Special Problems in Children Part 2 Flashcards
What is this?
Cutis marmorata
(Physiological Livedo Reticularis)
What is this and what causes it?
Harlequin Colour Change
It is suspected to be linked to the immaturity of the hypothalamus controlling the dilation of peripheral blood vessels.
What is this?
What causes it?
What is the treatment?
Milia (50% of babies get it)
A Build up of keratin in the pilosebaceous glands
Self limiting (Although cryotherapy or squeezing out the contents helps)
What is the cause of Milia in young adults?
Usually damage to the skin secondary to sun exposure.
What is this?
How do you treat it?
Miliaria (Heat Rash)
Keep the skin cool.
What are the causes of nappy rash?
- Dampness
- Friction
- Exposure to urine and faeces
- Presence of microorganisms.
What type of nappy rash is this?
Irritant Contact Dermatitis
(It spares the skin folds & has shiny macules and papules)
What type of nappy rash is this?
Candida dermatitis
(Satellite Lesions are a hallmark of Candida Dermatitis)
What sort of nappy rash is this?
Psoriasiform dermatitis
(Pink well demarcated plaques involving the creases)
How do you manage nappy rash?
- Avoid the causative agent/ Regular nappy changes
- Barrier cream - Bepanthen ointment (containing dexpanthenol) or Sudocrem
- Low potency steroids at the start (A nappy gives occlusion so be mindful of this)
-
Topical Imidazole if Candida
- Check for oral thrush - treat with nystatin drops or miconazole gel.
What is thought to cause Seborrheic Dermatitis in children?
Malassezia furfur
What is the treatment for seborrhoeic dermatitis in children?
- Soft brush after overnight olive oil or emollient
- Topical antifungal creams - ketoconazole cream with or without hydrocortisone.
What are the 3 types of warts?
- Plane warts (Verruca Plana)
- Common Warts (Verruca Vulgaris)
- Filiform Warts
What types of warts are these?
What subtype of HPV causes them?
Where are they most commonly found?
Plane Warts (Verruca Plana)
HPV 3, 10 & 28
Face, hands and shins.
What types of warts are these?
What subtype of HPV causes them?
Where are they most commonly found?
Common Warts (Verruca Vulgaris)
HPV 1,2 & 4
Fingers, Periungual Folds and Plantar Surfaces
What types of warts are these?
What subtype of HPV causes them?
Where are they most commonly found?
Filiform warts
Same subtype of common warts (HPV 1, 2 & 4)
Eyelids or perioral
What is the resolution of warts?
65% in 2 years
What is the instruction for using salicyclic acid for treating warts?
- Soak daily in warm water and pared with a file, emery board or pumice stone prior to application of salicylic acid.
- Care should be taken to protect the surrounding skin.
- Occlusion with cling film or plaster will enhance penetration.
- Perseverance for at least 8-12 weeks is required.
What other topical agents can be used for warts?
- Imiquimod (off-licence but effective)
- Retinoids
- Glycolic acids
- 5-FU
- Podophyllin
- Bleomycin
- Dithranol
What common pigmented lesions are most common in children?
- Ephelides (Freckles)
- Specled Lentiginous Naevus(Naevus Spilus)
- Blue Naevi
-
Spitz Naevus(Spindle Cell naevus, juvenile melanoma)
- Pigmented Spindle Cell Naevus of Reed (PSCNOR)
- Halo Naevus
What is this?
Speckled Lentiginous Naeevus (Naevus Spilus)
Melanoma can arise from these lesions so carefulmonitoring, serial photography & referral if suspicious lesions.
What is this?
Blue Naevus
(Homogenous and stable whereas melanoma is heterogenous and changing)
What is this?
Spitz Naevus (Syn. Spindle Cell Naevus or Juvenile Melanoma)
A form of benign Melanocytic compound naevi
They grow rapidly but usually never exceed 1cm in diameter.
What is this?
Who usually gets this?
What should you do about them?
A Pigmented Spindle Cell Naevus of Reed (PSCNOR)
More prevalent in young girls and on the thighs.
They have a starburst pattern.
They should be excised to exclude melanoma.
What is this?
Halo Naevi
A form of benign melanocytic naevi
More common in teenagers and will usually regress overtime.
What is Idiopathic photodermatosis is this?
Juvenile spring eruption.
Affects only the ears.
Boys > Girls
8-24 hours after sun exposure
How is juvenile spring eruption treated?
- Prevention - Sun avoidance, Sunscreen
- Treatment
- Topical steroids
- Antihistamines
- Emollients
What photodermatosis is this?
Acitinic Prurigo
- Itchy erythematous papules and nodules to sun exposed areas.
- Treatment -systemic and topical steroids for shortterm.
- Thalidomide if very difficult to treat.
What % of cases of psoriasis cases are seen in children?
1/3 of all cases
What form of psoriasis is more common in children?
Plaque or Guttate
Guttate
What causes Guttate Psoriasis?
URTI -> Beta-Haemolytic Strep Group A infection.
Usually resolves over 1 month.
What percentage of patients with guttate psoriasis will go on to develop psoriasis?
1/3
What are the treatments for guttate psoriasis?
- Vitamin D Analogues
- Corticosteroids
- Tacrolimus
- Phototherapy
In adults - antibiotics for the Group A Strep - but not in children.
What form of nappy rash is this?
Psoriasis
Name the 2 types of Pityriasis Lichenoides (PL)
- Pityriasis Lichenoides et Varioliformis Acuta (PLEVA)
- Pityriasis Lichenoides Chronics (PLC)
At what ages does PL occur?
First decade of life
Ages 5,10 and 12.
Where does PL usually occur on thebody?
Tunk, thighs and upper arms
What is this?
Pityriasis lichenoides et varioliformis acuta (PLEVA)
Purpuric, necrotic and ulcerative features.
Usually resolve in weeks or months.
High fever and constituational symptoms can occur.
What is this?
Pityriasis lichenoides chronica (PLC)
The lesions have light scales
They resolve with dyspigmentation but without scars.
What is PL often confused with?
- varicella (Shorter course than PL)
- pityriasis rosea
- insect bites
- scabies
What is the treatment for PL?
Topical Corticosteroids & Erythromycin
Tacrolimus has also been successful
