Skin 2- child health Flashcards
What causes warts?
Human papillomavirus
Commonly in children and on fingers and soles of feet (verrucae)
How are warts treated?
They can be difficult to treat- but daily application of a proprietary salicylic acid and lactic acid paint or glutaraldehyde (10%) lotion can be used
Cryotherapy with liquid nitrogen is effective treatment but can be painful and often needs repeated application- its use should be reserved for older children
What are the treatments for acne?
Topical treatment is directed at encouraging the skin to peel using a keratolytic agent such as (benzoyl peroxide), applied once or twice daily after washing
Sunshine, in moderation
For more severe acne, oral antibiotic therapy with tetracyclines-only when over 12 years old, because they may discolour the teeth in younger children or erythromycin is indicated
oral retinoid isotretinoin is reserved for severe acne in teenagers unresponsive to other treatments
How does a candida infection present?
Causes and complicates napkin rashes
Erythematous, includes the skin flexures and there may be satellite lesions
Treatment is with a topical antifungal agent
What causes a rash fo erythema multiforme?
Herpes simplex infection Mycoplasma pneumoniae infection Other infections Drug reaction Idiopathic (target lesions with a central papule surrounded by an erythematous ring
What causes the rash of erythema nodosum?
Streptococcal infection Primary tuberculosis Inflammatory bowel disease Drug reaction Idiopathic
What are the common fungal infections?
Ringworm- dermatophyte fungi invade dead keratinous structures such as the horny layer of skin, nails and hair
Scalp ringworm- tinnea capitis, sometimes acquired from cats and dogs, scaling and patchy alopecia with broken hairs
How are fungal infections diagnosed?
Examination under filtered ultraviolet (Wood’s) light may show bright greenish/yellow fluorescence of the
infected hairs with some fungal species
Rapid diagnosis can be made by microscopic examination of skin scrapings for fungal hyphae -definitive identification of the fungus is by culture
What is the management for fungal infections?
Treatment of mild infections is with topical antifungal preparations, but more severe infections require systemic antifungal treatment for several weeks, any animal source of infection also needs to be treated
How does pediculosis capitis (headlice) present?
Presentation may be itching of the scalp and nape or from identifying live lice on the scalp or nits (empty egg cases) on hairs-louse eggs are cemented to hair close to the scalp and the nits (small whitish oval capsules) remain attached to the hair shaft as the hair grows
Secondary bacterial infection on nape of neck, misdiagnosis of impetigo
Sub-occipital lymphadenopathy is common
What is the treatment for pediculosis capitis?
Solution of 0.5% malathion to the hair and leaving it on overnight-the hair is then shampooed and the lice and nits removed with a fine- tooth comb
Treatment should be repeated a week later
Permethrin (1%) as a cream rinse would be an alternative application-it is left on for 10 min only
Wet combing to remove live lice (bug-busting), every 3–4 days for at least 2 weeks is a useful and safe physical treatment particularly when parents treat with enthusiasm
How does a psoriatic lesion present?
This familial disorder rarely presents before the age of 2 years
The guttate type is common in children and often follows a streptococcal or viral sore throat or ear infection
Lesions are small, raindrop-like, round or oval erythematous scaly patches on the trunk and upper limbs, and an attack usually resolves over 3–4 months, most get a recurrence of psoriasis within the next 3– 5 years
Chronic psoriasis with plaques or annular lesions is less common, fine pitting of the nails may be seen in chronic disease but is unusual in children
What is the management for psoriasis?
Treatment for guttate psoriasis is with bland ointments-coal tar preparations are useful for plaque psoriasis and scalp involvement- dithranol preparations are very effective in resistant plaque psoriasis- calcipotriol, a vitamin D analogue, which does not stain the skin, can also be useful for plaque psoriasis in those over 6 years old
Can develop psoriatic arthritis
How does scabies (sarcoptes scabei) present?
Burrows down the epidermis along the stratum corneum
Severe itching occurs 2–6 weeks after infestation and is worse in warm conditions and at night
In older children, burrows, papules and vesicles involve the skin between the fingers and toes, axillae, flexor aspects of the wrists, belt line and around the nipples, penis and buttocks
In infants and young children, the distribution often includes the palms, soles and trunk
How is scabies diagnosed?
Clinical grounds with the history of itching and characteristic lesions, although burrows are considered pathognomonic they may be hard to identify because of secondary infection due to scratching
Itching in other family members is a helpful clinical indicator
Confirmation can be made by microscopic examination of skin scrapings from the lesions to identify mite, eggs and mite faeces
