Spots & Rashes Flashcards
Dark skinned newborn with discolouration at base of spine + buttocks. Looks like bruising. What’s this?
Mongolia blue spots
fades!
Who gets strawberry naevi?
preterm girls
Unilateral, don’t cross midline (capillary malformation in dermis)
Associated with Sturge Weber syndrome (convulsions)
What’s this?
port wine stain
How many cafe au lait spots make it into neurofibromatosis?
> 5
Uncommon but serious blistering form of impetigo, affecting neonates? What bac?
bullous impetigo
staph aureus
If a strawberry naevus (cavernous haemangioma) obstructs a neonate’s airway or vision, what do you give?
oral propanolol!
the answer to everything tehe
Patches of urticaria arising at 2days old, which come and go and usually clear in a fortnight. What’s this?
erythema toxicum
White spots of retained keratin on nose and cheeks. What’s this?
milk spots
What causes albinism?
defective melanin synthesis
skin cancer risk
What’s the most common cause of nappy rash?
irritant dermatitis
the irritant is the nappy :p
Which kind of nappy rash is CREASE-SPARING?
irritant dermatitis
When is nappy rash NON-crease-sparing?
When it’s complicated by Candida.
candida gets into the creases
Two others causes of nappy rash that AREN’T irritant dermatitis…
seborrhoeic dermatitis,
eczema
What’s the posh name for cradle cap?
infantile seborrhoeic dermatitis
Is cradle cap itchy?
no,
unperturbed
What % of UK children get atopic eczema?
20%
Genetic deficiency of skin barrier function. What’s this?
eczema
What % of eczema resolves by age 16?
75%
when does eczema tend to present?
first yr of life
When you itch eczema lots, it leads to excoriations, weeping and crusting. what can happen then
lichenification
where do they get eczema if they’re an infant
face and trunk
where do they get eczema if they’re older
flexor surfaces
infection of eczema with HSV can cause
eczema herpeticum
Name 5 causes of eczema exacerabations.
- skin infections
- contact with irritant / allergen
- psychological stress
- heat / humidity
- change in meds
Tell me all the human herpes viruses
hsv 1 hsv 2 vzv cmv ebv hhv 6,7,8
What is caused by hhv 6 & 7?
roseola infantum
what is caused by hhv 8?
kaposi sarcoma
How do you avoid precipitants of eczema?
no soap,
soft clothing,
cut nails short,
avoid allergens.
Kate love there are 8 points to remember for the management of eczema. Fire away!
- avoid precipitants
- emollients
- topical corticosteroids
- immunomodulators
- occlusive bandages
- Abx / antivirals (if skin infected)
- antihistamines
- psychosocial.
give an example of an immunomodulator for eczema
tacrolimus
what is tacrolimus
immunomodulator for eczema
why would you prescribe antihistamines in eczema
stop itch
what could you recommend for psychosocial tips for eczema
national eczema society
put these on overnight, with cream underneath, to stop scratching eczema…. ?
occlusive bandages
what virus causes verrucas
HPV
how do you treat verrucas?
topical salicyclic acid + lactic acid or cryotherapy (liquid nitrogen)
what virus causes molluscum contagiosum?
poxvirus
widespread small pearly papules with central umbilication. What’s this?
molluscum contagiosum
How soon should molluscum contagiosum disappear?
within 1 yr
How do you treat molluscum contagiosum if it’s persisting past 1 yr?
cryotherapy
anti-bac cream if overlying infection
Infant has febrile illness and roseola infantum. What infective agent?
hhv 6&7
What is the incubation period for chickenpox?
10-21 days
how long do you keep IgG to VZV for?
life
how is VZV spread?
airborne!
after chickenpox VZV can stay latent in dorsal root ganglion. what can it reactivate as?
shingles
First there was papules. Then there was
vesicles …. pustules … crusts
what are chickenpox ‘crops’?
vesicles with surrounding erthyema
last 7ds
4 COMPLICATIONS OF CHICKENPOX PLZ
- bac superinfection
- encephalitis; ataxic cerebellitis
- purpura fulminans
- haemorrhagic eruptions
what can happen if you’re immunocompromised and your chickenpox disseminates
haemorrhagic eruptions
which bac do superinfections of chickenpox?
staph / strep
toxic shock! nec fasch!
vasculitis which is complication of chickenpox?
purpura fulminans
Do you use oral aciclovir to treat chickenpox?
NO decreases natural immunity
when would you treat chickenpox with aciclovir?
if imm comp, IV aciclovir
most imm comp chickenpox treat with IV aciclovir. If HIGH RISK imm comp treat with …???
‘human varciella zoster immunoglobulin’
Red maculopopular rash, starts on back of ears, spreads down
measles
where does the measles rash start
back of ears
is measles notifiable
yes obviously
how is measles spread?
droplet spread
how infectious is measles?
highly
how do you test for measles?
PCR blood or saliva
white grains on buccal mucosa – pathognomonic for measles…?
koplik’s spots
what are koplik’s spots?
white grains on buccal mucosa
pathognomic for measles
I want the symptoms of measles, in order of appearance.
- fever
- cough, coryza, conjunctivitis
- Koplik’s spots
- rash
Give me 2 complications of measles
measles encephalitis
SSPE
What is ‘SSPE’ and when is it got?
subacute sclerosing panencephalitis
measles
Describe the management of measles.
isolate
supportive.
(if imm comp, ribavarin)
An immmunocompromised child gets measles. What is the treatment?
isolate.
supportive.
RIBAVARIN
what kind of med is ribavarin?
anti-viral
what is the causative agent of mumps
mumps virus .
which infection causes swelling of parotids
mumps
what serum marker is raised in MUMPS?
plasma amylase
what is treatmentfor mumps?
self-limiting
apart from parotid swelling, what are 2 more symptoms of mumps?
earache
pain on eating/drinking
This virus is devastating as a congenital infection but mild as a childhood infection, It causes maculopapular rash and lymphadenopathy…
rubella
If a child with sickle cell or thalassaemia gets slapped cheek (parvovirus b19) what can happen?
aplastic crisis
What are the enteroviruses?
coxsackie, polio, echovirus
coxsackie, polio and echovirus are all
enteroviruses
your little girl has impetigo. should you be sending her to nursery?
no
honey coloured lesions makes you think of
impetigo
what kind of lesions do you get in impetigo
honey coloured
on face neck and hands
what causes impetigo
staph / strep
superficial skin infection
how contagious is impetigo
highly
how do you treat mild impetigo
topical Abx cream
how do you treat severe impetigo
fluclox
or co-amox
what infection causes boils
staph aureus
infections of hair follicles and sweat glands
child with fever, erythema and oedema of eyelid. What’s this?
periorbital cellulitis
from local trauma to skin, dental abscess, sinus inf
Treatment for periorbital cellulits?
IV CEFTRIAXONE, quick!
to prevent ORBital cellulitis (proptosis, meningitis) (where supected, do CT head to check for posterior spreadintohead)
Which bac cause toxic shock syndrome
staph
strep
when i say strep in skin i mean
strep pyogenes (group A strep)
not group B strep, that’s strep agalactiae
(strep throat = strep pyogenes too)
- Fever >39
- Hypotension
- Diffuse macular erythematous rash
what you thinking?
toxic shock syndrome
What are the three signs of toxic shock syndrome?
- Fever >39
- Hypotension
- Diffuse macular erythematous rash
Toxic shock syndrome is caused by toxins released from bac at any site, causing organ dysfunction! Which bacterias?
staph / strep
Signs of toxic shock are fever, hypotension and rash. But what are some symptoms?
Mucositis, vomiting/diarrhoea, renal & liver, clotting & thrombocytopenia, ...altered consciousness.
Toxic shock syndrome needs treatment on ICU. With what?
IV Abx and surgical debridement of infection :/
Cellulitis can be staph or strep, whereas erysipelas almost always…
group A strep
What is the difference between where gets infection in cellulitis and in erysipelas?
erysipelas - upper dermis + superficial lymphatics
cellulitis - lower dermis + subcutaneous fat
The rash is more RAISED in which, cellulitis or erysipelas?
ERYSIPELAS (rash more raised)
What are the symptoms of scarlet fever?
fever headache sandpaper maculopapular rash, starting at neck / chest tonsilitis, sore throat strawberry tongue flushed cheeks w perioral sparing
Scarlet fever rash is MACULOPAPULAR sandpaper rash. Where does it typically start?
neck
What might a child with scarlet fever’s face look like?
flushed cheeks w perioral sparing
strawberry tongue
(red exudatey tonsils)
Diagnosis of scarlet fever usually clinical. What investigations if in doubt?
throat swab and culture
What is the difference between strep throat and scarlet fever?
both group A strep.
scarlet fever = strep throat with a rash
(caused by the TOXIN)
How is scarlet fever spread?
droplet
How is scarlet fever spread?
droplet
Treatment for scarlet fever and strep throat?
10 days Pen V
rest, fluids, paracetamol
Give me two rare but feared complications of scarlet fever.
rheumatic fever
post-strep glomerulonephritis
What is tinea capitis?
scalp ringworm
scaling and alopecia
dermatophytosis , a.k.a
ringworm
fungal
Annular fungal skin lesions in ringworm. Severe ring is called…
kerion
Give me three types of tinea fungus ..
capitis, corporis, pedis, cruris (groin)
How do you diagnose ringworm?
skin scrapings:
microscopy and culture
(fungal hyphae)
What is the treatment for ringworm?
topical or systemic antifungal e.g. clotrimazole
treat dog or cat if infected
eight-legged mite burrows down epidermis.
scabies
differential of ringworm?
granuloma annulare (raised edge, yrs)
what kind of agent is scabies?
parasitic
when do you get itching from scabies?
2-6wks after infection
what is main symptom of scabies?
ITCHING
(worse at night and in warmth)
can turn into RED RASH
where on the body does scabies tend to go?
between fingers and toes
armpits
nipples, penis, buttocks
If scabies burrows get really scratched, what might happen?
secondary infection
crusted pustular lesions
How do you diagnose scabies?
skin scraping
- microscopy - mites/eggs/mitepoo
what is the scabies mite called?
sarcoptes scabei!
parasitic
What is the treatment for scabies?
PERMETHRIN cream over whole body
treat whole family!!
hotwash bedding and put clothes in sealed bag for 3ds
dont share towels / have sex
what is pediculosis capitis?
head lice
nits are eggs
What’s the treatment for nits?
DIMETICONE lotion
wet combing
As well as acute glomerulonephritis, what else happens in Henoch Schonlein purpura?
symmetrical rash on
buttocks; arm/leg extensors; ankles
arthralgia
abdo pain
What actually is Henoch Schonlein purpura?
VASCULITIS iga+g complexes
unknown cause, preceded by URTI
Arthralgia
Abdo pain
Symmetrical rash on buttocks, arms/legs, ankles
and Acute glomerulonephritis.
What’s this?
Henoch Schonlein purpura
sever bullous erythema multiforme involving mucus membs. from infection or drug reaction.
steven johnson syndrome
sepsis, electrolyte imbalance ://
Word to describe rash which is…
flat, altered colour / texture
macular
Word to describe rash which is…
raised
papular
Roughening and accentuated skin markings is called
lichenification
What is ulcer?
loss of epidermis and dermis
Purpura = ?
bleeding into skin or mucosa
Small purpura are called…
whereas large purpura are called…
petechiae
ecchymoses
What do measles, rubella, scarlet fever, and slapped cheek all have in common?
MACULOPAPULAR
give me some key infective causes of maculopapular rash
measles, rubella, scarlet fever, slapped cheek
What kind of rash is chickenpox and shingles?
VESICULAR
what kind of rash is impetigo?
VESICULAR
Give me 3 things which would give PURPURIC rash?
Henoch Schonlein purpura
malaria
septicaemia
Give me 4 VIRAL causes of fever and rash?
parvovirus
measles
rubella
chickenpox
(eczema herpeticum, roseola infantum)
Give 2 BACTERIAL causes of fever and rash?
scarlet fever
impetigo
Give me 3 non infective causes of fever and rash?
kawasaki
systemic JIA
henoch schonlein purpura
