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
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
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
4
Q
Eczema
maintenance mnx aim
A
create an artificial barrier over the skin to compensate for the defective skin barrier
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
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
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
8
Q
Eczema
what can be used to treat very severe flares
A
IV abx or oral steroids
9
Q
Eczema
other specialist trx in severe eczema
A
- zinc impregnated bandages
- topical tacrolimus
- phototherapy
- systemic immunosuppressants eg: corticosteroids, methotrexate + azathioprine
10
Q
Eczema
thin creams
A
- E45
- Diprobase
- Oilatum cream
- Aveeno cream
- Cetraben cream
- Epaderm cream
11
Q
Eczema
thick greasy emollients
A
- 50:50 ointment (50% liq paraffin)
- hydromol ointment
- diprobase ointment
- cetraben ointment
- epaderm ointment
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
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
14
Q
Eczema
which areas to avoid topical steroids in children
A
face, around eyes and in the genital region
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
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
17
Q
Eczema
what is the most common organism in opportunist bacterial infections
A
staphylococcus aureus
18
Q
Eczema
trx for bacterial infection
A
oral abx (flucloxacillin)
more severe cases may require admission + IV abx
19
Q
Eczema Herpeticum
what is it
A
a viral skin infection caused by herpes simplex virus (HSV) or varicella zoster virus (VZV)
20
Q
Eczema Herpeticum
what is the most causative organism
A
HSV-1
21
Q
Eczema Herpeticum
what may infection of HSV-1 be associated with
A
a coldsore in the patient or a close contact
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
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
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
25
Eczema Herpeticum
confirm dx
viral swabs of the vesicles although trx is usually started based on the clincial appearance
26
Eczema Herpeticum
trx
mild/mod: PO aciclovir
severe: IV aciclovir
27
Eczema Herpeticum
complications
can be life threatening esp in immunocompromised children
bacterial superinfection leads to more severe illness. Needs abx trx
28
Viral Exanthemas
what is exanthem
an eruptive widespread rash
29
Viral Exanthemas
what are the 6 viral exanthemas
```
first disease: measles
second disease: scarlet fever
third disease: rubella
fourth disease: Dukes' disease
fifth disease: parvovirus B19
sixth disease: roseola infantum
```
30
Measles
what is it caused by
the measles virus
31
Measles
how is it spread
resp droplets
32
Measles
when do sx start after exposure and with what
10-12d
fever
coryzal sx
conjunctivitis
33
Measles
what is the pathognomonic feature
Koplik spots: greyish white spots on the buccal mucosa that appear 2d after the fever
34
Measles
describe the rash
erythematous, macular rash with flat lesions
35
Measles
where and when does the rash start
starts classically behind the ears
3-5d after the fever
36
Measles
mnx
- notifiable disease- report to PHE
- self resolving after 7-10d
- children should isolate until 4d after their sx resolve
37
Measles
complications
```
Pneumonia
Diarrhoea
Dehydration
Encephalitis
Meningitis
Hearing loss
Vision loss
Death
```
38
Scarlet Fever
what is it associated with
group A strep infection, usually tonsillitis
39
Scarlet Fever
what is it caused by
an exotoxin produced by the streptococcus pyogenes (group A strep)
40
Scarlet Fever
describe the rash
red-pink, blotchy, macular rash
with rough sandpaper skin
that starts on the trunk and spreads outwards
pts can have red, flushed cheeks
41
Scarlet Fever
other features apart from the rash
- strawberry tongue
- sore throat
- cervical lymphadenopathy
- flushed face
- lethargy
- fever
42
Scarlet Fever
mnx
- notifiable disease
- phenoxymethylpenicillin (penicillin V) for 10d
- keep child off school until 24h after starting abx
43
Scarlet Fever
what other conditions can pts have associated with group A strep infection
- post-strep glomerulonephritis
| - acute rheumatic fever
44
Rubella
what is it caused by
the rubella virus
45
Rubella
how is it spread
resp droplets
highly contagious
46
Rubella
when do sx start after exposure
2w
47
Rubella
describe the rash
milder erythematous macular rash
starts on face and spreads to rest of body
lasts 3d
48
Rubella
what other sx apart from rash may they have
- mild fever, joint pain, sore throat
| - lymphadenopathy behind ears and back of neck
49
Rubella
mnx
- notifiable disease
- self limiting
- child stay off school for at least 5d after the rash disappears
- avoid pregnant women
50
Rubella
complications
- thrombocytopenia
| - encephalitis
51
Rubella
why is it dangerous in pregnancy
can lead to congenital rubella syndrome:
1. deafness
2. blindness
3. congenital heart disease
52
what is Duke's disease
aka fourth disease with no organism found and non-specific 'viral rashes'
disagreement whether this actually exists
53
what is fifth disease also known as
- Parvovirus B19
- slapped cheek syndrome
- erythema infectiosum
54
Parvovirus B19
what is it caused by
Parvovirus B19 lol
55
Parvovirus B19
what do symptoms start as
- mild fever
- coryza
- non-specific viral sx: muscle aches, lethargy
56
Parvovirus B19
when does the rash appear
after 2-5d after initial sx
57
Parvovirus B19
describe the rash
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
58
Parvovirus B19
mnx
- 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
59
Parvovirus B19
who is at risk of complications
- immunocompromised
- pregnant women
- haem conditions
60
Parvovirus B19
why do those at risk of complications need serology testing for parvovirus
to confirm dx and check FBC + reticulocyte count for aplastic anaemia
61
Parvovirus B19
complications
- APLASTIC ANAEMIA
- encephalitis or meningitis
- pregnancy complications: fetal death
- rarely hepatitis, myocarditis or nephritis
62
Roseola Infantum
aka
roseola
sixth disease
63
Roseola Infantum
what is it caused by
HHV-6 (common)
HHV-7
64
Roseola Infantum
what is the typical pattern of illness
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
65
Roseola Infantum
describe the rash
mild erythematous macular rash
across the arms, legs, trunk and face
not itchy
66
Roseola Infantum
mnx
- full recovery within a week
| - do not need to be kept off nursery if they are well enough to attend
67
Roseola Infantum
main complication
febrile convulsions due to high temp
68
Roseola Infantum
| what may immunocompromised pts be at risk of
- myocarditis
- thrombocytopenia
- Guillain-Barre syndrome
69
rose-pink macular rash with surrounding pale halos and febrile seizures. What does child have
Roseola Infantum caused by HHV6
70
Hand, Foot and Mouth Disease
what is it caused by
coxsackie A virus
71
Hand, Foot and Mouth Disease
incubation period
3-5d
72
Hand, Foot and Mouth Disease
presentation
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
Hand, Foot and Mouth Disease
dx
based on the clinical appearance of the rash
74
Hand, Foot and Mouth Disease
mnx
supportive
resolves spontaneously 7-10d later
highly contagious: avoid sharing towels and bedding, washing hands and careful handling of dirty nappies
75
Hand, Foot and Mouth Disease
complications (3)
- dehydration
- bacterial superinfection
- encephalitis
76
Erythema Multiforme
what is it
an erythematous rash caused by a hypersensitivity reaction
77
Erythema Multiforme
common causes
- viral infections
- medications
- herpes simplex virus (causing coldsores)
- mycoplasma pneumonia
78
Erythema Multiforme
presentation of rash
- widespread, itchy, erythematous rash
| - “target lesions”: red rings within larger red rings, with the darkest red at the centre
79
Erythema Multiforme
other symptoms (excluding rash)
- stomatitis
- mild fever
- muscle and joint aches
- headaches
- general flu-like sx
80
Erythema Multiforme
mnx if severe (esp if it affects oral mucosa)
- admit
| - IV fluids, analgesia and steroids (systemic or topical).
81
Erythema Multiforme
mnx if not severe
resolves spontaneously within one to four weeks without any treatment
82
Scabies
what are they
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
Scabies
how long can it take for any sx or rash to appear after the initial infestation
8 weeks
84
Scabies
presentation
- incredibly itchy small red spots
| - possible track marks where the mites have burrowed
85
Scabies
where is the classic location of the rash
between the finger webs, but it can spread to the whole body.
86
Scabies
trx
permethrin cream
87
Scabies
instructions for applying permethrin cream
- apply to whole body
- when skin is cool
- leave on for 8-12h then wash off
- repeat a week later
88
Scabies
trx for difficult to treat or crusted scabies
single dose PO ivermectin , repeated a week later
89
Scabies
mnx for all household and close contacts
treated in exactly the same way, even if asymptomatic (permethrin)
90
Scabies
hygiene mnx
- 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
Scabies
how long can itching continue for after trx
up to 4w
92
Scabies
trx for itching
Crotamiton cream and chlorphenamine at night
93
Scabies
what is crusted scabies aka
Norwegian scabies
94
Scabies
what is crusted scabies
a serious infestation with scabies in patients that are immunocompromised
95
Scabies
presentation of crusted scabies
Rather than individual spots and burrows, they have patches of red skin that turn into scaly plaques
often misdiagnosed as psoriasis
96
Scabies
what may immunocompromised pts not have an itch in crusted scabies
they do not mount an immune response to the infestation
97
Scabies
mnx for immunocompromised pts
may need admission
PO invermectin + isolation
98
Urticaria
aka
hives
99
Urticaria
presentation
- small itchy lumps
- may have patchy erythematous rash
- can be localised or widespread
100
Urticaria
presentation other than rash
- angioedema and flushing of skin
101
Urticaria
what can it be classified into
- acute urticaria
| - chronic urticaria
102
Urticaria
acute urticaria pathophysiology
- allergic reaction
| - mast cells release histamine and other inflammatory chemicals
103
Urticaria
chronic urticaria pathophysiology
- autoimmune reaction
| - mast cells release histamine and other inflammatory chemicals
104
Urticaria
causes of acute urticaria
- Allergies to food, medications or animals
- Contact with chemicals, latex or stinging nettles
- Medications
- Viral infections
- Insect bites
- Dermatographism (rubbing of the skin)
105
Urticaria
how can chronic urticaria be sub-classified depending on the cause
- Chronic idiopathic urticaria
- Chronic inducible urticaria
- Autoimmune urticaria
106
Urticaria
what is chronic inducible urticaria
episodes of chronic urticaria that can be induced by certain triggers:
- Sunlight
- Temperature change
- Exercise
- Strong emotions
- Hot or cold weather
- Pressure (dermatographism)
107
Urticaria
what is autoimmune urticaria
chronic urticaria associated with an underlying autoimmune condition e.g. SLE
108
Urticaria
mnx
antihistamines
109
Urticaria
what is the antihistamine of choice for chronic urticaria
fexofenadine
110
Urticaria
what medication may be considered for severe flairs
short course of oral steroids
111
Urticaria
mnx for very severe cases
- refer
- Anti-leukotrienes such as montelukast
- Omalizumab, which targets IgE
- Cyclosporin
112
Molluscum Contagiosum
cause
molluscum contagiosum virus, which is a type of poxvirus.
113
Molluscum Contagiosum
features
- small, flesh coloured papules
- central dimple
'crops' of multiple lesions in a local area
114
Molluscum Contagiosum
how is it spread
through direct contact or by sharing items like towels or bedsheets
115
Molluscum Contagiosum
general advice
- continue normal activities
- avoid sharing towels
- avoid scratching or picking
116
Molluscum Contagiosum
when to refer
- immunocompromised
- very extensive lesions
- lesions on the eyelid or anogenital area
117
Molluscum Contagiosum
specialist trx options
- top potassium hydroxide, benzoyle peroxide, podophyllotoxin, imiquidmod or tretinoin
- surgical removal
- cryotherapy
118
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
what are they
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
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
difference between them
SJS: affects <10% of body SA
TEN: affects >10% of body SA
120
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
whom is at a higher risk
certain HLA genetic types
121
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
causes caused by medications (4)
- Anti-epileptics
- Antibiotics
- Allopurinol
- NSAIDs
122
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
causes caused by infections (4)
- Herpes simplex
- Mycoplasma pneumonia
- Cytomegalovirus
- HIV
123
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
presentation
- 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
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
where can it affect
- skin
- eyes
- urinary tract
- lungs
- internal organs
125
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
mnx
emergency
- supportive
- steroids
- immunoglobulins
- immunosuppressants
126
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
complications
- secondary infection
- permanent skin damage
- visual complications
127
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
what is Nikolsky sign
rub the skin and blisters form and the skin tears off like a burn
128
Staphylococcal Scalded Skin Syndrome
pathophysiology
- staph aureus produces epidermolytic toxins
| - which break down the proteins that hold skin together
129
Staphylococcal Scalded Skin Syndrome
whom does it usually affect
children <5y
130
Staphylococcal Scalded Skin Syndrome
why do younger children develop this
Older children and adults have usually developed immunity to the epidermolytic toxins.
131
Staphylococcal Scalded Skin Syndrome
presentation
- 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
Staphylococcal Scalded Skin Syndrome
what sign is positive in SSSS
Nikolsky sign: where very gentle rubbing of the skin causes it to peel away
133
Staphylococcal Scalded Skin Syndrome
systemic sx
fever, irritability, lethargy and dehydration
sepsis -> death
134
Staphylococcal Scalded Skin Syndrome
mnx
- admit + treat with IV abx
| - fluids + electrolyte balance
135
Staphylococcal Scalded Skin Syndrome
prognosis
recovery in 5-7d
136
Seborrhoeic Dermatitis
what is it
an inflammatory skin condition that affects the sebaceous glands
137
Seborrhoeic Dermatitis
what are the sebaceous glands
the oil producing glands in the skin.
138
Seborrhoeic Dermatitis
where does it affect
areas that have a lot of sebaceous glands:
- the scalp
- nasolabial folds
- eyebrows
139
Seborrhoeic Dermatitis
presentation
- crusted dry flaky scalp (cradle cap)
140
Seborrhoeic Dermatitis
what is thought to be associated with it
Malassezia yeast
141
Seborrhoeic Dermatitis
what is Infantile seborrhoeic dermatitis
cradle cap: crusted flaky scalp
142
Seborrhoeic Dermatitis
when does infantile seborrhoeic dermatitis go away
usually resolves by 4 months of age, but can last until 12 months.
143
Seborrhoeic Dermatitis
stepwise mnx for infantile seborrhoeic dermatitis
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
Seborrhoeic Dermatitis
presentation of mild seborrhoeic dermatitis of the scalp
flaky itchy skin on the scalp (dandruff)
145
Seborrhoeic Dermatitis
presentation of more severe seborrhoeic dermatitis of the scalp
dense oily scaly brown crusting on the scalp
146
Seborrhoeic Dermatitis
who does seborrhoeic dermatitis of the scalp present with
adolescents and adults
147
Seborrhoeic Dermatitis
stepwise trx for seborrhoeic dermatitis of the scalp
1. ketoconazole shampoo, left on for 5 minutes
| 2. top steroids if sever itching
148
Seborrhoeic Dermatitis
presentation of seborrhoeic dermatitis of the face and body
red, flaky, crusted, itchy skin commonly affecting the eyelids, nasolabial folds, ears, upper chest and back
149
Seborrhoeic Dermatitis
1st line trx for Seborrhoeic dermatitis of the face and body
clotrimazole or miconazole cream used for up to 4 weeks
localised inflamed areas: top hydrocortisone 1%
severe: refer
150
Pityriasis Rosea
who does it often occur in
adolescents + young adults
151
Pityriasis Rosea
cause
HHV-6 or HHV-7 but no definitive causative organism has been established
152
Pityriasis Rosea
describe the start of the rash
herald patch: faint red or pink, scaly, oval shaped lesion that is 2cm or more in diameter
153
Pityriasis Rosea
describe the rash 2 days after the herald patch
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
Pityriasis Rosea
mnx
The rash resolves without treatment within 3 months
155
what is a possible long-term complication, which can occur up to 10 years after initial measles infection
Subacute sclerosing panencephalitis.
156
Psoriasis
describe the skin
dry, flaky, scaly, faintly erythematous skin lesions that appear in raised and rough plaques
157
Psoriasis
where on the body
extensor surfaces of the elbows, knees and scalp
158
Features of plaque Psoriasis
most common
thickened erythematous plaques with silver scales, commonly seen on the extensor surfaces and scalp.
159
features of guttate psoriasis
2nd most common
commonly in children
small raised papules across trunk and limbs
mildy erythematous and slightly scaly
160
what is guttate psoriasis often triggered by
steptococcal throat infection
stress
medications
161
does guttate psoriasis resolve
often spontaneously within 3-4 months
162
features of pustular psoriasis
rare severe form
pustules form under areas of erythematous skin
163
treatment of pustular psoriasis
medical emergency, admit
164
features of erythrodermic psoriasis
rare severe form
extensive erythematous inflamed areas covering most of the surface area of the skin
skin comes away in large patches
165
treatment of erythrodermic psoriasis
medical emergency, admit
166
Psoriasis specific signs
- Auspitz sign
- Koebner phenomenon
- Residual pigmentation
167
Psoriasis
What is Auspitz sign
small points of bleeding when plaques are scraped off
168
169
Psoriasis
What is Koebmer phenomenon
the development of psoriatic lesion to areas of skin affected by trauma
170
Psoriasis
What is residual pigmentation
residual pigmentation of the skin after the lesions resolve
171
Treatment of plaque psoriasis
1. hydrocortisone cream
2. calcipotriol topical (vit D analogue)
3. tacrolimus (calcineurin inhibitors, adults)
172
If topical trx for psoriasis fails?
refer to derm
methotrexate, cyclosporine, retinoids or biologics
173
nail changes that can occur in patients with psoriasis
nail pitting, thickening, discolouration, ridging and onycholysis (separation of the nail from the nail bed).
174
Psoriasis
associated conditions
Nail psoriasis
Psoriatic arthritis
Psychosocial
