Rashes Flashcards
Define impetigo
Highly contagious superficial epidermal infection of skin by staphylococcal and streptococcal bacteria characterised by golden crusts
What is the key history of a impetigo case?
Infants and shool age children
Very contagious often spread from direct contact (e.g at nursey)
Erythematous macule that vesticulates or pustules becoming a superficial erosion with a golden crust.
What are the different classifications of impetigo?
Bullous - fluid filled - typically staph
Non-bullous - more common - staph or strep
Name the rash
Impetigo
How is impetigo diagnosed?
Typically clinical
May require a skin swab
What is the typical management of impetigo?
Local and non-bollous - topical hydrogen peroxide 1% cream
Widespread - topical fusidic acid or oral 5d amoxicillin
Bullous - oral antibiotics - 7d flucloxacillin
How long should children with impetigo be off school?
48hrs after starting treatment
Or until all lesions are healed
What is a key complication of impetigo to be aware of?
Cellulitis
Ecthyma
Septic arthirits
Sepsis
Scarring
Acute post-streptococcal glomerulonephritis
What is Henoch-Schonlein purpura?
Most common vasculitis in children between 3-15yrs
IgA small vessel leukocytoclastic vasculitis often post URTI
What are the key signs and symptoms of HSP?
Arthralgia/arthritis
Abdominal pain
Rash (palpable purpura across buttocks and extensor surfaces)
Renal disease -> asymptomatic microscopic haematuria or isolated proteinuria.
What are the key investigations for HSP?
Skin biopsies of lesion -> neutrophils and monocytes
Renal function tests and urinalysis -> assess renal impacts
What is the typical management for HSP?
Analgesia and supportive measures
Corticosteroids for symptoms control
Severe abdominal pain may require surgical review to assess for risk of intussusception or bowel infarcts
Renal to renal specialist if dialysis needed
What are the key complications of HSP?
Pulmonary or GI tract haemorrhage
Renal impairement leading to end stage renal disease
Neurological complication such as headache and seizures
Eye complications like keratitis or uveitis
What layer of the skin is affected in cellulitis?
Dermis and subcutaneous tissue
What is the most common pathogen causes cellulitis?
Group A Streptococcus - strep, pyrogenes
What is the typical management of cellulitis?
Antibiotics - oral or IV - penicillins - flucox
Analgesia
Elevation to reduce swelling
Wound debridement is necessary -> prevent necrosis or abscess formation
What is urticaria?
Hives - rapid pruritic (itchy), red raised wheels that vary in size and shape.
Typically resolve within 24hrs
Angio-oedema in severe cases.
Can be acute or chronic (>6w)
What are some common triggers for urticaria?
Allergens - foods, medications, insect stings
Physical stimuli - pressure, cold, heat
Infections - viral or bacterial
Autoimmune processes
Stress and emotional factors
Genetics - predisposition
What is the process underpinning urticaria?
Can be immune or non-immune - increased vascular permeability and wheal formation due to histamine etc release from mast cells and basophils.
What scoring system can be used in urticaria?
Urticaria Activity Score (UAS7) -? patient recoords severity of itching and number of weals for 7days
<7 indicates good disease
>28 indicates severe disease
What is the management for urticaria?
Identification and removal of triggers
First line - non-sedating anti-histamines - cetirizine, loratadine
If severe - short course oral prednisolone
Symptoma management - antipruritic creams - calamine lotion
Patient education and regular follow up
When should urticaria be referred to a dermatologist?
Pain and persistent
Not controlled by anti-histamines
Anio-oedema and no wheels not responding to treatment
Food or latex allergy
Chronic and difficult to manage - solar or cold
What is measels?
Highly contagious viral disease caused by paramyxovirus (measles morbillivirus) -> transmitted by droplets
What is the aetiology of the measles morbillivirus?
Single-stranded enveloped RNA virus.
Transmitted by respiratory droplets or direct contact with secretions
Incubation 7-21 days
Infectious from four days before to after the rash
What are the signs and symptoms of measles?
Prodromal symptoms for ten days after
high fever - above 40 degrees
Coryzal symptoms
Conjuncitivities
Koplik spots - small grey discolouration of the mucosal membranes
Rash - behind the ears then spread down the trunk to limbs over 3-4days
What investigations should be done for suspected measles?
Requires lab confirmation
Oral fluid - measles RNA and measles specific IgM and IgG.
Or serology or PCR
Note is a notifiable disease
What is the typical management of measles?
Supportive care - antipyretics and ensuring adequate fluid intake
Vitamin A administration - reduce risk of blindness
Remain off school at least 4 days after rash - avoid pregnancy women or immunosuppressed individuals.
What is the prevent strategy for measles?
Measles, Mumps and Rubella vaccine
Prophylatic immunoglobulin conact for high risk close contacts.
What are some potential complications of measles?
Acute otitis media
Bronchopneumonia
Encephalitis
Diarrhoea
Keratoconjunctivies and blindness
Increased opportunisitic infection for months following
Rare but important = sclerosing panencephalitis -> degenerative -> motor, behaviour and cognitive decline to death, occurring often 7yrs after infection
What is rubella?
German measles
Contagious viral illness - caused by rubella togavirus and transmitted by respiratory droplets.
What is the key epidemiology of rubella?
Rare in UK due to vaccination at 12M in MMR
Most vulnerable is pregnant women due to risk of congenital rubella syndrome
What are the key signs and symptoms of rubella?
Non-specific 2-3weeks after exposure
Prodrome low-grade fever, mild conjunctivitis and rhinorrhoea.
Erythematous rash on face down trunk lasting 3 days
Lymphadenopathy post auricular
Arthralgia
Asymptomatic in 50%
What is the key investigation for rubella?
Primarily confirmed with serological testing - rubella-specific IgM or IgG in acute and convalescent serum samples
PCR testing.
Notifiable disease
What is the key management of rubella?
Supportive majority improve within 1w
Paracetamol for joint pain and fever
Isolation - 5days after rash, avoid pregnant women
What are people considered immune to rubella?
Immunocompetent and received at least 2 doses of the MMR vaccine
What are the complications of rubella?
Rubella encephalopathy
Arthirits
Thrombocytopenia
Panencephalitis
What are the potential foetal abnormalities in congenital rubella syndrome?
Cataracts
Deafness
Patent ductus arteriosus
Brain damage
What is the key feature of chickenpox?
Pruritic vesicles
What is the key feature of parvovirus B19?
Slapped cheek appearance
Can lead to aplastic anaemia
What is an exanthem?
A widespread rash occuring alongside systemic symptoms of infection
