Paeds Derm Management

Question 1

Acne Vulgaris very mild/general tips

Answer 1

Avoid over cleaning skin, Use pH close to skin, maintain a healthy diet

Question 2

Acne vulgaris mild to moderate

Answer 2

Retinoid e.g. adapalene 
Antibiotic e.g. Clindamycin 
Azelaic acid 
Start once a week, apply at night 
Salicylic acid wash

Question 3

Moderate acne not responding to treatments

Answer 3

Oral antibiotics for max 3 months, e.g. Doxycycline or Lymecycline
Plus topical retinoid or benzoyl peroxide
Consider switching progesterone pill for COCP

Question 4

Severe acne

Answer 4

Refer to dermatologist 
Oral isotretinoin but be warned side effects 
Systemic corticosteroids 
Oral antibiotics
Review treatments every 2-3 months

Question 5

Mild atopic eczema/general eat ice

Answer 5

Emollient e.g. e45 plus mild topical corticosteroid (1% hydrocortisone) until 48 hours of flare subsiding
Remove triggers
Cut nails short
Refer to itchywheezysneezy.com
Safety net about signs of infection 
Encourage frequent use of emollients 
Explain association with atopy 
Steroids use up to 14days , not the same as systemic

Question 6

Eczema herpeticum

Answer 6

Admit, oral aciclovir
Plus same day ophthalmology also and derm specialist review if around eyes
Advise parents of the signs rapidly worsening painful eczema, clustered blisters, punched out erosions

Question 7

Moderate and severe eczema

Answer 7

Emollient, topical corticosteroid (betamethasone 0.025% if moderate 0.1% if severe)
Don’t give steroids if <12 months old
Add topical tacrolimus(calcineurin inhibitors) in children >2 years

Question 8

Infected eczema

Answer 8

Flucloxacilline or erythromycin if penicillin allergy

Question 9

Uncomplicated cellulitis

Answer 9

Oral antibiotics, manage at home

Question 10

Cellulitis with systemic illness

Answer 10

Admit, resus, oxygen, fluids, IV antibiotics until fever settles
MDT approach if complex e.g. microbiology, surgeons, ophthalmologists in orbital
High dose flucloxacillin 7days , ciprofloxacin if penicillin allergy
Pain relief

Question 11

Erysipelas

Answer 11

Penicillin V

Question 12

Guttate Psoriasis

Answer 12

Photo therapy
Emollient
Topical corticosteroid with vitamin D if scales problematic

Question 13

Hemangioma

Answer 13

Beta blocker and corticosteroid
May need surgery. Cryotherapy, electrotherapy, vascular laser surgery
May need topical antibiotics egg. Metronidazole

Question 14

Hand foot mouth disease

Answer 14

Symptomatic treatment, hydration and analgesia

Question 15

Lyme disease

Answer 15

Doxycycline, amoxicillin, cefuroxime

Question 16

Molluscum contagiosum

Answer 16

Doesn’t require treatment, avoid squeezing or sharing towels, treat infection if infected

Question 17

Nappy rash

Answer 17

Disposable nappies, exposure to air as much as possible, frequent nappy change, daily bath, use sudocrem barrier protection.

Add mild steroid cream e,g. 1% hydrocortisone
If candida add topical imidazole

Question 18

Necrotising fasciitis

Answer 18

Surgical debridement, IV fluids, IV antibiotics

IVIG

Question 19

Headline/pediculosis

Answer 19

Dimeticone 4% lotion

Question 20

Peri orbital cellulitis

Answer 20

High dose ceftriqxone,
Incision, drainage and culture of peri ocular abscess
Refer to ophthalmology

Question 21

Ringworm

Answer 21

Topical anti fungal self. Clotrimazole
Hydrocortisone cream if inflamed
Severe infections need systemic anti fungal e.g. oral terbinafine, oral itraconazole

Question 22

Scabies

Answer 22

Scabicide e.g. permethrin 5% apply to WHOLE body wash off after 8-12 hours
Treat household contacts
Decontaminate clothing and towels
Treat post scabietic itch with crotamiton

Question 23

Seborrheic dermatitis (cradle cap, not itchy)

Answer 23

Massage olive/vegetable oil
Special shampoos containing ketoconaoke, coal tar, zinc pyrithione,
Refer if lasting over a month

Question 24

Viral warts

Answer 24

Salicylic acid or lactic acid paint or glutaraldehyde lotion, cryotherapy