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paediatrics > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is eczema?

A

An itchy, dry inflammatory skin disease

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2
Q

Give examples of endogenous types of eczema.

A
  • Atopic – ‘genetic barrier dysfunction’
  • Seborrheoic – face/scalp – scale associated
  • Discoid – annular/circular patches
  • Pomphylx – vesicles affecting palms/soles
  • Varicose – oedema/venous insufficiency
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3
Q

Give examples of exogenous types of eczema.

A
  • Allergic contact dermatitis (sensitised to allergen)
  • Irritant contact dermatitis (friction, cold, chemicals e.g. acids, alkalis, detergents, solvents)
  • Photosensitive/photoaggravated eczema
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4
Q

What can flares of eczema be associated with?

A
  • Infections/viral illness
  • Environment: central heating, cold air
  • Pets: if sensitised/allergic
  • Teething
  • Stress
  • Sometimes no cause for flare found
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5
Q

What is the commonest type of eczema?

A

Atopic

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6
Q

What is atopy?

A

Overactive immune response to environmental stimulus

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7
Q

How can atopy lead to eczema?

A

Immune mediated defects in the skin barrier leads to dry inflamed skin

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8
Q

What is the triad of atopy?

A
  • Asthma
  • Eczema
  • Hayfever

Can have 1, 2 or 3 and usually FMH

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9
Q

How does atopic eczema tend to present in infancy?

A

Typically starts on the face/neck (cheeks common), can spread more generally

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10
Q

How does atopic eczema present 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 causes atopic eczema?

A
  • Inherited abnormalities in the skin leading to barrier defect
  • Abnormality in filaggrin expression
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12
Q

What does filaggrin do?

A
  • Filaggrin proteins bind the keratin filaments together.

- Also play a role in producing a natural moisturising factor.

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13
Q

What is the consequence of losing skin barrier function?

A

Loss of water

  • Irritants may penetrate (soap, detergent, solvents, dirt)
  • Allergens may penetrate (pollens, dust-mite antigens, microbes)
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14
Q

Who is usually affected by seborrheoic dermatitis?

A

Often babies under 3 months, usually resolves by 12 months

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15
Q

What is seborrheoic dermatitis associated with in infants?

A

Cradle cap

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16
Q

Where does seborrheoic dermatitis mainly affect?

A

Scalp and face

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17
Q

What microorganism is sebeorrhoeic dermatitis associated with?

A

Associated with proliferation of various species of the skin commensal Malassezia in its yeast form.

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18
Q

How is seborrheoic dermatitis treated?

A
  • Emollients
  • Antifungal creams
  • Antifungal shampoos
  • Mild topical steroids
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19
Q

How does discoid eczema present?

A

Scattered annular/circular patches itchy eczema

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20
Q

How can discoid eczema occur?

A

As part of atopic eczema or as a separate entitiy

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21
Q

Where does pomphylx eczema affect?

A

Hand and foot

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22
Q

How does pomphylx eczema present?

A
  • Characterised by vesicles on the hand and feet

- Intensely itchy

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23
Q

Where does varicose eczema affect?

A

Affects legs in association with venous insufficicency

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24
Q

What is varicose eczema often associated with?

A
  • Oedema
  • Varicose veins
  • Chronic leg swelling
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25
Q

How does varicose eczema present?

A
  • Skin dry and inflammed

- Skin may ulcerate

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26
Q

How is varicose eczema treated?

A
  • Emollients
  • Topical steroids
  • Compression stockings
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27
Q

What causes allergic eczema?

A

Becoming sensitised to an allergen

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28
Q

What type of testing may be useful in allergic eczema?

A

Patch testing

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29
Q

What causes irritant eczema?

A

Repeated contact

  • Water and soaps
  • Touching irritant foods such as citrus and tomatoes
  • Chemical irritants
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30
Q

Should children with eczema have allergy testing?

A
  • Eczema has many causes and allergy is just one
  • Majority of children with mild eczema do not need allergy testing
  • 80% of childhood eczema is mild
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31
Q

When should food allergy be suspected?

A
  • Immediate reactions (lip swelling, facial redness/itching, anaphylactoid symptoms)
  • Late reactions (worsening of eczema 24/48 hours after ingestion) – especially if pattern with specific food (food diaries encouraged).
  • GI problems
  • Failure to thrive
  • Severe unresponsive eczema
  • Severe generalised itching
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32
Q

How can food allergy be tested for?

A
  • Blood test for specific IgE antibodies to certain foods

- Skin prick testing

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33
Q

What are the commonest food allergies?

A
  • Milk/dairy
  • Soy
  • Peanuts
  • Eggs
  • Wheat
  • Fish
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34
Q

What should you beware of in allergy testing?

A

False positive tests and limitations of allergy testing particularly in atopic eczema

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35
Q

Give examples of airborne allergens.

A
  • House dust mite
  • Pet dander
  • Pollen
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36
Q

How should food allergies be confirmed?

A
  • Dietary restrictions/eliminations >8 weeks – refer dietitian
  • Eliminate one food at a time
  • Reintroduce food to confirm allergy
37
Q

How should eczema be treated?

A
  • Emollients (Lotions, creams or ointments – fragrance free, greasier ointments more effective)
  • Topical steroids
  • Calcineurin inhibitors (e.g protopic – steroid sparing topical agents)
  • UVB light therapy
  • Immunosuppressive medication
38
Q

What is a possible side effect of topical steroids?

A

Skin thinning with prolonged use

39
Q

Give examples of different strengths of topical steroids.

A
  • Very potent (Dermovate)600x
  • Potent (Betnovate)100x
  • Moderate (Eumovate) 25x
  • Mild (Hydrocortisone)
40
Q

How much steroid should be applied?

A

1 finger tip unit covers the area of a palm

41
Q

How should steroids be used?

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
42
Q

What is impetigo?

A

A common acute superficial bacteria

43
Q

How does impetigo present?

A

Pustules and honey-coloured crust erosions

44
Q

What is the causative agent of impetigo?

A

Staph aureus

45
Q

How is impetigo treated?

A
  • Topical antibacterial (fucidin)

- Oral antibiotic (flucloxacillin)

46
Q

What is molluscum contagiosum?

A

Common benign self-limiting infection

47
Q

What is the causative organism in molluscum contagiosum?

A

Moluscipox virus

48
Q

How is molluscum contagiosum transmitted?

A

Transmission to close direct contacts

49
Q

How does molluscum contagiosum present?

A

Pearly papules with umbilicated centres

50
Q

What is the incubation for molluscum contagiosum?

A

2 weeks - 6 months

51
Q

How is molluscum contagiosum managed?

A
  • Can take up to 24 months to clear
  • Reassurance
  • 5% potassium hydroxide
52
Q

What are viral warts?

A

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

53
Q

What are warts on the sole of the foot known as?

A

Verucas

54
Q

How do viral warts present?

A

Often skin coloured growths

55
Q

How are viral warts transmitted?

A

Direct skin contact

56
Q

How are viral warts treated?

A
  • Need to stimulate own immune system to respond
  • Cryotherapy
  • Topical paints (salicylic acid)
  • 90% will resolve in 24 months
57
Q

What is viral exanthems associated with?

A

Viral illness

  • Chicken pox
  • Measles
  • Rubella
  • Roseola (herpes virus 6)
  • Erythema infectiosum (parvovirus B19, slapped cheek)
58
Q

Why does viral exanthems occur?

A

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

59
Q

How does viral exanthems present?

A
  • Fever
  • Malaise
  • Headache
60
Q

What is chickenpox?

A
  • Chickenpox is a highly contagious disease caused by primary infection with the varicella-zoster virus.
  • One infection is thought to confer lifelong immunity.
61
Q

Who is susceptible to the varicella zoster virus at all times?

A

Immunocompromised individuals

62
Q

How does chickenpox present?

A
  • Red papules (small bumps) progressing to vesicles (blisters) often start on the trunk.
  • Itchy. Associated with viral symptoms.
63
Q

What is the timeline of chickenpox?

A
  • Incubation 10-21 days
  • Contagious 1-2 days before rash appears and until lesions have crusted
  • Self limiting
64
Q

What are some rare complications of chickenpox?

A
  • Pneumonia

- Encephalits

65
Q

How is chickenpox treated?

A
  • Self-limiting

- Infection control (keep of school/nursery)

66
Q

What are some other names for slapped cheek?

A
  • Fifth disease

- Erythema infectiosum

67
Q

What causes slapped check?

A

Parovirus

68
Q

How does slapped check present?

A
  • Viral symptoms.

- Erythematous rash cheeks initially and then also lace like network rash (trunk and limbs). Can take 6w to full fade.

69
Q

What does parovirus target?

A

Red cells in bone marrow

70
Q

How does slapped check resolve?

A

Mild self-limiting illness

71
Q

What is in the incubation period for slapped check?

A

7-10 days

72
Q

What are some rare complications of slapped check?

A
  • Aplastic crisis (if haemolytic disorders)

- Risk to pregnant women (spontaneous abortion, intrauterine death, hydrops fetalis)

73
Q

What causes hand foot and mouth disease?

A

Enterovirus

  • Coxsackie virus A16
  • Enterovirus 71
  • Other Cxsackie virus
74
Q

How does hand foot and mouth disease present?

A
  • Blisters on the hands, feet and in the mouth

- Viral symptoms

75
Q

When do epidemics of hand foot and mouth disease occur?

A

Late Summer or Autumn months

76
Q

How is hand foot and mouth disease managed?

A
  • Self-limiting

- Treatment is supportive

77
Q

How does orofacial granulomatosis present?

A
  • Lip swelling and fissuring

- Oral mucosal lesions: ulcers and tags, cobblestone appearance

78
Q

What is orofacial granulomatosis associated with?

A

Crohn’s disease

79
Q

What are the clinical features of erythema nodosum?

A
  • Painful, erythematous subcutaneous nodules
  • Over Shins; sometimes other sites
  • Slow resolution - like bruise,6-8 weeks
80
Q

What are the causes of erythema nodosum?

A
  • Infections: Streptococcus, Upper respiratory tract
  • Inflammatory bowel disease
  • Sarcoidosis
  • Drugs: OCP, Sulphonamides, Penicillin
  • Mycobacterial Infections
  • Idiopathic
81
Q

What is dermatitis herpetiformis?

A

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

82
Q

How does dermatitis herpetiformis present?

A
  • Itchy blisters can appear in clusters
  • Often symmetry
  • Scalp, shoulders, buttocks, elbows and knees
83
Q

How is dermatitis herpetiformis investigated?

A
  • Detailed history
  • Coeliac screening
  • Skin biopsy
84
Q

How is dermatitis herpetiformis treated?

A
  • Emollients
  • Gluten free diet
  • Topical steroids
  • Dapsone
85
Q

What are the classes of urticarial?

A
  • Acute <6 weeks

- Chronic >6 weeks

86
Q

What can cause urticarial?

A
  • Viral infection
  • Bacterial infection
  • Food or drug allergy
  • NSAIDS, OPIATES,
  • Vaccinations
87
Q

What is usually the cause of chronic urticaria?

A
  • Idiopathic

- Can be autoimmune

88
Q

How does urticarial present?

A
  • Wheals/hives
  • Associated angioedema (10%)
  • Areas of rash can last from few minutes up to 24 hours
89
Q

What is the treatment for urticarial?

A

-Withdraw possible triggers

Antihistamines

  • Newer generation (desloratadine)
  • 3 x daily

-Ranitidine
Montelukast
-Omalizumab
-Ciclosporin

paediatrics (37 decks)

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