Paediatric - dermatology Flashcards
(153 cards)
1
Q
What are some key dermatological conditions in children (9)?
A
- Eczema
- Acne vulgaris
- Uticaria + angioedema
- Anaphylaxis
- Birth marks
- Stephensons-johnson syndrome
- Nappy rash
- Allergic rhinitis (not really derm, but anyway…)
- Infectious rashes
2
Q
What is acne vulgaris?
A
Chronic inflammation of the pilosebaceous unit
3
Q
What bacteria is commonly responsible and found in the skin of those with acne?
A
Cutibacterium acnes (people with acne aren’t cute)
4
Q
What makes up the pilosebaceous unit (2)?
A
- Hair follicule
- Sebaceous gland
5
Q
How is acne vulgaris treated (4)?
A
- Benzoyl peroxide
- Topical/ oral retinoids
- Topical/ oral antibiotics
- Contraceptive pill (female only)
6
Q
What is the typical presentation of a patient with acne vulgaris?
A
Erythematous papules/ pustules on face and back
7
Q
What is an example of an oral retinoid for acne vulgaris?
A
Isotretinoin
8
Q
When can isotretinoin not be used?
A
During pregnancy (teratogenic)
9
Q
Example of an oral antibiotic for acne vulgaris?
A
Lymecycline
10
Q
Example of a topical antibiotic for acne vulgaris?
A
Clindamycin
11
Q
What is an example of an oral contraceptive used for acne vulgaris?
A
Co-cyprindiol
12
Q
What is eczema?
A
A group of conditions that cause the skin to become dry, red and itchy
13
Q
What are the main 2 types of eczema?
A
- Atopic dermatitis
- Contact dermatitis
14
Q
What are the two types of contact dermatitis?
A
- Allergic contact dermatitis
- Irritant contact dermatitis
15
Q
What is the pathophysiology of atopic dermatitis?
A
Defects in the skin barrier allow irritants, microbes to enter –> immune response –> inflammation
16
Q
What is a key risk factor for eczema?
A
Family history
17
Q
What age does eczema usually present?
A
Early childhood
18
Q
Is eczema lifelong?
A
Sometimes (if a child is going to grow out of it they usually have done by age 18)
19
Q
Where is eczema usually found on the body?
A
Flexor surfaces - inside of elbows and knees and on the face
20
Q
How is eczema managed (4)?
A
- Lifestyle changes (e.g. washing with soap less, itching less)
- Emollients
- Steroids
- Specialist treatments (e.g. DMARDs, phototherapy))
21
Q
What is an example of a mild topical steroid?
A
Hydrocortisone 0.5 - 2.5%
22
Q
What is an example of a moderate topical steroid?
A
Clobetasone butyrate 0.05%
23
Q
What is an example of a potent topical steroid?
A
Betamethasone 0.1%
24
Q
What is an example of a very potent topical steroid?
A
Clobetasol propionate 0.05%
25
What are some side effects of topical steroids (4)?
* Skin thinning
* Bruising
* Tearing
* Enlarged blood vessels under skin
26
What areas should topical steroids be used with caution in?
Face and genital areas
27
What is the most common bacteria to infect the skin of those with eczema?
Staph aureus
28
How is staph aureus skin infection treated?
Flucloxacillin
29
What can exacerbate symptoms of eczema?
Frequent washing of skin with soap and water
30
What is eczema herpeticum?
Viral skin infection
31
What are some risk factors for eczema herpeticum?
* **Eczema**/ other skin condition sufferer
* Patient/ close contact with a **coldsore**
32
What is the most and second most common cause of eczema herpeticum?
1. HSV-1
2. VZV
33
What sort of rash does eczema herpeticum cause?
Widespread, painful, vesicular, erythematous rash
*After vesicles burst they leave small punched out ulcers*
34
What are the signs/ symptoms of eczema herpeticum (3)?
* **Rash**
* **Systemic symtoms** e.g. fever, lethargy, irritability
* Lymphadenopathy
35
How is eczema herpeticum treated?
Acyclovir (may need to be IV)
*admission if severe*
36
What is a complication of eczema herpeticum?
Bacterial superinfection
37
What is the medical term for hives?
Urticaria
38
What is the pathophysiology of urticaria?
The release of histamine and other pro-inflammatory chemicals by mast cells under the skin causing inflammation + oedema
39
What are the two types of urticaria?
* Acute
* Chronic
40
What are some causes of acute urticaria (5)?
* Allergies (food/ meds/ animals)
* Contact with chemicals/ latex/ stinging nettles
* Infections (viral)
* Insect bites
* Rubbing skin
*all of these can cause mast cells to release histamine*
41
What are the 3 subclassifications of chronic urticaria?
* **Chronic idiopathic urticaria** - no identifiable cause
* **Chronic inducible urticaria** - identifiable triggers (e.g. sunlight, temp change, emotions)
* **Autoimmune urticaria** - underlying autoimmune condition (e.g. SLE)
42
What other symptoms can occur with urticaria (3)?
* Itching
* Fatigue
* General unwell feeling (due to inflammation)
43
How is urticaria managed?
* Antihistamine
* Steroids (for flares)
* Specialist drugs
44
What is the antihistamine of choice for urticaria?
Fexofenadine
45
What specialist drugs can be used?
* Anti-leukotrienes (e.g. montelukast)
* Omalizumab (targets IgE)
* Ciclosporin (anti-inflammatory)
46
What other symptoms may also occur with urticaria (2)?
* Angioedema
* Flushing of the skin
47
What is angioedema?
Sudden swelling of a body part
48
What part of the body is often affected by angioedema?
Tongue
49
What are the top 3 causes of angioedema?
* Allergy
* ACE inhibitors
* Hereditary angioedema (C1 esterase inhibitor deficiency)
50
What is allergic rhinitis?
Allergic inflammatory response in the nasal mucosa and eyes
51
What type hypersensitivity is allergic rhinitis?
Type 1 hypersensitivity
52
What are the 3 types of allergic rhinitis?
* **Seasonal** e.g. hay fever
* **Perennial** e.g. house dust mite allergy
* **Occupational** - associated with work/ school environment
53
What are the main signs/ symptoms of allergic rhinitis (4)?
* Runny, blocked nose
* Sneezing
* Itchy eyes + nose
* Red swollen eyes
54
What other medical conditions is allergic rhinitis associated with (2)?
* Eczema
* Asthma
*these three make the atopic triad*
55
What are some tiggers for allergic rhinitis (4)?
* Tree pollen/ grass
* House dust mites
* Pets
* Mould
56
How is allergic rhinitis managed (3)?
* Oral antihistamines
* Nasal corticosteroids
* Nasal antihistamines
57
What are 3 examples of non-sedating antihistamines?
* Cetirizine
* Loratadine
* Fexofenadine
58
What are 2 examples of sedating antihistamines?
* Chlorphenamine
* Promethazine
59
What is an example of a nasal steroid spray?
Mometasone
60
What is the pathophysiology of anaphylaxis?
Upon second exposure to an irritant, IgE causes degranulation of mast cells --> histamine + other pro inflammatory chemicals released
61
What type of hypersensitivity is anaphylaxis?
Type 1 hypersensitivity
62
What differentiates anaphylaxis from other forms of allergies?
Compromise of airway, breathing or circulation
63
What are the signs/ symptoms of anaphylaxis (9)?
* Urticaria
* Itching
* Angioedema - particularly lips + eyes
* Abdo pain
* SOB
* Wheeze/ stridor
* Tachycardia
* Lightheaded
* Collapse
64
How is anaphylaxis managed (4)?
* A-E assessment
* Adrenaline IM (again after 5 min)
* Antihistamine
* Steroids (IV hydrocortisone)
65
How should patients be managed after the initial acute anaphylaxis (3)?
* Admitted for observations in case of a biphasic reaction
* Measure serum **tryptase** within 6 hours
* Patient education + give epi pen
66
What is tryptase and why is it measured?
It is released when mast cells degranulate
*tryptase stays in blood for 6 hours so must be measured within this time period*
67
Where should an epi pen be administered?
Upper outer thigh
68
What are the two categories of birth marks?
* Vascular birth marks
* Pigmented birth marks
69
What are 3 types of vascular birth marks?
* **Salmon patches** (nevus simplex) - pink/ red marks, often on forehead
* **Haemangioma** - raised bright red areas (purple if under skin)
* **Port wine stains** (nevus flammeus) - red, purple, dark patches/ marks on face
*the first two tend to fade and port wine stains can get darker if not treated*
70
Which one of the vascular birth marks can raise further health concerns?
Port wine stains can be associated with other weird health problems
71
What are the 3 main types of pigmented birth marks?
* **Blue grey spots** (mongolian birth spots)
* **Cafe au lait spots** (light brown patches found anywhere)
* Congenital melanocytic nevi (moles)
72
Where are blue grey spots often found and why can this sometimes be concerning?
Found on lower back/ buttocks
*Can be concerning because it can mimic injuries seen in abuse*
73
What is a risk of congenital melanocytic nevi?
Have a higher chance of developing into moles, depending on the size of the lesion
74
What is a severe skin reaction that can follow medication use or infection?
Stephens-johnson syndrome
75
What is a more severe form of Stephens-johnson syndrome?
Toxic epidermal necrolysis (TEN)
76
What is the difference between SJS and TEN?
* SJS affects < 10% skin surface
* TEN affects > 30% skin surface
*between 10-30% of skin is an intermediate form*
77
What happens in the skin in stephens-johnson syndrome?
Autoimmune disorder where a disproportionate immune response causes epidermal necrosis resulting in blistering and shedding of the skin
78
What type hypersensitivity is SJS and TEN?
Type 4 hypersensitivity
79
What may predispose a person to SJS?
Certain HLA genes
80
What are the signs/ symptoms of SJS (6)?
Begins with:
* Fever
* Cough
* Sore throat, mouth, eyes
* Pruritus
* Muscle/ joint aches
Then develop:
* Purple red - blistering rash
81
What are some of the common medications that cause SJS (4)?
* NSAIDs
* Allopurinol
* Abx
* Anti-epileptics
82
What are some of the common infections that cause SJS (4)?
* HSV
* M. pneumoniae
* CMV
* HIV
83
How is SJS/TEN managed (4)?
* Supportive care
* Steroids
* Immunoglobulins
* Immunosuppressants
84
What are some complications of SJS/TEN (3)?
* Secondary infection
* Skin damage
* Visual complications
85
What is a milder rash that can follow medication use and infections?
Erythema multiforme
*used to be considered same spectrum as SJS/TEN, however now separate*
86
What does an erythema multiforme rash look like?
Typically target lesions (like lymes disease)
*accompanied with general flu like symptoms*
87
What are some common causes of erythema multiforme (2)?
* HSV
* M. pneumoniae
88
How is erythema multiforme managed?
Generally self limiting
89
What condition may cause red lumps to form across a childs shins?
Erythema nodosum
90
What are some causes of erythema nodosum (8)?
* Strep throat
* Gastroenteritis
* M. pneumoniae
* TB
* Medications
* Sarcoidosis
* IBD
* Lymphoma/ leukaemia
*pregnancy in adults*
91
What type of condition is erythema nodosum?
Type 4 hypersensitivity
92
How is erythema nodosum investigated (5)?
* Inflammatory markers
* Throat swab
* CXR
* Stool microscopy/ culture (for gastroenteritis)
* Faecal calprotectin
93
What rash in sometimes found in those with coeliacs disease?
Dermatitis herpetiformis
94
What is an important cause of rash around the pelvis and genital area in babies?
Nappy rash
95
What is nappy rash?
Contact dermatitis where the skin comes into contact with the nappy, faeces and urine
96
What age is nappy rash most common?
9-12 months
*maybe because they start to move more???*
97
What are some risk factors for nappy rash (4)?
* Poorly absorbent nappy
* Delayed changing of nappy
* Irritant cleaning products
* Diarrhoea
98
What are some complications of nappy rash?
* Infection
* Ulceration
99
What are the most common causes of infection from a nappy rash (2)?
* **Candida**
* Strep/staph
100
What might suggest a candida infection rather than just a nappy rash (4)?
* Rash in skin folds
* Well demarcated scaly border
* Satellite lesions
* Circular lesions spreading outward
101
How can nappy rash be managed (3)?
* Change nappy frequently
* Use more absorbent nappies
* Use genital cleaning products
102
What are some infectious causes of rash in children (14)?
* Chicken pox (VZV)
* Hand foot and mouth (coxsackie virus)
* Molluscum contagiosum
* Ringworm
* Scabies
* Head lice
* Staphylococcal scalded skin syndrome
* Meningococcal sepsis (+ other bacterial sepsis)
* Impetigo
* Rubella
* Measles
* Roseola
* Slapped cheek
* Scarlet fever
103
What is the pathophysiological cause of non-blanching rashes?
Bleeding under the skin from capillaries
104
What two words can be used to describe non-blanching rashes depending on their size?
* **Petechiae** = small < 3mm
* **Purpura** = larger 3-10mm
105
What are some causes of non blanching rashes in children (6)?
* Meningococcal septicaemia
* Henoch Schonlein purpura
* Idiopathic thrombocytopenia purpura
* Acute leukaemia
* Strong coughing/ trauma
* Viral
106
How should a non-blanching rash be managed in children?
Urgent referral to a hospital unless benign cause is clear
107
How should a non-blanching rash be investigated?
* **Bloods** (FBC, U&E, CRP, coagulation, culture)
* **Lumbar puncture** (meningitis)
* **BP**
* **Urine dip**
108
What is the presentation of molluscum contagiosum virus?
Papules with a central dimple that appear in clusters in a local area
109
How is Molluscum contagiosum spread?
Direct contact/ sharing towels
110
What causes molluscum contagiosum?
Molluscum contagiosum **virus**
111
How is molluscum contagiosum treated (3)?
* Nothing - body will fight it off on its own
* Creams e.g. potassium hydroxide
* Surgery/ cryotherapy
112
What is ringworm?
A fungal infection of the skin causing a rash
113
What is the most common cause of ringworm?
Trichophyton
114
What is ringworm on the scalp called?
**Tinea capitis**
*Wear a **cap** on your head*
115
What is ringworm on the foot called?
Tinea pedis (athlete's foot)
116
What is ring worm on the groin called?
Tinea cruris
117
What is ringworm on the body called?
Tinea corporis
118
What is ringworm on the nail called?
Onychomycosis
119
What is the rash associated with ringworm like?
Well demarcated, scaly, erythematous itchy rash. With rings/ circles spreading outwards - centre is lighter than border
120
How else might tinea capitis present?
Hair loss
121
Where is tinea pedis found on the foot?
Between the toes
122
How does onychomycosis present?
Thickened discoloured (white/ yellow) deformed nails
123
How is ringworm treated?
* Lifestyle advice (keep areas dry, don't share towels etc...)
* Anti-fungal creams/ shampoos
* Oral anti-fungals
124
What is an example of an anti-fungal cream?
Miconazole
125
What is an example of an oral anti-fungal?
Fluconazole
126
How should onychomycosis be treated?
* Amorolifine (nail cream)
* Oral terbinafine (send nail clipping to confirm)
127
What is important to do when prescribing patients oral terbinafine?
Monitor LFTs before and during treatment
128
What is a complication of ringworm if it is mistaken for dermatitis and steroid creams are prescribed?
Tinea incognito
*Steroid cream suppresses immune system, when stopped the rash comes back bigger and better*
129
What is scabies?
Parasitic infection where tiny 8 legged creatures burrow under skin
130
How long can the intubation period of scabies be?
Up to 8 weeks
131
What is the presentation of scabies?
Small itchy red spots with track marks where the mites have burrowed
132
Where does scabies typically affect?
Between the fingers (although can spread to whole body
133
How is scabies treated (2)?
* **Permethrin** cream
* Oral ivermectin
134
What parasite causes head lice?
Pediculus humanus capitis
135
What are nits?
Unviable eggs or eggs that have hatched
136
What is the presentation of a child with head lice?
* Itchy scalp
* Visible nits
137
How are head lice treated (2)?
* **Dimeticone**
* Fine comb
138
What is an inflammatory condition that affects the skin, particularly the sebaceous glands known as?
Seborrhoeic dermatitis
139
Which parts of the body are often affected by seborrhoeic dermatitis (3)?
* Scalp
* Nasolabial folds
* Eyebrows
140
What is thought might cause seborrhoeic dermatitis?
Yeast colonisation (improves with anti-fungals)
141
How can seborrhoeic dermatitis present in babies?
Crusty, flaky scalp
142
What is seborrhoeic dermatitis in babies known as?
Infantile seborrhoeic dermatitis (**cradle cap**)
143
When does cradle cap usually resolve by?
4-12 months
144
What can seborrhoeic dermatitis cause when it infects the scalp of older children/ adults/ those with hair?
Dandruff!!!
145
How is seborrhoeic dermatitis treated (2)?
* **Ketoconazole** shampoo (if in hair)
* Anti-fungal cream e.g. miconazole (if on face)
146
What sometimes causes patchy hair loss from the scalp in children?
Alopecia areata
147
What is alopecia areata?
Autoimmune condition where the body attacks hair follicles
148
How does alopecia areata present?
Spot/ patchy baldness without inflammation + short hair regrowth around the edge
149
How is alopecia areata managed?
Not much is usually done, topical corticosteroids can be given
150
Where may suggest a poor prognosis for alopecia areata?
Early onset hair loss
151
What skin condition may cause depigmentation of the skin leading to white patches?
Vilitigo
152
What is the pathophysiology of vilitigo?
Autoimmune destruction of melanocytes
153
