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Paediatrics > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is the cause of acne vulgaris?

A

Chronic inflammation
With or without localised infection
Increased production of sebum, trapping of keratin

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2
Q

What is the management of acne?

A 
Topical benzoyl peroxide to reduce inflammation
Topical retinoids slows sebum 
Topical antibiotics e.g. clindamycin
Oral antibiotics e.g. lymecycline
Oral contraception
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3
Q

What is the risk of oral retinoids?

A

Careful follow up
Need reliable contraception
Highly teratogenic

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4
Q

What is roaccutane?

A

Oral isotretinoin - retinoid

Reduces production of sebum, inflammation

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5
Q

What are some of the side effects of roaccutane?

A

Dry skin and lips
Photosensitivity
Depression, anxiety, aggression, suicidal ideation
Rare - Stevens-Johnson, toxic epidermal necrolysis

Highly teratogenic, stop one month before becoming pregnant

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6
Q

What is eczema?

A

Chronic atopic condition
Defects in skin barrier
Inflammation of the skin

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7
Q

What is the presentation of eczema?

A

Infancy
Dry red itchy sore patches
Over flexor surfaces - inside of elbows, knees

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8
Q

What is key to the maintenance of eczema?

A 
Create artificial barrier over skin to compensate
Use of emollients 
Do not scratch and scrub
Use of soap substitutes 
Avoid triggers, enviromental, stress
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9
Q

What is the management of flares?

A 
Thicker emollients
Topical steroids
Wet wraps 
Treat infections
IV antibiotics, oral steroids

Zinc impregnated bandages
Topical tacrolimus
Phototherapy
Immunosuppressants - corticosteroids, methotrexate, azathioprine

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10
Q

What are some examples of some emollients that can be used for eczema?

A

Thin creams:
E45, diprobase, oilatum, Aveeno, cetraben

Thick:
50:50 liquid paraffin
Hydromol, diprobase ointment

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11
Q

What is the steroid ladder for eczema?

A

Mild - hydrocortisone
Moderate - eumovate
Potent - betnovate
Very potent - dermovate

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12
Q

What is a common cause of bacterial infection in eczema?

A

Staphylococcus aureus
Treatment with flucloxacillin
May need admission, IV antibiotics

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13
Q

What is eczema herpeticum?

A

Viral skin infection due to herpes simplex virus or varicella zoster virus

Usually occurs in patient with pre-existing skin condition e.g. eczema or dermatitis

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14
Q

What is the presentation of eczema herpeticum?

A

Widespread painful vesicular rash - vesicles containing pus, sometimes itchy
Fever, lethargy, irritability
Reduced oral intake
Lymphadenopathy

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15
Q

What is the management of eczema herpeticum?

A

Viral swabs

Aciclovir - oral or IV

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16
Q

What is the cause of bullies impetigo?

A

Staph aureus infection
Blistering rash
Treated with systemic antibiotics e.g. penicillinase resistant penicillin

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17
Q

What are the causes of napkin rashes?

A 
Common 
Contact dermatitis
Infantile seborrhoeic dermatitis
Candida infection
Atopic eczema

Rare
Langerhans histiocytosis
Wiskott-Aldrich syndrome

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18
Q

What occurs in a nappy rash?

A

Irritant dermatitis if nappies not changed enough or diarrhoea
Irritant effect of urine
Affects buttocks, perineal region, lower abdomen and top of thighs. Flexures spared.
Use of emollients or mild corticosteroids.
Candida can cause rash, use topical anti fungal agent

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19
Q

What is infantile seborrhoeic dermatitis?

A

Cradle cap
Crusted flaky scalp
Self limiting condition - 4 months-12 months

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20
Q

What is the treatment for cradle cap?

A

Baby oil, brush scalp
White petroleum jelly
Anti-fungals next step for up to 4 weeks - clotrimazole or miconazole

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21
Q

What is seborrhoeic dermatitis of the scalp?

A

Dandruff or oily scale brown crusting
More common in adults and adolescents

Use ketoconazole shampoo
Topical steroids if severe itching

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22
Q

What occurs in seborrhoeic dermatitis of the face and body?

A

Red flaky crusted itchy skin
Affects eyelids, nasolabial folds, ears, chest, back.

Treat with clotrimazole or miconazole antifungals
Up to 4 weeks

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23
Q

What are some itchy rashes?

A 
Atopic eczema
Chickenpox
Urticaria/allergic reactions
Contact dermatitis
Insect bites/papular urticaria
Scabies
Fungal infections
Pityriasis rosea
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24
Q

What are causes of exacerbation of eczema?

A 
Bacterial infection
Viral infection
Ingestion of allergen e.g. egg
Contact with irritant
Environment
Change in medication
Psychological stress
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25
Q

When are skin rashes examples of systemic disease?

A 
SLE or dermatomyositis facial rash
Purpura over buttocks, lower limbs, elbows - HSP
Erythema nodosum and erythema multiforme
Stevens-Johnson
Urticaria
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26
Q

What occurs in Steven-Johnsons?

A

Bullous form of erythema multiforme
Involves mucous membranes
Eye involvement - conjunctivitis, corneal ulceration, uveitis

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27
Q

What are causes of erythema nodosum?

A 
Streptococcal infection
Primary tuberculosis
IBD
Drug reaction
Idiopathic
Sarcoidosis - common association in adults, rare in children

Tender nodules over legs
Fever and arthralgia

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28
Q

What are the causes of erythema multiforme?

A

Herpes simplex
Mycoplasma pneumoniae
Drug reaction
Idiopathic

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29
Q

What is psoriasis?

A

Chronic autoimmune condition causes psoriatic skin lesions

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30
Q

What are the types of psoriasis?

A

Plaque psoriasis - thickened erythematous plaques with silver scales on extensor surfaces and scalp

Guttate psoriasis - common in children, small raised papule across trunk/limbs
Often triggered by strep throat infection

Pustular psoriasis - pustules under erythematous skin, med emergency

Erythrodermis psoriasis

31
Q

What is the presentation of psoriasis?

A

Guttate more common, triggered by throat infection

Plaques of psoriasis smaller, softer, less prominent.

32
Q

What is Auspitz sign?

A

Bleeding when plaques scraped off

33
Q

What is Koebner phenomenon?

A

Development of psoriatic lesions on skin affected by trauma

34
Q

What is residual pigmentation?

A

Pigmentation of the skin after the lesions resolve

35
Q

What is the management of psoriasis?

A 
Topical steroids
Topical vit D analogues - calcipotriol
Topical dithranol
Topical calcineurin inhibitors e.g. tacrolimus
Phototherapy

Dovobet, Enstilar

36
Q

What are common signs and associations with psoriasis?

A

Nail psoriasis - nail pitting, thickening, discolouration, ridging, onycholysis

Psoriatic arthritis

Psychosocial implications, increased risk of CVD, obesity, hyperlipidaemia, HTN, type 2 diabetes

37
Q

What are the viral exanthems?

A 
First disease: Measles
Second disease: Scarlet Fever
Third disease: Rubella (AKA German Measles)
Fourth disease: Dukes’ Disease
Fifth disease: Parvovirus B19 
Sixth disease: Roseola Infantum
38
Q

What are the features of the measles rash?

A

Koplik spots on muccosa
Rash on face, behind ears, 3-5 days after fever, macular
Fever, coryza, conjunctivitis

39
Q

What are the complications of measles?

A 
Pneumonia
Diarrhoea
Dehydration
Encephalitis
Meningitis
Hearing loss
Vision loss
Death
40
Q

What are the features of Scarlet fever?

A

Group A strep - tonsillitis, due to the endotoxin

Red-pink macular rash
Sandpaper skin
Fever
Lethargy
Flushed face
Sore throat
Strawberry tongue
Cervical lymphadenopathy
41
Q

What is the treatment for scarlet fever?

A

Phenoxymethylpenicillin 10 days

No school until 24 hours after starting antibiotics

42
Q

What is the Rubella rash?

A

Milder erythematous macular rash, starts on face, spreads to rest of body
Cervical lymphadenopathy

43
Q

What are the complications of parvovirus B19?

A

Aplastic anaemia
Encephalitis or meningitis
Pregnancy complications including fetal death
Rarely hepatitis, myocarditis or nephritis

44
Q

Who is at risk of complications with slapped cheek syndrome/B19?

A

immunocompromised patients
pregnant women
patients with haematological conditions such as sickle cell anaemia, thalassaemia, hereditary spherocytosis and haemolytic anaemia

45
Q

What are causes of acute urticaria?

A

Stimulation of release of mast cells and histamine

Allergies to food, medications or animals
Contact with chemicals, latex, stinging nettles
Medications
Viral infections
Insect bites
Dermatographism - rubbing of the skin

46
Q

What are causes of chronic urticaria?

A

Autoimmune condition
Autoantibodies target mast cells, release histamines

Chronic idiopathic
Chronic inducible: sunlight, temp, exercise, strong emotions, hot or cold weather, pressure

Autoimmune chronic urticaria is associated with an underlying autoimmune condition e.g. SLE

47
Q

What is the management of urticaria?

A

Antihistamines
Fexofenadine
Oral steroids

Anti-leukotrienes e.g. montelukast
Omalizumab - targets IgE
Cyclosporin

48
Q

What are the features of chickenpox?

A 
Widespread erythema
Raised vascular blisters
Trunk or face 
Spreads outwards affecting whole body
Fever, itching, malaise
49
Q

What are the complications of chickenpox?

A 
Bacterial superinfection
Dehydration
Conjunctival lesions
Pneumonia
Encephalitis (presenting as ataxia)
50
Q

What is the management of chickenpox?

A

Mild self limiting
Aciclovir if immunocompromised, neonates, those at risk of infection

Calamine or chlorphenamine for itching

51
Q

What is molluscum contagiosum?

A

Small flesh coloured papules, central dimple
Due to viral poxvirus
Crops of lesions

Spread through contact or sharing items

Resolves without treatment
Specialist treatment for those with extensive lesions or immunocompromised e.g.

topical potassium hydroxide, benzoyl peroxide, surgical removal or cryotherapy

52
Q

What is tinea capitis?

A

Ringworm of the scalp

Well demarcated hair loss
Itching, dryness, erythema of scalp
More common in kids

53
Q

What is tinea pedis?

A

Ringworm of feet
Athletes foot

White/red
Flaky cracked itchy patches
Between the toes
Skin may split and bleed

54
Q

What is tinea cruris?

A

Ringworm of the groin

55
Q

What is tinea corporis?

A

Ringworm on the body

56
Q

What is onchyomycosis?

A

Fungal nail infection

Thickened discoloured deformed nails

57
Q

What is the presentation of ringworm rash?

A

Itchy rash
Erythematous scaly
Well demarcated

Check toenails in presenting with ringworm, may be because fungal nail infection has spread to the skin

58
Q

What is the management of ringworm?

A

Microscopy and culture of scrapings from scales

Anti-fungals
Creams - clotrimazole
Shampoo - ketoconazole for tinea capitis
Oral antifungals e.g. fluconazole

Nail lacquer for 6-12 months
Mild topical steroid to settle inflammation

Wear loose breathable clothing, keep clean and dry, avoid sharing towels etc
Avoid scratching

59
Q

What is tinea incognito?

A

Fungal skin infection results from use of steroids to treat initial fungal infection

Steroid improves inflammation but dampens immune response

60
Q

What is scabies?

A

Tiny mites burrow under skin, causes infection
Lay eggs in skin, can take up to 8 weeks for symptoms

Track marks where burrow
Rash in finger webs

61
Q

What is the management of scabies?

A

Permethrin cream applied to whole body when cool
Left on for 8-12 hours
Repeat 1 week later to kill all eggs
Treat whole household

Oral ivermectin single dose after 1 week if difficult to treat/crusted scabies (immunocompromised patients)

62
Q

What is the management of headlice?

A

Dimeticone lotion, fine combs, detection combing

63
Q

What are the differentials for non blanching rashes?

A 
Meningococcal sepsis
Other bacterial sepsis
Henoch Schonlein Purpura
Idiopathic thrombocytopenia purpura
Acute leukaemia
Haemolytic uraemia syndrome
Mechanical - strong coughing, vomiting or breath holding causes superior vena cava distribution 
Traumatic - NAI
Viral illness
64
Q

What are key investigations in a non blanching rash?

A

Full blood count: Anaemia can suggest HUS or leukaemia. Low white cells can suggest neutropenic sepsis or leukaemia. Low platelets can suggest ITP or HUS.
Urea and electrolytes: High urea and creatinine can indicate HUS or HSP with renal involvement.
C-reactive protein (CRP): This is a non-specific indication of inflammation or infection and can be useful but not definitive in excluding sepsis.
Erythrocyte sedimentation rate (ESR): This is a non-specific indication of inflammatory illness such as a vasculitis (HSP) or infection.
Coagulation screen, including PT, APTT, INR and fibrinogen can diagnose clotting abnormalities.
Blood culture: This can be useful but not definitive in diagnosing or excluding sepsis.
Meningococcal PCR: This can confirm meningococcal disease, although this should not delay treatment.
Lumbar puncture: To diagnose meningitis or encephalitis.
Blood pressure: Hypertension can occur in HSP and HUS. Hypotension can occur in septic shock.
Urine dipstick: Proteinuria and haematuria can suggest HSP with renal involvement, or HUS.

65
Q

What is impetigo?

A 
Superficial bacterial skin infection
Staph aureus
Golden crust - staph infection
Contagious 
Due to break in skin
Bullous or non bullous
66
Q

What is non-bullous impetigo?

A

Occurs around nose/mouth
Exudate from lesions dries - golden crust

Treatment with topical fusidic acid, oral flucloxacillin if wide spread/more severe

67
Q

What is bullous impetigo?

A

Always due to staph aureus
Toxins create vesicles
Then burst - crust
Lesions painful and itchy

More common in neonates and children under 2
Feverish and unwell

Swabs and treatment with flucloxacillin

68
Q

What is staphylococcus scalded skin syndrome?

A

Severe bullous impetigo infection leads to widespread lesions

Generalised patches of erythema on skin
Skin thin and wrinkled
Bullae burst, leaves sore burnt looking skin

Nikolsky sign - gentle rubbing of skin can cause it to peel away

IV antibiotics and fluids

69
Q

What are the complications of impetigo?

A 
Cellulitis if the infection gets deeper in the skin
Sepsis
Scarring
Post streptococcal glomerulonephritis
Staphylococcus scalded skin syndrome
Scarlet fever
70
Q

What are modes of HPV transmission in children?

A

Non sexual, directly
Maternal transmission?
Sexual abuse - anogenital warts ?safeguarding

71
Q

What are the clinical manifestations of HPV infection?

A

Oral HPV infections
Juvenile onset laryngeal papillomas
Anogenital warts

72
Q

What strains of HPV cause cervical cancer?

A

HPV 16 and HPV 18

73
Q

What strains of HPV cause genital warts and laryngeal papillomatosis?

A

HPV 6 and HPV 11

74
Q

What are risk factors for persistent genital HPV infections?

A

Early age first sexual intercourse
Multiple partners
Smoking
Immunosuppression

Paediatrics (17 decks)

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