W7 - Paediatric Dermatology Flashcards
how do you describe morphology
what is the birthmark?
small red mark at a few weeks of life - getting bigger
strawberry haemangioma
what is this
Strawberry Naevus/ Capillary Haemangioma
what is the aetiology of Strawberry Naevus/Capillary Haemangioma
Not present at birth - appear first month of life.
Get bigger until 6-10 months -> resolve.
Most fully resolve by 5-7 years.
Treatment: usually not needed. Near eye or obstructing airway = propranolol.
Complications: ulceration, bleeding + infection.
when would you treat starwberry naevus
over the eye - obstruct vision
in nappy area - get infected
what is the management of strawberry haemangioma
propranolol
what is the rash
2 day old gets spots - concern over chicken pox
baby well
Erythema Toxicum Neonatorum
what is the aetiology of Erythema Toxicum Neonatorum
Occurs in neonatal period (up to 28 days)
Raised yellow vesicles on an erythematous base
Occurs in 50% of babies, particularly term+
Completely benign
Settles in a few weeks
what is the rash
1 day old baby
has spots on head
mum has 2 ulcers
baby lethargic and not feeding
neonatal herpes simplex
what is the aetiology of neonatal herpes simplex
Very serious condition
Tends to affect babies whose mum has had this primary infection in pregnancy and gave birth vaginally
Usually occurs on scalp
Can disseminate to multiple organs including the brain
Needs urgent treatment with IV aciclovir
33% mortality rate (despite treatment)
why is neonatal herpes simplex so serious
urgent IV aciclovir
33% mortality even with treatment
what is primary herpes and why is that important
mums first infection with herpes - only primary herpes can be given to baby
what is the rash
stork mark \ naevus simplex
what is the aetiology of stork mark
Always midline
40% of neonates
Often: neck or forehead
A delay in the maturation of skin cells during embryonic development – dermal capillary dilatation
Usually disappears with time
what is this
milia
what is the aetiology of milia
Tiny white bumps on the nose, chin or cheeks.
Dead skin cells get trapped under the skin and form tiny cysts.
50% of neonates, but can also occur any age.
Treatment = not needed -> disappear on their own in a few weeks or months.
what is this
‘Cradle Cap’/Infantile seborrheic dermatitis
what is cradle cap
10% of infants
3 weeks -> 12 months
Cause unknown - ? Hyperactivity of sebaceous glands secondary to maternal androgens
Self limiting
Baby shampoo/oil, gentle brushing
what is this
infantile acne
why does this look odd for infantile acne
darker skin - harder to see
what is the aetiology of infantile acne
Affects cheeks, chin and forehead
Boys > girls
6w - 12 months
Papules, pustules, nodules, cysts + comedones
Aetiology unknown ? Genetic (normal hormone levels)
Benzoyl peroxide or erythromycin gel
Oral antibiotics
what antibiotics MUST NOT be used to treat infantile acne
tetracyclines - doxycycline
causes dental scaring
what is this
mongolian blue spot OR
slate grey naevus
what is blue spot
Very common birth mark in babies with darker skin tones
Occurs in 90% of east Asian babies
Area of darker pigmentation often on buttocks but can occur in thighs and arms
Doesn’t cause any harm will usually fade by 4 years of age
Always document if you see on a baby check
what is this
measles
what is the signs symptoms and presentation of measles
Maculopapular + starts behind ears
Prodromal phase: fever, corysa and conjunctivitis
Complications = encephalitis and subacute sclerosing panencephalitis
what are these lesions
coplic spots
what is this
varicellar zoster
what is the aetiology of varicella zoster rash
Papules which progress to vesicles
Often occur in crops
Infectious from 2 days before rash, until all lesions crusted over
Symptomatic management
Immunocompromised = zoster immunoglobulin
what is the treatemnt for varicella zoster
calamine/emollient, sedating antihistamine, paracetamol.
why must you NOT give ibuprofen
increased scarring and necrosis, increased risk chickenpox pneumonitis
what is this
hand foot and mouth
what is the aetiology of hand foot and mouth
Caused by Coxsackie virus
Tends to occur in children under 5y
Blisters on hands and feet and in mouth
Symptomatic Management
what could cause hand foot and mouth to be more severe
if parents get infected
if baby has eczema
what is this
Molluscum Contagiosum
what is aetiology of Molluscum Contagiosum
Caused by pox virus
Umbilicated centre
Contagious
Self limiting: can take up to 2 years to clear
how is molluscum contagiosum spread
normally scratching
what associated condition MUST you consider
a compromised immune system
consider HIV
what is this
parvovirus B19
what MUST be considered with parvo virus
stay away from pregnant women - can cause miscarriage
what is the aetiology of parvovirus B19
Common in children + can occur adults
Fifths disease
Fever, runny nose, sore throat, headache
Can cause miscarriage in pregnancy
Aplastic crises in haemolytic anaemia
how would pityriasis rosacea present
starts with herald patch
what is this
Guttate Psoriasis
what is the aetiology of Guttate Psoriasis
developed widespread rash over trunk.
He is systemically well.
2 weeks ago he had antibiotics for tonsillitis.
A throat swab grew Strep
what is this
Staph Scalded Skin
what is aetiology of Staph Scalded Skin
Caused by a toxigenic strain of bacteria
Two exotoxins are produced which breakdown desmoglein 1
This results in separation of the skin through the granular cell layer
Tends to affect under 5 years
Skins looks red and blistered like a burn
Treat IV antibiotics
what is this
axillary freckling
what is this
cafe au late spot
what is this
neurofibromas
what is this
lisch nodules
what links these images together
Neurofibromatosis Type 1
what is the genetic inheritance of neurofibromatosis type 1
Autosomal Dominant
what is this
adenoma sebaceum
what is this
Ash Leaf patches
what is this
Shagreen patches
what condition link all 3 of these images
Tuberous Sclerosis
what are some other features of Tuberous Sclerosis
Polycystic kidneys
Infantile spasms
Epilepsy
Learning difficulty
what is this
port wine stain
(in ophthalmic division of trigeminal nerve)
what is this
congenital vascular lesion in brain
what condition links these 2 images
Sturge Weber syndrome
what is Sturge Weber syndrome
associated with
epilepsy, learning difficulty and hemiplegia
what is this
Epidermolysis bullosa
what is aetiology of Epidermolysis bullosa
A rare genetic condition causing blistering of the skin and mucous membranes
Epidermis and dermis not adequately attached, so minor trauma causes separation.
Increased risk of skin cancer due to chronic inflammation.
Reduced life expectancy due to infections.
what is this
meningococcal scepticaemia
what is aetiology of meningitis scepticaemia
Caused by Neisseria Meningitidis, common nasal organism.
Meningococcal septicaemia occurs when the organism gets into the blood stream. It can kill a well child in hours.
Children present unwell with fever. The rash can start as blanching but usually becomes non blanching.
Lesions become non blanching + irregular with necrotic centres.
what is the treatment for meningococcal septicaemia
80mg/kg of ceftriaxone IV.
what vaccination is used for meningococcal disease
Men ACBWY
what should be considered for family and close contacts
prophylactic antibiotics
rifampicin or ciprofloxacin.
what is this
Henoch-Schonlein Purpura
what is aetiology of Henoch-Schonlein Purpura
Raised palpable purpura on buttocks and extensor surfaces.
Most common vasculitis in children.
No fever + Child systemically well.
Associated with joint pain, joint swelling, abdominal pain and glomerulonephritis
who gets henoch-schonlein purpura
Peak incidence: 4-10yrs.
M:F = 2:1
Recurrence in 1/3 patients in future.
what is the risk in henoch-schonlein purpura
Risk of IgA nephropathy and renal failure.
what should you do as an investigation for Henoch-schonlein purpura
Check urine for blood and protein. Measure BP – protocol.
what is this
Immune Thrombocytopenic Purpura
what is aetiology of Immune Thrombocytopenic Purpura
Petechial rash is caused by low platelets
Often associated with easy bruising and bleeding from mucosa
Systemically well
Tends to occur 1-2 weeks after a viral infection due to cross reacting antibodies
what is overall treatment and management
Check FBC and film
Most don’t need treatment.
Treatment options include steroids and IVIG
Usually resolved in 6-8 weeks
Avoid contact sports until platelets >50
