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Flashcards in Paediatric Dermatology Deck (31):
1

Age range of eczema

Atopic eczema worse between ages 2-4
Worse pre-puberty (no sebum production to act as a barrier)
Tends to improve into teen years and beyond

2

Distribution of atopic eczema in different age groups

Infants: cheeks often first affected
Toddlers: Extensor aspects of joints and genitals
School age on: flexural pattern

3

Perioral dermatitis cause and treatment

typically occurs after beclamethasone, treatment is to stop using creams on the face +/- oral tetracyclines

4

Management of eczema

Bathing: lukewarm watern, soap-free cleanser
Dilute K+ permangenate compresses for acute severe patch
Avoid wool
Emolliients after bathing
Topical steroids
Pimecrolis/tacrolimus for severe refractory eczema
Antihistamines may help reduce irritation, e.g. at night
Systemic steroids
MTX, AZA, phototyherapy for severe cases

5

Steroid creams suitable for facial dermatitis

Hydrocortisone 0.5% or 1%
Suitable for face and other body parts with thin skin

Others are too strong

6

Common causes of nappy rash

Usually a form of irritant contact dermatitis (due to bile salts and ammonium hydroxide in waste)
Other causes: candida, impetigo, seborrhoeic dermatitis etc.
NOT due to dermatophyte fungal infections (tinea)

7

Management of nappy rash

Use disposable nappies over cloth
Gently clean with water and soft cloth
Pat dry gently, allow to air dry
Apply protective emollient ointment
give evening fluids early to reduce night time wetting
Observe if certain foods are related to rash (e.g. orange juice increasing stool acidity)
+/- mild topical steroid (e.g. hydrocortisone)

8

Definition of acne vulgaris

Cutaneous disorder affecting adolescents and young adults involving hyperkeratisation, increased sebum production, infection and inflammation of the pilosebaceous follicles

9

Predisposing and provoking factors of acne vulgaris

Family history
Stress
high BMI (in females)
PCOS
Meds: steroids, hormones, AEDs, EGFR inhibitors
Application of occlusive cosmetics (e.g. make up)
High environmental humidity
Diet high in dairy and high GI foods

10

pathophysiology of acne vulgaris

increased proliferation and reduced desquamation of keratinocytes lining follicle - partial obstruction of follicle with sebum and keratin- inflammatory cells + sebum acts as growth medium for PROPIONIBACTERIUM ACNES - enzymes produced by bacterium promote degradation and rupture of follicular wall

Sebaceous glands are enlarged and sebum production increased by prepubertal levels of DHEA (androgens)

11

Pathogen responsible for acne vulgaris

Propionibacterium acnes

12

Management of acne

Investigate for hyperandrogenism in females (PCOS)
if Mild:
topical benxoyl peroxide (clearasil)
Low dose COCP
Antiseptic washes with salicylic acid
Light/laser therapy
MODERATE: as above plus
tetracycliness for 6 months (or erythromycin or trimethoprim if allergic)
Antiandrogen therapy: COCP, cyproterone acetate + ethinylesrtadiol and/or spironolactone
Isotretinoin (reduces sebum production, only use for 6-12m at a time)
SEVERE:
higher dose antibiotics, oral isotretinoin, referral to derm

13

Bacteria responsible for impetigo

Strep pyogenes
Bullous impetigo: Staph aureus

14

Common sites of impetigo

Exposed areas (hands and face) or in skin folds (esp. armpits)

15

Appearance of impetigo

Round oozing patches of pustules enlarging every day
Clear blisters = bullous impetigo
May be golden yellow crusts

16

Management of impetigo

Soak with water/whitevinegar mixture
Antiseptic ointment (betadine, hydrogen peroxide, chlorhexadine)
Oral fluclox 7 days
Cover affected areas,avoid close contact with others, stay home from school until crusts dried out, use separate towels and flannels, change ans wash clothes and linen daily

17

Scalded skin syndrome definition

Red blistering skin that looks like a burn or a scald due to a staphylococcal infection of the skin and the release of epidermolytic toxins A and B

18

Presentation of scalded skin syndrome

Begins with systemic symptoms: fever, irritability, widespread erythema
Rash develops within 24-48 hours
- tissue paper-like wrinkling of the skin followed by appearance of bullae
- particularly affects armpits, groin, orifices
- top layer of skin peels in sheets, leaving exposed moist, red tender area
- NIKIOLSKY SIGN PRESENT
May be painful and tender around infection site
May have associated weakness and dehydration
Confirm diagnosis with biopsy and bacterial culture

19

Management of scalded skin syndrome

Hospitalisation
IV antibiotics (fluclox) = oral in several days if respond well
Supportive treatment (paracetamol, maintain fluid and electrolyte intake, skin care)
Usually heal completely within 5-7 days of starting treatment

20

Copmlications of scalded skin syndrome

If untreated, or if treatment unsuccessful
Sepsis
Cellulitis
Pneumonia
Death in severe infection

21

Scarlet fever definition

A bacterial illness with a distinctive rash of tiny pink-red spots covering the whole body in children who have recently had impetigo or a throat infection caused by strep pyogenes

22

Age range and risk factors for scarlet fever

4-8y (older kids have developed antibodies against strep toxins, children under 2 still have maternal antibodies)
Risk factors:
- living in overcrowding
- close contact with someone who has a strep infection

23

Clinical features of scarlet fever

1-4 day incubation
Sudden fever with:
sore throat, swollen neck glands, headache, nausea and vomiting, loss of appetite, strawberry tongue, abdominal pain, body aches, malaise
Characteristic rash (12-48 hours after onset of fever)
- starts below ears, neck, chest, armpits and groin - covers body over 24h
Scarlet spots - boiled lobster appearance
As progresses, looks like sunburn with goosebumps
Rough sandpaper like feel
Pastia lines
fever peaks by day 2 returns to normal in 5-7d
Rash starts to fade and peel like sunburn by day 6

24

Cause of pastia lines

rupture of fragile blood vessels in skin folds
Occurs in scarlet fever

25

Cause of scarlet fever

Group A strep (strep pyogenes) exotoxin

26

Management of scarlet fever

Penicillin/amoxycillin for up to 10 days
ADDITIONAL:
Paracetamol PRN
Eating soft foods, drinking cool liquids
Oral antihistamines or calamine lotion for itch
Keep fingernails short

27

Complications of scarlet fever

Rheumatic fever
Otitis media
Pneumonia
Septicaemia
Glomerulonephritis
Osteomyelitis
Death

28

How contagious is chicken pox

>90% to non-immune household contacts

29

Management of alopecia areata

Steroid injections and creams

30

Psoriasis treatment algorithm

1. Emollients, topical vitamin D, coal tar,
2. Topical steroids, retinoids or dithranol
3. Phototherapy
4. Oral MTX, retinoids, cyclosporin

31

Type of skin condition that sometimes occurs as a sequel to strep throats

Guttate psoriasis