Revision lecture: child with a rash

Question 1

Impetigo

Answer 1

Very common
Superficial infection of staph aureus or b-haemolutic strep
2 forms: bullous or non-bulbous

Risk: poor hygiene + skin conditions

Question 2

Non-billous

What more commonly causes bullous

Answer 2

Vesicles → honey crusted lesions
spreads rapidly
lymphadenopathy

staph aureus

Question 3

Mgmt

Answer 3

Avoid itchy/touching
avoid towel sharing

Fusidic acid
Mupirocin

Flucloxacillin

Question 4

Complications

Answer 4

rare

• cellulitis
• staph scalded skin syndrome
• scarlet fever
• post-strep glomerulnephrotos
• re-infetion of house hold contacts

Question 5

HSP

Answer 5

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

Question 6

Mgmt

Answer 6

Self limiting

- High dose NSAIDs (not if renal involvement) +/- steroids (interusseption or renal involvement)

Question 7

Complications

Answer 7

• renal involvement
• GI bleed
• pulmonary hypertension
• Intusseuception

Question 8

Prognosis

Answer 8

Excellent - 25% have recurrent symptoms

Lots of urine dip - checking for significant proteinuria

Question 9

Nappy rash differentials

Risk facors

Answer 9

• Contact dermatitis
• Candida
• superimposed Bacterial rash

immunodeficiency, irritant soaps, poor nappy hygiene, atopy, diarrhoea

Question 10

Raised clear boarder - discrete satellite lesions

- through skin folds

Answer 10

Candida infection

Question 11

Mgmt

Answer 11

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)

Question 12

D+V what worried about

Answer 12

• 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

Question 13

Viral induced rash

Answer 13

from gastroenteritis - mostly caused by rotavirus (>50%)

Question 14

If blood diarrhoea

Answer 14

Stool MC+S

FBC/UE/culture

Question 15

Who gets Abx

Answer 15

Septicaemia, salmonella + C Diff

Question 16

When to come back

Answer 16

Fluid < 50%
difficult to wake between sleeps
abnormal movements or seizures

Question 17

Advice

Answer 17

Appropriate hand hygiene
oral rehydration
most get back to normal 5-7 days

Question 18

Sticky eye

Answer 18

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

Question 19

EBV

Answer 19

itchy macropapular rash in teens → antibiotics - co presents with tonsilitius

Question 20

Scabies

Answer 20

Permethrin or malathion - wash everything

Question 21

oral candidiasis

Answer 21

Oral antifungal - nystatin - keep breast feeding

Question 22

Chickenpox

Answer 22

Support
avoid pregnant women
paracetamol
contagious until all vesicles scab over

Question 23

Molloscum contagiosum

Answer 23

contagious don’t need to do anything