Paeds Dermatology Flashcards
What is the histopathological correlation of Atopic dermatitis?
spongiosis
When does atopic dermatitis typically present?
Typically the first year of life, but can be earlier
What are the key elements in the pathophysiology of atopic dermatitis?
Immune dysregulation (increased IgE, TH2 dysregulation) Abnormal defensin - changed response to infection Exposure to environmental irritants
What are the clinical features of atopic dermatitis
Patchy, erythematous, poorly defined, scaly, itchy rash Dry skin Excoriation Lichenification Bacterial superinfection Micropapular or discoid variants
What is the typical distribution of atopic dermatitis in babies?
Face first then elbows and knees (from crawling)
What is the typical distribution of atopic dermatitis in older children?
Elbows and knee flexures
What is the typical distribution of atopic dermatitis in adults?
More localised
Mostly hands and face
Flexural surfaces
What is the non-pharmacological management of atopic dermatitis?
Avoid triggers Emollients and bathing Wet wraps (tubular bandages help with emollient penetration)
What is the pharmacological management of atopic dermatitis?
Appropriate strength steroids: Mild: Face, genitals, flexures Moderate: Trunk, limbs Potent: Palms, soles, elbows, knees Very potent: nodules and lichenification + severe disease (discontinue after 2x weeks)
Topical calcineurin inhibitor for very sensitive areas
What are some side effects of topical corticosteroids?
Irritation and stinging Skin atrophy Erythema and telangiectasia Perioral dermatitis Infection masking Glaucoma and cataracts (when applied to eyelids)
If rash flares following cessation of corticosteroids for atopic dermatitis, what conditions should be queeried?
Fungal infection
Psoriasis
Perioral dermatitis
What are the indications for specialist referral in atopic dermatitis?
Non-compliance with topical steroids Chronic steroid use Suspected misdiagnosis Very severe or non-responsive disease Allergy
What is the management for bacterial superinfections in atopic dermatitis?
Dry-swab (mostly s.aureus)
Antibiotics based on sensitivities
Dilute chlorine baths
Intranasal mupirocin ointment for nasal strep carriers
What are the clinical features of discoid eczema?
Very itchy round or oval patch preceded by emotional stress
Rapid lichenification
Almost always accompanied by bacterial superinfection
What is the management for discoid eczema?
Potent topical steroids
Very potent steroids for lichenified lesions
Antibiotics for bacterial superinfection
In what demographic is micropapular eczema common in, and what is the key feature
non-white babies
Pigmentation changes
