Dermatology - Common Rashes

Question 1

Cause of meningococcal rash?

Answer 1

Neisseria meningitidis

Question 2

Appearance of meningococcal rash?

Answer 2

Non-blanching purpuric or petechial rash. All children presenting with this assumed to have meningococcus until proven otherwise.

Question 3

Other symptoms that accompany a meningococcal rash?

Answer 3

pyrexia, malaise, meningitis (20-30%)

Question 4

Management of a meningococcal rash?

Answer 4

Immediate admission to hospital, resuscitation and administration of broad-spectrum antibiotics

Question 5

Complications of a meningococcal rash?

Answer 5

septicaemia, meningitis

Question 6

What is SJS/TEN?

Answer 6

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, acute, and potentially fatal skin reactions that cause sheet-like skin detachment and mucosal loss.

Question 7

Causes of SJS/TEN?

Answer 7

Drugs (most common), chemicals (burns), infections, systemic illnesses

Question 8

Appearance of lesions in SJS/TEN?

Answer 8

Widespread blisters/bullae over erythematous/macular/haemorrhagic skin.

Can also have haemorrhagic erosions on mucus membranes.

Question 9

How do lesions in SJS/TEN progress?

Answer 9

Blisters start on the face before spreading to other areas

Question 10

Associated symptoms in SJS/TEN?

Answer 10

fever, arthralgia, myalgia, conjunctivitis, pneumonitis

Question 11

Management of SJS/TEN?

Answer 11

supportive (hydration/maintain airway), identify and remove causative agent, dermatology and critical care input

Question 12

What is impetigo?

Answer 12

Impetigo is a superficial bacterial infection affecting the skin, most commonly in young children.

Question 13

Cause of impetigo?

Answer 13

Staphylococcal aureus or streptococcal skin infection

Question 14

Appearance of skin lesions in impetigo?

Answer 14

erythematous macules (may progress to be vesicular/bullous) on face, neck or hands

Question 15

Epidemiology of impetigo?

Answer 15

infants and young children

Question 16

Management of impetigo?

Answer 16

Topical (fusidic acid, mupirocin) or systemic (flucloxacillin or clarithromycin)

Question 17

What is Kawasaki disease?

Answer 17

An acute systemic vasculitis that affects young children.

Question 18

Cause of Kawasaki disease?

Answer 18

autoimmune-mediated (medium-sized blood vessel vasculitis)

Question 19

Symptoms seen in Kawasaki disease?

Answer 19

• fever > 5 days
• conjunctivitis
• polymorphous exanthem
• fissuring of lips
• strawberry tongue
• diffuse erythema of oral and pharyngeal mucosa
• periungual desquamation of fingers and toes
• erythema of palms and soles

Question 20

Investigations in Kawasaki disease?

Answer 20

• echocardiography (needs follow up 6 weeks later)
• inflammatory markers (ESR and CRP)
• alpha-1 antitrypsin

Question 21

Management of Kawasaki disease?

Answer 21

• high dose intravenous immunoglobulin
• aspirin

Question 22

What is Staphylococcal scalded skin syndrome?

Answer 22

a blistering skin disease caused by the exfoliate staphylococcal toxin.

Question 23

Cause of SSSS?

Answer 23

exfoliative staphylococcal toxin

Question 24

Appearance of SSSS?

Answer 24

blistering initially, then desquamation affecting flexural areas, buttocks, hands, or feet

Question 25

Epidemiology of SSSS?

Answer 25

typically occurs in children under three years old

Question 26

Associated symptoms in SSSS?

Answer 26

* fever * irritability * diffuse blanching erythema around the mouth * desquamation as above * positive Nikolsky’s sign (the epidermal layer easily sloughs off when pressure is applied)

Question 27

Management of SSSS?

Answer 27

hospital admission, supportive care, analgesia and intravenous antibiotics (flucloxacillin is first-line)

Question 28

What is the first line Abx in SSSS?

Answer 28

IV flucloxacillin

Question 29

What is eczema herpeticum?

Answer 29

**Eczema herpeticum** is a **complication of atopic eczema** that occurs with infection of the **herpes simplex virus (HSV)**.

Question 30

Cause of eczema herpeticum?

Answer 30

type I HSV co-infection with active atopic eczema

Question 31

Management of eczema herpeticum?

Answer 31

* oral acyclovir * systemic antibiotics for secondary bacterial infection

Question 32

What is erythema nodosum?

Answer 32

Red or violet subcutaneous nodules located **pretibially**

Question 33

Causes of eythema nodosum?

Answer 33

* streptococcal pharyngitis * idiopathic * sarcoidosis * primary tuberculosis * inflammatory bowel disease * drug reactions

Question 34

What is erythema multiforme?

Answer 34

Erythema multiforme (EM) is a **type IV hypersensitivity reaction** that presents with a skin rash.

Question 35

What is erythema multiforme typically triggered by?

Answer 35

It is typically triggered by an infection (most commonly herpes simplex virus), however, it can also develop secondary drug reactions.

Question 36

What age group does erythema multiforme typically affect?

Answer 36

20-40

Question 37

Causes of erythema multiforme?

Answer 37

HSV (90%), mycoplasma pneumonia, medications, autoimmune disease, sarcoidosis

Question 38

Appearance of lesions in erythema multiforme?

Answer 38

Target-like lesions on the skin. Progresses to erosions of bullae which can involve oral, genital or mucosal areas.

Question 39

Management of erythema multiforme?

Answer 39

Usually self-limiting, aciclovir is used to treat HSV infections Oral antihistamines and corticosteroids can be used to reduce pruritus.

Question 40

What is measles?

Answer 40

Measles is an infectious disease caused by a **morbillivirus** of the paramyxovirus family.

Question 41

Appearance of measles rash?

Answer 41

maculopapular rash lasts 6-8 days

Question 42

Associated symptoms of measles?

Answer 42

fever, coryza, cough, non-purulent conjunctivitis, Koplik spots

Question 43

Epidemiology of measles?

Answer 43

young children with a seasonal peak in late winter/spring

Question 44

Prevention of measles?

Answer 44

MMR vaccine at 18 months

Question 45

Associated symptoms in glandular fever?

Answer 45

fever, fatigue, sore throat, lymphadenopathy

Question 46

Why should you not give penicillin to a patient with EBV?

Answer 46

A maculopapular rash can occur due to being treated with penicillin whilst infected with EBV

Question 47

What pathogen causes chickenpox?

Answer 47

VZV

Question 48

Appearance of skin lesions in chickenpox?

Answer 48

starts on head and trunk, then spreads throughout the body. Red macules -\> papules -\> pustule-\> crusting

Question 49

What is scabies?

Answer 49

Scabies is a **highly contagious** skin infestation caused by a **parasitic mite**. It is spread by close contact and is more common among disadvantaged populations.

Question 50

Cause of scabies?

Answer 50

an infestation of the skin by mite *Sarcoptes scabiei* resulting in a pruritic eruption

Question 51

Appearance of lesions in scabies

Answer 51

mall, erythematous papule with haemorrhagic crusts on fingers, elbows, axillary folds, thighs, genitalia, feet

Question 52

management of scabies?

Answer 52

hygiene advice, topical permethrin, oral ivermectin

Question 53

What is tinea corporis?

Answer 53

Tinea corporis (also called **ringworm**) is a dermatophyte (fungal) infection of the body.

Question 54

Cause of tinea corporis?

Answer 54

*Trichophyton tubrum*, *Microsporum canis*, *Epidermophyton*

Question 55

Appearance of lesions in tinea corporis?

Answer 55

pruritic, circular, erythematous scaly patch spreading centrifugally. Central clearing is seen

Question 56

Management of tinea corporis?

Answer 56

daily application of topical antifungals Systemic therapy indicated in patients with failed topical therapy (terbinafine, fluconazole or itraconazole).

Question 57

Cause of molluscum contagiosum?

Answer 57

Poxvirus