skin Flashcards
allergy risk factors?
personal and fh of atopic disease (asthma, eczema, allergic rhinitis) or food allergy
food allergy related symptoms?
skin: pruritus, erythema, acute urticaria, angioedema GI: nausea, colic, vomiting, diarrhoea URT: rhinorrhoea, sneezing, congestion, nasal itching
diagnosis of allergy?
skin prick test RAST for specific IgE Ab ideally: elimination diet (then reintroduction in small amt) referral to allergy specialist
cows milk protein allergy tx?
food avoidance advice + hydrolysed milk formula
treatment of mild eczema?
emollients! replace shower soap w dermol non soap substitute. mild potency topical steroids (e.g. hydrocortisone 1%)
treatment of moderate eczema?
emollients non-soap based substitute Dermol mild / moderate potency topical steroids (EUMOVATE/ BETNOVATE) topical calcineurin inhibitors bandages and dressings
tx of severe eczema?
emollients non soap based substitute potent topical steroids e.g. Dermovate topical calcineurin inhibitors bandages and dressings phototherapy systemic therapy
what are vulnerable sites for steroid use?
face and neck - never use potent topical steroids vulnerable sites e.g. axillae / groin - only use for short periods if v bad
Tacrolimus - what is this? and used for?
Topical calcineurin inhibitor can be considered in moderate to severe eczema not controlled by steroids in those above 2 yrs
Tx for eczema with superimposed Staph aureus bacterial infection
flucloxacillin if pen allergic: clari or erythromycin
if suspected eczema herpeticum- tx?
adjunctive oral acyclovir refer immediately for dermatology
complications of eczema
secondary bacterial infection e.g. staph/ strep viral infection - HSV - eczema herpeticum
FUNDSHIT
Frequency Urgency Nocturia Dysuria Stream- poor Haematuria Incontinence Terminal dribbling
what is otitis media with effusion?
collection of fluid in middle ear space without signs of acute inflammation
complications of otitis media w effusion?
significant (conductive) hearing loss, especially if bilateral and lasts for >1 month chronic damage to tympanic membranes speech and lang development affected balance problems
risk factors for otitis media w effusion?
adenoidal infection/ hypertrophy triggered by cold/ sore throat/ viral or bacterial infection cleft palate downs primary ciliary dyskinesia allergic rhinitis
otitis media w effusion ix?
otoscopy assess for hearing loss refer for ENT / audiometry/ tympanometry where appropriate
what does tympanometry assess?
ability of eardrum to react to sound
what does audiometry assess?
level of hearing loss
who do we screen every 3-6 months for otitis media w effusion?
down’s cleft palate
otitis barotrauma
recently travelled by aeroplane, been scuba diving, or received a blow to the ear
otitis externa
Mainly pain or itching, and inflammatory changes in the ear canal or surrounding skin
ddx of hearing loss?
foreign body in canal impacted ear wax perforated eardrum otitis media w effusion sensorineural
What signs may you see on otoscopy for otitis media w effusion
middle ear effusion impaired drum mobility hearing loss
What signs may you see on otoscopy for acute otitis media ?
earache, fever middle ear effusion opaque drum bulging drum impaired drum mobility hearing loss
otitis media w effusion first line mx?
active observation for 3 months spontaneous resolution common should have 2 hearing tests using audiometry + tympanometry after 3 months, refer to ENT
otitis media w effusion conservative or surgical options?
conservative- hearing aids, autoinflation to ventilate middle ear and equilibrate pressure surgery- insertion of grommets
erythema multiforme
target lesions may also be vesicular or bullous
causes of erythema multiform?
HSV most common mycoplasma pneumoniae other infections drugs - NSAIDs, sulphonamides, penicillin
Steven Johnson syndrome
severe form of erythema multiforme w mucosal bullae of mouth, conjunctiva and anogenital region
mx of Steven Johnsons?
tx cause + steroids
cause of Steven johnsons?
most common HSV
tx of acne vulgaris?
benzoyl peroxide severe- oral abx w tetracyclines (for >12 yo) or erythromycin Oral retinoid isotretinoin (aka Accutane)
itching of scalp and nape w live lice on hairs ?>
head lice infestation pediculosis capitis
tx of head lice?
0.5% malathion to hair and leave overnight + shampoo and remove lice and nits w fine-tooth comb or permethrin as cream rinse or wet combing to remove live lice every 3-4 days for >2 wks
molluscum contagiosum cause?
poxvirus
skin coloured pearly papules w central umbilication
molluscum contagiosum
tx of molluscum contagiosum?
nothing or topical abx to prevent or treat secondary bacterial infection or cryotherapy in older children to hasten disappearance of more chronic lesions
UV woods light may show bright green/ yellow fluorescence of infected hairs
Tinea capitis (scalp ringworm)
tinea capitis mx?
topical anti fungal or systemic if severe
nappy rash - candidal infection presentation?
erythematous, involves skin flexures and may have satellite lesions
candidal nappy rash tx
antifungal therapy
contact dermatitis nappy rash mx?
emollients, if severe- topical steroids hygiene
chronic tic disorder with multiple vocal and motor tics
gilles de la tourettes
eczema herpeticum
caused by HSV infection of eczematous skin. infection spreads along the skin and haematogenously. lesions disseminate rapidly and may cause life threatening infection. can also affect the conjunctiva and cornea and can cause keratitis, that if left untreated, leads to blindness.
Eczema herpeticum with superadded bacterial infection mx
IV antibiotics (e.g. co-amoxiclav) and IV aciclovir. Monitor hydration carefully. Analgesics, antipyretics, antihistamines should be prescribed. Discontinue the topical tx w steroids and other immunosuppressants now and restarted 1 wk after pt has improved. Urgent opthalmic opinion should be sought if any concern about possible eye involvement
flaccid fragile blisters on infant - history of eczema and atopy in the family
bullous impetigo - localized presentation of staphylococcal scalded skin syndrome. caused by staph aureus. (can also be caused by group A strep)
blistering in the neonatal period ddx
bullous impetigo. epidermolyis bullosa - e.g. pemphigus vulgaris, pemphigoid
treatment of bullous impetigo
co-amoxiclav.
mx of staphyloccocal scalded skin syndrome
parenteral abx. careful monitoring as they are at risk of heat and fluid losses. + pain relief.
granuloma of umbilical lesion
umbilical cord usually dries and separates within 6-8 days after birth and the surface epithelializes. Where this is incomplete/ mild infection present, granulation tissue can develop and persist. A granuloma is not painful. Mx: cauterization using silver nitrate stick, repeated once a week til lesion has resolved.
nappy rash with satellite lesions
candida infection. confluent zones of papules and pustules involving the skin creases.
nappy rash with marked redness with exudate, vesicular and pustular lesions
bacterial infection. take skin swab.
factors which predispose child to nappy rash
lack of hygiene (how often is area cleaned/ nappy changed). type of nappy used- disposable/ reusable cotton nappies. Exposure to irritants- soap/ detergents. trauma- e.g. friction from nappies/ overvigorous cleaning. recent abx use- predisposes to candida colonization.
nappy rash with satellite lesions (candida) mx
topical imidazole cream (clotrimozole/ econazole/ miconazole). + skin care advice + if child > 1month old and inflammation is causing discomfort, consider applying topical hydrocortisone once daily in addition.
nappy rash with flexural sparing
nappy dermatitis (irritant dermatitis)
nappy rash mx if causing child discomfort
barrier protection at each nappy change to protect skin: Zinc and Castor Oil ointment. + if child > 1 month, consider topical hydrocortisone for max of 7 days. + skin care advice.
nappy rash mx if causing no discomfort
advise on skin care. Prescribe barrier preparation to apply thinly at each nappy change: - Zinc and Castor oil ointment or Metanium ointment. Or white soft paraffin ointment/ dexpanthenol 5% ointment.
Nappy rash mx if bacterial infection confirmed/ suspected.
oral flucloxacillin for 7 days. + prescribe barrier prep (e.g. zinc ointment) + skin care advice + topical hydrocortisone if causing child discomfort.
1st line tx of scabies in child > 2 months old
permethrin 5% cream
tx of impetigo localized infection
topical fusidic acid (3-4 x daily for 7 days)
tx of impetigo extensive infection. (severe infection/ areas where it is impractical to use topical drugs)
oral flucloxacillin 1st line. oral clarithro/ erythromycin if pen allergic
tx of bullous impetigo
oral flucloxacillin. or erythro if pen allergic
what is this
salmon patch/ stork bite
commonly on eyelids/ glabella (middle of forehead) and nuchal area
common finding in neonates
flat pink/ salmon colored lesion
disappears w age
what is this
bright red strawberry haemangioma
small arterio-venous malformation
tend to grow rapidly during first yr of life but tx not necessary as they regress spontaneously after 1st year (usually nothing by 7 yrs)
treat any that interfere with vision/ feeding etc
what is this
port wine stain
assoc w neurological disorder if within trigeminal distribution - sturge weber.
most are permanent and deepen over time
what is this
mongolian blue spot
commonly seen in darker skinned people over lower back/ buttocks
may last for months/ yrs but usually disappear by age 4
commonly mistaken for a bruise
what is best diagnostic investigation for Biliary atresia?
radionucleotide scan of hepatobiliary tract
aka
cholescintigraphy
or
hepatobiliary scan
replacement of fluid deficit in dehydration
24h
what supplement for breastfeeding women?
Vitamin D
recurrent fractures + discolouration of sclera
osteogenesis imperfecta
blue sclera, bowing of the limbs.
what complication is most common in an immunocompromised child who develops chickenpox
pneumonitis
