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Paediatrics > Paediatric dermatology > Flashcards

Paediatric dermatology Flashcards

1
Q

Chicken pox : Definition

A
  1. Chickenpox is caused by the varicella zoster virus(VZV).
  2. It causes a highly contagious, generalised vesicular rash. It is common in children
  3. Spread by respiratory droplets
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2
Q

Chicken pox : Clinical features

A
  1. Fever (first symptoms)
  2. General fatigue
  3. Rash
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3
Q

Chicken pox : Rash features

A
  • Description
    1. Widespread erythematous rash
    2. Raised vesicular (fluid filled), blistering lesions
  • Spread
    1. Starts on the trunk or face and spread outwards to the whole body
  • Infectivity
    1. Contagion stops when lesions have scabbed over
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4
Q

Chicken pox : Management

A
  1. Conservative mx : Chlophenamine for itching
  2. Acyclovir : immunocompromised or risk of complications
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5
Q

Chicken pox : Complications

A

Shingles/Ramsay hunt syndrome : VZV can lie Dorman in sensory dorsal root ganglion cells and reactivate late in life

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6
Q

Chicken pox in pregnancy

A
  1. If not immune - Varicella zoster Ig following exposure
  2. Infection < 28 weeks : Congential varicella syndrome
  3. Infection during deliver : Transmit life threatening neonatal infection to new born
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7
Q

Hand, foot and mouth disease : Definition

A

Hand, foot and mouth disease is caused by the coxsackie A virus. Incubation is usually 3 – 5 days

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8
Q

Hand, foot and mouth disease : Presentation

A
  1. Preceding URTI sx : dry cough, sore throat and fever
    1-2 days later
  2. Rash :
    * Painful mouth ulcers
    * Blistering red spots all over the body } mostly hands and feet
    * May be itchy
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9
Q

Hand, foot and mouth disease : Management

A

Conservative Mx : analgesia and rest

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10
Q

Nappy rash : definition

A

Nappy rash is contact dermatitis in the nappy area. It is usually caused by friction between the skin and nappy and contact with urine and faeces in a dirty nappy.

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11
Q

Nappy rash : Clinical presentation of rash

A
  1. Sore, red inflamed skin : skin that comes into contact with nappy
  2. Spares groin creases
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12
Q

Nappy rash : Complication

A

Complication of nappy rash is getting an superimposed infection
1. Risk : Oral antibiotics can increase risk of nappy rash getting infected with thrush

  1. Clinical features
    i) Oral thrush
    ii) Rash
    * Rash extends to groin creases
    * Large red macules with a well demarcated scaly border
    * Rash extends in a circular pattern - spreads outwards with satellite lesion ( smaller similar patches near main rash)
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13
Q

Nappy rash : Management

A
  1. Highly absorbent nappies
  2. Don’t delay changing nappy
  3. Water or gentle alcohol free products
  4. Ensure the nappy area is dry before replacing the nappy
  5. Maximise time not wearing a nappy
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14
Q

Head lice : Definition

A

Parasite causing infestations of the scalp - most common in school age children

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15
Q

Head lice : Presentation

A

Itchy scalp or lice visualised

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16
Q

Head lice : Management

A
  1. Dimeticone 4% lotion applied over 7 days
  2. Fine comb
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17
Q

Non- blanching rashes : definition

A

Non-blanching rashes are caused by bleeding under the skin.

  1. Petechiae : small (< 3mm), non blanching, red spots on the skin caused by burst capillaries.
  2. Purpura are larger (3 – 10mm) non-blanching red-purple papule caused by leaking of blood vessels under the skin
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18
Q

Non- blanching rashes : Differential diagnosis

A
    • Meningococcal septicaemia : feverish + unwell with sx of meningitis
    • Henoch-Schonlein purpa : Rash on lower extremities with abdominal and joint pain
    • Idiopathic thrombocytopenic purpura (ITP): This develops over several days in an otherwise well child.
    • Acute leukaemias: Gradual development of petechiae - with other signs such as anaemia, lymphadenopathy and hepatosplenomegaly.
    • Haemolytic uraemic syndrome -(HUS : This is associated with oliguria (very low urine output) and signs of anaemia. This often presents in a child with recent diarrhoea
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19
Q

Non- blanching rashes : Investigation

A
  1. FBC
    * Anaemia : HUS or Leukaemia
    * Low platelets : ITP or HUS
    * ESR : Raised in vasculitis such as HSP
  2. Urea and electrolytes:
    * High urea and creatinine / + Urine dip : can indicate HUS or HSP with renal involvement.
  3. Meningococcal PCR: This can confirm meningococcal disease, although this should not delay treatment
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20
Q

Impetigo : Definition

A
  1. Impetigo is a superficial bacterial skin infection
  2. A “golden crust” is characteristic of a staphylococcus skin infection
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21
Q

Impetigo : Causative pathogens

A
  1. Staphylococcus aureus - always cause of bullous Impetigo
  2. Streptococcus Pyogenes
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22
Q

Impetigo : Transmission

A
  1. Direct contact of discharge of scabs from infected person
  2. Very contagious : school exclusion until lesions are crusted or 48 hours after abx therapy
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23
Q

Non - Bullous Impetigo : Clinical features

A
  1. ’ Gold crust’ (dried exudate from lesions)
    * around nose or mouth
  2. No systemic sx
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24
Q

Non - Bullous Impetigo : Management

A
  1. First line : Hydrogen peroxide 1%
  2. Second line : (Topical abx) fusidic acid cream
    If severe severe : Oral Flucloxacillin
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25
Q

Bullous Impetigo : Clinical features

A
  1. Rash
    * 1-2cm fluid filled vesicles } painful and itchy
    * Gold crust : when vesicles burst
  2. Systemic sx : feverish and unwell
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26
Q

Bullous Impetigo : Management

A
  1. PO Flucloxacillin
27
Q

Bullous Impetigo : Complications

A
  1. Staylococcus scalded skin syndrome
    * Severe version of infection - lesions are wide spread
  2. Post streptococcal glomerulonephritis
  3. Scarlet fever
28
Q

Eczema : Incidence in children

A

Presents < 2 years
Self resolves in 75% of children by 10 years

29
Q

Eczema : Clinical features in children

A

Rash : itchy erythematous rash
Distribution
* Infants : Face + trunks
* Young children : extensor surfaces
* Older children : typical flexor distribution

30
Q

Eczema : Management in children

A

1 . Large quantitiés of topical emollient
* 10 x the amount of topical steroid used
* Applied 30 min before steroid
* Wet wrapping of emollient under bandages

2 . Topical steroid

31
Q

Seborrhoeic dermatitis : Definition

A

Common skin condition that affects areas of the body which have high density of oil glands

32
Q

Seborrhoeic dermatitis : Clinical features

A

1.* Red, itchy scaly skin with coarse yellow scales*
* Occurs where there are many oil glands

  1. Cradle cap : first few weeks of life
    * Thick yellow/brown scales/crusting on scalp
33
Q

Seborrhoeic dermatitis : Management

A
  1. Gentle cleansing of scalp : to remove scales
  2. Moisturising
  3. Topical anti-fungal cream if remains persistent
34
Q

Roseola Infantum: Definition

A

Roseola is a viral infection which is characterized by a sudden onset of high fever, followed by the appearance of a rash once the fever subsides.

35
Q

Roseola Infantum : Causative pathogen

A

Human herpesvirus 6

36
Q

Roseola Infantum : Clinical features

A
  1. High fever - up to 40 degrees
  2. Mild Pharyngitis
  3. Lymphadenopathy
  4. Rash
    * ‘Rose pink’ macular non pruritic rash
    * Trunk - initially starts on the trunk, prominent over thighs and buttocks
    * Macule - surrounded by fine halo
    * Disappears within two days without desquamation
37
Q

Roseola infantum : Rash

A
  1. ‘Rose pink’ macular non pruritic rash
  2. Trunk - initially starts on the trunk, prominent over thighs and buttocks
  3. Macule - surrounded by fine halo
    Disappears within two days without desquamation
38
Q

Roseola infantum : Definition

A

Viral infection spread by respiratory droplets causing fever and distinct ‘Rose-pink’ rash

39
Q

Measles : Definition

A

A highly contagious viral infection caused by the measles virus

40
Q

Measles : Causative pathogen

A

Single-stranded RNA morbillivirus

41
Q

Measles : Clinical presentation

A
  1. Prodromal phase (4 days - infectious phase)
    * 3Cs : Conjunctivitis, Cough, Coryza
    * Fever
  2. Koplik spots - develop before rash
    * small white spots inside the cheek
  3. Rash -
    * Erythematous and maculopapular rash
    * Initial : fore head and neck
    * Spread : trunk and limp
    Leaves behind brownish discolouration
42
Q

Measles : Investigations

A

IgM antibodies - detected within a few days of rash onset

43
Q

Measles : Management

A

Supportive
Notifiable disease - inform public health

44
Q

Measles : Complication

A
  • Otitis media: the most common complication
  • Pneumonia: the most common cause of death
  • Encephalitis: typically occurs 1-2 weeks following the onset of the illness)
45
Q

Erythema infectiosum - Causative organism

A

AKA : Fifth disease
Parovirus B19

46
Q

Erythema infectiosum : Transmission

A

Transmission via respiratory secretion

47
Q

Erythema infectiosum : Clinical presentation

A
  1. Mild prodromal symptoms - 1 week after exposure
    * Headaches, fever, sore throat, abdominal pain
  2. Symptom free period 7-10 days
  3. Rash develops - ‘Slapped cheek appearance’
48
Q

Erythema infectiosum : Rash

A

Rash occurs in 3 phases

  1. ’Slapped cheek’ appearance - bright red, nasolabial folds spared
  2. Erythematous maculopapular rash on proximal extremities - arms and extensor surfaces and trunk
  3. Fades into classic lace-like reticular pattern
49
Q

Erythema infectiosum : Complication

A

Aplastic crisis
* Replicates in bone marrow - can cause aplastic crisis in patients with pre-existing bone marrow stress
e.g. sickle cell anaemia

50
Q

Erythema Toxicum Neonatorum : Definition

A
  • Common benign skin condition that occurs in newborns
  • 20-30% of newborns affected
51
Q

Erythema Toxicum Neonatorum : Rash

A
  1. Red rash - small raised white bumps surrounded by redness
  2. Small erythematous papule and vesicles, occasionally pustules
  3. Lesions are surrounded by diffuse blotchy erythema - gives the appearance of a distinct halo
52
Q

Erythema Toxicum Neonatorum : Prognosis

A

Most lesions disappearing by 2 weeks of onset

53
Q

Scarlet fever - Definition

A

acterial Infection with a group A beta haemolytic streptococci

54
Q

Scarlet fever : Causative organism

A

Group A beta haemolytic streptococci

55
Q

Scarlet fever : Clinical features

A

.1. Sore throat : Tonsillitis, red pharynx with white exudates
2. Fever : headache, malaise
3. Strawberry tongue
4. Rash-
* ’Sand-paper’ : rough texture
* Fine, ‘pinhead’ appearance
* Initial : Torso, marked over flexors/skin folds

56
Q

Scarlet fever : Rash features

A
  1. ’Sand-paper’ : rough texture
  2. Fine, ‘pinhead’ appearance
  3. Initial : Torso, marked over flexors/skin folds
  4. ‘Flushed’ cheeks - area around mouth spared
  5. Small papule or diffuse erythema - blanching
  6. Desquamation/Peeling of skin - prominent on the soles of the feet, palms of hand
57
Q

Scarlet fever : Complication

A
  1. Post streptococcal glomerulonephritis
  2. Rheumatic fever
58
Q

Scarlet fever : Diagnosis

A
  1. Clinical diagnosis
  2. Antistreptolysin O titres
  3. Throat swab
59
Q

Scarlet fever : Management

A
  1. Penicillin V for 10 days } return to school 24 hours after antibiotics
  2. Notifiable disease - inform public health
60
Q

Scarlet fever : Complication

A
  1. Otitis media } most common
  2. Acute glomerulonephritis } 10 days after
  3. Rheumatic fever } 20 days after infection
61
Q

Rubella : Definition

A

Rubella, also known as German measles, is a viral infection caused by the togavirus.

62
Q

Rubella : Clinical presentation

A

Infectious 7 days before sx onset
1. Prodrome : Mild corzal symptoms
Low grade fever, headache
2. Lymphadenopathy: suboccipital and postauricular
3. Rash:
* Light pink maculopapular, non confluent

63
Q

Rubella : Rash

A
  1. Rash:
    * Light pink maculopapular, non confluent
    * Initially : Starts behind ear , onto the face
    * Spread : to whole body, usually fades by the 3-5 day
    Lymphadenopathy: suboccipital and postauricular

Paediatrics (13 decks)

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