Dermatology

Question 1

Causes os eczema

Answer 1

mixture of genetic and environmental triggers.
-irritnks, skin infections, stress, contact allergens, extremes in temperature, inhaled allergens, FH of atopy.

Breastfeeding is protective.

Question 2

Presentation of eczema in infants and in children

Answer 2

infants: erythematous scaly weeping lesions, usually on the face, neck, trunk and wrists (known as cradle cap)
children: dry and thickened skin, with scaling hyperpigmentation in flexor surfaces.

Question 3

what is eczema herpeticum? how is it managed?

Answer 3

HSV 1 infection superimposed on top of atopic eczema.
blistering, pustular, systemic illness with fever and lymphadenopathy. Very infectious.

Will need IV flucloxacillin and IV acyclovir

Question 4

Complications of eczema to look out for?

Answer 4

bacterial skin infections - crusting, surrounding cellulitis

Eczema herpeticum - systemic illness as will as infectious rash.

Question 5

Diagnosis of eczema

Answer 5

itchy skin plus three of the following:

• itchy skin folds
• history of asthma or hayfever
• dry skin
• visual flexural eczema
• onset in first two years of life

Question 6

Management of eczema

Answer 6

Parental advice: regular emollients, avoid triggers, look for signs of bacterial infections, 60% of children will recover by teens, keen nails short to avoid scratching.

• Emollient - substitute for soaps, regular use as moisturiser
• Topical steroid cream for flare ups - start with 1% hydrocortisone then step up, most potent is beclomethasone or dermoid cream.
• Antihistamines to stop scratching
• Topical calcineurin inhibitors (tacrilimus) can be used if unresponsive to steroids

Question 7

What is impetigo? how common is it and what are the risk factors?

Answer 7

highly contagious ‘honeycomb crust’ bacterial infection, most common skin infection in children, more common in areas of poor hygiene and overcrowding.

Question 8

Causes of impetigo?

Answer 8

staph aureus

other causes: strep pyogens or group B heamolytic strep

Question 9

complications of impetigo?

Answer 9

if due to strep can have scarlet fever or glomerulonephritis.

bullous impetigo is common neonates if due to staph aureus

Question 10

Presentation of impetigo

Answer 10

itchy rash with blisters, developing into a honeycomb crust, usually around the face and mouth.
if bullous disease - can have malaise, blisters rupturing, can occur on top of eczema

Question 11

Management of impetigo

Answer 11

skin swab for culture and sensitivity.
isolation until infection resolves or been on antibiotics for 48hrs.
topical abx - fusidic acid
oral abx - flucloxacillin
good hygine, bathe only using water, usually resolves rapidly.

Question 12

how common is nappy rash? what are the risk factors?

Answer 12

25% of infants, usually due to contact dermatitis.

more common if using baby wipes, skin cleaning regimines, recent diarrhoea or abx use, PTB.

Question 13

causes of nappy rash

Answer 13

overhydration of the skin causing friction, prolonged contact with nappy and chemicals, results in a rash.

Ammonia is released by bacterial breakdown of urine which can be an irritant.

Question 14

presentation of nappy rash (contact dermatitis)

Answer 14

eryethema and papules over areas of contact, with SPARING of the creases and gluteal cleft.

Question 15

presentation of nappy rash complicated by candida infection

Answer 15

erythema, well defines rash, no sparing of skin folds, may have satellite lesions eg oral candida.

Question 16

Treatment for nappy rash: contact dermatitis or candia infection

Answer 16

contact dermatitis -conservative management - can use prophylactic barrier cream.

candida - topical antifungals - miconazole gel or nystatin suspension.

Important to explain to parents it is not a sign or poor care - some babies have sensitive skin! use high absorbency nappies, fragrance free, change quickly, avoid irritant soaps and bubble baths.

Question 17

What is stevens johnsons syndrome?

Answer 17

Detactchemnet of basement membrane of the skin, causing severe dehydration and increasing exposure to further infection effecting skin and mucous membranes, genitals and eyes.
It is immune medicated type 4 hypersensitivity disorder, which can present as a spectrum, from SJS to Toxic epidermal necrolysis.

Question 18

what is the difference between SJS and TEN (stevens j and toxic epidermal necrolysis?)

Answer 18

• If 10% of the body is effected - SJS

* If over 30% of the body is effected - TEN

Question 19

Causes of Steven Johnsons syndrome

Answer 19

adverse reactions to medications or viral infections

Medications: carbamazepine, sulphonamides, antivirals, phenytoin, lamotrigine, salicaytes, sertraline, NSAIDS< antifungals, allopurinol.

Infections: HSV, EBV, CMV, enterovirus, cocksakie, influenza, mumps, typhoid.

Question 20

Presentation of SJS

Answer 20

Prodrome - viral illness, cough, fever
sudden rash - non itchy, palms and soles and extensor surfaces moving to trunk. Wide spreads blisters and erythematous skin. Mayalgia, arthalgia, cough.

OE: fever, tachycardic, hypotenion, altered GCS.

Question 21

Management of SJS

Answer 21

A-E approach
identify and remove causative agent.
supportive therapy: fluids, emollient creams, systemic steroids and antihistamines

Question 22

Complications of SJS

Answer 22

• Life threatening condition
• can cause permanent damage to eye sight
• can progress to TEN if more than 30% of the body is effected.

Question 23

What is erythema nodosum?

Answer 23

hypersensitivity reaction, inflammation of fat cells under the skin resulting in tender red nodules.

Question 24

caused of erythema nodosum?

Answer 24

hypersensitivity due to infection, medication, systemic disease, or idiopathic

Question 25

Presentation of erythema nodosum

Answer 25

fever, malaise, arthralgia

Painful rash which becomes rad and tender. can mimic bruises or insect bites, usually found on shins.

Question 26

Management of erythema nodosum

Answer 26

investigate for a cause of infection - throat swab, bloods.
self limiting disease, usually lasts between 2-6 weeks.
symptomatic relief with analgesia and cool compress.

Question 27

what is scabies? what causes it?

Answer 27

contagious skin infection by direct contact with the mite sarcopates scabies. the mites deposits eggs inside the epidermis
more common in overcrowding, poor nutrition, poor hygiene, immunosuppression

Question 28

presentation of scabies?

Answer 28

widespread itchy papular vesicular rash, usually in wrists, hands and axilla.

Question 29

management of scabies

Answer 29

treat all members of the household simultaneously.
topical anti-parasite - Permethrin or Melathion.
can treat itch with antihistamine

Question 30

what is a dermoid cyst?

Answer 30

cysts found most commonly in the midline, external angle of the eye or behind the ear. typically scabs and includes hair follicles.