Skin Conditions in Children

Question 1

What is fifth disease?

Answer 1

It is caused by a parvovirus. The condition happens after a cold.

Redness on cheeks (slapped cheek)

Affected from 5-7 years old

Fifth disease will last 2 weeks to 1 month, but will resolve itself

Question 2

What is Roseola (sixth disease)?

Answer 2

It is a viral condition

Starts with a high fever/cold and maculopapular (red bumps) bumps appear.

Affect 2-3 years olds

Treat the fever, but does not affect chance for sixth disease. No treatment needed for rash itself.

Question 3

What is Hand/Foot/Mouth Disease?

Answer 3

It is a viral disease that is passed from the gut.

Starts with a cold and fever for 2 days followed by 2 days of mouth sores, and another 2 days of rash on the hands and feet

Affect kids under 5

Fairly mild condition

Can be hard to diagnose before sores and rash appear

Question 4

What is Molluscum?

Answer 4

It is a viral condition(similar to warts)

Spread via skin-to-skin contact. Scratching can spread molluscum across skin

Takes 12-18 months to resolve on its own, so it is usually froze off to prevent embarassment

Question 5

What is Erythema toxicum?

Answer 5

Sounds a lot worse than it really is

flat red splotches, white pimple-like bump in the middle

Seen in the first few days of life (7-14 days)

Generally benign

Question 6

What is Milia?

Answer 6

Used to be called pediatric acne

It looks like folliculitis. It is a gathering of sebum (requires no treatment)

Question 7

What is impetigo?

Answer 7

This is a bacterial condition. Most common bacterial infection in kids

Found in kids 2-5

Involves lesions on the face. It presents itself with vesicles –> pustules–> honey-coloured crust

Self-limited to 2 to 3 weeks.

Pharmacists can prescribe appropriate antibiotics for impetigo

Question 8

What should pharmacist do if a lesion looks like atypical impetigo?

Answer 8

Refer atypical cases, prescribe for typical impetigo

Question 9

What is bullous impetigo?

Answer 9

In addition to lesions commonly associated with impetigo, blisters occur on the trunk of infants and young children

Question 10

What is Ecthyma?

Answer 10

A more serious form of impetigo. It occurs when staph infection is deeper in the tissues

Painful fluid- or pus-filled sores that turn into deep ulcers

Question 11

What are the most common skin rashes in children?

Answer 11

Eczema (itchier and less crusts)

Contact dermatitis (itchy and potentially painful)

Herpes simplex (cold sores can be painful, tingling, and exudate clear fluid) they can be anticipated. They are found on the lips

Impetigo (cold sore-like lesions not on the lips)

Shingles (reactivation of chickenpox virus)

Question 12

Is polysporin with antibiotics an adequate treatment for impetigo?

Answer 12

No, polysporin is far too weak for impetigo

This is where we use Medsask resources to prescribe stronger prescription

Question 13

Are most bacterial skin infections caused by gram-negative bacteria?

Answer 13

No, most bacterial skin infections are caused by gram-positive bacteria (ex. stapholococcus)

Question 14

What is the significance of Polysoporin Complete?

Answer 14

It contains separate antibiotics that can eliminate gram positive and negative bacteria

It also contains low concentration of lidocaine (low-level anesthetic)

Question 15

Why are ointments more effective than creams?

Answer 15

Ointments are more occulusive, they hold onto more moisture and promote faster healing vs. creams

Question 16

What is a good topical antibiotic for impetigo?

Answer 16

Mupirocin 2% and Fucidin 2% are both great options

Apply to affected areas three times a day for up to 10 days

If condition is not trending down, refer to an MD for closer inspection

Question 17

Should crusts be removed before applying topical antibiotics?

Answer 17

If crusts are very thick, use warm water compress to soften them first, then remove for better antibiotic contact and efficacy

Question 18

What is folliculitis?

Answer 18

Associated with ingrown hairs and shaving. These are risk factors for the infection of a hair follicle

There are afew types of folliculitis:

Bacterial folliculitis

Hot tub folliculitis

Razor bumps

Boils (furuncles and carbuncles)–> deeply infected hair follicles (staph)

Question 19

What is a good antibiotic for the different types of folliculitis?

Answer 19

If it is deep seated in a boil, refer to doctor and get oral antibiotic

If infection is closer to the skin surface, pharmacists can prescribe Mupirocin 2% and Fucidin 2%

Question 20

Can furuncles and carbuncles be treated with topical antibiotics?

Answer 20

Depends how deeply seated the infection is, we need to question if a topical agent is strong enough to penetrate lesion. Referral to MD is a valid decision if they need extra attention

Question 21

Can a topical antibiotic penetrate a lesion like a boil?

Answer 21

No definitive answer, make judgements based on how bad it looks. Refer worse cases to MD and treat lighter cases

Question 22

What is mononucleosis?

Answer 22

It is a viral condition. Feels like a long-term cold in combination with aches, pains, and rashes

Question 23

What are the four main viral diseases that children are vaccinated for?

Answer 23

Measles (harder on kids than Rubella)

Mumps (mainly hits the jaw gland, characterized by “hamster face”)

Rubella (german measles)

Chickenpox (Itchier than measles, small vesicles that crust over)

Besides preventative measures like vaccines, no great treatment options

Question 24

What vaccines have the worst skin reactions?

Answer 24

Chickenpox and Measles

Question 25

Are skin rashes following vaccination a serious concern?

Answer 25

If the rash is limited to the skin and does not seem to affect other body systems, it is relatively benign. It is still worth getting it checked out by an MD. A vaccine-induced rash could be indicative of an anaphylactic shock

If the rash appears to be spreading via other body systems, we need to be concerned.

Question 26

What does measles look like?

Answer 26

This is very rare because most people are vaccinated

If a rash appears after a cold, it is most likely not measles. But anti-vaxxers are bringing it back

39-40*C fever

Quite sick for 3-5 days

Dry raspy cough that can last after rash clears up

Question 27

What does Rubella (German Measles) look like?

Answer 27

Similar presentation as measles, but more mild

Question 28

What does chickenpox look like?

Answer 28

A maculopapular rash.

red spots appear–>spots fill with fluid and may burst–> spots scab over an have indent in middle(look like molluscum)

Question 29

What can be used to treat chickenpox?

Answer 29

Calamine over spots and reapply regularly, acetaminophen, and cold compress are great options

Question 30

What are the guidelines about using NSAIDs like ibuprofen to help with chickenpox?

Answer 30

Do not give anyone NSAIDs for chickenpox(legal requirement, rather than clinical significance)

Ibuprofen was blamed without clear scientific evidence ro complicate chickenpox into flesh-eating disease

Question 31

What does mumps look like?

Answer 31

Glands in the neck become swollen(hamster face).

Symptoms take 2-3 weeks to develop(painful neck glands)