Skin Conditions of Childhood Flashcards

Question

Describe the duration of treatment and agents for diaper rash

Answer 1

If just a diaper rash --> TX < 3 days If yeast infected, >3 days and: a) Fiery Red b) vesicles/Sqatellites c) Skin fold involvement

Answer 2

Keep the area clean Anti-fungal Steroid Cream Barrier Cream

Answer 3

Infant Oral Thrush - Yeast infection of the mouth If have oral thrush with a diaper rah, automatically fungal

Answer 4

Antifingals: 1) Clotrimazole 1% 2) Miconazole 2% Applied BID for approximately 1 week and 1 week after clearing If no improvement - suspect bacterial - MD referral Steroids (0.5-1% HC - Can go up to Spectro Eczema - legal aspects here tho) for 2 days --> 1 FTU

Answer 5

Antifungla --> HC --> Barrier - Wait 2-3 mins between each application - Ensure barrier is completly removed before the next application Uninfected: 1) HC 0.5-1 % BID for 1-2 days 2) BArrier Creamk 4-5x day everyday Infected: 1) ANti-fungal cream BID for 14 days 2) HC 0.5-1% BID for 1-2 days 3) Barrier Cream 4-5x per day everyday **** Do not mix corticosteroids and antifungals prior to applying

Answer 6

Refer to doctor if the rash does not improve in 7 days or resolve within 14 days

Answer 7

Lice are alive Nits are the eggs of lice and are laid close to the scalp for warmth - Glued to the hair shaft and do not wash out (need a special comb) Symptoms --> None to itching

Answer 8

Nix and Kwellada-P --> Permethrin 1% - pediculocides Physical Agents --> Resultz (ispropyl myristate), ZAP (coconut and anise oil), NYDA (dimethicone) Drug of Choice --. NYDA

Answer 9

Permethrin 1% - Synthetic Pyrethroid (incraesed potency) - High amount of safety in children Application: 1) Wash hair with regular shampoo 2) Add creme rinse for 10 minutes 3) Rinse out Manufacturer states that repeats are not needed as has residual activity and enough will hang around to kill the nits --> Cut the losses and repeat to be sure Will need to remove the nits and resistance is possible

Answer 10

Isopropyl Myristate - Not an insecticide; dissolves lice exoskeleton 10 Mins of Application Repeat in 7 days

Answer 11

Resistant Lice - Resistant to insecticides Anise Seed Oil 15% added --> Aromatic compounds are somewhat deadly to lice --> Very hard to see what is in the ultra version on website --> Aromatic, some of the aromatic compounds have anti-lice properties whether agricultural or on people Permethrins - Use it twice - Some resistance developping to NIX

Answer 12

Dimethicone - Penetrates deeply and suffocates the lice and egg's breathing system - Physical and contact reaction with the lice

Answer 13

Coconut/Anise OIl --> 15 minutes of contact - Nit pick --> Repeat in 9 days - Still a decent choice - Aromatic oils have some value; do not know the concentration of effective dosages of the oils

Answer 14

1) Dry hair 2) Apply NYDA (10-34 mL) 3) After 30 minutes of contact, then start nit-combing with product in the hair and product will dry 4) Leave the product in the hair for 8 hours (if overnight can use shower cap) 5) Wash out with regular shampoo in the next morning 6) Re-check the hair in 8-10 days 7) Repeat in 9 days (range 7-10 days)

Answer 15

Scalp can be itchy for a few days after lice treatment --> Lice will put anti-coagulants in the scalp

Answer 16

Lice can develop resistance to insecticides Lice will not develop resistance to NYDA Used to be worried about repeats to reduce resistance - NYDA can be repeated safely

Answer 17

Suspect resistance if treatment resistance Use a different agent (a different drug) No resistant lice to NYDA so can use it again; most likely missed some of the lice

Answer 18

Can use spectro eczema on diaper rash area - Spectro eczema for 1 dose for 2 days - Spectro eczema is used in the UK for diaper rash - Not indicated on label HC 1% is low level; HC 2.5% can be prescribed as an RX; and is better agent Zincofax - Use the CS once a day; covering it up, more absorption but not too concerned for one day use

Answer 19

Rash in the folds - Not a complete disganostic yes or no for for a fungal infection 3 day rule - Dial more into fungal infection Spots above or below the diaper area - Thinking infection

Answer 20

Can use Canesten (vaginally or for the feet) - clotrimazole --> off the shelve MD may prescribve ketoconazole for insurnace coverage reasons Ketoconazole is similar to Canesten 1 vs 2% Canesten - Go with 1% - Nothing compels us to go with xtra strength

Answer 21

Human Papilloma Virus Transmission - Touch to touch (self-innoculation can occur) 25% "spontaneously" regress --> Fail to mention spontaneous is one year Cosmetic nuisance up to being painful

Answer 22

Salicyclic Acid Preps Duofilm Liquid (Salicylic acid and lactic acid) Compound W for 8 weeks

Answer 23

Soak the wart first Rub off dead skin Vaseline at the base Apply the drops Cover the wart Continue OD for 8-12 weeks

Answer 24

Duofilm Liquid - 8-12 weeks Compound W - 8 weeks

Answer 25

1) Lightly press the tip 2) Attach the tip to the applicator 3) Press down the tip into the canister and hold for 2 to 3 seconds - will hear a hiss sound 4) Apply the cold tip precisely on the wart - Soak the wart first 20 Seconds on the Hand 40 Seconds on the Foot (20 seconds, reload, another 20 seconds)

Answer 26

Apply every 2-3 weeks for about 4 repeats

Answer 27

Equally effective so let the parent decide based on what they think the child can handle

Answer 28

On the Face --> Refer Multiple Lesions - Likely refer

Answer 29

Mild acne --> Comedonal < 20 comedones (whitehead/blackhead) Or < 15 inflammatory papules, or a lesiob count < 30

Answer 30

Core is a concern Need to remove the core to remove the wart

Answer 31

School Wart Remover (40% Salicylic Acid) 12 weeks for a wart

Answer 32

Dual Action: Freeze area then apply salicylic acid OD for 14 days - repeat for 4 cycles Non-Dual Action: Freeze area Q2-3 weeks

Answer 33

OD to Q2days for 12 weeks

Answer 34

Saliva is contact dermatitis from teething If not sure, just refer Eczema and teething are common at this age If parent is whiping saliva off the cheek, then more clues to a rash from teething Teething around 6 months; eczema also common the face at this age

Answer 35

Starts with cold symptoms and then a rash develops AKA - Slapped Cheek

Answer 36

Human Parvovirus

Answer 37

6th Disease - 2-3 years of age 5th Disease - 5-6 years of age and up to early adolescence 5th Disease commonly develops after 6th disease

Answer 38

Fifth disease is contagious although it is a mild disease No treatment for fifth disease - Rash is not itchy - Low grade fever can be present and Advil or Tylenol is unlikely required

Answer 39

Rashes and utricaria (hives) are common with URTi --> Hives will tend to be itchy and move --> Rash with fifth disease is unlikely to be itchy No one will know its fifth disease as it will intially present just as cold type symptoms A low grade fever (not flu symptoms) may be present Will know its fifth disease when a rash hits and develops Fifth --> Virus with a little bit of cold symptoms and a rash

Answer 40

The rash is due to the virus If Tylenol or Advil is given prior to the rash, the drug will commonly be blamed for the rash (drug-induced rash)

Answer 41

Fifth disease begins with a low fever, headache, and mild cold-like symptoms A rash appears a few days later A distinctive red rash on the face that makes the child appear to have a "slapped cheek" A few days later the rash spreads down to the trunk, arms and legs and usually lasts 1-3 weeks After a few days, the rash, which may be itchy (unlikely), takes on a lacy-net like look In the time it takes for the rash to completly clear, it may seem to get worse before it finally fades away

Answer 42

AKA Sixth Disease

Answer 43

URTi initially; presents like a cold however a fever is present The rash develops later Contagious

Answer 44

High fever in sixth disease compared to fifth disease so therefore antipyretic medication usage is more common Tylenol and Advil are more likely to be blamed for the rash rather than sixth disease

Answer 45

No treatment for the rash; treatment of fever does not help with the rash The rash is not blistering and no puss present A splotchy rash that develops on the face and trunk and then spreads to the legs and arms Rash should go away in 2-3 days No treatment here

Answer 46

In sixth disease, rash should disappear in 2-3 days - Rash is maculopapular (flat lesions, pimple like) In fifth disease, the rash lasts longer (approx. 2 weeks) - Erythema rash (just redness)

Answer 47

Starts with a high fever that lasts for 3 to 5 days CHild may be cranky or irritable When the fever ends, a rash of small pinkish-red spots develop on the childs face and body The spots will turn white when you touch them and they may have a lighter ring around them The rash usually spreads to the neck, face, arms and legs The rash can last from a couple of hours up to 2 days The rash is not commonly itchy

Answer 48

A maculopapular rash is made of both flat and raised lesions A marker for many diseases, allergic reacytions, and infections Most of the time, the cause is a viral infection

Answer 49

GI Virus - Gets past the gut Starts with a cold Appears as 2 days of fever, 2 days of mouth sores and 2 days of a rash Cold symptoms initially, then get mouth ulcers (spots in the mouth that burst open) If involves the hands and feet, easily diagnositic

Answer 50

Somewhat easier to diagnosis than other childhood derm conditions when limited to the hands, feet and mouth Sometimes may not present in the mouth and may only presnet around the mouth

Answer 51

Ages under 5 years old

Answer 52

Nothing for treatment here Maybe some eczema cream - Not as itchy as chicken pox Tough it out situation

Answer 53

Hand, foot and mouth is usually not a severe dillness

Answer 54

Small, painful ulcers in the mouth A skin rash that looks like red spots, often with small blisters on top that appears on the hands (palms) and feet (soles), buttocks and sometimes other places

Answer 55

Disease is spread via contact with an infected person's saliva or stool Not spread for animals

Answer 56

Antibiotics are not required for hand/foot/mouth disease (viral) and will not help it go away any faster It can last for 7-10 days

Answer 57

A viral infection that is transmitted via skin to skin contact - 10-20 lesions on average

Answer 58

Similar to the wart virus Warts are dense (vasculature and core udnerneath) Molluscum lesions are soft and malleable --> Dome shaped with indentations on the top

Answer 59

Self-limiting: Will disappear in 6-9 months with the immune system MD is required for treatment - No OTC therapies effective here First Line --> Frozen off by cryotherapy Second Line --> curretage (cutting) of lesions - lidocaine injection underneath Cantharine (beetle juice) is not likely to be effective here

Answer 60

Any age can be effected by molluscum In adults - Differential --> STD Traditionally affects children 10 years and younger

Answer 61

Firm, dome shaped, flesh-colored bumps Relatively painless, but they can be very itchy Molluscum is generally asymptomatic and is often not accompanied by a fever or malaise May have only one lesion but often presents as a group of papules spread throughout the body

Answer 62

The disease can spread throughout the body via self-contamination

Answer 63

Used to be called childhood acne - Cosmetic front here; low level stuff Self-limiting and will go away on its own in a couple of weeks Little white bumps that commonly occur along the nose line

Answer 64

No pharmacological therapy here A face cloth can be used to help get rid of the little bumps

Answer 65

About to 40-50% of newborn babies will have milia; most often on the cheek, nose and chin Typically appears a day or two after birth

Answer 66

Angular Chelitis - Bust open the sides of the mouth and get irritation Impetigo - Vesicles and lesions around the mouth (commonly) that have golden and yellow exudate

Answer 67

Pharmacists have prescribing authority for impetigo - Does the individual have access to care? While we have prescribing authority here, impetigo can have various presentations so it is okay to refer

Answer 68

Most common bacterial skin infection in children aged 2-5 years old

Answer 69

Contagious skin infection that mainly affects children and infants Appears as red sores on the face, especially around a child's nose and mouth The sores burst open and develop honey coloured crusts --> Sores that do not blister aare common (non-bolous) - No blistering other than oozing (70%) Red sores that quickly rupture, ooze for a few days, and then form a yellowish-brown crust Itching and soreness are generally mild

Answer 70

Impetigo is more common in the summer

Answer 71

All age groups, but is usually seen in young children

Answer 72

All age groups, but is usually seen in young children Streptococcus pyogenes or Staphylococcus Aureus Involves the face Has regional lympadenopathy Self-limited to 2 to 3 weeks Vesicles may progress to pustules --> easily rupture --> honey-coloured crusts

Answer 73

A less common form of impetigo, called bullous impetigo, may feature large blisters that occur on the trunk of infants A more serious form of impetigo, called ecthyma, penetrates deeper into the skin - causing painful fluid-or pus-filled sores that turn into deep ulcers --> RAre

Answer 74

Commonly occurs in children aged 2-5 years old

Answer 75

Crowded Conditions - Spreads easily in schools and child care setting More common in the summer Transmitted through skin to skin contact

Answer 76

Eczema - Will be itchier, less crusts Contact Dermatitis - Will have contact with something Herpes SImplex - Painful and tingling Impetigo is not painful or itchy; golden crusts can hue us into impetigo Impetigo can affect other areas other than around the mouth --> e.g. butt

Answer 77

Cold Sores --> More cases of impetigo than herpes simplex; however symptoms are close enough that they can through us off Cold Sore - Typically around the age of 10 Impetigo - Typically around 2-5 years of age Cold Sores --> HAve a little vesicle inside When its off the lip margin --> Impetigo If on the lip margin --> Cold Sores - Older kids, more painful and little vesicles

Answer 78

1) Cold sores involve red lesions. Impetigo may involve red lesions but these rupture quickly and then form golden-brown crusts. 2) Impetigo spreads more quickly than cold sores. 3) Impetigo never occurs inside the mouth and can form anywhere on the body. Largely not the case with HSV-1. 4) Impetigo is usually painless and only visual. Cold sores can cause pain and early stages can present with tingling. 5) HSV-1 is transmitted through infected bodily fluid, particularly saliva – lips, nose, eyes, mouth, cheeks, genital region Impetigo is caused by a bacteria that preys on manipulated skin and can occur anywhere

Answer 79

Impetigo is self-limiting and often improves within a week of treatment or within a few weeks without treatment

Answer 80

Polysporin can be used; however, prescribed agents are more effective Do not select polysporin unless there is no acess to Fucidin or mupirocin Polysporin - Not concerned about gram negtaive here (polymyxin); use of this agent is for gram positive coverage (bacitran and gramcidin)

Answer 81

Mipirocin and Fucidin If crusts are thick, use warm water compress to soften the crusts first and then remove for better antibiotic contact

Answer 82

Self-limiting condition - Should have a couple of days less when treated

Answer 83

Impetigo usually requires 5-7 days of therapy - Often go for 5 days here Mupirocin 2% cream or ointment Apply to affected areas three times daily for up to 10 days. Rub in gently. Fusidic ACid 2% Cream or Oitment Apply to affected areas three to four times daily for 7-14 days. RUb in gently. (Just choose TID or QID)

Answer 84

Impetigo requires 5-7 days of therapy --> Just go for 5 days Once its clear, stop --> No need to continue for 1 week after like antifungals If trajectory is not better in 5 days, cosnider misdiagnosis

Answer 85

Ozanex (ozenoxacin) - Quinolone cream for impetigo - Continue to recommend mupirocin or fusidic acid - Apply a thin layer to the affected areas 2 times a day for 5 days

Answer 86

Measles Mumps Rubella (German Measles) Chicken Pox MMRV (MEasles, Mumps, Rubella, varicella) Vaccinations

Answer 87

Chicken Pox Measles Meningitis Mumps Polio Whooping Cough

Answer 88

12 Months old 18 Months old Grade 6 --> Varicella (Chicken Pox) vaccine

Answer 89

All conditions are viral Measles harder on children than German measles Chicken pox is itchier than measles Chicken pox are small vesicles that crust over Mumps mainly hits the jaw glands Not a lot of therapy for any of them

Answer 90

Starts with a fever (39-40 C), runny nose, red watery eyes, and a cough (dry raspy) that can last after the rash clears Red bumps with tiny white dots appear a few days later on the inside of the cheeks Rash appears on face and progresses down the back and trunk to arms and hands and finally legs and feet Classic MAculaopapular Rash - Flat, red lesions but eventuallyd evelops bumps that may be itchy Rash lasts about 5 days; total illness lasts 7-14 days Quite sick for 3-5 days

Answer 91

Generally a mild disease in children Occurs most often in children aged 5 to 9 years of age Starts with 1-2 days of a mild fever (37 C), swollen and tender lymph nodes Rash then begins on face and spreads downward Standard MAculopapular rash - Rash can itch and last for up to 3 days MLess tough on a child than measles - MIld skin reaction, low fever, low cold-like symptoms About a week and then done No treatment here Many individuals with rubella have few or no symptoms

Answer 92

Not leading to death - However can be painful

Answer 93

Parotid Glands well and patient develops a "hamster-like" face - Painful and swollen salivary galnds The symptoms of mumps normally appear 2-3 weeks after the patient has been infected; however, almost 20% of people with the virus do not suffer any sigbs or symptoms at all

Answer 94

Most reactions at the injection site occur within 2 weeks and most general reactions or fever within 7 days - Chicken pox and measles are the worst for rashes --> More than just local reactions - Measles Vaccine Rash - Call MD if rash onset at day 7-10 and persists for > 3 days

Answer 95

Fevers are still common for most vaccinations as moutning an immune response Rashes are quite rare --> No more than 5% Most rashes are not caused by the vaccine - Large rashes have a low potential to develop Feverish and local site reactions are common after vaccination

Answer 96

Pain, tenderness, swelling or redness at the injection site lasts for 24 to 48 hours (51% of children) fever lasts 24-48 hours

Answer 97

Can result in a fever (10%) and rash (5%) about 7 to 10 days following injection fever lasts 2 or 3 days The mild pink rash is mainly on the trunk and last 2 or 3 days. No treatment is necessary and child is not contagious

Answer 98

Pain or swelling at the injection site for up to 1-2 days (19% of children) Fever lasting 1 to 3 days begins 17 to 28 days after vaccine (14%) - Can give acet or ibu Chicken Pox-like vaccine rash (usually 2 lesions) at the injection site (3%) Chicken Pox like vaccine rash (usually 5 lesions) scattered over the body (4%) The mild rash begins 5 to 26 days after the vaccine and usually lasts a few days Children with these vaccine rashes can go to day care or school --> Vaccine rashes are not contagious, avoid school if widespread and weeping lesions (likely chickenpox)

Answer 99

Pain, tenderness, swelling OR redness at the injection site in 15-30% Mild fever in 15% for 1-2 days No serious reactions

Answer 100

A rash that looks like measles, rubella. or chicken poc may occur about 1-2 weeks after the vaccine

Answer 101

Incubation period of chickenpox ranges from 11-21 days Prodromal Sx --> Low grade fever, headache and malaise On the following day, charcteristic rash begins --> Lesions evolve from erythemous macules to form small papules Quickly, a clear vesicle arises on the erythemous base --> Vesicles turn into lesions Described as "de-drop on a rose petal"

Answer 102

1) Chickenpox rash starts with red spots that can occur anywhere on the body 2) The spots fill with fluid. The blisters may burst. They may spread or stay in a small area. 3) The spots scab over. More blisters might appear while others scab over. Scabs 4 or 5 days later - Could be mistaken as molluscum

Answer 103

1) Polysporin - Chicken pox is a virus so not effective 2) Calamine/Witch Hazel --> Astringents - Can use to help relieve itchiness and dry skin out 3) Benadryl --> Not effective 4) Cool Compress - Can be effective to help reduce swelling 5) Tylenol (yes), Advil (No)

Answer 104

Take a cool oatmeal bath Calamine Lotion Cool, wet wash cloth for itchy areas

Answer 105

--> never give ASA to a child within 6 weeks of recieving vaccine - Reye's Syndrome

Answer 106

Tylenol - Can help relieve pain with sores that develop on skin ir in the mouth Ibuoprofen and NSAID's - NOOO - CAn make you very ill

Answer 107

NSAID's - Risk of necrotizing soft tissue infections -Necortizinfg Fascitis/Cellulitis - Cannot use ASA for this reason; Ibuprofen now on the radar Chicken pox is not that painful but can have a mild fever - Ibuprofen can likely be used; however, LEGAL - Do not recommend Ibuprofen should not be recommended for chickenpox management --. Sufficient evidence to contraindicate ibuprofen for the management of chickenpoix symptoms due to elevated risk of NSTI

Answer 108

ACETAMINOPHEN