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Year 4 Paediatrics > Dermatology > Flashcards

Dermatology Flashcards

(85 cards)

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1
Q

Give three red flags for a chronic rash

A

Skin Pain
Mucous Membrane Involvement
Unwell Child

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2
Q

Give three causes of a clear fluid filled rash

A

HSV
Impetigo
Chickenpox

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3
Q

Give three causes of a pus filled rash

A

Acne
Folliculitis
Pustular Psoriasis

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4
Q

Give three causes of a raised rash

A

Urticaria
Viral Warts
Milia

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5
Q

Give three causes of a red and scaly rash without epidermal breakage

A

Psoriasis
Tinea
Sebhorreic Dermatitis

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6
Q

Give a cause of a red and scaly rash with epidermal breakage

A

Atopic Eczema

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7
Q

Give three differentials for a purpuric rash (non blanching)

A

Meningococcal Septicaemia
ITP
Leukaemia

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8
Q

Define Acne Vulgaris. What is the cause?

A

Inflammatory disease of Pilosebaceous Follicles

Under influence of androgens, sebaceous glands produce more sebum and subsequently get blocked

Can become colonised with bacteria - Propionibacterium Acne

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9
Q

Acne Vulgaris commonly affects face/chest/upper back. How does it present?

A

Non Inflammatory (open and closed comedones - black and white heads

Inflammatory (Papules, Postules, Nodules, Cysts)

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10
Q

If Acne is localised then topical therapy can be used. Describe the three different types

A

Benzoyl Peroxide - reduces sebum production and P.Acne growth (may cause skin to peel)

Topical Antibiotics - used in combination with another topical therapy, erythromycin/Tetracycline

Topical Retinoids - Anti Inflammatory effect, contraindicated in pregnancy

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11
Q

If Acne is diffuse then systemic therapy can be used. Describe the three different types

A

Doxycycline (if over 12 - photosensitivity and oesophagitis)

Anti Androgens - COCP

Oral Isotretinoin - Highly effective but toxic so given under consultant supervision

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12
Q

How long does Systemic Acne Therapy take to ‘work’ in theory

A

Allow 3-4 months before review

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13
Q

How can Acne scarring be treated?

A

Laser Resurfacing

Chemical Peels

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14
Q

Define Eczema/Atopic Dermatitis

A

Chronic atopic condition caused by genetic defect in skin barrier function (loss of variants of filaggrin)

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15
Q

Describe the pathophysiology of Eczema

A

Tiny gaps in skin barrier provide entrance for irritants/allergens/microbes , that create an immune response resulting in inflammation

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16
Q

Name three exacerbating factors for Eczema

A

Infections
Allergens
Sweating

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17
Q

How does Eczema typically present?

A

Itchy erythematous dry scaly patches

Infants - Face and Extensor
Children and Adults - Flexor

Nail pitting and ridging

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18
Q

How do Eczema exacerbations present?

A

Erythematous, Vesicular, Weepy

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19
Q

What is the maintenance therapy for Eczema?

A

Emollients (thick layers, should be used as soap substitutes)

Can be thin - E45, Diprobase
Or thick - Hydromol, Cetraben

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20
Q

How are Eczema flares treated?

A

Thicker emollients, Topical Steroids, Wet Wraps

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21
Q

The use of steroids should be the weakest possible for the shortest possible time. Describe the steroid ladder

A

Mild (Hydrocortisone)
Moderate (Eumovate - Clobetasone Diproprionate)
Potent (Betnovate)
Very Potent (Dermovate)

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22
Q

Describe some specialist treatment in resistant eczema

A

Zinc bandages
Topical Tacrolimus
Phototherapy

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23
Q

State three possible infective organisms in Eczema

A

S.Aureus
Eczema Herpeticum
Molluscum Contagiosum

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24
Q

What is Napkin Dermatitis/Nappy Rash?

A

Common due to urine/faeces/friction in the nappy area

Spares the folds and favours the convexities

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25
When would you suspect Candida infection in Nappy Rash?
If there are satellite lesions
26
How is Nappy Rash managed?
Frequent nappy changes Drying after bathing Hydrocortisone Ointment
27
If Nappy Rash fails to respond to initial management, what other diagnoses could be considered?
Psoriasis Zinc Deficiency Langerhans Cell Histiocytosis
28
Give five causes of Pruritus Ani in infants
``` Contact dermatitis from faeces/urine/sweat Allergic Contact Dermatitis Threadworms Anal Disease (eg Crohns) Candidiasis ```
29
How should Pruritus Ani be investigated?
Threadworms are normally visible | Swans of Perianal Skin for MC&S
30
How should Pruritus Ani be managed?
Treat underlying cause Improve Perianal Hygiene Mild Steroid Ointment (if infective causes ruled out)
31
Give three causes of Pruritus Vulvae
Contact Dermatitis Diabetes Mellitus Threadworms
32
How should Pruritus Vulvae be managed?
Ensure no evidence of lichen sclerosus or diabetes Void regularly Change damp underwear Wipe front to back Treat acute inflammation with topical steroid until redness settles
33
Give three common allergens in Allergic Contact Dermatitis (delayed type IV hypersensitivity)
Nickel Plasters Henna Tattoos
34
How is Allergic Contact Dermatitis investigated and managed?
Ix - Patch test left on for 48hrs and then read on day 5 to 7 Mx - Allergen withdrawal and topical steroids
35
What is Perioral Lip Lick?
Eczema around mouth | Common in mouth breathers
36
How is Perioral Lip Lick managed?
Frequent lip balms Topical steroids Reduce irritant foods for 2-3 weeks (acidic, vinegar, tomato based)
37
Cutaneous warts are caused by cutaneous infection with HPV. How does it present?
Painless form papules with rough hyperkeratoic surface Typically affects hands/knees/face/feet Normally resolves within 3 years
38
Cutaneous warts normally don’t require management. If they are painful, or causing psychosocial problems, how can they be managed?
Destructive techniques - Keratolytic with Salicyclic, Liquid Nitrogen Cryotherapy, Podophyllotoxin Immune Based - Immunotherapy
39
What is Impetigo?
Superficial bacterial skin infection caused by S.Aureus and less commonly S.Pyogenes characterised by Golden Crust
40
Describe the pathophysiology of Impetigo
When bacteria enter via a break in the skin (may be healthy or may be related to dermatitis) Contagious so children should be kept home from school
41
Impetigo can be Bullous or Non Bullous. How does Non Bullous Impetigo present?
Typically occurs around nose and mouth Exudate dries to form golden crust - unsightly but not unwell
42
How is Non Bullous Impetigo managed?
Localised - Topical Fusidic Acid/Hydrogen Peroxide Widespread - Oral Flucloxacillin Don’t touch lesions, remain off school until healed/48h of Anitbiotics
43
Impetigo can be Bullous or Non Bullous. How does Bullous Impetigo present?
Staphylococcus Aureus produces epidermolytic toxins, breaking down skins structural proteins, causing fluid filled vesicles Vesicles grow and burst to form golden crust - painful and itchy May have systemic symptoms If widespread -Staphylococcal Scalded Syndrome
44
Which form of Impetigo is more common in under 2s?
Bullous
45
How is Bullous Impetigo managed?
Flucloxacillin (may require IV if severely unwell)
46
Give three complications of Impetigo
Cellulitis Sepsis Post Strep GN
47
Define Psoriasis and state the four main subtypes
Chronic autoimmune condition that causes symptoms of recurrent psoriatic lesions Plaque, Guttate, Pustular, Erythrodermic
48
How does Chronic Plaque Psoriasis present?
Thickened erythematous scabs that can be on extensor surfaces and scalp 1-10cm More common in adults
49
How does Guttate Psoriasis present? Note: Most common form in children
Small raised papules across trunk and limbs that are mildly erythematous and scaly Often triggered by Streptococcal throat infections, stress or drugs Resolves within 3-4 months
50
How does Pustular Psoriasis present?
Pustules form under areas of erythematous skin Can be systemically unwell and initially require hospital admission
51
How does Erythrodermic Psoriasis present?
Severe extensive erythematous areas covering most of skins surface Raw exposed areas Medical emergency and admission
52
Give three clinical features OE of Psoriasis
Auspitz Sign - small points of bleeding when plaques are scraped Koebner Sign - development of lesions where skin has previously been affected by trauma Residual pigmentation after resolution
53
Name five nail changes in Psoriasis
``` Pitting Thickening Discolouration Ridging Oncholysis ```
54
Name three management options for Psoriasis
Topical (Steroids, Vit D Analogue - Calcipitriol) UVB Phototherapy Severe - Systemic Methotrexate/Ciclosporin
55
Eczema Herpeticum is a viral skin infection. Describe the pathophysiology
Usually infection with HSV1, but can be with VZV Normally occurs in a patient with pre-existing skin conditions Associated with cold sore in patient or close contact
56
How does Eczema Herpeticum typically present?
Patient who already suffers eczema presenting with widespread, painful vesicular rash (containing pus) May have systemic symptoms such as fever/lethargy/irritable After the vesicular rash bursts - small punched out ulcers with red base
57
Eczema Herpeticum is normally a clinical diagnosis. How is it managed?
Aciclovir (oral or IV depending on severity) Note: very dangerous in those who are immunocompromised
58
Define Erythema Multiforme
Erythematous rash caused by hypersensitivity reaction Caused by viral infection (especially HSV), Mycoplasma Pneumoniae, Drugs (NSAIDs, Penicillins)
59
How does Erythema Multiforme present?
May or may not have preceding URTI/Fever/Flu Widespread itchy rash, characterised by target lesions Doesn’t normally affect mucous membranes
60
Erythema Multiforme is a clinical diagnosis. How is it managed?
Treat any underlying cause Often mild and resolves spontaneously in 1-4 weeks If severe - Fluids, Analgesia and Steroids
61
Molluscum Contagiosum is a viral skin infection. How does it present?
Small flesh coloured papules with a characteristic control papule Spread through direct contact/sharing towels or bedding
62
How is Molluscum Contagiosum managed?
Normally self resolves within 18 months Avoid sharing towels and scratching Any signs of bacterial superinfection - topical fusidic If immunocompromised/in problem area - Benzoyl Peroxide/Cryotherapy
63
Define Pityriasis Rosea
Generalised self limiting rash often occurring in adolescents and young adults. May be caused by HHV6 or HHV7
64
How does Pityriasis Rosea present?
May have a prodrome (headache, tiredness, flu) ``` Herald patch (Red/Pink scaly oval lesion, around 2cm on torso) Becomes widespread in ‘Christmas Tree Fashion’ along ribs ``` In darker skin tones it will appear grey
65
How is Pityriasis Rosea treated?
Normally resolves without treatment in 3 months Can cause skin discolouration which will resolves within another 3 months Not contagious
66
What is Seborrhoeic Dermatitis?
Inflammatory condition of sebaceous glands Affects scalp/nasiolabial folds/eyebrows Malassezia yeast plays a role
67
How does Infantile Seborrhoeic Dermatitis present?
AKA Cradle Cap Crusty flakey scalp, normally resolving by four months
68
How is Infantile Seborrhoeic Dermatitis (AKA Cradle Cap) treated?
Brush scalp with oil then wash off White petroleum jelly overnight If fails - topical anti fungal such as Clomitrazole for 4 weeks
69
Seborrhoeic Dermatitis of scalp most commonly occurs in adolescents and young adults, how is it managed?
Ketoconazole shampoo left on for five minutes Often recurs after successful treatment
70
How is Seborrhoeic Dermatitis of Face and body managed?
4 weeks Clotrimazole Localised inflammation can be treated with Hydrocortisone
71
What is Ringworm?
Fungal infection of the skin also known as tinea/dermatophytosis Can be subdivided into: Capitis, Pedis, Cruris, Corporis, Onchomycosis
72
How does Ringworm present?
Itchy rash that is erythematous, scaly and well demarcated | Edge of ring is more prominent in colour
73
How does Tinea Capitis present specifically?
Well demarcated hair loss Scalp Dryness
74
How does Tinea Pedis present specifically?
White/Red/Flaky itchy patches between toes More likely if feet are sweaty and damp for long periods
75
How does Onchomycosis present specifically?
Thickened discoloured nail
76
Ringworm is normally a clinical diagnosis, describe the different antifungal medications options
Topical Clomtrimazole Ketoconazole Shampoo Oral Fluconazole/Itraconazole
77
How is Onchomycosis treated?
Amorolfine Nail Lacquer If resistant then Oral Terbinafine
78
Daktacort is also a management option for Ringworm. What is contained within it?
Miconazole | Hydrocortisone
79
What is Tinea Incognito?
Extensive but less well recognised infection due to steroid use (eg mistakenly diagnosed as dermatitis)
80
What is Erythema Nodosum?
Red lumps that appear across patients shins due to inflammation of subcutaneous fat (hypersensitivity reaction)
81
Name five associations with Erythema Nodosum
``` Strep Throat TB Lymphoma NSAIDs IBD ```
82
What is Staphylococcal Scalded Syndrome?
Condition caused by a type of S.Aureus that produces epidermolytic toxins (proteases that break down skin) usually affecting children <5y
83
How does Staphylococcal Scalded Syndrome present?
Intitially generalised erythema patches, skin then wrinkles, and then bullae form When bullae burst it looks like a scald/burn Systemic symptoms
84
What is Nikolsky sign in Staphylococcal Scalded Syndrome?
Rubbing of skin causes it to peel away
85
How is Staphylococcal Scalded Syndrome managed?
IV antibiotics | Fluids

Year 4 Paediatrics (15 decks)

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