Skin Rashes and Dermatology Flashcards
What is the diagnostic criteria for KAWASAKI DISEASE?
Fever for FIVE DAYS plus at least FOUR out the following five features:
- conjunctivitis (bilateral, non-purulent)
- rash (confluent, urticarial)
- adenopathy (cervical)
- strawberry tongue / oral involvement
- hands and feet swollen / painful
Outline some features of KAWASAKI DISEASE that may be present, but are NOT part of the diagnostic criteria.
✔️ irritability ✔️ aseptic meningitis ✔️ nausea and vomiting ✔️ abdominal pain ✔️ arthritis / arthralgia ✔️ aseptic pyuria ✔️ inflammation at recent BCG injection site
Outline some differential diagnoses for KAWASAKI DISEASE.
✔️ Henoch Schloin Purpura ✔️ non-specific vasculitis ✔️ non-specific viral infection (e.g. CMV, EBV) ✔️ GAS infection (e.g. ARF, tonsillitis, Scarlet fever( ✔️ Stephen Johnson Syndrome ✔️ meningococcal disease ✔️ DIC ✔️ acute drug reaction
Describe the appropriate management of KAWASAKI DISEASE.
- Primary survey (ABCDE)
- Admit the patient onto the Paediatrics Ward
- Appropriate fluid balance (enteral or IV)
- Paracetamol for fever management
- Aspirin 3 to 5 mg / kg (be cautious of Reye’s Syndrome)
- Corticosteroids in high risk patients (prednisolone 2mg)
- IV Ig infusion (2g / kg) –> commence within TEN DAYS of symptom onset to reduce the risk of coronary aneurysm
Describe how patients with KAWASAKI DISEASE should be followed up.
- Cardiology F/U (echocardiogram at admission, 2 weeks and 6 weeks post-admission)
- Paediatric F/U (follow up for Reye syndrome within 6 weeks)
Outline the clinical presentation of ACUTE MENINGOCOCCAL DISEASE.
✔️ acute onset (<12 hours) fever, lethargy, irritability, reduced feeding
✔️ vomiting + diarrhoea
✔️ non-blanching petechial / purpuric skin rash
✔️ headache, neck stiffness, photophobia (if bacterial meningitis is present)
What are the appropriate investigations for ACUTE MENINGOCOCCAL DISEASE?
- Primary survey
✔️ airways –> check own and patent
✔️ breathing –> give O2 if < 90%
✔️ circulation –> insert 2 x large bore IVCs and collect appropriate bloods BEFORE commencing antibiotics
✔️ disability –> check GCS and pupil size
✔️ exposure - Commence empirical antibiotic therapy IMMEDIATELY
✔️ IV ceftriaxone for 5 days
✔️ readjust once blood culture results have been returned - IV fluids
✔️ resuscitation (20mL per kg of 0.9% NaCl)
✔️ bolus (%age dehydration x 10 x weight of 0.9% NaCl)
✔️ maintenance (4:2:1 of 0.9% NaCl + 5% dextrose +/- 5 or 20 mmol / L K+) - Notify public health
- Chemoprophylaxis of close contacts
Which bacteria is responsible for STAPH SCALDED SKIN SYNDROME?
Epidermolytic toxins A and B produced by toxic strains for Staph. aureus.
SSSS is most common in infants < 5 years of age.
Describe the clinical presentation of SSSS.
✔️ localised Staph infection
✔️ subsequent exudate and weeping
✔️ tender and erythematous skin
✔️ high fever
✔️ formation of serous blisters that rupture, exposing underlying dermis
✔️ Nikolsky’s Sign –> rubbing of skin causes exfoliation of the epidermis
✔️ irritability is worse when the child is patted and comforted
Outline the management of SSSS.
- Admit patient
- Consult burns team for most appropriate management of burns
- Supportive care
- IV antibiotics against Staph aureus (IV flucloxacillin or vancomycin if MRSA)
- Look for and treat focus of infection
- Monitor temperature, fluids and electrolytes
some say that fluids help to excrete the toxin in the kidneys - Handle skin carefully
What are some complications of SSSS?
✔️ significant dehydration ✔️ electrolyte imbalances ✔️ cellulitis ✔️ poor temperature control ✔️ septicemia ✔️ pneumonia
Outline the diagnostic criteria of HENOCH SCHOLEIN PURPURA.
Petechial / purpuric rash plus at least ONE of the following:
- abdominal pain
- nephritis
- arthritis / arthralgia
- leukocytoclastic vasculitis
Define HENOCH SCHOLEIN PURPURA.
HSP is the most common vasculitis in children. The exact cause is unknown. It is believed to be an IgA mediated vasculitis.
Key features are: ✔️ petechia / purpuric rash ✔️ abdominal pain ✔️ nephritis ✔️ arthritis / arthralgia ✔️ leukocytoclasic vasculitis
Describe the rash seen in HSP.
✔️ bilateral
✔️ common in gravity - dependent areas (lower limbs, buttocks)
✔️ petechial / purpuric
✔️ blanching
The rash is present in 75% of cases.
Identify complications of HSP.
RENAL PROBLEMS ✔️ nephritic syndrome ✔️ glomerulonephritis ✔️ hypertension ✔️ renal impairment ✔️ end stage kidney disease
NEUROLOGICAL PROBLEMS ✔️ labile mood ✔️ apathy ✔️ hyperactivity ✔️ encephalopathy ✔️ acute intracranial haemorrhage
RESPIRATORY PROBLEMS
✔️ diffuse alveolar haemorrhage
GASTROINTESTINAL PROBLEMS
✔️ intussusception
DERMATOLOGICAL PROBLEMS
✔️ non-pitting subcutaneous oedema
