Revision lecture: child with a rash Flashcards
Impetigo
Very common
Superficial infection of staph aureus or b-haemolutic strep
2 forms: bullous or non-bulbous
Risk: poor hygiene + skin conditions
Non-billous
What more commonly causes bullous
Vesicles → honey crusted lesions
spreads rapidly
lymphadenopathy
staph aureus
Mgmt
Avoid itchy/touching
avoid towel sharing
Fusidic acid
Mupirocin
Flucloxacillin
Complications
rare
- cellulitis
- staph scalded skin syndrome
- scarlet fever
- post-strep glomerulnephrotos
- re-infetion of house hold contacts
HSP
IgA mediated
Often in winter period following URTI (90%)
Within 24 hrs becomes raised and purpuric
+ abdo pain (vasculitis - swelling of mesentery - risk of intussesption)
+ joint pain
+ diarrhoea, haematuria, scrotal pain
Mgmt
Self limiting
- High dose NSAIDs (not if renal involvement) +/- steroids (interusseption or renal involvement)
Complications
- renal involvement
- GI bleed
- pulmonary hypertension
- Intusseuception
Prognosis
Excellent - 25% have recurrent symptoms
Lots of urine dip - checking for significant proteinuria
Nappy rash differentials
Risk facors
- Contact dermatitis
- Candida
- superimposed Bacterial rash
immunodeficiency, irritant soaps, poor nappy hygiene, atopy, diarrhoea
Raised clear boarder - discrete satellite lesions
- through skin folds
Candida infection
Mgmt
Regular nappy changes (6-12 days)
Thorough cleaning with water
‘Naked’, nappy-free time
Barrier creams
Topical anti-fingals for candida infection - clotrimazole
Topical antibiotics for bacterial infection - fusidic acid
topical steroids: 0.5% hydrocortisone (severe)
D+V what worried about
- dehydration - do fluid challenge 50mls/kg over 4 hours and observe - look at gastroenteritis under 5’s
advise
50% of normal and wee 50% normal - little and often - if not eating a bit of sugar not too worried about food
- no bloody diarrhoea - no stool
Viral induced rash
from gastroenteritis - mostly caused by rotavirus (>50%)
If blood diarrhoea
Stool MC+S
FBC/UE/culture
Who gets Abx
Septicaemia, salmonella + C Diff
When to come back
Fluid < 50%
difficult to wake between sleeps
abnormal movements or seizures
Advice
Appropriate hand hygiene
oral rehydration
most get back to normal 5-7 days
Sticky eye
cleaning with sterile water 4-5 days for 24 hrs if not improve than swab it and start chloramphenicol
- check notes for pregnancy if they had STI
EBV
itchy macropapular rash in teens → antibiotics - co presents with tonsilitius
Scabies
Permethrin or malathion - wash everything
oral candidiasis
Oral antifungal - nystatin - keep breast feeding
Chickenpox
Support
avoid pregnant women
paracetamol
contagious until all vesicles scab over
Molloscum contagiosum
contagious don’t need to do anything
