Skin diseases in a child - (acne, eczema, haemangioma, milia, molluscum contagiosum, mongolian blue spot, nappy rash (irritant, candida, seborrhoeic), seborrhoeic dermatitis, tinea) Flashcards
(incl. acne, eczema, haemangioma, milia, molluscum contagiosum, mongolian blue spot, nappy rash (irritant, candida, seborrhoeic), seborrhoeic dermatitis, tinea)
What is shown on the pictures?
Left: forceps mark - can sometimes cause facial/trigeminal nerve palsy. Tested in newborns when crying.
Right: subcutaneous fat necrosis, could be from hypercalcaemia
What is the definition of macular, papular and pustular?
Macule - are circumscribed changes in the color of skin that are neither elevated nor depressed and ≤ 1 cm in diameter.
Papule - elevated, solid, palpable lesion that is ≤ 1 cm in diameter. They may be solitary or multiple.
Pustule - a circumscribed elevation of the skin that contains a purulent exudate that may be white, yellow, or greenish-yellow in color.
What condition is shown?
Erythema toxicum - “baby rash”, high in eosinophils and may get secondary bacterial infection but usually asymptomatic
Describe the features of erythema toxicum.
- Common skin condition in term neonates
- Self limiting benign lesions
- Blotchy widespread red rashes
- No discomfort to the babies
- Self-resolve within 1 week
- No treatment needed
What condition is shown? What is it caused by?
Epidermolysis bullosa
This is a genetic skin condition
Name 3 bullous skin conditions that you may find on a child.
- Epidermolysis bullosa - genetic
- Staphylococcal scalded skin syndrome - Staph. aureus
- Stevens Johnson syndrome - drug reaction
What is this?
Haemangioma
What is this?
Haemangioma taht has disappeared with time
What might haemangiomas be treated with?
Beta blockers
What is this condition?
Port wine stain AKA Sturge Weber syndrome
What are the features of Sturge Weber syndrome? What is it also known as? What is the cause?
AKA: Neuro Cutanous Syndrome - “port wine stain”
- Glaucoma (ipsilateral)
- Hemiparesis (contralateral)
- Seizures
Sporadic condition
What condition is this?
Fungal diaper rash with right sided hydrocele - manage with frequen change of nappies, barrier cream (Sudocream) and antifungal creams in fungal superinfection
How do you diagnose a hydrocele? What is the management?
- Differentiate from hernia (reducible? cough?)
- Use transillumination
No treatment requires - resolves by 1 years. If hernia, refer to surgeons for repair within a few weeks.
What condition is shown?
Umbilical granuloma
How do you manage unbilical granulomas?
- Dead tissue
- Usually no treatment
- If big in size, cauterise with silver nitrate (ensure this does not touch normal skin)
- Salt also can be applied
What condition is shown?
Molluscum contagiosum
What is the cause of molluscum contagiosum? What is the treatment?
Pox virus - spreads by direct contact or can be sexually transmitted in adults
No active treatment required
What condition is shown? What is it caused by?
Viral wart - human papilloma virus (there are 150 types/strains). Spread by touch and close contact. Can cause cervical cancer.
How are viral warts treated?
- Peeling medicines like salicylic acid
- Cryotherapy if extensive
- Laser treatment
What condition is shown here?
Skin and tissue necrosis in meningococcaemia
What condition is shown? What is the causes?
Impetigo - staphylococcus aureus
What is the management of impetigo?
- Antibacterial cream
- In extensive cases - oral antibiotic e.g. flucloxacillin, erythromycin
What condition is this?
Scabies
What are the features of scabies? How can it be treated?
- Very itchy condition
- Secondary bacterial infection can occur
- Treatment of whole family
- Local treatment with permethrin or malathion
What is this condition called?
Ring worm - fungal infection
What itch mite causes scabies?
Sarcoptes scabiei
What is ringworm of the head called? What is the treatment?
Tinea corporis - topical antifungal cream
List 3 causes of alopecia in a child.
- Tinea capitis
- Alopecia areata
- Trichotillomania
- Telogen effluvium
- Nutritional deficiency
What is tellogen efluvium?
Increased proportion of hairs shift from the growing phase (anagen) to the shedding phase (telogen). Normally only 10% of the scalp hair is in the telogen phase, but in telogen effluvium this increases to 30% or more
What are the causes of telogen effluvium?
- Childbirth: postpartum hair loss. This can resolve after a few months or transition into female pattern alopecia.
- Endocrine disorders (eg, hypothyroidism, hyperthyroidism)
- Discontinuing the contraceptive pill
- Physiological neonatal hair loss
- Acute or chronic illness, especially if there is fever
- Psychological stress
- Weight loss, unusual diet, or nutritional deficiency (eg, iron deficiency/)
- Certain medications
- Skin disease affecting the scalp (eg, erythroderma)
- Excessive sun exposure.
What is the underlying cause of alopecia areata?
Autoimmune condition causes patchy hair loss
What is this condition?
Kerion
What is the cause of kerion? How is it treated?
Host immune response to fungal infection of hair follicle with secondary bacterial infection
Manage conservatively with antibiotics and antifungals - does not require surgery.
What is this condition called?
Hand, foot and mouth disease
What is the cause of hand, foot and mouth disease? How is it managed?
Coxsackie virus A16 - managed symptomatically
What is this condition called?
Pityriasis alba - common skin condition in dark skinned children, more common in summer, no treatment needed (should distinguish from Tinea vesicolor)
What is this condition? Where is it most common? What is it caused by? How is it treated?
Tinea vesicolor - common skin condition caused by a fungus that normally lives in skin.
In right conditions like warm, moist and oily skin the fungus Malassezia furfur overgrows and causes the rash.
Treatment: Antifungal cream
What is this condition?
- Skin pigmentation disorder
- May be auto immune mediated
- Refer to dermatologist
What is this condition called?
Pityriasis rosea - there is a herald patch and the rash is in a Christmas tree distribution
What are the features of pityriasis rosea? How is it treated?
- Common harmless red scaly skin rashes
- Presence of Herald patch is important
- Can last several weeks
- Self limiting
- No treatment needed
What is this condition? What is the cause?
Carotenemia - benign condition which occurs in vegetarians and young (Polish) children from excess consumption of beta carotene e.g. carrots, sweet potatoes
What is this condition ? What is it associated with?
Acanthosis nigricans - associated with diabetes type 2, obesity and malignancy
What is this condition?
Henoch Schonlein Purpura
What are 4 causes of purpura?
- Idiopathic Thrombocytopaenic Purpura
- Henoch Schonlein Purpura
- Platelet function disorders
- Coagulation disorders
What are the main systems affected by Henoch Schonlein Purpura?
- Systemic Vasculitis
- Purpura
- Joint pain
- Abdominal pain
- Renal impairment
What are these patches called?
Café au lait spots - occurs in type 1 and 2 neurofibromatosis
What is the inheritance pattern of neurofibromatosis?
Autosomal dominant - causes lesions in the skin, nerves, brain, spinal cord and bones.
What is this condition? (NB: it may also have nail manifestations)
Tuberous sclerosis may have associated periungal fibromas
What is tuberous sclerosis and how is it inherited?
Tuberous sclerosis complex (TSC) is an autosomal-dominant, neurocutaneous, multi-system disorder characterised by cellular hyperplasia, tissue dysplasia, and multiple organ hamartomas
Lesions in the skin, eyes, kideneys, and brain.
What is this condition?
Ataxia telangiectasia - prominent blood vessels (telangiectasia) over the white (sclera) of the eyes usually occur by the age of 5–8 years, but sometimes appear later or not at all
How is ataxia telangiectasia diagnosed?
It is a rare, neurodegenerative, autosomal recessive disease causing severe disability.
Name 4 neurocutaneous sydnromes found in children.
- Neurofibromatosis
- Tuberous Sclerosis
- Sturge Weber Syndrome
- Ataxia telangiectasia
What is seen here?
White reflex indicates:
- Congenital cataracts
- Retinoblastoma
What is this condition called?
Seborrhoeic dermatitis AKA “cradle cap”
What is the management of seborrhoeic dermatitis ?
- Greasy and yellow crusts
- Can be seen in scalp and eyelids
- Baby shampoo and olive oil application
What is the cause of this skin condition?
Nickel allergy - contact dermatitis
What is this skin condition?
Hives AKA urticaria
What is this skin condition?
Urticaria
- Transient itchy skin swelling
- Prevalence is 10-15% of population
- Acute
- Chronic: recurring or lasting > 6 weeks
What is this condition?
Urticaria and angioedema
Name 5 common causes of urticaria.
- Idiopathic in 50% of cases
- Foods: milk, egg, nuts, seafood
- Drugs: penicillin, NSAIDS
- Viral infections
- Bees & wasps
- Blood products
Summarise the management of urticaria.
- Non sedating antihistamines
- Higher doses may be needed
- Short term steroids
- Montelukast
- Cyclosporine in severe cases
- Reassurance
What is this condition?
Eczema
(NB: can sometimes look similar to seborrhoeic dermatitis)
What are the features of eczema/atopic dermatitis?
- Chronic inflammatory skin condition
- Common,10 – 20% of children suffer
- In 60% of cases start before 1yr of age
- In infants affects cheeks, chins and limbs
- After infancy affect flexural surfaces
- Commonly resolves with age
What is the pathogenesis of eczema?
- Complex and multifactorial
- Genetic predisposition
- 20% risk if one parent is affected
- 50% if both parents had AD (atopic dermatitis)
How is eczema managed?
- Topical Treatments
- Emollients +/- containing antimicrobials
- Topical steroids
- Topical calcineurin inhibitors (tacrolimus, pimecrolimus; reduced IL-2 release and IL-2R expression)
- Oral antihistamines
- Treatment of infections
What is the inflammatory response in atopic dermatitis?
TH2 cell response leading to the release of IL4, IL5 and IgE
What skin barrier defects can predispose to eczema?
- Deficiency of filaggrin or ceramide
- Deficiency of antimicrobial peptides
Why is eczema so dry?
Predisposing factors lead to trans epidermal water loss
What is this condition?
Lick eczema - saliva is an irritant and can cause eczema. Can be prevented with a barrier cream
What is this condition?
Eczema herpeticum
What causes eczema herpeticum? How is eczema herpeticum managed?
- Viral superinfection of eczema
- A serious condition with 50%mortality if untreated
- Treatment: flucloxacillin + acyclovir
How do allergy symptoms change with age?
Name some common food allergens.
- •Cow’s Milk Protein
- •Soya
- •Eggs
- •Wheat
- •Peanuts
- •Tree nuts
- •Fish
- •Shell fish
What are the potencies of different topical steroids?
Use topical steroid ladder
- Hydrocortisome = mild
- Dermovate = very potent
How does % of steroid absorbed vary across different body areas?
- Forearm absorbs 1%
- Armpit absorbs 4%
- Face absorbs 7%
- Eyelids and genitals absorb 30%
- Palm absorbs 0.1%
- Sole absorbs 0.05%
