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Paediatrics > Paediatric Dermatology > Flashcards

Paediatric Dermatology Flashcards

1
Q

What are common presentations in paediatric dermatology?

A
  • Eczema
  • Infection – viral and bacterial
  • Manifestations of systemic disease
  • Vascular birthmarks
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2
Q

Eczema - aetiology

A
  • Familial tendancy
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3
Q

Eczema - epidemiology

A
  • Common, affects 1/5 children
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4
Q

Eczema - severity

A
  • Varies from mild, moderate, severe
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5
Q

Eczema - presentation

A
  • Classically red, dry itchy skin eruption
  • Flares and settles intermittently
  • Different patterns recognised
    • Atopic eczema
    • Food allergy
    • Discoid eczema
    • Seborrheic dermatitis
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6
Q

Atopic eczema - aetiology

A
  • Filaggrin mutation predisposes – structural protein which binds keratin fibres together
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7
Q

Atopic eczema - pathophysiology

A
  • Barrier defect
    • Increased permeability to irritants and allergens
    • Water loss
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8
Q

Atopic eczema - presentation

A
  • Classic eczema
  • Widespread diffuse scaly red eruptions
  • Very itchy
  • Onset anytime in childhood
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9
Q

Atopic eczema - triggers

A
  • Illness
  • Stress
  • Teething
  • Environment – cold air, central heating
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10
Q

Atopic eczema - management

A
  • Topical steroids (mainstay)
    • Strengths and adequate amounts need to be used
    • Once daily for 1-2 weeks on affected area, then alternate days and increase again for flare ups
  • Moisturiser (emollient)
    • Helps symptoms such as itch
    • Lighter during day, thicker at night
  • Soap substitute
  • If topical steroids don’t work
    • Steroid sparing agents – protropic ointment or Elidel cream
    • Phototherapy UVB
    • Immunosuppresion – methotrexate, ciclosporin, mycofenalate mofetil, azathioprine
    • Biologics – Dupilomab (IL4 inhibitor)
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11
Q

What is “1 fingertip unit”?

A
  • 1 fingertip unit
    • 0.5g
    • Roughly covers surface area under 2 adults hands
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12
Q

Describe the topical steroid ladder?

A
  • Very potent
    • Dermovate 600x
  • Potent
    • Betnovate 100x
  • Moderate
    • Eumovate 25x
  • Mild
    • Hydrocortisone
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13
Q

When should you suspect food allergy?

A
  • Immediate reactions (type 1 reaction)
    • Lip swelling, facial redness/itching, anaphylactoid symptoms
  • Late reactions (type IV hypersensitivity)
    • Worsening of eczema 24/48 hours after ingestion
    • GI problems
    • Failure to thrive
    • Severe eczema unresponsive to treatment
    • Severe generalised itching
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14
Q

Discoid eczema - presentation

A
  • Scattered annular/circular patches of itchy eczema
  • Can occur in this pattern as part of atopic eczema or in isolation
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15
Q

Discoid eczema - management

A
  • Stubborn to treat
  • Potent topical steroid with antibacterial component
    • Such as Betnovate C ointment
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16
Q

Seborrheoic dermatitis - aetiology

A
  • Associated with proliferation of various species of skin commensals
    • Malassezia in its yeast form
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17
Q

Seborrheoic dermatitis - presentation

A
  • Mainly scalp and face
  • Often babies under 3 months, usually resolves by 12 months
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18
Q

Seborrheoic dermatitis - management

A
  • Emollients
    • To loose scalp
  • Daktocort ointment
  • Protopic ointment
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19
Q

What are common skin infections?

A
  • Impetigo
  • Molluscum contagiosum
  • Viral warts
  • Viral exanthems
  • Varicella zoster (chicken pox)
  • Parovirus (slapped cheek)
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20
Q

Impetigo - aetiology

A
  • Usually staph aureus
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21
Q

Impetigo - epidemiology

A
  • Common superficial bacterial skin infection
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22
Q

Impetigo - presentation

A
  • Pustules and honey coloured crusted erosions
  • Very contagious
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23
Q

Impetigo - treatment

A
  • Topical antibacterial
    • Fucidin
  • Oral antibiotic
    • Flucloxacillin
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24
Q

Molluscum contagiosum - aetiology

A
  • Mulluscipox virus
    • Transmissible by close direct contact
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25
Q

Molluscum contagiosum - epidemiology

A

Common

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26
Q

Molluscum contagiosum - presentation

A
  • Self-limiting condition
  • Classically pearly papules, umbilicated centre
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27
Q

Molluscum contagiosum - management

A
  • Reassurance, can take up to 24 months to clear
  • 5% potassium hydroxide
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28
Q

Viral warts - aetiology

A
  • Human papillomavirus (HPV)
    • Transmitted by direct skin contact
29
Q

Viral warts - presentation

A
  • Benign self-limiting condition
30
Q

Viral warts - treatment

A
  • No treatment required
  • Stimulate own immune system to respond to presence of virus
    • Topical treatments such as salicyclic acid and paring
    • Cyrotherapy
    • Oral zinc
31
Q

Viral exanthems - aetiology

A
  • Associated viral illnesses
    • Chicken pox
    • Measles
    • Rubella
    • Roseola (herpes virus 6)
    • Erythema infectiosum (parovirus B19, slapped cheek)
    • Hand foot and mouth
    • Eczema coxsackium
    • Eczema herpeticum
32
Q

Viral exanthems - epidemiology

A

Common

33
Q

Viral exanthems - pathophysiology

A
  • Either reaction to toxin produced by organism, damage to skin by organism or immune reaction
34
Q

Viral exanthems - presentation

A
  • Fever
  • Malaise
  • Headache
35
Q

Viral exanthems - management

A
  • Self-limiting so only supported treatment
36
Q

Chicken pox - aetiology

A
  • Varicella-zoster virus
    • Highly contagious
    • Contagious 1-2 days before rash appears until lesions have crusted over
37
Q

Chicken pox - presentation

A
  • Red papules (small bumps) progressing to vesicles (blisters) often start on trunk
  • Itchy
  • Associated with viral symptoms
38
Q

Chicken pox - management

A
  • Self-limiting
  • Infection control
39
Q

Chicken pox - complications

A
  • Rarely associated with pneumonia, encephalitis
40
Q

What is parovirus also called?

A

Also called slapped cheek

41
Q

Parovirus - presentation

A
  • Often mild, self-limiting illness
  • Viral symptoms
  • Erythematous rash cheeks initially and then also lace like network rash on trunks and arms
42
Q

Parovirus - complications

A
  • Virus attacks red cells
    • Very rarely aplastic crises (if haemolytic disorders)
  • Risk to pregnant woman
    • Spontaneous abortion, IUD, hydrops fetalis
43
Q

Hand foot and mouth disease - aetiology

A
  • Enterovirus
    • Usually coxsackie virus A16
    • Can also be due to enterovirus 71 and other coxsackivirus types
44
Q

Hand foot and mouth disease - epidemiology

A
  • Epidemics late summer or autumn months
45
Q

Hand foot and mouth disease - presentation

A
  • Blisters on hands, feet and in mouth
  • Viral symptoms
46
Q

Hand foot and mouth disease - management

A
  • Self-limiting so treatment is supportive
47
Q

Eczema coxsackium - presentation

A
  • Self-limiting
  • Associated viral symptoms
  • History of eczema
  • Flared sites picks out areas of eczema
48
Q

Eczema herpeticum - presentation

A
  • Unwell child
  • History of eczema
  • Monomorphic punched out lesions
49
Q

Eczema herpiticum - treatment

A
  • Withhold topical steroids for 24 hours
  • Aciclovir
    • Oral or IV depending on age and how well
  • Opthalmology review if near eye
50
Q

What are examples of systemic diseases with skin manifestations in children?

A
  • Orofacial granulomatosis
  • Erythema nodosum
  • Dermatitis herpetiformis
  • Urticaria
51
Q

Orofacial granulomatosis - aetiology

A
  • Can be associated with Crohn’s disease
52
Q

Orofacial granulomatosis - presentation

A
  • Lip swelling and fissuring
  • Oral mucosal lesions
    • Ulcers and tags
53
Q

Orofacial granulomatosis - management

A
  • Check faecal calprotectin if GI symptoms
  • Consider patch testing
  • Benzoate and cinnamate free diet
54
Q

Erythema nodosum - aetiology

A
  • Infections
    • Streptococcus, upper respiratory tract
  • Inflammatory bowel disease
  • Sarcoidosis
  • Drugs
    • OCP, sulphnoamides, penicillin
  • Mycobacterial infections
  • Idiopathic
55
Q

Erythema nodosum - clinical features

A
  • Painful, erythematous subcutaneous nodules
  • Over shins, sometimes other sites
  • Slow resolution like bruise
56
Q

Erythema nodosum - management

A
  • Painful, erythematous subcutaneous nodules
  • Over shins, sometimes other sites
  • Slow resolution like bruise
57
Q

Dermatitis herpetiformis - epidemiology

A
  • Rare but immunobullous disease that has been linked to coeliac disease
58
Q

Dermatitis herpetiformis - presentation

A
  • Itchy blisters can appear in clusters
  • Often symmetry
  • Scalp, shoulders, buttocks, elbows and knees
59
Q

Dermatitis herpetiformis - management

A
  • Coeliac screening
  • Skin biopsy
  • Emollients
  • Gluten free diet
  • Topical steroids
  • Dapsone
60
Q

Urticaria - classification

A
  • Acute
    • <6 weeks
  • Chronic
    • >6 weeks
61
Q

Urticaria - aetiology

A
  • Viral infection
  • Bacterial infection
  • Food or drug allergy
  • NSAIDs, opiates
  • Vaccinations
62
Q

Urticaria - presentation

A
  • Wheals/hives
  • Associated angioedema
  • Areas of rash can last from few minutes up to 24 hours
63
Q

Urticaria - treatment

A
  • Consider possible triggers including medication and withdrawal
  • Antihistamines
    • E.g Desloratadine – 3x daily
64
Q

What are examples of vascular birthmarks?

A
  • Infantile haemangioma
  • PHACES
65
Q

Infantile haemangioma - epidemiology

A
  • Very common
66
Q

Infantile haemangioma - presentation

A
  • Not present on skin at birth
  • Proliferative phase between 6 weeks up to 8 months
  • Then starts to involute
  • Can be superficial or deep
  • Ulceration of buttocks, genitals or posterior shoulder
67
Q

Infantile haemangioma - treatment

A
  • No treatment needed as will resolve
  • Beta blockers can speed up process of involution
    • Topical
      • Timolol 0.5% gel
    • Oral
      • Propranolol solutions
68
Q

What is PHACES?

A

Syndrome:

  • Pituitary fossa abnormality
  • Haemangioma
  • Arterial anomalies
  • Cardiac anomalies or coarctation of aorta
  • Eyes
  • Sternal cleft
69
Q

PHACES - management

A
  • Low dose propranolol can result in improvement of segmental haemangioma
  • MDT approach

Paediatrics (37 decks)

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