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Paeds > Skin and allergy > Flashcards

Skin and allergy Flashcards

1
Q

Which surfaces does eczema appear on usually?

A

Flexor surfaces and face and neck

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2
Q

What are periods of uncontrolled eczema called?

A

Flares

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3
Q

Give a brief overview pathophysiology of eczema

A

Break in skin barrier -> entrance for irritants, microbes and allergens -> immune response -> inflammation and other symptoms

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4
Q

What are management ideas for mild eczema?

A 
Emollients
Soap substitutes
Avoid activities breaking down skin barrier
Destress
Avoid irritants
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5
Q

How do you manage eczema flares?

A

Topical steroids
Thicker emollients
“Wet wraps”

Treat complications

(rare) - IV abx or oral steroids for severe flares
(specialist) zinc bandanges, topical tacrolimus, phototherapy, immunosuppressants (methotrexate, aziathoprine)

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6
Q

Side effects of steroid use in eczema?

A

Thinning of skin
Telangiectasia
Systemic absorption of steroid

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7
Q

Most common bacterial infection in eczema?

How to treat?

A

Staph aureus

Oral flucloxacillin

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8
Q

Eczema herpeticum is caused by which virus(es)?

A

HSV-1 or VZV

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9
Q

Give a typical presentation of eczema herpeticum

A

Widespread, painful, vesicular rash

Systemic symptoms - fever, lethargy, irritability, reduced oral intake

Swollen lymph nodes

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10
Q

How do you confirm a diagnosis of eczema herpeticum?

A

Viral swabs of the vesicles

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11
Q

Gold standard drug to treat eczema herpeticum

A

Oral aciclovir

Severe = IV aciclovir

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12
Q

In which group of children is eczema herpeticum more dangerous?

A

Immunocompromised children

Can get bacterial superinfection (more severe illess) which needs abx

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13
Q

What is the hallmark pathology of Stevens-Johnson Syndrome?

A

Epidermal necrosis

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14
Q

Main difference between Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis?

A

SJS affects <10% of body surface area, TEN affects >10%

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15
Q

Give medication causes of Stevens-Johnson Syndrome

A

Anti-epileptics
Antibiotics
Allopurinol
NSAIDs

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16
Q

Give infection causes of Stevens-Johnson Syndrome

A

Herpes simplex
Mycoplasma pneumonia
CMV
HIV

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17
Q

What is a common presentation of Stevens-Johnson Syndrome?

A

Non-specific symptoms (cough, fever, sore mouth/eyes/skin)

Followed by purple/red rash

Followed by blistering of skin, peeling away - leaving raw tissue underneath

Lips and mucus membranes, eyes inflamed and ulcerated

Also affects urinary tract, lungs and internal organs

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18
Q

What management is appropriate for Stevens-Johnson Syndrome?

a) admit where?
b) conservative care
c) what drugs?

A

a) Admit to derm/burns unit
b) Supportive care - nutrition, antiseptics, analgesia, opthalmology.
c) Tx: steroids, immunoglobulins and immunosuppressants

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19
Q

Give 3 complications of Stevens-Johnson Syndrome

A

Secondary infection

Permanent skin damage

Visual complications

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20
Q

What hypersensitivity type is allergic rhinitis?

A

IgE-mediated Type 1 hypersensitivity

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21
Q

Allergic rhinitis can occur at different times of the year: on a ______ level, a _______, level and also be associated with _______ (e.g. work/school)

A

Seasonal
Perennial
Occupational

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22
Q

Runny, blocked and itchy nose, sneezing and itching, red swollen eyes is associated with?

A

Allergic rhinitis

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23
Q

Investigations for allergic rhinitis?

A

History

Skin prick testing (? allergies)

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24
Q

Management of allergic rhinitis

a) conservative
b) pharmacological

A

a) Avoid trigger
b) Oral antihistamines - non-sedating (cetirizine) and sedating (chlorphenamine)

Nasal corticosteroids sprays (fluticasone)

Nasal antihistamines

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25
Q

What is another name for urticaria?

What is urticaria?

A

Hives

Small itchy lumps on skin

Sometimes patchy, red rashes on skin

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26
Q

What chemical is responsible for urticaria and which cells release it?

A

Histamine - released by mast cells

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27
Q

How do acute urticaria and chronic idiopathic urticaria differ in terms of pathology?

A

Acute - allergic reaction

Chronic - autoimmune reaction

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28
Q

What are potential causes of acute urticaria?

A 
Allergies to food, meds, pets
Chemicals, latex contact
Medications
Viral infections
Insect bites
Dermatographism (skin rubbing)
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29
Q

What triggers can happen with chronic urticaria?

A 
Sunlight
Temp change
Exercise
Strong emotions
Hot/cold weather
Pressure

Autoimmune - SLE

30
Q

What is the gold standard treatment for urticaria?

A

Antihistamines - Fexofenadine

Short course of oral steroids only for severe flares

(Specialist) - Anti-leukotrienes (montelukast), Omalizumab (anti-IgE), Cyclosporin

31
Q

What type of hypersensitivity reaction is anaphylaxis?

A

Type 1 IgE mediated

32
Q

What key feature separates anaphylaxis from non-anaphylactic allergic reaction?

A

Compromised A B C

33
Q

What acute symptoms can appear with anaphylaxis?

A 
Urticaria
Itching
Angiooedema (swelling lips/eyes)
Abdo pain
SOB
Wheeze
Stridor (larynx is swollen)
Tachycardia
Lightheaded
Collapse
34
Q

What is the ABCDE management approach to anaphylaxis?

A

A – Airway: Secure the airway
B – Breathing: Provide oxygen if required. Salbutamol can help with wheezing.
C – Circulation: Provide an IV bolus of fluids
D – Disability: Lie the patient flat to improve cerebral perfusion
E – Exposure: Look for flushing, urticaria and angio-oedema

35
Q

What are the 3 medications given to anaphylactic patients?

A
  1. IM adrenaline (repeat after 5mins as needed)
  2. Antihistamines (cetirizine)
  3. Steroids (IV hydrocortisone)
36
Q

What can happen after the initial anaphylaxis?

A

Rebound anaphylaxis

37
Q

What gold standard lab test can confirm anaphylaxis within 6 hours of the event?

A

Serum mast cell tryptase

38
Q

What is crusted dry flaky scalp on infants caused by?

A

Seborrhoeic dermatitis due to Malassezia yeast

39
Q

What drug can be used to treat seborrhoeic dermatitis?

A

Antifugals e.g. ketoconazole shampoo or miconazole cream

Localised areas can be treated with topical steroids (hydrocortisone)

40
Q

List the 5 ringworm pathologies

A 
Tinea capitis
Tinea corporis
Tinea cruris
Tinea pedis
Oncychomycosis (nail)
41
Q

What is the most common type of fungus that causes ringworm?

A

Trichophyton

42
Q

What is the risk of fungal toenail infections?

A

Infection can spread to the skin

43
Q

Treatment for ringworm

A

Antifungals - creams/shampoos, oral anti-fungals

Conservative treatment such as loose clothing, good hygiene

44
Q

Clinical features of ringworm infection

A

Itchy rash that is:

Erythematous, scaly and well-demarcated

45
Q

What is nappy rash caused by?

A

Contact dermatitis due to friction between skin and nappy +/- urine/faeces

Sometimes staph/strep/candida can complicate

46
Q

Give some risk factors for nappy rash

A 
Delayed nappy changing
Irritant soaps
Vigorous cleaning
Poorly absorbent nappies
Diarrhoea
Pre-term infants
47
Q

How do candida and nappy rash differ?

A 
Candida rash extends into skin creases
Larger red macules
Well-demarcated scaly border
Circular pattern to rash, going outwards
Satellite lesions
Oral thrush (white tongue coating)
48
Q

How can nappy rash be managed?

A 
Switch to high absorbing nappies
Change nappy often and clean skin
Water/alcohol-free cleaning
Dry nappy area before replacing
Maximise time free of wearing nappy

Treat complications - e.g. antifungal miconazole for candida or antibiotic flucloxacillin for staph

49
Q

What organism causes scabies?

A

Mites

50
Q

What is the classic location of scabies rash?

A

Between finger webs

51
Q

What does scabies rash look like?

A

Little red, itchy spots on skin

52
Q

What is the gold standard treatment for scabies?

A

Permethrin cream

(if difficult to treat, use oral ivermectin single dose)

Treat all household members even if asymptomatic

Wash and hoover and clean all clothes

53
Q

What is Norweigian scabies?

A

Crusted scabies - occurs in immunocompromised patients

Admit for treatment with oral ivermectin and isolated nursing!! (highly contagious!)

54
Q

Treatment of choice for headlice?

A

Dimeticone 4% lotion applied to hair

Fine combs

(Bug buster kit)

55
Q

Give differential diagnoses for NON-BLANCHING rashes (8 total)

A
  1. Bacterial sepsis
  2. HSP
  3. ITP
  4. Acute leukaemia
  5. HUS
  6. Mechanical
  7. Traumatic
  8. Viral illness
56
Q

Investigations for NON-BLANCHING RASHES

A

FBC (HUS/Leukaemia/ITP/Sepsis)

U&Es (HUS/HSP)

CRP

ESR (HSP/infection)

Coag screen (clotting abnormalities)

Blood culture (sepsis)

Meningococcal PCR

LP (meningitis/encephalitis)

BP check (HSP, HUS. HypoTN in septic shock)

Urine dipstick (proteinuria/haematuria with HSP or HUS)

57
Q

What 2 chronic conditions can erythema nodosum indicate?

A

IBD

Sarcoidosis

58
Q

What conditions can erythema nodosum be caused by usually?

A 
Strep throat infections
Gastroenteritis
Mycoplasma pneumonia
TB
Pregnancy
Meds (OCP and NSAIDs)
59
Q

Which investigations to carry out for erythema nodosum and find the underlying cause?

A

ESR/CRP
Throat swab (?strep)
CXR (mycoplasma, TB, sarcoidosis, lymphoma)
Stool MC&S (campylobacter, salmonella)
Faecal calprotectin (IBD)

60
Q

How is erythema nodosum managed?

A

Conservatively - rest and analgesia

Steroids for inflammation if needed

Self-resolving in 6 weeks usually

61
Q

What is a typical presentation of erythema nodosum?

A

Red, inflammed subcut nodules on both shins

Painful, tender

Bruises can appear too later over nodules

62
Q

What causes Staphylococcal Scalded Skin Syndrome?

A

S. aureus producing epidermolytic toxins

63
Q

What age is Staphylococcal Scalded Skin Syndrome most common in?

A

Children under 5 years

older children usually have developed immunity to it

64
Q

What is Nikolsky sign?

A

Positive sign seen in SSSS

Gentle rubbing of skin causes it to rub away.

65
Q

What are important features of Staphylococcal Scalded Skin Syndrome?

A

Erythema –> Bullae blisters –> Burst —> Expose skin below

Can progress to fever, irritability, lethargy, dehydration.

Dangerous: sepsis and death

66
Q

How is Staphylococcal Scalded Skin Syndrome treated?

A

Admit and start IV antibiotics

Fluid and electrolyte balance (due to dehydration)

67
Q

What are the 4 types of psorasis?

A
  1. Plaque (mostly in adults)
  2. Guttate - (strep infection, mostly in children, trunk and limbs)
  3. Pustular (rare, severe)
  4. Erythrodermic (rare, severe)
68
Q

Auspitz sign, Koebner phenomenon and residual pigmentation of skin are seen in what condition?

A

Psorasis

Auspitz sign = small points of bleeding when plaque scraped of

Koeber phenomenon = psoriatic lesions to skin affected by trauma)

Residual pigmentation left on skin after resolution of psoriasis

69
Q

Which surfaces does psoriasis usually occur on?

A

Extensor surfaces + scalp

70
Q

What are pharmcological management options for psoriasis?

A

Steroids
Vit D analogues
Dithranol
Phototherapy (if extensive)

71
Q

What non-skin issues can be seen with psoriasis?

A

Nail psoriasis

Psoriatic arthritis (usually in middle age)

Psychosocial issues

Paeds (8 decks)

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