Paeds - skin and allergy Flashcards
what is eczema?
inflammatory skin condition characterized by dry, pruritic skin with chronic relapsing course.
what are the risk factors for eczema?
age <5 years fam history of eczema allergic rhinitis asthma active or passive exposure to smoke
what are the clinical features of eczema?
pruritus
xerosis (dry skin)
infants usually show involvement of the cheeks, forehead, scalp and extensor surfaces.
Children typically have involvement of flexures, particularly the wrists, ankles, antecubital and popliteal fossa.
Erythema is often noted in the acute flares
scaling in acute flares
papules
how is eczema treated?
avoid irritants
1st line - emollients
if not controlled with emollients intermittent topical corticosteroids can be added
if infection suspected add oral antibiotic
if persistent pruritus - antihistamine or doxepin
what is stevens-johnsons syndrome?
Stevens-Johnson syndrome (SJS) is a severe skin detachment with mucocutaneous complications. It is an immune reaction to foreign antigens. SJS is a more severe form of erythema multiforme major and a less severe manifestation of toxic epidermal necrolysis (TEN)
what can cause stevens-johnsons syndrome?
Infection (URTI, OM, pharyngitis, mycoplasma pneumoniae, herpes, EBV, CMV
vaccination can precipitate
Medicines - many -e.g. anticonvulsants, antibiotics
what is the difference between stevens-johnsons syndrome and toxic epidermal necrolysis
SJS - <10% of total body surface involvement - any of the causes
TEN - >30% of total body surface involvement - drug related
what are the symptoms of stevens-johnsons syndrome?
sudden onset of rash
erosions or ulcerations of the eyes, lips, mouth, pharynx, oesophagus, GI tract, kidneys, liver, anus, genital area or urethra.
eye involvement may include conjunctivitis, corneal ulceration and uveitis.
what investigations should you order for stevens-johnson syndrome?
skin biopsy - will show keratinocyte apoptosis with detachment of the epidermal layer of the skin from the dermal layer blood cultures - will be negative FBC glucose magnesium phosphate urea LFTs ABG
how is stevens-johnsons syndrome managed?
withdraw causative agent
prophylactic anticoagulation (enoxaparin)
PPI (omeprazole)
Dressing, topical antibacterials and emollients
ophthalmological examination
IV fluids
pain relief
what is allergic rhinitis?
inflammatory disorder of the nose where the nose becomes sensitized to allergens such as house dust mites and grass, tree and weed pollens
what are the different classifications of allergic rhinitis ?
- seasonal: symptoms occur around the same time every year. Seasonal rhinitis which occurs secondary to pollens is known as hay fever
- perennial: symptoms occur throughout the year
- occupational: symptoms follow exposure to particular allergens within the work place
what are the clinical features of allergic rhinitis?
sneezing nasal pruritus eye redness nasal congestions rhinorrhoea
how is allergic rhinitis managed?
oral antihistamine plus allergen avoidance
intranasal antihistamine plus allergen avoidance
2nd line - montelukast
if severe an intranasal corticosteroid can be added
what is urticaria?
it is also known as hives
a skin condition characterised by erythematous, blanching, oedematous, non painful, pruritic lesions that typically resolves within 24 hours and leave no residual symptoms
chronic - episodes lasting for more than 6 weeks.
what is angioedema?
swelling involving the deeper layers of the sub-dermis and occurs in association with urticaria. It can also occur in the absence of urticaria
what causes urticaria and/or angio-oedema?
usually caused by IgE-mediated reaction. most common agents involved are drugs (NSAIDs, penicillins, muscle relaxants, diuretics) and foods (milk, eggs, peanuts, tree nuts, shellfish)
what are the symptoms of urticaria and angioedema?
erythematous oedematous lesions pruritus resolved within 24 hours swelling of face, tongue or lips blanching lesions
what investigations would you consider for urticaria?
FBC complete metabolic panal urinalysis ESR CRP anti-IgE receptor antibodies TSH skin biopsy
