Skin

Question 1

How does eczema herpeticum present

Answer 1

deterioration of eczema
pain
lethargy
systemic upset

Question 2

what would you expect to see in eczema herpeticum

Answer 2

• most common involvement is the limbs

- vesicular rash often with crusting and punched out lesions that coalesce

Question 3

how do you confirm diagnosis of eczema herpeticum

Answer 3

• viral swab in first 48 hours of vesicles
• serum viral pcr is better but costly so not done
• a bacterial swab for staph aureus should also be done

Question 4

What is the management of eczema herpeticum

Answer 4

• Oral (IV if systemic upset) aciclovir for 5 days- don’t await swab
• dermatology opinion
• opthalmology opinion

Question 5

When should you get an opthalmology opinion in eczema herpeticum

Answer 5

If peri-orbital involvemnt

Question 6

What is the atopic march

Answer 6

• eczema
• allergic rhinitis
• asthma
• food allergy

Question 7

Why does eczema occur

Answer 7

Fillagrin is an epidermal protein that plays a vital role in skin barrier function. Mutations of this protein lead to a deficiency of fillagrin leading to development of atopic dermatitis

Question 8

how do you diagnose atopic dermatitis

Answer 8

• Hx of ill defined, dry erythematous patches
• commonly flexure areas although non-flexure areas are affected in the young
• FH of atopy.

Question 9

What is he management of eczema

Answer 9

• emollients
• topical steroids
• topical calcineurin inhibitorss
• wet/dry bandage applications with topical treatment

Question 10

how should emollients be used

Answer 10

• un-perfumed, used on a daily basis for washing/moisturising.
• Should use 250mg-500mgs weekly
• Available at home, nursery and schools.

Question 11

What is the role of emmolients

Answer 11

• provides an effective barrier to the skin
• decreases moisture loss
• protects against irritants

Question 12

How do you use topical steroids in eczema

Answer 12

• applied to active areas of eczema to induce remission

- Used BD for 5-7 days then reduce frequency/potency

Question 13

Local side effects of steroid cream

Answer 13

• telangiectasia on cheeks
• striae
• thinning of skin

All of these generally avoided if the correct strength is used

Question 14

Which topical steroid should you use for mild eczema and eczema on face

Answer 14

hydrocortisone

Question 15

Which topical steroid should you use for moderate eczema

Answer 15

Clobetasone butyrate 0.05%

Question 16

Which topical steroid should you use for severe eczema

Answer 16

betametasone 0.1%

Question 17

What is a topical calcineurin inhibitors

Answer 17

• third line
• tacrolimus or pimecrolimus
• need to be 2years or older

Question 18

What features of eczema can impact QoL

Answer 18

• itching/scratching and sleep deprivation can impair functioning
• regular applications of topical medications is time consuming

Question 19

Which bacteria causes impetigo

Answer 19

Staphylococcus aureus or Streptococcus pyogenes

Question 20

What are the clinical findings of non-bullous impetigo

Answer 20

• tiny pustules or vesicles that evolve rapidly into honey-coloured crusted plaques
• under 2 cm in diameter
• usually start on the face
• little or no surrounding erythema or oedema
• regional lymph nodes are often enlarged

Question 21

What is Ecthyma

Answer 21

• non-bullous impetigo but ulcerates and becomes necrotic.

- deeper and may occur with lymphadenitis

Question 22

What are the clinical findings of bullous impetigo

Answer 22

• Thin roof that rupture spotaneously
• on the face, trunk, extremities, buttocks, or perineal region
• more common if underlying disease e.g. atopic eczema
• associated with pain and malaise
• most commonly in neonates

Question 23

how long should children with impetigo stay of school

Answer 23

• until lesions are all dry and scabbed over,

- antibiotics for 48 hours

Question 24

What is the management of impetigo

Answer 24

• topical fusidic acid TDS for 7 days

- Mupirocin if MRSA positive.

Question 25

What is the management of impetigo

Answer 25

• topical fusidic acid TDS for 7 days
• Mupirocin if MRSA positive.
• 7 days oral fluclox if systemic upset (clari/erythro if pen allergic)