Skin- child health Flashcards
When does eczema usually present?
Prevalence of 20% in UK
First year of life, uncommon in the first 2 months unlike infantile seborrhoeic dermatitis
Family history of atopic disorders- asthma, allergic rhinitis
Exclusive breast feeding may delay onset of eczema in predisposed children
50% resolve by 12 and 75% by 16
How is eczema diagnosed?
Made clinically
Elevated IgE level
Skin prick and radioallergosorbent (RAST) tests- this will also identify food and other allergens which may cause anaphylaxis
Immune deficiency disorder needs to be excluded
Immunological changes in atopic disease are probably secondary to enhanced antigen penetration through a deficient epidermal barrier
What are the clinical features of eczema?
Pruritus- exacerbation of rash
The excoriated areas become erythematous, weeping and crusted- distribution of the eruption tends to change with age
Atopic skin is dry- scratching leads to lichenification: accentuation of the normal skin markings
What are the causes fo exacerbations of eczema?
Bacterial infection, e.g. Staphylococcus, Streptococcus spp. Viral infection, e.g. herpes simplex virus Ingestion of an allergen, e.g. egg Contact with an irritant or allergen Environment: heat, humidity Change or reduction in medication Psychological stress Unexplained
What can eczematous skin become infected with?
Staphylococcus or Streptococcus
inflammation increases the avidity of skin for Staph. aureus and reduces the expression of antimicrobial peptides (releases superantigens makes eczema worse)
HSV- extensive vesicular reaction, eczema herpeticum
Regional lymphadenopathy is common and often marked in active eczema
What is the management for eczema?
Avoiding irritants and precipitants Emollients Topical corticosteroids Immunomodulators Occlusive bandages Antibiotics & antiviral agents Dietary elimination Psychosocial support
When is acyclovir used to treat HSV?
Severe symptomatic skin, ophthalmic, cerebral and systemic infections
What is gingivostomatitis?
most common form of primary HSV illness in children
10 months-3
there are vesicular lesions on the lips, gums and anterior surfaces of the tongue and hard palate, which often progress to extensive, painful ulceration with bleeding
High fever
Illness may persist for 2 weeks
Eating an drinking is painful
Severe need fluids and acyclovir
What is eczema herpeticum?
serious condition, widespread vesicular lesions develop on eczematous skin
this may be complicated by secondary bacterial infection- which may result in septicaemia.
What are herpetic whitlows?
these are painful, erythematous, oedematous white pustules on the site of broken skin on the fingers
spread is by auto-inoculation from gingivostomatitis and infected adults kissing their
children’s fingers
in sexually active adolescents, HSV2 may be the cause
What eye disease does HSV cause?
blepharitis or conjunctivitis
It may extend to involve the cornea, producing dendritic ulceration-this can lead to corneal scarring and ultimately loss of vision
Any child with herpetic lesions near or involving the eye requires ophthalmic investigation of the cornea by slit lamp examination
What is impetigo?
This is a localised, highly contagious, staphylococcal and/or streptococcal skin infection- most common in infants and young children
More common in pre-existign skin disease (eczema)
How does impetigo present?
lesions are usually on the face, neck and hands and begin as erythematous macules which may become vesicular/pustular or even bullous
Rupture of the vesicles with exudation of fluid leads to the characteristic confluent honey-coloured crusted lesions- infection is readily spread to adjacent areas and other parts of the body by autoinoculation of the infected exudate
What is the management for impetigo?
Topical antibiotics (e.g. mupirocin) are sometimes effective for mild cases Narrow-spectrum systemic antibiotics (e.g. flucloxacillin) are needed for more severe infections Although more broad-spectrum antibiotics such as co-amoxiclav or cefaclor have simpler oral administration regimens, taste better and therefore have better adherence
Affected children should not go to nursery or school until lesions are dry
Nasal carriage is a source of infection- erradicated using nasal cream containing mupirocin or chlorhexidine and neomycin
How does Staphylococcal Scalded skin syndrome (SSS) present?
Caused by an exfoliative staphylococcal toxin, which causes separation of the epidermal skin through the granular cell layers
Affects infants and young children
Fever and malaise
purulent, crusting, localised infection around the eyes, nose and mouth
widespread erythema and tenderness of the skin
Areas of epidermis separate on gentle pressure (Nikolsky sign)- leaving denuded areas of skin:dry and heal without scarring
