Case 15 - rash Flashcards
(22 cards)
What is shown in image?
Erythema toxicum neonatorum:
* Migratory raised erythematous rash concentrated on trunk
* Overlying papules/pustiles containing eosinophils
* Onset 2-3 days and resolves <3-5
What is shown here?
- Atopic dermatits
- Dry, erythematous itchy skin - breakdown occurs from screatching
- Infants face, neck, scalp and extensors are affected with nappy area sparing
- Childhood is flexural, wrists neck and ankles
- Majority in infants resolves
What is shown in image?
- Milia
- Sometimes referred to as milk spots
- White papules at birth found on nose and cheeks
- Cause is build up of sebaceous material in skin follicles
What is shown in image?
Transient neonatal pustular melanoses
* Benign, presents at birth
* Vesicles, superficial pustiles, pigmented macules
* Forehead, chin, neck, chest, back and buttocks
* Rupture and resolve within 48hrs leaving macules for months
What is shown in image?
Seborrheic dermatitis
* Self limiting eruption of non-inflammatory erythematous greasy plaques
* Occurs within 1 month of age and can last to 12 months
* Scalp - often called cradle cap, behind ears, eyebrows, nasolabial folds
* Can spread to flexures and nappy area
* NOT itchy and infant not disturbed
Vesicular rash
- Small, fluid filled
- 5-10mm
- If larger - blister
- If 0.5cm - bullae
What is this?
Morbilliform rash
* Rash that looks like measles
* Rose-red flat (macular) slightly elevated (maculopapular) eruption of circular/elliptical lesions 1-3mm in diameter
* Healthy looking skin in between
Petechial rash
- Small - 1-2mm red, brown or purple
- Caused by minor bleeding into skin from capillary rupture
- Non-blanching
- Purpura if 2-10mm and ecchymosis if larger than 10mm
Causes of maculopapular rash in children
Viral:
* Roseola infantum - human herpes
* Slapped cheek - parvovirus B19
* Measles
Bacterial:
* Scarlet fever (group A strep)
* Rheumatic fever
* Lyme disease
Other:
* Kawasaki
* Juvenile idiopathic arthritis
Cause of vesicular, bullous, pustular rash in children
Viral:
* Varicella zoster
* Herpes simplex
* Hand foot and mouth - Coxsackie
* Molloscum (Pox virus)
Bacterial:
* Impetigo
* Boils
* Staphylococcal bullous impetigo
Other:
* SJS, TEN, erythema multiforme
Cause of petechial or purpuric rash in children
Viral
* Enterovirus
* Adenovirus
Bacterial:
* Meningococcal
* Endocarditis
Other:
* Thrombocytopenia - ITP, leukaemia
* HSP
* Vasculitis
Acute urticaria - how long does it last?
- Resolves within 6 weeks - chronic is at least 6 weeks
- Common triggers include infections, allergen exposure (eg food or drugs)
Classification of chronic urticaria
- Chronic spontaneous urticaria - no cause
- Chronic inducible urticaria - eg physical triggers (cold, pressure, heat, solar) or others (eg aquagenic (water), sweating (cholinergic), exercise)
Management of acute urticaria in child
- Cetirizine - high dose (up to 4x recommended dose)
- Or other non-sedating antihistamine
Examples of sedating antihistamines
- Chlorphenamine - Piriton
- Alimemazine - Vallergan
- Hydroxizine - Atarax, Ucerax
- Ketotifen - Zaditen
- Promethazine - Phenergan
Examples of non sedating antihistamines
- Cetirizine
- Levocetirizine
- Loratadine
- Desloratadine
- Fexofenadine
- Mizolastine
- Rupatadine
Management of eczema in children
- Emollient- eg hydromol ointment
- Dermol as soap substitute
- Mild strength topical steroids
When to give abx for eczema?
If suspect local bacterial infection:
* Painful
* Weeping
* Crusting
If local - can be topical eg fusidic acid
If more severe - oral flucloxacillin
Dermol help reduce bacterial burden on skin
Ointments vs creams vs lotions
- Ointment - greasiest, no preservatives to less skin sensitivity, good for moderate to severe dryness and night time use
- Creams - less greasy, preservatives may irritate skin, apply more often than ointments, daytime application and weeping eczema
- Lotions - good for mildly dry skin, hairy skin, face or weeping eczema
Examples of lotion, cream and emollient
- Lotion - doublebase
- Cream - epimax, balneum
- Ointment - hydromol, zeroderm, 50% white soft paraffin/50% liquid paraffin
Examples of mild, moderate, potent and very potent steroids
- Mild - 1% or 2.5% hydrocortisone
- Moderate - Eumovate, betnovate RD
- Potent - betnovate, metosyn
- Very potent - dermovate
