Paediatrics > Paediatric Dermatology > Flashcards

Paediatric Dermatology Flashcards

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1
Q

What are common presentations in paediatric dermatology?

A
  • Eczema
  • Infection – viral and bacterial
  • Manifestations of systemic disease
  • Vascular birthmarks
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2
Q

Eczema - aetiology

A
  • Familial tendancy
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3
Q

Eczema - epidemiology

A
  • Common, affects 1/5 children
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4
Q

Eczema - severity

A
  • Varies from mild, moderate, severe
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5
Q

Eczema - presentation

A
  • Classically red, dry itchy skin eruption
  • Flares and settles intermittently
  • Different patterns recognised
    • Atopic eczema
    • Food allergy
    • Discoid eczema
    • Seborrheic dermatitis
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6
Q

Atopic eczema - aetiology

A
  • Filaggrin mutation predisposes – structural protein which binds keratin fibres together
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7
Q

Atopic eczema - pathophysiology

A
  • Barrier defect
    • Increased permeability to irritants and allergens
    • Water loss
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8
Q

Atopic eczema - presentation

A
  • Classic eczema
  • Widespread diffuse scaly red eruptions
  • Very itchy
  • Onset anytime in childhood
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9
Q

Atopic eczema - triggers

A
  • Illness
  • Stress
  • Teething
  • Environment – cold air, central heating
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10
Q

Atopic eczema - management

A
  • Topical steroids (mainstay)
    • Strengths and adequate amounts need to be used
    • Once daily for 1-2 weeks on affected area, then alternate days and increase again for flare ups
  • Moisturiser (emollient)
    • Helps symptoms such as itch
    • Lighter during day, thicker at night
  • Soap substitute
  • If topical steroids don’t work
    • Steroid sparing agents – protropic ointment or Elidel cream
    • Phototherapy UVB
    • Immunosuppresion – methotrexate, ciclosporin, mycofenalate mofetil, azathioprine
    • Biologics – Dupilomab (IL4 inhibitor)
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11
Q

What is “1 fingertip unit”?

A
  • 1 fingertip unit
    • 0.5g
    • Roughly covers surface area under 2 adults hands
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12
Q

Describe the topical steroid ladder?

A
  • Very potent
    • Dermovate 600x
  • Potent
    • Betnovate 100x
  • Moderate
    • Eumovate 25x
  • Mild
    • Hydrocortisone
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13
Q

When should you suspect food allergy?

A
  • Immediate reactions (type 1 reaction)
    • Lip swelling, facial redness/itching, anaphylactoid symptoms
  • Late reactions (type IV hypersensitivity)
    • Worsening of eczema 24/48 hours after ingestion
    • GI problems
    • Failure to thrive
    • Severe eczema unresponsive to treatment
    • Severe generalised itching
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14
Q

Discoid eczema - presentation

A
  • Scattered annular/circular patches of itchy eczema
  • Can occur in this pattern as part of atopic eczema or in isolation
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15
Q

Discoid eczema - management

A
  • Stubborn to treat
  • Potent topical steroid with antibacterial component
    • Such as Betnovate C ointment
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16
Q

Seborrheoic dermatitis - aetiology

A
  • Associated with proliferation of various species of skin commensals
    • Malassezia in its yeast form
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17
Q

Seborrheoic dermatitis - presentation

A
  • Mainly scalp and face
  • Often babies under 3 months, usually resolves by 12 months
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18
Q

Seborrheoic dermatitis - management

A
  • Emollients
    • To loose scalp
  • Daktocort ointment
  • Protopic ointment
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19
Q

What are common skin infections?

A
  • Impetigo
  • Molluscum contagiosum
  • Viral warts
  • Viral exanthems
  • Varicella zoster (chicken pox)
  • Parovirus (slapped cheek)
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20
Q

Impetigo - aetiology

A
  • Usually staph aureus
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21
Q

Impetigo - epidemiology

A
  • Common superficial bacterial skin infection
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22
Q

Impetigo - presentation

A
  • Pustules and honey coloured crusted erosions
  • Very contagious
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23
Q

Impetigo - treatment

A
  • Topical antibacterial
    • Fucidin
  • Oral antibiotic
    • Flucloxacillin
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24
Q

Molluscum contagiosum - aetiology

A
  • Mulluscipox virus
    • Transmissible by close direct contact
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25
Molluscum contagiosum - epidemiology
Common
26
Molluscum contagiosum - presentation
* Self-limiting condition * Classically pearly papules, umbilicated centre
27
Molluscum contagiosum - management
* Reassurance, can take up to 24 months to clear * 5% potassium hydroxide
28
Viral warts - aetiology
* Human papillomavirus (HPV) * Transmitted by direct skin contact
29
Viral warts - presentation
* Benign self-limiting condition
30
Viral warts - treatment
* No treatment required * Stimulate own immune system to respond to presence of virus * Topical treatments such as salicyclic acid and paring * Cyrotherapy * Oral zinc
31
Viral exanthems - aetiology
* Associated viral illnesses * Chicken pox * Measles * Rubella * Roseola (herpes virus 6) * Erythema infectiosum (parovirus B19, slapped cheek) * Hand foot and mouth * Eczema coxsackium * Eczema herpeticum
32
Viral exanthems - epidemiology
Common
33
Viral exanthems - pathophysiology
* Either reaction to toxin produced by organism, damage to skin by organism or immune reaction
34
Viral exanthems - presentation
* Fever * Malaise * Headache
35
Viral exanthems - management
* Self-limiting so only supported treatment
36
Chicken pox - aetiology
* Varicella-zoster virus * Highly contagious * Contagious 1-2 days before rash appears until lesions have crusted over
37
Chicken pox - presentation
* Red papules (small bumps) progressing to vesicles (blisters) often start on trunk * Itchy * Associated with viral symptoms
38
Chicken pox - management
* Self-limiting * Infection control
39
Chicken pox - complications
* Rarely associated with pneumonia, encephalitis
40
What is parovirus also called?
Also called slapped cheek
41
Parovirus - presentation
* Often mild, self-limiting illness * Viral symptoms * Erythematous rash cheeks initially and then also lace like network rash on trunks and arms
42
Parovirus - complications
* Virus attacks red cells * Very rarely aplastic crises (if haemolytic disorders) * Risk to pregnant woman * Spontaneous abortion, IUD, hydrops fetalis
43
Hand foot and mouth disease - aetiology
* Enterovirus * Usually coxsackie virus A16 * Can also be due to enterovirus 71 and other coxsackivirus types
44
Hand foot and mouth disease - epidemiology
* Epidemics late summer or autumn months
45
Hand foot and mouth disease - presentation
* Blisters on hands, feet and in mouth * Viral symptoms
46
Hand foot and mouth disease - management
* Self-limiting so treatment is supportive
47
Eczema coxsackium - presentation
* Self-limiting * Associated viral symptoms * History of eczema * Flared sites picks out areas of eczema
48
Eczema herpeticum - presentation
* Unwell child * History of eczema * Monomorphic punched out lesions
49
Eczema herpiticum - treatment
* Withhold topical steroids for 24 hours * Aciclovir * Oral or IV depending on age and how well * Opthalmology review if near eye
50
What are examples of systemic diseases with skin manifestations in children?
* Orofacial granulomatosis * Erythema nodosum * Dermatitis herpetiformis * Urticaria
51
Orofacial granulomatosis - aetiology
* Can be associated with Crohn’s disease
52
Orofacial granulomatosis - presentation
* Lip swelling and fissuring * Oral mucosal lesions * Ulcers and tags
53
Orofacial granulomatosis - management
* Check faecal calprotectin if GI symptoms * Consider patch testing * Benzoate and cinnamate free diet
54
Erythema nodosum - aetiology
* Infections * Streptococcus, upper respiratory tract * Inflammatory bowel disease * Sarcoidosis * Drugs * OCP, sulphnoamides, penicillin * Mycobacterial infections * Idiopathic
55
Erythema nodosum - clinical features
* Painful, erythematous subcutaneous nodules * Over shins, sometimes other sites * Slow resolution like bruise
56
Erythema nodosum - management
* Painful, erythematous subcutaneous nodules * Over shins, sometimes other sites * Slow resolution like bruise
57
Dermatitis herpetiformis - epidemiology
* Rare but immunobullous disease that has been linked to coeliac disease
58
Dermatitis herpetiformis - presentation
* Itchy blisters can appear in clusters * Often symmetry * Scalp, shoulders, buttocks, elbows and knees
59
Dermatitis herpetiformis - management
* Coeliac screening * Skin biopsy * Emollients * Gluten free diet * Topical steroids * Dapsone
60
Urticaria - classification
* Acute * \<6 weeks * Chronic * \>6 weeks
61
Urticaria - aetiology
* Viral infection * Bacterial infection * Food or drug allergy * NSAIDs, opiates * Vaccinations
62
Urticaria - presentation
* Wheals/hives * Associated angioedema * Areas of rash can last from few minutes up to 24 hours
63
Urticaria - treatment
* Consider possible triggers including medication and withdrawal * Antihistamines * E.g Desloratadine – 3x daily
64
What are examples of vascular birthmarks?
* Infantile haemangioma * PHACES
65
Infantile haemangioma - epidemiology
* Very common
66
Infantile haemangioma - presentation
* Not present on skin at birth * Proliferative phase between 6 weeks up to 8 months * Then starts to involute * Can be superficial or deep * Ulceration of buttocks, genitals or posterior shoulder
67
Infantile haemangioma - treatment
* No treatment needed as will resolve * Beta blockers can speed up process of involution * Topical * Timolol 0.5% gel * Oral * Propranolol solutions
68
What is PHACES?
Syndrome: * Pituitary fossa abnormality * Haemangioma * Arterial anomalies * Cardiac anomalies or coarctation of aorta * Eyes * Sternal cleft
69
PHACES - management
* Low dose propranolol can result in improvement of segmental haemangioma * MDT approach
Paediatrics
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