Dermatology Flashcards
(139 cards)
1
Q
Pathophysiology eczema
A
Defects in skin barrier
Entrance for irritants, microbes and allergens
Can stimulate an immune response
Inflammation and associated symptoms
2
Q
Distribution of eczema
A
Face and trunk in infants
In younger children extensor surfaces
In older children flexor surfaces and creases of face and neck
3
Q
Management of eczema
A
Avoid irritants
Emollients
Topical steroids
Wet wraps and oral cyclosporine in severe cases
4
Q
Severe eczema management
A
Zinc-impregnated bandages Topical tacrolimus Phototherapy Systemic immunosuppressants Oral corticosteroids Methotrexate Azathioprine
5
Q
Management of eczema flares
A
Thicker emollients
Wet wraps
Treating infections
6
Q
Eczema trigger
A
Cold air Dietary products Washing powders Cleaning products Emotional event or stresses
7
Q
Thin emollients
A
E45 Diprobase Oliatum cream Aveeno cream Cetraben cream Epaderm cream
8
Q
Thick, greasy emollients
A
50:50 ointment Hydromol ointment Diprobase ointment Cetraben ointment Epaderm ointment
9
Q
Side effects of topical steroids
A
Thinning of skin, more prone to flares, bruising, tearing, stretch marks, enlarged blood vessels (telangiectasia)
10
Q
Mild steroids topical
A
Hydrocortisone
0.5-2.5%
11
Q
Moderate topical steroids
A
Betamethasone valerate 0.025% (Betnovate)
Clobetasone butyrate (Eumovate)
12
Q
Potent topical steroids
A
Fluticasone propionate 0.05% (Cutivate)
Betamethasone valerate 0.1% (Betnovate)
13
Q
Very potent topical steroids
A
Clobetasol propionate
0.05% (Dermovate)
14
Q
Eczema herpeticum causes
A
HSV 1 (more common) or 2 Varicella zoster virus Severe primary infection of skin Seen in children with atopic eczema Rapidly progressing painful rash
15
Q
Presentation of eczema herpeticum
A
Widespread, painful, vesicular rash Rapidly progressing rash Monomorphic punched-out erosions (1-3mm) Fever, lethargy, irritability, reduced oral intake Lymphadenopathy
16
Q
Management of eczema herpeticum
A
Viral swabs of vesicles
IV aciclovir
17
Q
Complications of eczema herpeticum
A
Life-threatening
Bacterial superinfection
18
Q
Psoriasis presentation
A
Dry, flaky, scaly, rough Faintly erythematous skin lesion Raised plaques Over extensor surfaces Elbows, knees, scalp
Rapid generation of new skin cells, abnormal buildup and thickening of skin in those areas
19
Q
Plaque psoriasis
A
Thickened erythematous plaques with silver scales
Commonly seen on the extensor surfaces and scalp
1cm-10cm in diameter
Most common form of psoriasis in adults
20
Q
Guttate psoriasis features
A
More common in children and adolescents
Precipitated by a streptococcal infection 2-4weeks prior to lesions appearing
Tear drop papules on trunk and limbs
Turn into plaques over time
21
Q
Guttate psoriasis management
A
Resolves within 3-4months
Phototherapy
Tonsillectomy
Topical agents
22
Q
Pustular psoriasis
A
Systemically unwell
Pustules form under areas of skin
Immediate admission to hospital
23
Q
Erythrodermic psoriasis
A
Extensive erythematous inflamed areas covering most of the surface area of the skin
Skin comes away in large patches
Raw exposed areas
Medical emergency requiring admission
24
Q
Specific signs associated with psoriasis
A
Auspitz sign: small points of bleeding when plaques are scraped off
Koebener phenomenon: development of psoriatic lesions in areas of skin affected by trauma
Residual pigmentation of skin after lesions resolve
25
Management of psoriasis
```
Psychosocial support
Topical steroids
Topical vitD analogue (calcipotriol)
Topical dithranol
Phototherapy with narrow band UV B light
```
Specialist: methotrexate, cyclosporine, retinoids, biologic medications
26
Complications/ associations of psoriasis
Nail psoriasis: nail pitting, thickening, discolouration, ridging, onycholysis
Psoriatic arthritis
Psychosocial
CVD: obesity, hyperlipidaemia, HTN, T2DM
27
Pathophysiology of acne vulgaris
Chronic inflammation and swelling in pilosebaceous unit—>form comedones
From Increased production of sebum, trapping of keratin, blockage of pilosebaceous unit
Androgenic hormones increase production of sebum
Propionibacterium acnes bacteria
28
Features of acne vulgaris
Comedones due to a dilated sebaceous follicle: open top is whitehead, closed top is blackhead
Follicle bursts releasing irritants: papules, pustules
Excessive inflammatory response: nodules, cysts
Scarring: ice pick scars, hypertrophic scars, rolling scars
Drug-induced acne is monomorphic
Acne fulminans: systemic upset, hospital admission, oral steroids
29
Classification of acne vulgaris
Mild: open and closed comedones with/without sparse inflammatory lesions
Moderate: widespread non-inflammatory lesions and numerous papules and pustules
Severe acne: extensive inflammatory lesions, nodules, pitting, scarring
30
Management of acne vulgaris
Single topical therapy: topical retinoids, benzoyl peroxide
Topical combination therapy: topical antibiotics (clindamycin), benzoyl peroxide, topical retinoid
Oral antibiotics or COCP
Oral isoretinoin
31
Topical benzoyl peroxide acne
Reduces inflammation
Helps unblock skin
Toxic to P.acnes bacteria
32
Topical retinoids acne
Chemicals related to vitamin A
| Slows production of sebum
33
Oral antibiotics acne
Tetracyclines: lymecycline
Contraindicated in pregnancy/ breast feeding/ <12
Erythromycin used in pregnant
Use for 3 months maximum
Always prescribe with topical retinoid or benzoyl peroxide to prevent resistance
Complications of long-term ax use: gram-negative folliculitis, treat with high dose oral trimethoprim
34
COCP acne
Dianette (co-cyrindiol)
Increases VTE risk
Only give for 3 months, second-line
35
Oral isoretinoin acne
Last-line options
Pregnancy is a contraindication,Need contraception
Roaccutane
36
Side effects of oral isoretinoin
Dry skin and lips
Photosensitivity of skin to sunlight
Depression, anxiety, aggression, suicidal ideation
Stevens-Johnson syndrome and toxic epidermal necrolysis
37
Human papilloma virus
Infects keratinocytes of skin and mucous membranes
Carcinogenic
6&11 genital wards
16&18 cancer, cervical cancer
38
HPV vaccination
12-13year olds in year8 will be offered 2 doses
Daughter may receive vaccine against parental wishes
Protects against 6,11,16,18
39
Management of genital warts
| HPV
First line
Multiple, non-keratinised warts: topical podophyllum
Solitary, keratinised warts: cryotherapy
Second line:
Imiquimod topical cream
40
Impetigo
Superficial bacterial infection
Staphylococcal aureus bacteria or strep pyogenes
Complication of eczema, scabies or insect bites
Common in children in warm weather
Contagious, need school exclusion until lesions are crusted and healed or 48hours after antibiotic treatment
41
Impetigo features
Face, flexures and limbs not covered by clothing
| Golden crust, around mouth
42
Impetigo spread
Direct contact with discharged from the scabs of an infected person
Spreads by scratching to other sites
Incubation 4-10days
43
Non-bullous impetigo
Typically occurs around nose or mouth
Systemically well
Golders crust from dried exudate
44
Management of non-bulbous impetigo
Antiseptic cream (hydrogen peroxide 1%) first line
Second line topical antibiotic creams:
Topical fusidic acid
Topical mupirocin if resistant
Extensive disease:
Oral flucloxacillin
Oral erythromycin is penicillin-allergic
School exclusion:
Until lesions are crusted and healed
Until 48 hours after ax treatment
45
Bullous impetigo
Staphylococcus aureus infection
Epidermolytic toxins that break down proteins that hold skin cells together
Vesicles-> exudate
More common in <2s and neonates
Systemic symptoms
If severe: staphylococcal scalded skin syndrome
Swabs of vesicles
46
Treatment of bullous impetigo
Flucloxacillin
| Oral/IV
47
Complications of impetigo
```
Cellulitis
Sepsis
Scarring
Post-streptococcal glomerulonephritis
Staphylococcal scalded skin syndrome
Scarlet fever
```
48
Staphylococcal scalded skin syndrome
Caused by staph aureus which produces epidermolytic toxin (protease)
Breaks down proteins that hold skin cells together
Usually affects <5 years old
Older children and adults usually have immunity
49
Presentation of staphylococcal scalded skin syndrome
Patches of erythema on skin
Skin looks thin and wrinkled
Formation of fluid filled blisters called bullae, which burst and leave sore, erythematous skin below
Similar appearance to burn or scald
Nikolysky sign: gentle rubbing of skin causes it to peel away
Systemic symptoms: fever, irritability, lethargy, dehydration
50
Management of staphylococcal scalded skin syndrome
Admission and treatment with IV ax
Fluid and electrolyte balance as patients are prone to dehydration
Children usually make a full recovery without scarring with adequately treated
51
Steven-Johnson syndrome and toxic epidermal necrolysis
```
Disproportional immune response
Epidermal necrolysis I
Blistering and shedding of top layer of skin
SJS <10% surface area affected
TEN: >10% surface area affected
HLA genetic
```
52
Causes of Steven-Johnson syndrome and toxic epidermal necrolysis
```
Medications:
Anti-epileptic
Antibiotics
Allopurinol
NSAIDs
```
```
Infections:
Herpes simplex
Mycoplasma pneumoniae
CMV
HIV
```
53
Presentation of Steven Johnson syndrome
Maculopapular rash with target lesions
Develop into vesicles or bullae
Mucosal involvement
Fever, arthralgia
Purple/red rash that spreads and blisters
Skin sheds
Pain, erythema, blistering and shedding lips and mucous membranes
Eyes inflamed and ulcerated
Urinary tract, lungs and internal organs involvement
54
Toxic epidermal necrolysis presentation
Systemically unwell, pyrexia, tachycardia
Positive Nikolysky sign: epidermal separates with mild lateral pressure
Purple/red rash that spreads and blisters
Skin sheds
Pain, erythema, blistering and shedding lips and mucous membranes
Eyes inflamed and ulcerated
Urinary tract, lungs and internal organs involvement
55
Management of SJS and TEN
```
Medical emergencies
Nutritional
Antiseptics
Analgesia
Ophthalmology input
Steroids
Immunosuppressants: cyclosporine and cyclophosphamide
Immunoglobulins
```
56
Complications of SJS TEN
Secondary infection
Permanent skin damage
Visual complications: scarring and blindness
57
Two types of contact dermatitis
Irritant contact dermatitis
Allergic contact dermatitis
Caused by cement
58
Irritant contact dermatitis
Non-allergic
Due to weak acids or alkalis
Often seen on the hands
Erythema is typical, crusting and vesicles are rare
59
Allergic contact dermatitis
TY4 hypersensitivity reaction
Often seen on head following hair dyes
Presents as acute weeping eczema which predominantly affects the margins of the hairline
Topical treatment with potent steroids
60
Viral exanthem
```
Eruptive widespread rash
First disease: measles
Second disease: scarlet fever
Third disease: rubella
Fourth disease: Duke’s disease
Fifth disease: parvovirus B19
Sixth disease: roseola infantum
```
61
Measles exposure
Symptoms start 10-12days after exposure
Respiratory droplet spread
Measles virus
Face rash 3-5days after fever
62
Measles features
Fever, coryzal symptoms, conjunctivitis
Koplik spots 2 days after fever
Rash behind ears ten to rest of body, erythematous macular rash with flat lesions
63
Measles management
Self resolving after 7-10days
Isolate children until 4 days after symptoms have resolved
Notifiable disease
64
Complications of measles
```
Pneumonia
Diarrhoea
Dehydration
Encephalitis
Meningitis
Hearing loss
Vision loss
Death
```
65
Scarlet fever transmission and cause
Cause: Group A streptococcus (tonsilitis)
| Step pyogenes exotoxin
66
Scarlet fever features
```
Red-pink blotchy macular rash
Sandpaper skin that starts on trunk and spreads outwards
Red, flushed cheeks
Fever
Lethargy
Flushed face
Sore throat
Strawberry tongue
Cervical lymphadenopathy
```
67
Scarlet fever management
Phenoxymethylpenicillin (Penicillin V) 10 days
Notifiable disease
Keep children off school until 24hours of antibiotics
68
Conditions associated with group A strep infections
Scarlet fever
Post-streptococcal glomerulonephritis
Acute rheumatic fever
69
Rubella transmission
Rubella virus
Highly contagious
Spread by resp droplets
Symptoms start 2 weeks after exposure
70
Rubella features
Symptoms start 2 weeks after exposure
Milder erythematous macular rash compared with measles
Rash starts on face and spreads to rest of body
Lasts 3 days
Mild fever, joint pain, sore throat
Lymphadenopathy behind ears and back of neck
71
Rubella management
Supportive and self-limiting
Notifiable disease
Children stay off school for 5 days after rash appears
Children should avoid pregnant women
72
Complications of rubella
Thrombocytopenia
Encephalitis
Dangerous in pregnancy-> congenital rubella syndrome (deafness, blindness, congenital heart disease)
73
Dukes disease
Non-specific viral rashes
74
Parvovirus B19
Fifth disease, slapped cheek syndrome, erythema infectiosum
75
Symptoms of parvovirus B19
Mild fever, coryza, non-specific viral symptoms (muscle aches and lethargy)
After 2-5 days rash appears rapidly, diffuse bright red rash on both cheeks
Reticular (net-like) mildly erythematous rash affecting trunk and limbs, raised and itchy
76
Management of parvovirus B19
Self-limiting
Symptoms fade over 1-2weeks
Supportive management, fluids, simple analgesia
Infectious prior to rash forming, once rash formed no longer infectious
77
Patients at risk of complications of parvovirus infection
```
Immunocompromised patients
Pregnant women
Sickle cell anaemia
Thalassaemia
Hereditary spherocytosis
Haemolytic anaemia
```
These patients need serology testing to confirm diagnosis
Check FBC, reticulocyte count for aplastic anaemia
78
Complications of parvovirus infection
Aplastic anaemia
Encephalitis or meningits
Pregnancy complications including fetal death
Rarely hepatitis, myocarditis, nephritis
79
Roseola infantum
Sixth disease
Human herpesvirus6
Human herpesvirus7
80
Roseola infantum presentation
Typical pattern of illness
Presents 1-2weeks after infection with a high fever (up to 40degrees), lasts 3-5 days then disappears suddenly
Coryzal symptoms, sore throat, swollen lymph nodes during the illness
Fever settles and rash appears for 1-2days
Mild erythematous macular rash across the arms, legs, trunk and face is not itchy
81
Management of roseola infantum
Children make full recovery within a week and don’t generally need to be kept off nursery if they are well enough to attend
82
Complication of roseola infantum
Febrile convulsions: high temperatures
| Immunocompromised patients at risk of myocarditis, thrombocytopenia, Guillian-Barre syndrome
83
Erythema multiforme
| Causes and associations
Erythematous rash caused by hypersensitivity reaction
Causes: viral infections, medications
Associations: herpes simplex virus, mycoplasma pneumoniae
84
Erythema multiforme presentation
Widespread, itchy, erythematous rash
Target lesions
Sore mouth; stomatitis
Symptoms come on abruptly over a few days, mild fever, stomatitis, muscle and joint aches, headaches, general flu-like symptoms
85
Erythema multiforme management
```
Diagnosis based on appearance of rash
Identify underlying cause
CXR for mycoplasma pneumoniae
Self resolves 1-4qeeks
Severe: IV fluids, analgesia
```
86
Pathophysiology of urticaria
Caused by release of histamine and mast cells
Allergic reaction in acute urticaria
Autoimmune reaction in chronic idiopathic urticaria
87
Causes of acute urticaria
Allergies to food, medications or animals
Contact with chemicals, latex or stinging nettles
Medications
Viral infections
Insect bites
Dermatographism
88
Chronic urticaria types
Chronic idiopathic urticaria
Chronic inducible urticaria
Autoimmune urticaria
89
Chronic idiopathic urticaria
Recurrent episodes of chronic urticaria without a clear underlying cause or trigger
90
Chronic inducible urticaria
Episodes of chronic urticaria that can be induced by certain triggers
Sunlight, temperature changes, exercise, strong emotions, hot or cold weather, pressure (dermatographism)
91
Autoimmune urticaria
Chronic urticaria associated with a chronic autoimmune condition
92
Management of urticaria
Fexofenadine (antihistamine)
| Short course of oral steroids for severe flares
93
Management of problematic urticaria
Anti-leukotrienes (montelukast)
Omalizumab (IgE)
Cyclosporin
94
Chickenpox presentation
Widespread, erythematous, raised, vesicular (fluid-filled) blistering lesions
Rash starts on trunk/face and spreads outwards
Whole body by day 2-5
Scab over and stop being contagious
Fever
Itch
Malaise and fatigue
95
Chickenpox infectivity
Highly contagious
Infected droplets from a cough or sneeze
Patients become symptomatic 10days to 3weeks after exposure
Stop bring infectious once lesions have crusted over
96
Chickenpox complications
```
Bacterial superinfection
Dehydration
Conjunctival lesion
Pneumonia
Encephalitis (ataxia)
Shingles
```
97
Antenatal and neonatal chickenpox
If not immune, give pregnant women varicella zoster immunoglobulin
In pregnancy, congenital varicella syndrome in baby if <28weeks gestation
Infection around delivery time: management with varicella zoster immunoglobulins and aciclovir
98
Management of chickenpox
Aciclovir: in immunocompromised, >14 presenting in <24hours, neonates, those at risk of complications
Encephalitis: need admission
Itching: calamine lotion and chlorphenamine (antihistamine)
Off school and avoid pregnant women until lesions have crusted over, 5 days after rash first appears
99
Hand foot and mouth disease presentation
Coxsackie A virus
3-5 days incubation
URT symptoms: tiredness, sore throat, dry cough, raised temperature
Small mouth ulcers after 1-2 days
Then blistering red spots around body, hands feet mouth (painful)
100
Management hand foot mouth disease
Supportive
Resolves 7-10days
Avoid sharing towels and bedding, washing hands and careful handling of dirty nappies
101
Complications of hand, foot and mouth disease
Dehydration
Bacterial superinfection
Encephalitis
102
Molluscum contagiosum features
Small, flesh coloured papules
Central dimple
Crops of multiple lesions in an area
Spread through contact, sharing bedsheets
103
Molluscum contagiousum management
Resolves spontaneously
Can take up to 18months to resolve
Once resolved skin returns to normal
Avoid scratching or picking at lesions
104
Management molluscum contagiousum
Avoid sharing towels or close contact with lesions
If bacterial superinfection: superficial fusidic acid or oral flucloxacillin
Immunocompromised patients: specialist referral, topical potassium hydroxide, benzoyl peroxide, podophyllotoxin, imiquimod, retinoin. Surgical removal and cryotherapy
105
Pityriasis rosea presentation
Prodromal symptoms prior to rash developing
Headache, tiredness, loss of appetite, flu-like symptoms
Herald patch (faint red, scaly, oval) >2cm diameter on torso
2days later rest of rash appears
Christmas tree rash on torso
Lesions grey or lighter if darker skin
Itch, pyrexia, headache, lethargy
106
Pityriasis rosea disease course
Rash resolves without treatment within 3 months
| Skin discolouration resovled in another few months
107
Pityriasis rosea disease course
Patient education and reassurance
Not contagious, can resume normal activities
Symptomatic treatment if bothered by itching
Emollients, topical steroids, sedating antihistamines at night to help sleep
108
Scabies
Sarcoptes scabiei mites burrow under skin and cause infection and intense itching
Lay eggs in skin, further infection and symptoms
8 weeks for symptoms/rash to appear after initial infection
109
Scabies presentation
Itchy small red spots
Track marks where mites have burrowed
Location of rash is between finger webs, can spread to whole body
110
Scabies management
```
Permethrin cream
If difficult to treat: oral ivermectin
Treat household contacts
Hot wash
Itching 4 weeks after infecton resolved, crotamitron cream, chlorphenamine at night
```
111
Crusted scabies
```
Norwegian scabies
Infection in immunocompromised patients
Scaly plaques
No itch
Oral ivermectin and admission/isolation
```
112
Head lice
Pediculus humanus capitis parasites
Cause infestations of scalp
Itchy sca,lp
113
Head lice management
Dimeticone 4% lotion to hair left overnight then washed off, 7 day
Bug buster kit, special combs
114
DD non-blanching rash
```
Meningococcal septicaemia
HSP
Idiopathic thrombocytopenic purpura
Acute leukaemia
Haemolytic uraemic syndrome: oliguria, presents in child with recent gastroenteritis
Mechanical: strong coughing, SVC obstruction, vomiting, breath holding
Viral illness: influenza, enterovirus
Traumatic
```
115
Erythema nodosum
Red lumps across shins
Inflammation of subcutaneous fat on shins (panniculitis)
Hypersensitivity reaction
116
Erythema nodosum hypersensitivity reaction causes
```
Streptococcal throat infections
Gastroenteritis
Mycoplasma pneumoniae
Tuberculosis
Pregnancy
COCP
```
117
Erythema nodosum chronci disease associations
IBD
Sarcoidosis
Lymphoma
Leukaemia
118
Erythema nodosum investigations
Inflammatory markers
Throat swab for strep infection
CXR: mycoplasma, TB, sarcoidosis, lymphomas
Stool microscopy and culture: campylobacter, salmonella
Faecal calprotectin for IBD
119
Management of erythema nodosum
Rest and analgesia
Conservative management
Steroids for inflammation
Most cases will fully resolve in 6 weeks
120
Seborrhoeic dermatitis
Inflammatory skin condition that affects the sebaceous glands
Scalp, nasolabial folds and eyebrows
Causes erythema, dermatitis and dry crusted skin
Cradle cap
Malassezia yeast
121
Infantile seborrheic dermatitis
Cradle cap, crusted flaky scalp
Self-limiting condition and resolves by 4 months of age, can last until 12 months
First line: oil, brush scalp, white petroleum jelly overnight,
Second line: antifungal clotrimazole, miconazole for up to 4 weeks
122
Seborrheic dermatitis of the scalp
Dandruff
Dense oily scaly brown crusting
More common in adolescents and adults
First line: ketoconazole shampoo, topical steroids if severe itching
123
Seborrheic dermatitis of face and body
Red, flaky, crusted, itchy skin
Commonly affects eyelids, nasolabial folds, ears, upper chest, back
First line treatment: clotrimazole or miconazole antifungal cream, hydrocortisone 1% for localised inflamed areas
124
Tinea capitis
Ringworms affecting scalp
| More common in children
125
Tinea pedis
Ringworm affected feet
Athletes foot
White or red, flaky, cracked, itchy patches between the toes
Skin may split and bleed
126
Tinea cruris
Ringworm of groin
127
Tinea corporis
Ringworm on body
128
Onychomycosis
Fungal nail infection
| Thickened, discoloured and deformed nails
129
Name of fungus causing ringworm
Trichophyton
130
Ringworm presentation
Itchy rash
| Erythematous, scaly, well demarcated
131
Management of ringworm
Clotrimazole and miconazole antifungal creams
Ketoconazole shampoo for tinea capitis
Oral antifungal: fluclonazole, griseofulvin, itraconazole
Fungal nail infections: amorolfine nail lacquer for 6-12months, oral terbinafine after checking LFTs
Daktacort: hydrocortisone 1% and miconazole 2%
132
Ringworm advice
Wear loose breathable clothing
Keep affected areas clean and dry
Avoid sharing towels, clothes or bedding
Use a separate towel for feet with tinea pedis
Avoid scratching and spreading to other areas
Wear clean dry socks every day
133
Tinea incognito
Fungal skin infection that results from the use of steroids to treat an initial fungal infction
Steroids slow down immune response, allowing fungus to grow
Less dermarcated border and less scales
134
Nappy rash
```
Contact dermatitis
Friction between skin and nappy
Contact with urine and faeces
Common 9-12months of age
Added fungal (candida), bacteria (staph/strep) infection
```
135
Risk factors for nappy rash
Delayed changing of nappies
Irritant soap products and vigorous cleaning
Poorly absorbent nappies
Diarrhoea
Oral antibiotics predispose to candida infection
Pre-term infants
136
Nappy rash presentation
Sore, red, inflamed skin in nappy area
Skin creases spared
Red papules
Erosions and ulceration eventually
137
More likely candida than nappy rash
```
Rash extending into skin folds
Larger red macules
Well-dermarcated scaly border
Circular pattern to the rash spreading outwards, similar to ringworm
Satellite lesions
Oral thrush
```
138
Management of nappy rash
Switch to highly absorbent nappies
Change nappy and clean skin as soon as possible
Use water or gentle products
Ensure nappy area is dry before replacing nappy
Maximise time not wearing nappy
139
Complications of nappy rash
Candida infection: clotrimazole cream or miconazole
Cellulitis
Jacquet’s erosive diaper dermatitis
Perianal pseudoverrucous papules and nodules
