Skin infections

Question 1

prevalence of herpes simplex virus in childrfen

Answer 1

18-35% of children by 5yo

Question 2

when should herpes simplex virus be treated promptly and with what

Answer 2

periobrital involvement
-eyes checkd for corneal involement which can cause scarring

treatment - acyclovir
-prophylaxi may be requied if reactivation becomes frequent

Question 3

what condition can herpes simplex virus accompany in children and how does it present

Answer 3

children with atopic eczema (eczema herpeticum)

infeciton can become widespead and acute detreriation in the severiry of their eczema causing monomorphic punched out erosinos which can be painful

Question 4

what causes impetigo
-who gets it

Answer 4

highly contagious skin infeciton caused by staph A
(occassionaly strep)

commonly seen in infants and young children

Question 5

characterisitic features of impetigo 3

Answer 5

annular erythematous lesions w a honey coloured crust

Question 6

when can impetigo become bullous

Answer 6

may become bullous as a result of cleaving of the epidermis by exfoliative staph endotoxins

Question 7

management priciples of impetigo

Answer 7

swabbed and paretns advised hwo to reduce spread
-avoid sharing towels and bathing with other children

Question 8

treatment of impetigo 3

Answer 8

topical antiseptic (cream) in bath
-also apply directly to affected areas

if only a few lesions consider topical ABx

if multiple lesions
oral ABx

Fluclox - first choice

Question 9

how is molluscum contagiosum characterised

Answer 9

small pearl umbilicated papules on the skin of children

Question 10

who gets molluscum contagiosum 2

Answer 10

agd 4-9

often more sever in children with eczeema and worse in flexural sites where lesiosn can become infected

Question 11

cause of molluscum contagiosum

Answer 11

DNA Pox virus

Question 12

management of molluscum contagiosum 2

Answer 12

become inflamed and then resolve oer 18mnths or more

no treatment gnerally required
-topical antiseptics may prevent them becoming infected

Question 13

how to get rid of molluscum contagiosum quicker 4

Answer 13

physically irritated
-rubbing
-piercing
-cryotherapy

chemically
-salicylic acid

Question 14

how does scabies present in infants compared to adults

Answer 14

extremely itchy rash simlar to adults

difference is with burrows that are commonly present in adults -these typical burrows are not present on the skin but appear:
-on the soles of the feet. (not usually seen in adults)

can also manifest as nodules in warm moist areas such as axilla, umbililicsu groin or penis

WHOLE FAMILY AND CARERS SHOULD BE TREATED

Question 15

treatment for scabies 2

Answer 15

permethrin

malathion

Question 16

why is tinea capatis increasing in incidence s

Answer 16

result of increaed immigration from african and carribean contunres where the incidence is higher

Question 17

main causal organism of tinea capatis 2

Answer 17

tricopyton tonsurans

-less commonly trichophyton violaceum

Question 18

how can tinea capatis present

Answer 18

spectrum can be:
-diffuse scales

-patchy alopecia w black dots (broken hairs)

-widespread pusutules associated with lymphadenopathy

Question 19

define a kerion in relation to tinea capatis
-what is this associated with in this condition

Answer 19

kerion- inflammatory pus filled abscess that sometimes oozes

can cause lymphadenopathy and can breakdown to leave a huge ulcer that scars

Question 20

how is tinea capatis diagnosed

Answer 20

micropscopy and cultures of scapring or brushgin from the scalp

Question 21

management of tinea capatis 3

Answer 21

ketoconazole shampoo help prevent spread to toerh children

but not a recongised treatment

oral griseofulvin
-licesned but cuasuses nausae

terbinafine (unlicensed)
-is most effective

review after four weeks and rescpra/contiuunue treatment if still clinically affected

Question 22

presentation of uritcaria 2

Answer 22

itchy papules (hives)

and pplaques which demonstrate a wheal and flare ( where the papule is white with surrounding eythema)

Question 23

what causes these lesions in uritcaria

-how does this cause swelling

Answer 23

histamine release from mast cells in the skin which have degranulated after stimulation by a trigger

-the histamine causes vasodilation of the blood vessels (hence erythema) and leakage of fluid from the capillaries causing swelling in the skin

Question 24

timeframe for acute uritcaria

Answer 24

less than 6-8 weeks

Question 25

how can causes of uritcaria be classified 5

Answer 25

5 ‘i’s

infection
infestation
injection
ingestion
inhalation

Question 26

how can causes of uritcaria be classified 5

Answer 26

5 ‘i’s

infection
infestation
injection
ingestion
inhalation

Question 27

regarding causes of urticaria describe each subset
-infection 3

Answer 27

bacterial

viral

fungal

Question 28

regarding causes of urticaria describe each subset
infestation 1

Answer 28

worms (diarrhoeal/perianal itch assocated)

Question 29

regarding causes of urticaria describe each subset
injection 3

Answer 29

drugs

immunisation

blood products

Question 30

regarding causes of urticaria describe each subset
ingestion 2

Answer 30

drugs- while exposed

foods -lasts hours

Question 31

regarding causes of urticaria describe each subset
inhalation 2

Answer 31

pollen

mould - lasts hours/while exposed

Question 32

what is the basic pathophsy of chronic urticaria
-what is it associated with 3

Answer 32

usually autoimmune trigger
-assoc w other autoimmune conditions such as thyroid disease

rarely associated with underlying chronic infection like gut paraisetes or tuberculosis

extremely rarely can occur as part of antiinflammatory syndrome when it presents in infancy assoc w pyrexia, malaise and joint or abdo pain

Question 33

management of uritcria if under 6 months 1

Answer 33

chlorpheniramine

Question 34

managment of uritcaria if over 6 months 2

Answer 34

chlorpheniramine
+
long acting antihistamine (astemizole)

Question 35

other parts of uritcaria managemnt 1

Answer 35

add sedative antihistamine at light if sleep is distrubed

Question 36

when should a child with uritcaria be referred

Answer 36

if they are unresponsive to 3 differnt antihistamines each for 4-6wks or they have additional symptoms or brusing