Dermatology Paeds

Question 1

IMPETIGO

Answer 1

Staph or strep from pa-ent’s nose or other children
Round, confluent, superficial lesions which rupture early = yellow crusts

Question 2

SCALDED SKIN SYNDROME

Answer 2

Staph = toxin release that causes erythema & desquama6on (exotoxin)

• Localised bullous impe6go OR
  localised generalized erythematous tender skin which closely resembles
  severe burn
• Other symptoms: malaise, fever, irritability, facial oedema

Question 3

Rx SCALDED SKIN SYNDROME

Answer 3

• Fluid rehydra6on
• Wound care
• A/B: IV Clindamycin

Question 4

STEVEN-JOHNSON SYNDROME

Answer 4

= severe form of erythema mul0forme

Causes
* Infec0ons: Mycoplasma pneumonia
* Drugs: sulphonamides, phenolphthalein
* Cause is o=en unknown

Lesions are large, bullous, crusted & mucous membranes (mouth, genitalia, eyes) are
involved

Question 5

ERYTHEMA TOXICUM

Answer 5

• Small pustules on erythematous base, in clumps
• Occur on any part of the body: mainly trunk & proximal part of upper limbs
• Child is well & apyrexial

Scraping: large number of eosinophils

Question 6

MILIA

Answer 6

• Benign kera*n filled cyst
• Arise in sebaceous glands that are not fully developed
• Due to estrogen

Question 7

Rubella

Answer 7

• Pink paculopapular, non-confluent, blanching rash
• Begins at the haed, primarily behind the ears !
  extend to trunk & extremi5es
• Transient, symptoms usually disappears within ± 3
  days

Question 8

Measles

Answer 8

• Erythematous maculopapular, blanching, par5ally
  confluent rash (large)
• Usually begins on face, frequenly behind ears !
  disseminates to rest of body (palms & soles spared)
• Begins to fade a?er ± 5 days with brown
  discoloura5on & desquama5on

Question 9

Scarlet fever

Answer 9

• Fine erythematous maculopapular, blanching rash
  (small); “sand-paper” like texture
• Usually begins in neck region; disseminated to head,
  trunk & extremi5es
• Dis5nct appearance in groin & bends of joint
• Pas5a’s lines
• Brown discoloura5on & desquama5on of skin during
  2nd to 4th week of infec5on, par5cularly palms & soles
• Early symptoms: sudden onset with “ fever

Question 10

Roseola infantum:
exanthem subitum

Answer 10

• Rose-pink maculopapular, patchy, blanching exanthem
• Originates on trunk; may spread to face & extremi5es
• Develops as the fever subsides
• Frequently observed from only several hours to max
  of 3 days

Question 11

erythema infecBosum

Answer 11

• Maculopapular, ini5ally confluent rash ! lace-like &
  re5cular appearance over 5me
• Ini5ally typical red flushed appearance of cheeks
  (“slapped cheek”) & periorbital pallor; spreads to
  extremi5es & trunk
• Mild pruritus: more pronounced a?er sunlight or heat
  exposure
• Rash fades a?er 5-8 days; may be recurrent for several
  months

Question 12

Tinea capitis

Answer 12

Scalp ringworm
* Patchy or diffuse areas of hair loss
* Erythema, papules, pustules
* 2° bacterial infec;ons = scarring &
patchy permanent hair loss
* Thickened, white, opaque hair
stumps: fungus is seen in scrapings
* Undergo inflammatory reac;on (due
to hypersensi;vity reac;on) with
forma;on of boggy swelling studded
with pustules = kerion

Question 13

Tinea corporis

Answer 13

Body ringworm
* Lesions are ring-shaped with ac;ve,
raised, scaly margins which spread
outwards
* Some;mes > 1 advancing edge is
present ! concentric rings are
formed
* Nail ringworms are rare in children

Question 14

Treatment Tinea

Answer 14

• Topical an;fungals: imidazole or clotrimazole
• Griseofulvin : Mul;ple skin lesions or involvement of the scalp or nails

Question 15

ATOPIC ECZEMA

Answer 15

= inflammatory skin disease which affects mainly the epidermis ! forma-on of intraepidermal
vesicles in acute stage
Most important features:
1. Itching
2. Dryness
3. Scaling
4. Thickening of skin
5. Vesicles
6. 2° infec-on

Question 16

Acute ATOPIC ECZEMA

Answer 16

• Swelling (oedema)
• Erythema
• Vesicles
• ‘Wheeping’: discharge a clear, serous fluid

Question 17

Subacute ATOPIC ECZEMA

Answer 17

• Mild erythema
• Scaling

Question 18

Chronic ATOPIC ECZEMA

Answer 18

• Lichnifica-on: leathery plaques, hyper/hypopigmenta-on,
  prominent skin markings
• Scaling
• Papules

Question 19

Clinical features of atopy

Answer 19

Face:
* Dennie Morgan lines: infraorbital folds
* Periorbital hyperpigmenta-on
* Muddy discoloura-on of the sclera: brownish stain
* Head lamp sign: nose area is spared
* Salute sign: crease along bridge of nose
* Fissure below ear: more common in infants
Hands:
* Hyperlinearity of the palms

Question 20

SCABIES

Answer 20

Direct skin-to-skin transmission of mite (Sarcoptes scabiei) from infected person

• Widespread small scratched paplues that cluster arround axillae & on
  bu@ocks
• Short, superficial burrows & vesicles
• Between fingers, on wrists, trunk & limb
• Heal: small, white spots with a dark rim, takes several months to fade
• Persistent scabies nodules (large lesions): axilla, groin & genitals

Question 21

WARTS

Answer 21

Cause = HPV
Types:
1. vulgaris
(Common warts) - Single or mulEple; papillomatous surface

2. Plane warts Small, flat warts that occur in large numbers on face &
   limbs
   Koebner phenomana = grow in line along scratch
   marks
3. Condylomata accuminata
   (Genital warts)
   Occur on genitalia or around anus
   Moist, vegetaEng papillomatous surface
   Consider sexual abuse