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Paeds > Paed Dermatology > Flashcards

Paed Dermatology Flashcards

1
Q

What is eczema?

A

Itchy, dry inflammatory skin disease

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2
Q

Types of eczema

A

Endogenous (internal cause)
- Atopic
- Seborrhoeic - face / scalp - scale associated
- Discoid - annular/circular patches
- Pomphylx - vesicles affecting palms/soles
- Varicose - oedema/venous insufficiency
Exogenous (external cause)
- allergic contact dermatitis (sensitised to allergen)
- irritant contact dermatitis (friction, cold, chemicals e.g. acids, alkalis, detergents, solvents)
Photosensitive/photaggravated eczema

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3
Q

Flares of childhood eczema can be associated with…..

A 
Infections/viral illness
environment 
- central heating
- cold air
Pets if sensitised/allergic 
Teething
Stress 
Sometimes no cause for flare
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4
Q

What is the most common type of eczema, especially in children?

A

Atopic eczema

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5
Q

What is atopy?

A

Overactive immune response to environmental stimuli

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6
Q

Pathology of atopic eczema

A

Immune mediated defects in the skin barrier function - dry inflamed skin
The “skin barrier defect”

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7
Q

Associations of atopic eczema

A

Usually 1 or more family members affected

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8
Q

3 conditions that atopy is often linked to

A

Asthma
Eczema
Hayfever

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9
Q

Where is atopic eczema seen in infancy?

A

Typically starts on face/neck (cheeks common)

Can spread more generally

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10
Q

Where is atopic eczema seen in older children?

A

Flexural pattern predominates (antecubital fossae, popliteal fossae, wrists, hands, ankles)
Facial eczema also possible / can recur

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11
Q

What is there an abnormality in in atopic eczema?

A

Filaggrin expression

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12
Q

What is the roles of filaggrin?

A

Bind the keratin filaments together

Play a role in producing natural moisturing factor

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13
Q

What is the features of the loss of skin barrier function of atopic eczema?

A

Loss of water
Irritants may penetrate (soap, detergents, solvents, dirt)
Allergens may penetrate (pollens, dust mite antigens, microbes)

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14
Q

Who and where is seborrheoic dermatitis mainly seen?

A

Babies under 3 months

Mainly scalp and face

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15
Q

When does seborrheic dermatitis usually resolve by?

A

12 months

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16
Q

Associations of seborrheoic dermatitis

A

proliferation of various species of the skin commensal malassezia in its yeast form
Cradle cap in infants

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17
Q

Treatment of seborrheic dermatitis

A

emollients
antifungal creams
antifungal shampoos
mild topical steriods

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18
Q

What is discoid eczema?

A

Scattered annular/circular patches itchy eczema

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19
Q

What can discoid eczema also occur as a part of?

A

Atopic eczema

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20
Q

Presentation of pomphylx eczema

A

hand and foot eczema
Characterised by vesicles
Can be intensely itchy

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21
Q

What does varicose eczema affect?

A

Legs in association with venous insufficienct

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22
Q

Associations of varicose eczema

A

Oedema
varicose veins
chronic leg swelling

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23
Q

Presentation of varicose eczema

A

Skin often dry and inflamed

may ulcerate

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24
Q

Treatment of varicose eczema

A

emollients
topical steroids
compression stockings

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25
Q

What is helpful in determining allergic eczema?

A

Allergic eczema

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26
Q

Causes of irritant eczema

A 
Repeated contact 
water and soaps
citrus 
tomatoes 
chemical irritants
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27
Q

What does eczema =?

A

Dermatitis

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28
Q

What % of childhood eczema is mild?

A

80%

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29
Q

Presentation of food allergy

A 
Lip swelling
facial redness / itching 
anaphylactoid symptoms 
Late reactions
- worsening of eczema 24/48 hours after ingestion 
GI problems 
failure to thrive
Severe eczema unresponsive to treatment 
Severe generalised itching - even when the  skin appears clear
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30
Q

What can be associated with food allergy?

A

Atopy

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31
Q

2 ways to test for food allergy

A

Blood test for specific IgE antibodies to certain foods

Skin prick testing

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32
Q

Commonest food allergies

A 
Milk / dairy 
Soy 
Peanuts
Eggs
Wheat
Fish
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33
Q

Airborne allergens

A

house dust mite
pet dander
pollens

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34
Q

How to find out if you are allergic to a food

A

dietary restrictions / eliminations > 8 weeks

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35
Q

Eczema treatment

A 
Emollients
- lotions
- creams / ointments 
Topical steroids
Calcineurin inhibitors (e.g. protopic - steroid sparing topical agents)
UVB light therapy
Immunosuppressive medication
36
Q

Features of emollients used for treatment of eczema

A

Fragrance free

Greasier ointments for effective

37
Q

S/Es of topical steroids

A

Skin thinning in prolonged use

Topical steroid phobia

38
Q

Types of topical steriods

A

Very potent (dermovate) - 600x
Potent (betnovate) 100x
Moderate (eumovate) 25x
Mild (hydrocortisone)

39
Q

How much topical steroids should be used?

A

Finger tip unit

40
Q

How to use topical steriods

A

Once daily for 1 - 2 weeks
if improvement then use alternate days for a few more days
Then if stubborn/persistent areas can use twice weekly in these areas
If at any point the eczema starts flaring, go back to daily applications

41
Q

Treatment of impetigo

A 
Topical antibacterial (Fucidin)
Oral antibiotic (flucloxacillin)
42
Q

What is molluscum contagiosum caused by?

A

Molluscipox virus

43
Q

incubation of molluscum contagiosum

A

2 weeks to 6 months

44
Q

Transmission of molluscum contagiosum

A

close direct contacts

45
Q

Presentation of molluscum contagiosum

A

Pearly papules

Umbilicated centre

46
Q

How long can molluscan contagiousum take to clear?

A

Up to 24 months

47
Q

Treatment of molluscan contagiousum

A

5% potassium hydroxide

48
Q

Presentation of viral warts

A

Often skin coloured

Sole of the foot - verruca

49
Q

What are viral warts?

A

Common non cancerous growths of the skin caused by an infection with HPV

50
Q

What do viral warts do?

A

Stimulate own immune system to respond

51
Q

Treatment of viral warts

A 
cryotherapy 
Topical paints (salicylic acid)
52
Q

How much of viral warts resolve in 24 months?

A

90%

53
Q

Presentation of viral exanthems

A

Fever
Malaise
Headache

54
Q

Pathology of viral exanthems

A

Either reaction to a toxin produced by the organism, damage to the skin by the organism or an immune response

55
Q

Associated viral illnesses of viral exanthems

A 
chicken pox
measles
rubella
roseola (herpes virus 6)
erythema infectiosum (paravirus B19, slapped cheek)
56
Q

What happens once have the varicella zoster infection?

A

Life long immunity

57
Q

Who is susceptible to chicken pox at all times?

A

Immunocompromised

58
Q

Presentation of chicken pox

A 
red papules (small bumps) progressing to 
vesicles (blisters)
often start on trunk 
itchy 
associated viral symptoms
59
Q

Incubation period of chicken pox

A

10-21 days

60
Q

When is chicken pox contagious?

A

1-2 days before rash appears and until lesions have crusted

61
Q

What is chicken pox rarely associated with?

A

Pneumonia

Encephalitis

62
Q

Incubation of parvovirus (slapped cheek)

A

7 - 10 days

63
Q

Presentation of parvovirus

A

Erythematous rash cheeks initially and then also lace like network rash (trunk and limbs)
viral symptoms
mild self limiting illness

64
Q

How long can parvovirus take to full fade?

A

6 weeks

65
Q

What does the virus in parvovirus target?

A

Red cells in bone marrow

66
Q

Complications of parvovirus (rare)

A 
Aplastic crisis (if haemolytic disorders)
Risks to pregnant women 
- spontaneous abortion 
- IU death 
- hydrops fetalis
67
Q

What causes hand foot and mouth disease?

A

Enterovirus

  • coxsackie virus A16
  • enterovirus 71
68
Q

Presentation of hand foot and mouth disease

A

blisters on the hands
Feet and in the mouth
Viral symptoms

69
Q

When is there epidemics of hand foot and mouth disease?

A

Late summer

Autumn months

70
Q

Treatment of hand foot mouth disease

A

Supportive

71
Q

Presentation of orofacial granulomatosis

A

lip swelling and fissuring
oral mucosal lesions
- ulcers and tags
- cobblestone appearance

72
Q

Common cause of orofacial granulomatosis

A

Crohn’s disease

73
Q

Presentation of erythema nodosum

A

Painful, erythematous subcutaneous nodules
Over shins
Sometimes other sites

74
Q

Resolution time of erythema nodosum

A

Slow resolution like a bruise 6 - 8 weeks

75
Q

Causes of erythema nodosum

A 
infectious
- streptococcus 
- upper resp tract
IBD
Sarcoidosis 
Drugs
- OCP
- Sulphonamides
- penicillin 
Mycobacterial infections
Idiopathic
76
Q

What is dermatitis Herpetiformis?

A

Rare but persistent immunoglobullous disease that has been linked to coeliac disease

77
Q

What is dermatitis herpetiformis linked to?

A

Coeliac disease

78
Q

Presentation of dermatitis herpetiformis

A

Itchy blisters that can appear in clusters
often symmetry
scalp, shoulders, buttocks, elbows, knees

79
Q

Treatment of dermatitis herpetiformis

A

Emollients
Gluten free diet
Topical steroids
Dapsone

80
Q

What is urticaria also known as?

A

Wheals / hives

81
Q

Associations of urticaria

A

Angioedema (10%)

82
Q

How long can urticaria rash last for?

A

From a few mins up to 24 hours

83
Q

Types of urticaria

A

Acute ( < 6 weeks)

Chronic ( > 6 weeks)

84
Q

Causes of urticaria

A 
Viral infection 
Bacterial infection 
Food or drug allergy 
NSAIDs, Opiates
Vaccinations
Idiopathic
85
Q

Treatment of urticaria

A

Consider possible triggers, including medication and withdraw
Antihistamines
- desloratadine

86
Q

What is joint pain and a salmon pink rash indicative of?

A

Systemic onset JIA

Paeds (28 decks)

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