Paeds - skin and allergy

Question 1

what is eczema?

Answer 1

inflammatory skin condition characterized by dry, pruritic skin with chronic relapsing course.

Question 2

what are the risk factors for eczema?

Answer 2

age <5 years 
fam history of eczema 
allergic rhinitis
asthma 
active or passive exposure to smoke

Question 3

what are the clinical features of eczema?

Answer 3

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

Question 4

how is eczema treated?

Answer 4

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

Question 5

what is stevens-johnsons syndrome?

Answer 5

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)

Question 6

what can cause stevens-johnsons syndrome?

Answer 6

Infection (URTI, OM, pharyngitis, mycoplasma pneumoniae, herpes, EBV, CMV

vaccination can precipitate

Medicines - many -e.g. anticonvulsants, antibiotics

Question 7

what is the difference between stevens-johnsons syndrome and toxic epidermal necrolysis

Answer 7

SJS - <10% of total body surface involvement - any of the causes

TEN - >30% of total body surface involvement - drug related

Question 8

what are the symptoms of stevens-johnsons syndrome?

Answer 8

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.

Question 9

what investigations should you order for stevens-johnson syndrome?

Answer 9

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

Question 10

how is stevens-johnsons syndrome managed?

Answer 10

withdraw causative agent
prophylactic anticoagulation (enoxaparin)
PPI (omeprazole)
Dressing, topical antibacterials and emollients
ophthalmological examination
IV fluids
pain relief

Question 11

what is allergic rhinitis?

Answer 11

inflammatory disorder of the nose where the nose becomes sensitized to allergens such as house dust mites and grass, tree and weed pollens

Question 12

what are the different classifications of allergic rhinitis ?

Answer 12

• 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

Question 13

what are the clinical features of allergic rhinitis?

Answer 13

sneezing 
nasal pruritus 
eye redness 
nasal congestions 
rhinorrhoea

Question 14

how is allergic rhinitis managed?

Answer 14

oral antihistamine plus allergen avoidance

intranasal antihistamine plus allergen avoidance

2nd line - montelukast

if severe an intranasal corticosteroid can be added

Question 15

what is urticaria?

Answer 15

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.

Question 16

what is angioedema?

Answer 16

swelling involving the deeper layers of the sub-dermis and occurs in association with urticaria. It can also occur in the absence of urticaria

Question 17

what causes urticaria and/or angio-oedema?

Answer 17

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)

Question 18

what are the symptoms of urticaria and angioedema?

Answer 18

erythematous oedematous lesions 
pruritus 
resolved within 24 hours 
swelling of face, tongue or lips
blanching lesions

Question 19

what investigations would you consider for urticaria?

Answer 19

FBC
complete metabolic panal 
urinalysis 
ESR
CRP
anti-IgE receptor antibodies 
TSH 
skin biopsy