Paeds Written - DERM Flashcards by Rebecca Thompson

Characteristic features of Candidal dermatitis (nappy rash)

Beefy red
well-defined patches
Involving skin folds/flexures
Satellite lesions

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Characteristic features of irritant nappy rash

Spares skin folds/creases

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Conservative measures in Nappy rash

Disposable high absorbency nappies > towel nappies
Change ASAP after soiling/wetting
Use fragrance & alcohol free wipes
Expose area to air when possible

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Indications for & pharmacological options in nappy rash

Asymptomatic + mild erythema = barrier (zinc & castor oil) applied at nappy changes

Inflamed + causing discomfort = 7 day topical hydrocortisone 1%

Persists + bacterial infection suspected/confirmed = 7 day oral flucloxacillin

Candidal = topical imidazole e.g. clotrimazole + STOP barrier creams

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Pattern of atopic eczema in children of different ages

Infants = face + trunk

Younger children = extensor surfaces

Older = typical flexor surfaces +/- creases of neck and face

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Treatment options for atopic eczema

Simple emollients

10:1 emollient to steroid ratio
Apply emollient –> wait 30 mins –> topical steroid
do NOT insert fingers into pots - use pump bottles to avoid bacteria

Topical steroids

Wet wrapping - emollients & bandage

Oral ciclosporin (severe)

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Topical steroid potency ladder

Help (Hydrocortisone)
Every (Eumovate)
Busy (Betnovate)
Dermatologist (Dermovate)

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Prognosis for atopic eczema

Clears in 50% by 5yo

75% by 10yo

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Causative organism for Impetigo

Staph aureus or Strep pneumonia

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Treatment options for impetigo

Systemically well + low risk = hydrogen peroxide 1% cream

Otherwise 1st line = topical fusidic acid 2%

More extensive = oral flucloxacillin (or clarithromycin if penicillin allergic)

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school exclusion guidance for impetigo

Avoid school/nursery etc. until all lesions crusted + healed OR 48 hours after starting Tx

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Treatment of eczema herpeticum

Immediate referral to Derm
Oral or IV aciclovir

+ Ophthalmology R/v is lesions around eyes

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Common causative organisms of ringworm

Trichophyton
Microsporum
Epidermophyton

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Typical ringworm lesion

Ring shaped (annular)
Red scaly lesions

+/- kerion – severe inflamed ringworm patch

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Tx for mild ringworm

topical anti fungal e.g. terbinafine, clotrimazole

+ hydrocortisone 1% if lots of inflammation

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Tx for severe or widespread ringworm

Systemic anti fungal e.g. oral terbinafine, itraconazole

NOTE: also used if affecting scalp - can be difficult to apply topicals

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Pityriasis rosea key clinical features

Herald patch - single patch on abdomen
THEN widespread (itchy) rash

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Tx needed for pityriasis rosea

No Tx needed

Unless itchy –> emollients, topical steroids, antihistamines

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Pityriasis veriscolor clinical presentation

Pale patches in pigmented skin
Pink patches in unpigmented skin

Often noticed after holiday (when usual skin tone changes colour)

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Triggers for erythema multiforme

Viral infections - Herpes simplex
Bacteria - mycoplasma
Sulphonamide Abx

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Triggers for Guttate psoriasis

Streptococcal throat infection

Viral URTI

Guttate psoriasis typical presentation

Raindrop-like small scaly patches

Affects trunk & upper limbs

Miliaria clinical presentation

Neonates
Small clear blisters
widely spread - head, neck, trunk
(Rubra ‘heat rash’ type more likely to affect covered skin)

When is treatment require for labial fusion?

If significant Sx

Indications for surgical separation of labial fusion?

Topical oestrogen failure (after 4-6 weeks Tx) Severe fusion Trapped urine --> vulval inflammation or terminal dribbling

Bacteria implicated in acne vulgaris

Propionibacterium acnes

Mild to moderate acne - Tx options

Topical retinoid (Adapalene) +/- benzoyl peroxide Topical Abx (clindamycin 1%) + benzoyl peroxide Azelaic acid 20%

Tx for Moderate acne (not responding to topicals)

Oral Abx (max 3 months) + Benzoyl peroxide / retinoid - 1st line = tetracycline e.g. lymecycline - 2nd line = erythromycin COCP + benzoyl peroxide / retinoid

Roaccutance side effects/warning

``` Very teratogenic - 2 contraceptives needed Dryness, pruritis Muscle aches Deranged LFTs ?low mood & suicidal ideation ```

Mechanism of roaccutane

synthetic form of vitamin A

Clinical features of Mongolian Blue spot

Blue/black macular discolouration at base of spine & on buttocks Afro-Carribbean or Asian

Appearance of erythema toxicum

``` Erythematous 2-3mm macules and papules Evolve into pustules Surrounded by blotchy area of erythema 'flea-bitten' Face, trunk & proximal extremities NOT palms/soles ```

Types of vascular malformations

Naevus flammeus = port wine stain Naevus simplex = salmon patch / stork bite / angel's kiss

Associations/conditions with Port wine stain:

Sturge-Weber syndrome Parkes Weber syndrome Kippel-Trenaunav syndrome Proteus syndrome

Ix needed for vascular malformation?

Clinical Dx 1st line = USS + MRI for Sturge Weber (identify intracranial lesions)

Risk factors for infantile haemangioma

LBW Premature Female Multiple gestation

Natural history / clinical course of infantile haemangioma

Develop few days/weeks after birth Last for 6-10 months Shrink EXCEPT: capillary haemangioma - present at birth

Features of superficial (infantile) haemagioma

Bright red area of skin Feels warm Upper eyelids, mid-forehead or nape of neck

Features of deep (infantile) haemangioma

Blue Forms lump Appears few weeks after birth

Important syndromes/conditions related to infantile haemagiomas?

Kasabach-Meritt - haemagioma + thrombocytopenia PHACES syndrome LUMBAR syndrome

Potential Ix for infantile haemagiomas

Clinical Dx USS MRI / MRA - gold standard for complex vascular tumours, done if: - deep - multiple - single large capillary haemagiona - near eye

Medical management of infantile haemagiomas

Topical or intra-lesional steroid Topical timolol - if small superficial near eyes, nappy area, lips, nasal tip, ear Oral propanolol - large lesions

When to refer an infantile haemagioma?

Threaten function - periocular, nasal tip, ear, lips, genitalia Large facial, anogenital or perineal Lumbosacral Ulcerating 'Beard' distribution - may have laryngeal haemangioma, need ENT Multiple lesions (>5) - need liver USS

Types of congenital haemagiomas

Rapidly involuting - RICH Non-involuting - NICH (Partially involuting) - PICH

Natural Hx of rapidly involuting congenital haemangioma (RICH)

Max size by birth | Involute by 12-18 months old

Natural HX of non-involuting congenital haemagiomas (NICH)

Continue to grow as baby grows | Do not shrink after birth

Presentation of a congenital haemangioma

Raised or flat Pink or purple + transient thrombocytopenia

Management for congenital haemangioma

Conservative Embolisation (if they need removal) - propanolol not effective

Potential complication of congenital haemangioma?

Heart failure - if large enough, can generate high blood flow

Causes of erythema nodosum

drugs (e.g. COCP, NSAIDs, sulphonamides) systemic (e.g. sarcoidosis, pregnancy, IBD) infectious (e.g. streptococcal infection, tuberculosis, and mycoplasma infection).