Paediatrics Dermatology Flashcards
(191 cards)
1
Q
What is eczema?
A
Chronic atopic condition
Defects in continuity of skin barrier causing inflammation
Runs in families
2
Q
When does eczema present?
A
Infancy with dry, red, itchy and sore patches on flexor surfaces
Comes in flares
3
Q
What is the management of eczema?
A
Maintenance = emollients (thick and greasy - artificial barrier) after washing + before bed soap substitutes
Flares = thicker emollients, topical steroids (sometimes tacrolimus)
4
Q
What are some specialist treatments in severe eczema?
A
Zinc impregnated bandages
Topical tacrolimus
Phototherapy
Systemic immunosuppressants (oral corticosteroids, methotrexate and azathioprine)
5
Q
What are the thin creams and thick creams used in eczema?
A
Thin = E45, diprobase cream, oilatum cream, aveeno cream, cetraben cream, epaderm cream
Thick = 50:50 ointment (50% liquid parafen), hydromol ointment, diprobase ointment, cetraben ointment, epaderm ointment
6
Q
What are the side effects of topical steroids?
A
Thinning of the skin = flares, bruising, tearing, stretch marks, enlarged blood vessels (telangiectasia)
7
Q
What is the steroid ladder for steroid cream?
A
Mild: Hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)
8
Q
What can treat bacterial infection of the skin in eczema? Which bacteria is most common?
A
Oral abx (flucloxacillin - if severe then IV)
Staphylococcus aureus
9
Q
What is eczema herpeticum?
A
Viral skin infection caused by herpes simplex virus (HSV) ot varicella zoster virus (VZV)
10
Q
What was eczema herpeticum previously known as?
A
Kaposi varicelliform eruption (don’t confuse with Kaposi’s sarcoma)
11
Q
What is the most common organism in eczema herpeticum?
A
Herpes simplex virus 1 (coldsore)
12
Q
Who does eczema herpeticum usually occur in?
A
Patients with pre-existing condition e.g. atopic eczema or dermatitis
13
Q
How does eczema herpeticum present?
A
Widespread, painful vesicular rash
Fever, lethargy, irritability
Lymphadenopathy
14
Q
Describe the rash in eczema herpeticum?
A
Widespreak, erythematous, painful, itchy, vesicles containing pus (burst and leave punched out lesions)
15
Q
What is the management of eczema herpeticum?
A
Viral swabs of the vesicles to confirm diagnosis
Aciclovir (mild = oral, severe = IV aciclovir)
16
Q
What are some complications of eczema herpeticum?
A
Can be life-threatening if not treated properly (in immunocompromised)
Bacterial superinfection
17
Q
What is psoriasis?
A
Chronic autoimmune conditon causing psoriatic skin lesions
18
Q
What causes psoriasis?
A
Genetic component (but not clear)
1/3 patients have first degree relative with psoriasis
19
Q
Describe the patches of psoriasis?
A
Dry
Flaky
Scaly
Faintly erythematous
Raised
Rough plaques
EXTENSOR SURFACES
20
Q
Why do psoriatic plaques occur?
A
Rapid generation of new skin cells causing
abnormal buildup and thickening of the skin
21
Q
Name 4 types of psoriasis?
A
Plaque psoriasis
Guttate psoriasis
Pustular psoriasis
Erythrodermic psoriasis
22
Q
Describe plaque psoriasis?
A
Thickened erythematous plaques
Silver scales
Exensor surfaces
Most common form of psoriasis
23
Q
Describe guttate psoriasis?
A
Common in children
Many small raised papules across trunk and limbs
Mildly erythematous and slightly scaly
Triggered by streptococcal throat infection, stress or medications
Resolves spontaneously in 3-4 months
24
Q
What is pustular psoriasis?
A
Rare severe form of psoriasis where pustules form under areas of erythematous skin
Pus is not infective
Systemically unwell - medical emergency
25
Describe **erythrodermic** psoriasis?
**Rare** and **severe** psoriasis
**Erythematous** inflamed areas on **most of the surface** of the skin
**Skin comes away in large patches** = raw exposed areas - medical emergency and requires admission
26
Which **specific signs** are **suggestive** of psoriasis?
**Auspitz sign** = small points of bleeding where plaques are scraped off
**Koebner phenomenon** = development of **psoriatic lesions** to areas of skin affected by trauma
**Residual pigmentation** = after lesions resolve
27
How is psoriasis diagnosed?
**Clinical appearance** of the lesions
28
What are the **treatment** options for psoriasis?
**Topical steroids**
**Topical vitamin D analogues** (calcipotriol)
**Topical dithranol**
**Topical calcineurin inhibitors** (tacrolimus) usually only used in adults
**Phototherapy** with **narrow band ultraviolet B light** for guttate psoriasis
29
Which **unlicensed** treatments can be used for **difficult to control** psoriasis?
**Methotrexate**
**Cyclosporine**
**Retinoids**
**Biologic medication**
30
Which **products** contain **both a potent steroid** and **vitamin D analogue**?
**Dovobet**
**Enstilar**
(not licensed in children)
31
What **conditions** are **associated** with **psoriasis**?
**Nail psoriasis** - pitting, thickening, discolouration, ridging and **onycholysis** (separation of the nail from nail bed)
**Psoriatic arthritis** - (10% of patients with psoriasis) within 10 years of developing skin changes
**Psychological** - depression and anxiety
Obesity, hyperlipidaemia, hypertension and type 2 diabetes
32
What causes **acne**?
**Blocking** of the **pilesebaceous unit** by **increased production** of sebum trapping **keratin**
Causing **chronic inflammation** with / without **localised infection**
33
What are the **pilosebaceous unit**?
Tiny dimples in skin containing **hair follicles** and **sebaceous glands** (produce natural skin oils and sebum)
34
Why is **acne** exacerbated by puberty / improving with anti-androgenic hormonal contraception?
**Androgenic hormones** increase the production of **sebum**
35
What are **swollen** and **inflamed** pilosebaceous units known as?
**Comedones**
36
What **bacteria** is thought to **overgrow** in **acne**?
**Propionibacterium** **acnes** (usually colonises the skin)
37
# Define the following terms:
**Macules**
**Papules**
**Pustules**
**Comedomes**
**Blackheads**
**Ice pick scars**
**Hypertrophic scars**
**Rolling scars**
**Macules** = flat marks on the skin
**Papules** = small lumps on the skin
**Pustules** = small lumps containing yellow pus
**Comedomes** = skin coloured papules representing blocked pilosebaceous units
**Blackheads** = open comedones with black pigmentation in the centre
**Ice pick scars** = small indentations in the skin that remain after acne lesions heal
**Hypertrophic scars** = small lumps in the skin that remain after acne lesions heal
**Rolling scars** = irregular wave-like irregularities of the skin that remain after acne lesions heal
38
What is the **management** of **acne**?
Reduce **symptoms** / **scarring** / **psychosocial impact**
39
What **medications** can be used for **acne**?
No treatment if mild
**Topical benzoyl peroxide** to reduce inflammation (**toxic to P. acnes** bacteria)
**Topical retinoids** (chemical related to **vit A**) slow production of sebum
**Topical abx** e.g. **clindamycin** (prescribed with **benzoyl peroxide** to reduce bacterial resistance)
**Oral abx** e.g. lymecycline
**Oral contraceptive pill** to stabalised hormones and **slow production of sebum**
40
What is the **last-line option** for treating **acne**?
**Oral retinoids** i.e. **isotretinoin** (specialist prescribes) - careful follow up and monitoring
41
What is the **most effective COCP** for treating **acne**?
**Co-cypindiol** (Dianette) due to **anti-androgen effects**
Higher risk of **thromboembolism** so treatment is discontinued once acne is controlled
42
What is the **oral isotretinoin** called?
Roaccutane (retinoid)
43
How does roaccutane work?
Reduce **production of sebum**
Reduce **inflammation**
Reduce **bacterial growth**
44
What is the **risk of roaccutane** in women?
**Teratogenic** (harmful to foetus) patients must have **effective** and **reliable** contraception - must stop medication a month before becoming pregnant
45
What are some **side effects** of **isotretinoin**?
**Dry** skin and lips
**Photosensitivity** of the skin to sunlight
**Depression** and suicidal ideation (must be screened for mental health issues before starting treatment)
Rarely **stevens-Johnson syndrome** and **toxic epidermal necrolysis**
46
What is an **ex****anthem**?
**Eruptive widespread rash**
47
Name the original six "**viral exanthemas**"
**First** disease: Measles
**Second** disease: Scarlet Fever
**Third** disease: Rubella (AKA German Measles)
**Fourth** disease: Dukes’ Disease
**Fifth** disease: Parvovirus B19
**Sixth** disease: Roseola Infantum
48
What is **measles** caused by?
**Measles virus** - highly contagious via **respiratory droplets**
49
How and **when** do **symptoms** of measles start?
**10** - **12** days after exposure
**Fever**, **coryzal** symptoms and **conjunctivitis**
50
What are **Koplik spots**?
**Greyish**-**white** spots on the **buccal mucosa** - pathognomic for measles
51
Describe the **rash** in **measles**?
**Starts on the face** behind the ears
3-5 days after the fever
**Spreads** to rest of body
**Erythmatous**, **macular** rash with **flat lesions**
52
What is the **management** of **measles**?
**Self-resolves** after 7-10 days of symptoms
**Isolate** until **4 days after** symptoms resolve
**Notifiable disease**
**30%** develop **complications**
53
What are the **complications** of **measles**?
**Pneumonia** (most common cause of death)
Diarrhoea
Dehydration
Encephalitis
Meningitis
Hearing loss
Vision loss
Death
54
What is **scarlet fever** associated with?
**Group A streptococcus** infection, usually **tonsillitis** (not caused by a virus)
55
What is **scarlet fever** caused by?
**Exotoxin** produced by the **strep pyogenes** (group A strep) bacteria
56
Describe the **rash** in **scarlet fever**?
**Red-pink**, **blotchy**, **macular rash** with rough "**sandpaper**" skin - starts on the **trunk** and **spreads outwards**
57
What are the **other features** of **scarlet fever**?
Fever
Lethargy
Flushed face
Sore throat
**Strawberry tongue**
Cervical lymphadenopathy
58
What is the **treatment** of **scarlet fever**?
**Abx** for the **underlying** strep bacterial infection
Phenoxymethylpenicillin (penicillin V) for **10 days**
**Notifiable disease**
**Kept off school** for **24 hours** after starting **abx**
59
Which **other conditions** are associated with **group A strep** infection?
**Post-strep**tococcal **glomerulonephritis**
Acute **rheumatic fever**
60
What is **Rubella** caused by? When do **symptoms appear**?
**Rubella virus**
2 weeks after exposure
61
Describe the **rash** in **rubella**?
Milder **erythematous macular** rash starting on **face** and spreading to **rest of the body**
62
How long does the **rash last** in **rubella**?
What are the associated symptoms?
**3 dyas**
Mild fever
Joint pain
Sore throat
**Lymphadenopathy**
63
What is the **management** of **rubella**?
Self-limiting
**Notifiable disease**
Stay off school for **5 days after rash disappears**
**Avoid pregnant women**
64
What are the **complications** of **rubella**?
**Thrombocytopenia**
**Encephalitis**
**Pregnancy** = congenital rubella syndrome (deafness, blindness, congenital heart disease)
65
What is the **fourth disease**?
**Dukes disease**- mostly forgotten in clinical practice (no organism found to explain it)
**Non-specific** viral rash
66
What is the **fifth disease** also known as?
**Parvovirus B19**
**Slapped cheek syndrome**
**Erythema infectiosum**
67
What are the **features** of **parvovirus infection**?
Mild fever, coryza, non-specific viral symptoms e.g. muscle aches and lethargy
**2-5 days after** **the rash appears** (bright red, both cheeks, "slapped cheeks"
**A few days after** the **reticular** (net-like) erythematous rash appears which affects the trunks and limbs (raised and itchy)
68
How is **parvovirus B19 managed**?
Self-limiting
Rash / symptoms **fade** over 1-2 weeks
**Supportive** with fluids / analgesia
**Infectious prior to rash** but once formed, no longer infectious and can return
69
Who is at risk of **complications** to **parvovirus**?
**Immunocompromised**
**Pregnant women**
**Haematological conditions** (sickle cell anaemia, thalassaemia, hereditary spherocytosis and haemolytic anaemia)
70
How to **manage** patients with **parvovirus** and at risk of complications?
**Serology testing** to confirm diagnosis
FBC and reticulocyte count for **aplastic anaemia**
71
What are some **complications** of **parvovirus** infection?
**Aplastic anaemia**
**Encephalitis** or **meningitis**
Pregnancy complications including fetal death
Hepatitis, myocarditis or nephritis
72
What is the **sixth disease**? What causes it?
**Roseola infantum**
Human herpes virus 6 (HHV-6)
Human herpes virus 7 (HHV-7)
73
How does **roseola** progress?
1-2 weeks after infection with **high fever** (up to 40) **suddenly** lasting 3-5 days then disappearing
Coryzal symptoms, sore throat, lymphadenopathy
**Fever settles** and **rash appears** for 1-2 days
74
How does the **rash appear** in **roseola**?
Mild erythematous **macular** across **arms**, **legs**, **trunk** and face - is **not itchy**
**Full recovery in a week**- don't generally need to be kept of nursery
75
What is the **main complication** of **roseola**?
**Febrile convulsions** due to high temperature
**Immunocompromised** = myocarditis, thrombocytopenia, Guillain-Barre syndrome
76
What is **erythema multiforme**?
**Erythematous rash** caused by **hypersensitivity reaction**
Caused by **viral infections** and **medncations**
77
Which **infections** are associated with **erythema multiforme**?
**Herpes simplex virus**
**Mycoplasma pneumonia**
78
How does **erythema multiforme** present?
**Widespread**, **itchy**, **erythematous** rash
Characteristic "**target lesions**" = red rings withing larger red rings - darkest red at centre
**Stomatitis**
Mild fever
Muscle
Joint aches
Headaches
Flu-like symptoms
79
What is the **management** of **erythema multiforme**?
**Clinically** diagnosed - on appearance of rash
**Establish** cause (e.g. coldsore or treatment with penicillin) **CXR** to look for **mycoplasma pneumonia**
**If mild usually** self-resolves within one to four weeks
Cases may be **recurrent**
80
How are **severe cases** of **erythema multiforme** managed?
Admit (especially where **oral mucosa** affected)
IV fluids
Analgesia
Steroids (systemic - use is contoversial / topical)
**Abx** / antivirals where infection is present
81
What are **urticaria**?
AKA **hives**
Small **itchy lumps** which appear on the skin
May be **patchy erythematous rash** (localised / widespread)
Associated **angioedema** and **flushing**
Can be **acute** or **chronic**
82
What is the **pathophysiology** of **urticaria**?
Release of **histamine** and other **pro-inflammatory chemicals** by **mast cells** in the skin
83
When is urticaria seen?
**Allergic reaction**
**Acute urticaria**
**Autoimmune reaction**
**Chronic idopathic urticaria**
84
What causes **urticaria**?
Something that **stimulates** the **mast cells** to **release histamine** e.g:
* **Allergies** to food, medication or animals
* **Contact** with chemicals, latex or stinging nettles
* Medications
* Viral infections
* Insect bites
* Dermatographism (rubbing of the skin)
85
What causes **chronic urticaria**?
**Autoantibodies** targetting **mast cells**, triggering them to **release histamines**
86
What are the **sub categories** of **chronic** **urticaria**?
Chronic **idiopathic** urticaria
Chronic **inducible** urticaria
Chronic **a****utoimmune urticaria**
87
What is **chronic idiopathic urticaria**?
Recurrent **episodes** of **chronic urticaria** without a clear underlying cause
88
What causes **chronic inducible urticaria**?
Chronic urticaria, triggered by:
* Sunlight
* Temperature change
* Strong emotions
* Hot or cold weather
* Pressure (dermatographism)
89
What is **autoimmune urticaria**?
Chronic **uritcaria** associated with an underlying autoimmune condition e.g. SLE
90
What is the **treatment** of **urticaria**?
**Antihistamines**: fexofenadine
**Oral steroids** for severe flares
If **severe**:
* **Anti-leukotrienes** e.g. **montelukast**
* **Omalizumab** which targets IgE
* **Cyclosporin**
91
What is **chickenpox** caused by?
**Varicella zoster virus** - **highly contagious** generalised **vesicular** rash
92
How does **chickenpox** present?
**Widespread**, **erythematous**, **raised**, **vesicular** (fluid filled), **blistering lesions**
Starts on **trunk** and **spreads outwards** affecting the **whole body** over 2-5 days
93
What are the **other symtoms** of chickenpox?
Fever
Itch
General fatigue and malaise
94
When is **chickenpox contagious**?
**Highly contagious** initially - spread through **direct contact** with lesions or through **infected droplets** (cough or sneeze)
**Symptomatic** 10 days - 3 weeks after exposure
**Stop being contagious** when all lesions have **crusted over**
95
What are some **complications** of **chickenpox**?
**Bacterial superinfection**
**Dehydration**
**Conjunctival lesions**
**Penumonia**
**Encephalitis** (presenting as **ataxia**)
96
Where does **varicella zoster** **virus** lie dormant? What can it **reactivate** as?
**Sensory dorsal root ganglion cells**
**Shingles** / **Ramsay Hunt syndrome**
97
What can be given to **pregnant** women who are **not immune** to VZV after **exposure**?
**Varicella zoster immunoglobulins**
98
What can **chickenpox** in pregnancy, **before 28 weeks gestation** cause?
**Developmental problems** in the foetus (**congenital varicalle syndrome**)
99
What can **chickenpox** in the mother **around time of delivery** cause?
**Life threatening neonatal infection**
Treated with **varicella zoster immunoglobulins** and **aciclovir**
100
When is **medication** considered for **chickenpox**? What is given?
Immunocompromised, adults, adolescents over 14 years **presenting within 24 hours,** neonates
## Footnote
**Aciclovir**
101
What can treat the **itching** in **chickenpox**?
**Calamine lotion** and **chlorphenamine** (antihistamine)
102
How long do **lesions** take to **scab over** in **chickenpox**?
**5 days** after rash appears
103
What causes **hand, foot and mouth** disease?
What is the incubation period?
**Coxsackie A virus**
Incubation is **3-5 days**
104
How does **hand, foot and mouth disease** **present**?
Fever, anorexia, cough, sore throat, abdo pain
After 1-2 days **small mouth ulcers appear** followed by **blistering red spot****s**across the body (most notable on the**hands**,**feet and mouth** (also buttock, genitals and legs)
Rash may be itchy
105
How is **hand, foot** and **mouth** disease **diagnosed**?
Clinical appearance
106
What is the **management** of **hand, foot and mouth**?
**Supportive** - fluid and simple analgesia e.g. paracetamol
Resolves **spontaneously** after 7-10 days
**Highly contagious** - avoid sharing towels and bedding, careful handling of dirty nappies
107
What are the **complications** of **hand, foot and mouth**?
Dehydration
Bacterial superinfection
Encephalitis
108
What is **molluscum contagiosum**?
**Viral** skin infection caused by **molluscum contagiosum virus** - type of **poxvirus**
109
What are the **features** of **molluscum contagiosum**?
Small, **flesh coloured papules** with a characteristic **central dimple**
Appear in **crops**
110
How is **molluscum contagiosum** spread?
Direct **contact** or **sharing items** like **bed towels** or **bed sheets**
111
What is the **treatment** of the **papules** in molluscum contagiosum?
Resolve by themselves - without treatment - takes up to **18 months**
**Scratching** should be **avoided** = spreading, scarring and infection
112
What is the **management** of **molluscum contagiosum**?
**No change in lifestyle** required - avoid sharing towels or close contact with lesions
113
What is the treatment if **bacterial superinfection** occurs in **molluscum contagiosum**?
**Topical fuscidic acid**
**Oral flucloxacillin**
114
When will specialist treatment be considered for molluscum contagiosum?
**Immunocompromised**
Lesions on **eyelids** / **anogenital area**
115
What are some **specialist treatment** options for **molluscum contagiosum**?
**Topical** potassium hydroxide, benzoyl peroxide, podophyllotoxin, imiquimod or tretinoin
Surgical removal and **cyrotherapy** (freezing with **liquid nitrogen**) - can lead to **scarring**
116
What is **pityriasis rosea**?
**Generalised, self limiting** rash of unknown cause occuring in adolescents and young adults (possibly caused by **HHV-6** or **HHV-7**)
117
How does **pityriasis rosea** present?
**Pro-drome** before rash = headache, tiredness, loss of appetite and flu-like symptoms
**Rash** = **herald patch** (faint red, scaly, oval lesion - 2cm/ more diameter on torso) then 2 days after **widespread** pink, scaly, oval lesions 2cm/less - follows **chrismas tree** fashion, following lines of the ribs
(**dark skinned** = grey / lighter than skin lesions)
**Other symptoms** = generalised itch, low grade pyrexia, headache, lethargy
118
What is the **disease** course of **pityriasis** **rosea**?
**Resolves** without treatment within **3 months** - can leave **discolouration of skin** where lesions were
119
What is the **treatment** of pityriasis rosea?
**No treatment** for rash - resolves spontaneously without any long term effects - **not contagious**
**Symptomatics treatment for itching** = emollients, topical steroids, **sedating antihistamines** (e.g. chlorphenamine) at night
120
What is **seborrhoeic dermatitis**?
**Inflammatory** skin condition affecting the **sebaceous glands** (oil producing glands) **in the skin** - affecting **scalp**. **nasolabial folds**, and **eyebrows**
Causing **erythema**, **dermatitis** and crusted dry skin
= **cradle cap** in infants
121
What is thought to **colonise** in **seborrhoeic dermatitis**?
**Malassezia yeast** (improves with **anti-fungal** treatment)
122
What is **cradle** **cap** also known as? How does it progress?
**Infantile seborrhoeic dermatitis** - self limiting - resolves by **4 months** can last **12 months**
123
What is the **treatment** for **infantile seborrhoeic dermatitis**?
Apply **baby** / **vegetable** / **olive oil** and **gently brush scalp** and **wash off**
**White petroleum jelly** can be used to soften the crusted aread overnight - washed off next morning
**Topical anti-fungal** cream e.g. clotrimazole or miconazole for **4 weeks**
**Referral** to dermatologist
124
How does **seborrhoeic dermatitis of the scalp present**?
Flaky itchy skin (dandruff) or oily scaly brown crusting normally in **adolescents**
125
What is the **treatment** of **seborrhoeic dermatitis of the scalp**?
**First line** = **ketoconazole** shampoo (left on for **5 minutes** before washing off)
**Topical steroids** if severe itching
**Reoccurs** after successful treatment
126
What is the **treatment** of **seborrhoeic dermatitis** of the **face and body**?
**Anti-fungal cream** e.g. clotrimazole / miconazole for **up to 4 weeks**
**Topical steroids** - localised inflammed areas e.g. hydrocortisone 1%
Severe cases refer to dermatologist
127
What is **ringworm**? What is it also known as?
**Fungal** infection of the skin
AKA **tinea** and **dermatophytosis**
128
# Define the following terms:
**Tinea capitis**
**Tinea pedis**
**Tinea cruris**
**Tinea corporis**
**Onychomycosis**
**Tinea capitis** = ringworm affecting the **scalp**
**Tinea pedis** = ringworm affecting the **feet**
**Tinea cruris** = ringworm of the **groin**
**Tinea corporis** = ringworm on the **body**
**Onychomycosis** = fungal nail infection
129
Which **fungus** commonly causes **ring worm**?
**Trichophyton** - contact with infected individuals, animals or soil
130
How does **ringworm present**?
**Itchy** rash = **erythmatous**, **scaly** and **well demarcated** rings (fainter in middle)
131
How does **tinea capitis** present?
**Well demarcated** hair loss
Itching, dryness, erythema of scalp
More common in **children** than **adults**
132
How does **tinea pedis** (athletes foot) present?
**White** / **red**, **flaky**, **cracked**, **itchy patches** between toes (may split and bleed)
Occurs after sharing changing rooms with athletes foot, & when feet are **sweaty** and **damp** for long periods
133
How does **onchomycosis** (fungal nail infections) present?
**Thickened**, **discoloured** and **deformed** nails
134
How is **ring worm** diagnosed?
**Clinically** (can scrape off some **scales** and send for **microscopy** and **culture** - to confirm)
135
What is the **treatment** of **ringworm**?
**Anti-fungal** medication:
* **Cream** = clotrimazole and miconazole
* **Shampoo** = ketoconazole
* **Oral** = fluconazole, griseofulvin, itraconazole
136
What is the **treatment** of **fungal nail infections**?
**amorolfine nail lacquer** (6-12 months)
Resistant = **oral terbinafine** (need LFTs monitoring before and whilst taking)
137
What can be given for **inflammation** and **itching** in **ringworm**?
Mild **topical steroids** (common combination = miconazole 2% and hydrocortisone 1% - **Daktacort**)
138
What **advice** should be given to **prevent spread** and **avoid recurrence**?
- Loose clothing
- Keep area **clean** and **dry**
- Avoid sharing towels, clothing and bedding
- **Seperate** towel for **tinea pedis**
- Avoid scratching and spreading to other aread
- Wear **clean**, **dry socks** every day
139
What is **tinea incognito**?
- Extensive, less well recognised fungal skin infection
- **Ringworm misdiagnosed as dermatitis** and a **topical steroid** prescribed (improving itching and inflammation) **accelerating growth of fungal infection** by dampening the **immune response** in the area
When steroids stopped then **itchy rash** returns **worse than previously** (less recognisable as ringworm)
140
What is **nappy rash**?
**Contact dermatitis** (caused by friction and contact with urine / faeces)
Common between **9-12 months**
Added infection with **candida** (fungus) or **bacteria** (staphylococcus / streptococcus)
141
What are some **risk factors** for **nappy rash**?
**Delayed** changing of nappies
**Irritant soaps** and vigorough cleaning
**Poorly absorbent** nappies
**Diarrhoes**
Oral abx predisponsing to **candida infection**
Pre-term infants
142
How does **nappy rash present**?
**Sore**, **red, inflammed skin** in nappy area
**Spares** the creases
A few **red papules**
Uncomfortable, itchy, infant will be **distressed**
Can lead to **erosions** and **ulcerations**
143
What would indicate **candidal infection** rather than **simple nappy rash**?
- In **skin folds**
- **Larger**, red **macules**
- Well **demarcated** scaly border
- **Satellite lesions** = small similar patches of **rash** or **pustules** near the **main rash**
- **Oral thrush**
144
What **measures** can be used to **improve nappy nash**?
- **Highly absorbent** nappies
- **Change** nappy after use
- **Water** / **alcohol free** products for cleaning area
- Ensure nappy area is **dry** before replacing
- Maximise **time not wearing a nappy**
145
What can be given for **nappy rash** infected with **candida** or **bacteria**?
**Anti-fungal cream** = clotrimazole or miconazole
**Antibiotic** = fuscidic acid cream / oral fluclox
146
What are some **complications** of **nappy rash**?
Candida
Cellulitis
Jacquet's erosive diaper dermatitis
Perianal pseudoverrucous papules and nodules
147
What are **scabies**?
Mites called **sarcoptes scabiei**
**Burrow** under skin and lay eggs causing **infection** and **itching**
Up to **8 weeks** for symptoms / **rash** to appear
148
How does **scabies** present?
**Itchy**, **small** red spots with **track marks** where the mites have **burrowed** - classically located between **finger webs** (can spread to whole body)
149
What is the **treatment** of **scabies**?
**Permethrin cream** (whole body - covering skin - **8-12 hours** left on then washed off - **repeat a week later** for eggs that have hatched) - not after bath/shower so the cream stays on top of skin
**Oral ivermectin** - single dose which can be **repeated a week later** for **difficult to treat** / **crusted scabies**
Highly **contagious** and all household needs treating
**Wash on hot** all clothes / linen / towels to **desroy the mites**
Thorough **hoovering** also **needed**
**Crotamiton cream** and chlorphenamine at **night** can **help with itching** (can contine for 4 weeks after successful treatment)
150
What are **crusted scabies** (aka **norwegian** scabies)?
**Scabies** in **immunocompromised patients** - **contagious** - patches of **red skin** that turn into **scaly plaques** (misdiagnosed a psoriasis)
May have **a****bsent itch**due to**immune response** to the infestation
**Admit** for **treatment** with **oral ivermectin** and **isolation**
151
What **parasite** causes **head lice**?
**Pediculus humanus capitis** parasite (commonly known as **nits** but these are **egg shells** which have hatched)
152
How are **head lice** spread?
**Head to head contact** or sharing combs or towels
153
How do **headlice present**?
**Itchy scale** (eggs / lice can be visible)
154
What is the **management** of **head lice**?
**Dimeticone 4%** lotion applied to **hair** and **left to dry** (8 hours overnight then **washed off**)
**Repeat 7 days later** to kill any lice that have hatched since
Special **fine combs** can be used to systematically comb the nits and lice out - can be used for **detection combing** after treatment (**The Bug Buster Kit** is recommended by NICE)
155
What are **non-blanching rashes**?
Rashes caused by **bleeding under the skin**
156
Define **petechiae** and **purpura**?
**Petechiae** = small (\<3mm) non-blanching, red spots on the skin caused by **burst capillaries**
**Purpura** = larger (3-10mm) non-blanching, red-purple, **macules** or **papules** created by **leaking of blood** from vessels under skin
157
List the **differentials** for a **non-blanching rash**?
**Meningococcal septicaemia** (other baterial sepsis) = fever need **emergency abx**
**Henoch-Schonlein purpura** (HSP) = purpuric rash on **legs and buttocks** associated abdo / joint pain
**Idiopathic thrombocytopenic purpura** (ITP) = develops over **several days** in **otherwise well child**
**Acute leukaemias** = gradual development of petechiae (along with anaemia, lymphadenopathy and hepatosplenomegaly)
**Haemolytic uraemic syndrome** (HUS) = **oliguria** (very low urine output) and **signs of anaemia** - child with **recent diarrhoea**
**Mechanical** = strongh coughing, vomiting or breath holding = **petechiae** in **SVC** distribution **above neck** and **prominently around eyes**
**Traumatic** = tight pressure on skin e.g. **non-accidental injury** can cause traumatic petechiae
**Viral illness** = when other **causes** are **excluded** typical causes are **influenza** and **enterovirus**
158
Which **investigations** are there for **non-blanching rashes**?
**FBC** = anaemia (HUS/leukaemia) low WCC (neutropaemic sepsis / leukaemia) low platelets (ITP or HUS)
**U&Es** = high urea and creatinine indicates HUS or HSP with renal involvement
**CRP** = non-specific indication of inflammation / infection
**ESR** = non-specific indication of inflammatory illness e.g. **vasculitis** (HSP) or infection
**Coagulation screen** = PT, APTT, INR and fibrinogen for **clotting abnormalities**
**Blood culture** = useful but not definitive in diagnosing / excluding sepsis
**Meningococcal PCR** = confirms meningococcal disease, should not delay treatment
**LP** = diagnose **meningitis** / **encephalitis**
**Blood pressure** = HTN in HSP and HUS (hypotension in septic shock)
**Urine dip** = proteinuria and haematuria suggests HSP with **renal involvement** or HUS
159
What is the **management** of **non-blanching rash**?
**Urgent referral** and **investigation** (unless clear and unconcerning cause)
If in doubt then **treat** for **meningococcal sepsis**
160
What is **erythema nodosum**?
**Red lumps** appear **across patients shins**
161
What causes **erythema nodosum**?
**Inflammation** and the **subcutaneous fat** on the shins (**hypersensitivity reaction** - associated lots of conditions)
162
What is **inflammation of fat** called?
**Panniculitis**
163
What **hypersensitivity reactions** cause **erythema nodosum**?
- Strep throat infections
- Gastroenteritis
- Mycoplasma pneumoniae
- TB
- Pregnancy
- Medications e.g. oral contraceptive pill and NSAIDs
164
Which **chronic diseases** cause **erythema nodosum**?
**IBD**
**Sarcoidosis**
Lymphoma
Leukaemia
165
How does **erythema nodosum present**?
**Red**, **inflamed**, **subcut nodules** across **both shins**
**Raised**, **painful** and **tender**
166
What are the **investigations** for **erythema nodosum**?
**Inflammatory markers** (CRP and ESR)
**Throat swab** for **strep infection**
**CXR** for mycoplasma, TB, sarcoidosis and lymphoma
**Stool microscopy** and **culture** for **campylobacter** and **salmonella**
**Faecal calprotectin** for IBD
Further imaging / endoscopy under specialist guidance
167
What is the **management** of **erythema nodosum**?
Investigate for **underlying condition**
**Conservatively** with rest / analgesia
**Steroids** help **settle inflammation**
Mostly resolves in **6 weeks**
168
What is **impetigo**?
**Superficial bacterial skin infection** usually caused by **staphylococcus aureus** bacteria - "golden crust" is characteristic
**Strep pyogenes** can also cause it
**Contagious** and children to be **kept off of school** during infection
169
How does **impetigo occur**? What is associated with it?
**Bacteria** enters via a **break in the skin** - may be associated with **eczema** or **dermatitis**
170
What are the **types of impetigo**?
**Non-bullous** or **bullous**
171
Where does **non-bullous impetigo** usually occur?
Around **nose** / **mouth**
**Exudate** from **lesions** dry to form **golden crust**
Do **not usually cause systemic symptoms**
172
What is the **treatment** for **non-bullous impetigo**?
**Antiseptic cream** (hydrogen peroxide 1% cream) first line
**Topical fusidic acid** treats localised
**Oral flucloxacillin** for more widespread (good for staph infections)
Advise **no touching** or **scratching** lesions, good hand hygiene, avoid sharing face towels and cutlery
Off school till all lesions healed / abx for at least 48 hours
173
What is **bullous impetigo**?
1-2cm **fluid filled vesicles** form on skin - burst = "**golden crust**"
Always caused by **staphylococcus aureus** bacteria - produce **epidermolytic toxins** which break down proteins that hold skin together
Heal without scarring
**Painful** and **itchy**
174
Who is **bullous** impetigo more common in?
**Neonates** and **children under 2 years**
175
How does **bullous impetigo** present?
More **systemic symptoms** e.g. **feverish** and **generally unwell**
176
What is **severe bullous impetigo** called?
**Staphylococcus scalded skin syndrome**
177
How to **confirm diagnosis** of **bullous impetigo**?
**Swabs** of the vesicles (confirm diaganosis, bacteria and abx sensitivities)
178
What is the **treatment** of **bullous impetigo**?
Abx usually **flucloxacillin** (orally / IV)
**Isolate** patients - condition is **contagious**
179
What are some **complications** of **bullous impetigo**?
**Cellulitis** if infection deepens in skin
**Sepsis**
**Scarring**
**Post strep glomerulonephritis**
**Staphylococcus scalded skin syndrome**
**Scarlet fever**
180
What is **staphylococcal scalded skin syndrome** (SSSS)?
Skin **infection** with **staphylococcys aureus** which produces **epidermolytic toxins** (protease enzymes which **break down proteins** that **hold skin cells together**)
181
Who does SSSS typically affect?
**Children** under 5 years (older children = **immunity** to **epidermolytic toxins**)
182
How does **SSSS present**?
Generalised **patches of erythema** (thin and wrinkled)
Formation of **bullae** (burst and leave **sore, erythematous skin**) appears like **burn** / **scald**
183
What sign is **positive** in SSSS?
**Nikolsky sign** - gentle rubbing of skin causes it to **peel away**
184
What are the **systemic symptoms** in SSSS?
**Fever**
**Irritability**
**Lethargy**
**Dehydration**
(If untreated can lead to **sepsis** and **potentially death**)
185
What is the **management** of **SSSS**?
**Admission** and **treatment** with IV abx
**Fluid** / **electrolyte balance** as prone to **dehydration**
Adequate treatment then **full recovery without scarring**
186
What are **Stevens-Johnson syndrome** (SJS) and **toxic epidermal necrolysis** (TEN) both?
**Spectrum of same pathology** where disproportional immune response causes **epidermal necrosis** resulting in **blistering** and **shedding** of the top layer of skin
SJS = less than 10% body surface area
TEN = more than 10%
Usually **drug related**
187
Which **medications** can cause **Stevens-Johnson syndrome**?
Anti-epileptic
Antibiotics
Allopurinol
NSAIDs
188
Which **infections** cause **SJS?**
Herpes simplex
Mycoplasma pneumonia
Cytomegalovirus
HIV
189
How does SJS / TEN present?
**Mild** / **severe - lifethreatening**
**Non-specific** symptoms = fever, **cough**, sore **throat**, sore **mouth**, sore **eyes** and **itchy** skin
**Rash develops** (purple/red) across skin and **blisters**
Skin breaks away and **leaves raw tissue underneath** (on eyes, lips and mucous membranes too)
Can **also affect** urinary tract, lungs and **internal organs**
190
What is the **management** of **SJS** and **TEN**?
Medical emergency - burns unit
**Supportive** - nutrition, antiseptics, analgesia, ophthalmology
**Steroids, immunoglobulins** and **immunosuppressants**
191
What are some **complications** of SJS or TEN?
**Secondary infection** - breaks in skin = cellulitis and sepsis
**Permanent skin damage** - scarring, damage to **skin**, **hair**, **lungs** and genitals
**Visual complications** - sore eyes to blindness
