e.g. SLE

108
Q

Urticaria

mnx

A

antihistamines

109
Q

Urticaria

what is the antihistamine of choice for chronic urticaria

A

fexofenadine

110
Q

Urticaria

what medication may be considered for severe flairs

A

short course of oral steroids

111
Q

Urticaria

mnx for very severe cases

A
  • refer
  • Anti-leukotrienes such as montelukast
  • Omalizumab, which targets IgE
  • Cyclosporin
112
Q

Molluscum Contagiosum

cause

A

molluscum contagiosum virus, which is a type of poxvirus.

113
Q

Molluscum Contagiosum

features

A
  • small, flesh coloured papules
  • central dimple
    ‘crops’ of multiple lesions in a local area
114
Q

Molluscum Contagiosum

how is it spread

A

through direct contact or by sharing items like towels or bedsheets

115
Q

Molluscum Contagiosum

general advice

A
  • continue normal activities
  • avoid sharing towels
  • avoid scratching or picking
116
Q

Molluscum Contagiosum

when to refer

A
  • immunocompromised
  • very extensive lesions
  • lesions on the eyelid or anogenital area
117
Q

Molluscum Contagiosum

specialist trx options

A
  • top potassium hydroxide, benzoyle peroxide, podophyllotoxin, imiquidmod or tretinoin
  • surgical removal
  • cryotherapy
118
Q

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

what are they

A

a spectrum of the same pathology

where a disproportional immune response causes epidermal necrosis, resulting in blistering and shedding of the top layer of skin

119
Q

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

difference between them

A

SJS: affects <10% of body SA

TEN: affects >10% of body SA

120
Q

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

whom is at a higher risk

A

certain HLA genetic types

121
Q

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

causes caused by medications (4)

A
  • Anti-epileptics
  • Antibiotics
  • Allopurinol
  • NSAIDs
122
Q

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

causes caused by infections (4)

A
  • Herpes simplex
  • Mycoplasma pneumonia
  • Cytomegalovirus
  • HIV
123
Q

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

presentation

A
  • start with fever, cough, sore throat, sore mouth, sore eyes + itchy skin
  • then purple or red rash that spreads across the skin
  • starts to blister
  • skin sheds –> pain, erythema
  • eye can become inflamed + ulcerated
124
Q

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

where can it affect

A
  • skin
  • eyes
  • urinary tract
  • lungs
  • internal organs
125
Q

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

mnx

A

emergency

  • supportive
  • steroids
  • immunoglobulins
  • immunosuppressants
126
Q

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

complications

A
  • secondary infection
  • permanent skin damage
  • visual complications
127
Q

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

what is Nikolsky sign

A

rub the skin and blisters form and the skin tears off like a burn

128
Q

Staphylococcal Scalded Skin Syndrome

pathophysiology

A
  • staph aureus produces epidermolytic toxins

- which break down the proteins that hold skin together

129
Q

Staphylococcal Scalded Skin Syndrome

whom does it usually affect

A

children <5y

130
Q

Staphylococcal Scalded Skin Syndrome

why do younger children develop this

A

Older children and adults have usually developed immunity to the epidermolytic toxins.

131
Q

Staphylococcal Scalded Skin Syndrome

presentation

A
  • starts w/ patches of erythema on skin
  • then skin looks thin + wrinkled
  • then bullae form
  • burst
  • leave very sore, erythematous skin below (similar to burn or scald)
132
Q

Staphylococcal Scalded Skin Syndrome

what sign is positive in SSSS

A

Nikolsky sign: where very gentle rubbing of the skin causes it to peel away

133
Q

Staphylococcal Scalded Skin Syndrome

systemic sx

A

fever, irritability, lethargy and dehydration

sepsis -> death

134
Q

Staphylococcal Scalded Skin Syndrome

mnx

A
  • admit + treat with IV abx

- fluids + electrolyte balance

135
Q

Staphylococcal Scalded Skin Syndrome

prognosis

A

recovery in 5-7d

136
Q

Seborrhoeic Dermatitis

what is it

A

an inflammatory skin condition that affects the sebaceous glands

137
Q

Seborrhoeic Dermatitis

what are the sebaceous glands

A

the oil producing glands in the skin.

138
Q

Seborrhoeic Dermatitis

where does it affect

A

areas that have a lot of sebaceous glands:

  • the scalp
  • nasolabial folds
  • eyebrows
139
Q

Seborrhoeic Dermatitis

presentation

A
  • crusted dry flaky scalp (cradle cap)
140
Q

Seborrhoeic Dermatitis

what is thought to be associated with it

A

Malassezia yeast

141
Q

Seborrhoeic Dermatitis

what is Infantile seborrhoeic dermatitis

A

cradle cap: crusted flaky scalp

142
Q

Seborrhoeic Dermatitis

when does infantile seborrhoeic dermatitis go away

A

usually resolves by 4 months of age, but can last until 12 months.

143
Q

Seborrhoeic Dermatitis

stepwise mnx for infantile seborrhoeic dermatitis

A
  1. apply baby oil, vegetable oil or olive oil, gently brushing the scalp then washing off
  2. white petroleum jelly overnight to soften crusted areas before washing off in morning
  3. Top clotrimazole or miconazole for up to 4w
  4. refer
144
Q

Seborrhoeic Dermatitis

presentation of mild seborrhoeic dermatitis of the scalp

A

flaky itchy skin on the scalp (dandruff)

145
Q

Seborrhoeic Dermatitis

presentation of more severe seborrhoeic dermatitis of the scalp

A

dense oily scaly brown crusting on the scalp

146
Q

Seborrhoeic Dermatitis

who does seborrhoeic dermatitis of the scalp present with

A

adolescents and adults

147
Q

Seborrhoeic Dermatitis

stepwise trx for seborrhoeic dermatitis of the scalp

A
  1. ketoconazole shampoo, left on for 5 minutes

2. top steroids if sever itching

148
Q

Seborrhoeic Dermatitis

presentation of seborrhoeic dermatitis of the face and body

A

red, flaky, crusted, itchy skin commonly affecting the eyelids, nasolabial folds, ears, upper chest and back

149
Q

Seborrhoeic Dermatitis

1st line trx for Seborrhoeic dermatitis of the face and body

A

clotrimazole or miconazole cream used for up to 4 weeks

localised inflamed areas: top hydrocortisone 1%

severe: refer

150
Q

Pityriasis Rosea

who does it often occur in

A

adolescents + young adults

151
Q

Pityriasis Rosea

cause

A

HHV-6 or HHV-7 but no definitive causative organism has been established

152
Q

Pityriasis Rosea

describe the start of the rash

A

herald patch: faint red or pink, scaly, oval shaped lesion that is 2cm or more in diameter

153
Q

Pityriasis Rosea

describe the rash 2 days after the herald patch

A

widespread faint red or pink, slightly scaly, oval shaped lesions, usually less than 2 cm in diameter.

on torso, arranged in a ‘christmas tree’ fashion following the lines of the ribs

154
Q

Pityriasis Rosea

mnx

A

The rash resolves without treatment within 3 months

155
Q

what is a possible long-term complication, which can occur up to 10 years after initial measles infection

A

Subacute sclerosing panencephalitis.

156
Q

Psoriasis
describe the skin

A

dry, flaky, scaly, faintly erythematous skin lesions that appear in raised and rough plaques

157
Q

Psoriasis
where on the body

A

extensor surfaces of the elbows, knees and scalp

158
Q

Features of plaque Psoriasis

A

most common
thickened erythematous plaques with silver scales, commonly seen on the extensor surfaces and scalp.

159
Q

features of guttate psoriasis

A

2nd most common
commonly in children
small raised papules across trunk and limbs
mildy erythematous and slightly scaly

160
Q

what is guttate psoriasis often triggered by

A

steptococcal throat infection
stress
medications

161
Q

does guttate psoriasis resolve

A

often spontaneously within 3-4 months

162
Q

features of pustular psoriasis

A

rare severe form
pustules form under areas of erythematous skin

163
Q

treatment of pustular psoriasis

A

medical emergency, admit

164
Q

features of erythrodermic psoriasis

A

rare severe form
extensive erythematous inflamed areas covering most of the surface area of the skin
skin comes away in large patches

165
Q

treatment of erythrodermic psoriasis

A

medical emergency, admit

166
Q

Psoriasis specific signs

A
  • Auspitz sign
  • Koebner phenomenon
  • Residual pigmentation
167
Q

Psoriasis
What is Auspitz sign

A

small points of bleeding when plaques are scraped off

168
Q
A
169
Q

Psoriasis
What is Koebmer phenomenon

A

the development of psoriatic lesion to areas of skin affected by trauma

170
Q

Psoriasis
What is residual pigmentation

A

residual pigmentation of the skin after the lesions resolve

171
Q

Treatment of plaque psoriasis

A
  1. hydrocortisone cream
  2. calcipotriol topical (vit D analogue)
  3. tacrolimus (calcineurin inhibitors, adults)
172
Q

If topical trx for psoriasis fails?

A

refer to derm
methotrexate, cyclosporine, retinoids or biologics

173
Q

nail changes that can occur in patients with psoriasis

A

nail pitting, thickening, discolouration, ridging and onycholysis (separation of the nail from the nail bed).

174
Q

Psoriasis
associated conditions

A

Nail psoriasis
Psoriatic arthritis
Psychosocial

Finals (47 decks)

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