Pediatric Dermatology - Block 4 Flashcards
What are the layers of the skin?
Epidermis: stratum basale, spinosum, granulosum, corneum
Dermis: connective tissue layer containing sweat glands, sebaceous glands, hair, nails, nerves, blood vessels
Subcutis: fatty layer
Human skin is normally ____?
Acidic which becomes a natural antimicrobial
Functions of the epidermis?
Keratinocytes, corneocytes and melanocytes:
1. Keep water and vital fluids in
2. Keeps foreign elements out
3. Vit D production and absorption
Function of the dermis?
Provides resilency
Functions of sebaceuous glands?
Produce sebum for supple skin
Functions of the subcutis?
Body temp reg and protects bones and muscles
Factors examined during a skin exam?
- Lesions
- Moles
- Freckles
What is diaper dematitis?
Affects the buttocks, genital, and perineum regions leading to Erythematous that may have vesicles or oozing
Secondary infection: Candida-induced plaques, paupules, and pustules, and macerations in inguinal folds
How do you manage diaper rashes?
- Frequent diaper changes
- Air drying
- Gentle clensing
- Topicals
What are the topicals used for diaper rash?
- Barriers
- Topical antifungal
- Topical CS
Barriers and its indication as a diaper rash topical?
Zinc oxide: ultra high potency containing astringent and absorbents
Petrolatum: Water impermeable layer but traps water
Antifungal and its indication as a diaper rash topical?
Imidazoles (clotrimazole, metronidazole): Cover with a barrier product
Only for secondary infection
A red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions
Allergic contact eczema (dermatitis)
A chronic skin disease characterized by itchy, inflamed skin.
Atopic dermatitis
A localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy-causing substance) or with an irritant such as an acid, cleaning agent, or other chemical.
Contact eczema (dermatitis)
Irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn.
Dyshidrotic eczema
Scaly patches of the skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) that become intensely irritated when scratched.
Dyshidrotic eczema
Yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body.
Seborrheic eczema
A skin irritation on the lower legs, generally related to circulatory problems
Stasis dermatitis
Coin-shaped patches of irritated skin (arms, back, buttocks, lower legs) that may be crusted, scalling, and itchy
Nummular eczema
What is the atopic triad?
Atopic dermatitis (1st to occur)
Allergic rhinitis
Asthma
What are the RF of AD?
- Urban environment
- Higher sociaoeconomic status
- High family ed
- Family hx
- Female (after 6)
- Smaller family size
- Functional mutations in the FLG gene
What are the predisposing factors that put a child at risk for developing AD?
- Climate
- Infection
- Genetics
- Environmental aeroallergens
- Urban versus rural living
- Breastfeeding and weaning
- Obesity
- Pollution/tobacco smoke
- Food/diet
What is the cause of AD?
Neuropeptides, irritation, or pruritis-induced scratching -> proinflammatory cytokines from keratinocytes
* T-cell mediated but IgE-independent reactions
* Skin barrier dysfunction and immune deviation
* Reduced antimicrobial peptides (AMPs)
How do we diagnose AD?
Earliest onset of AD usually occurs between 3 and 6 months of age or before 5YO
* Presentation will vary with age
Clincial diagnosis: atopy, pruritus, eczema, altered vascular
Required sx for AD diagnosis?
Uncontrollable itching that causes irritability, sleep disruptions, and excoriation
AD presentations during infancy?
Facial eruptions that progress to red, scaling, oozing:
* Nose is spared (headlight sign)
* Eybrows are thin or absent (Herthoge’s sign)
* Lesions on flexor surfaces
AD presentations in toddlers?
Extension of lesions to the lower legs, then to the entire body
* exclusion of the groin, axillary, and nose
AD presentations throughout childhood?
Dry, flakey, rough, cracked:
* Bleeding or lichenifications
* Increased folds under eyes (Dennie-Morgan folds)
AD presentations in adults?
Lesions with underlying erythema: brown macular ring around neck
What are the triggers for pruritus?
- Heat and sweating
- Wool
- Stress
- Foods
- ALcohol
- Upper respiratory infection
- DUst mites
What is allokinesis?
Sensation where stimulus hause itching but normally doesn’t evoke itching
Scoring tools for AD?
SCORAD (Scoring of Atopic Dermatitis): score >50 = severe AD, and <25 = mild AD
Patient-Oriented SCORAD (PO-SCORAD)
EASI (Eczema Area and Severity Score) - subjective
POEM (Patient-Oriented Eczema Measures) - Objective
What are the complications associated with AD?
- Sleep dysfunction
- Secondary infection from Staph or Strep
- Disseminated infection with herpes simplex or vaccinia virus
Smallpox vaccine (live) is CI
What are treatment goals for AD?
- Symptomatic relief
- Control
- Eliminate tirggers
- Prevent future exacerbations
- Support
- Minimize ADRs
- Treat secondary infection if present
Non Phar for AD?
- Moisturize (apply after bathing)
- Lukewarm bath
- Non soap cleanser
- Wet wrap
- Keep fingernails short
- SOft cotton clothes
- Sedating antihistamine for scratching at night
- Keep cool
- Treat promptly
- Attempt to distract the child with activities
- Identify and remove irritants
What are the types of moisturizers used?
- Occlusives
- Humectants (not recommended in AD)
- Emollients
Function of occlusives?
Provides an oily layer on the skin to slow transepidermal water loss -> increasing moisture content of the stratum corneum
FUnction of humectants?
Increase water holding capacity