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Specialties > Paeds Written - DERM > Flashcards

Paeds Written - DERM Flashcards

1
Q

Characteristic features of Candidal dermatitis (nappy rash)

A

Beefy red
well-defined patches
Involving skin folds/flexures
Satellite lesions

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2
Q

Characteristic features of irritant nappy rash

A

Spares skin folds/creases

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3
Q

Conservative measures in Nappy rash

A

Disposable high absorbency nappies > towel nappies
Change ASAP after soiling/wetting
Use fragrance & alcohol free wipes
Expose area to air when possible

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4
Q

Indications for & pharmacological options in nappy rash

A

Asymptomatic + mild erythema = barrier (zinc & castor oil) applied at nappy changes

Inflamed + causing discomfort = 7 day topical hydrocortisone 1%

Persists + bacterial infection suspected/confirmed = 7 day oral flucloxacillin

Candidal = topical imidazole e.g. clotrimazole + STOP barrier creams

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5
Q

Pattern of atopic eczema in children of different ages

A

Infants = face + trunk

Younger children = extensor surfaces

Older = typical flexor surfaces +/- creases of neck and face

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6
Q

Treatment options for atopic eczema

A

Simple emollients

  • 10:1 emollient to steroid ratio
  • Apply emollient –> wait 30 mins –> topical steroid
  • do NOT insert fingers into pots - use pump bottles to avoid bacteria

Topical steroids

Wet wrapping - emollients & bandage

Oral ciclosporin (severe)

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7
Q

Topical steroid potency ladder

A

Help (Hydrocortisone)
Every (Eumovate)
Busy (Betnovate)
Dermatologist (Dermovate)

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8
Q

Prognosis for atopic eczema

A

Clears in 50% by 5yo

75% by 10yo

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9
Q

Causative organism for Impetigo

A

Staph aureus or Strep pneumonia

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10
Q

Treatment options for impetigo

A

Systemically well + low risk = hydrogen peroxide 1% cream

Otherwise 1st line = topical fusidic acid 2%

More extensive = oral flucloxacillin (or clarithromycin if penicillin allergic)

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11
Q

school exclusion guidance for impetigo

A

Avoid school/nursery etc. until all lesions crusted + healed OR 48 hours after starting Tx

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12
Q

Treatment of eczema herpeticum

A

Immediate referral to Derm
Oral or IV aciclovir

+ Ophthalmology R/v is lesions around eyes

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13
Q

Common causative organisms of ringworm

A

Trichophyton
Microsporum
Epidermophyton

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14
Q

Typical ringworm lesion

A 
Ring shaped (annular)
Red scaly lesions

+/- kerion – severe inflamed ringworm patch

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15
Q

Tx for mild ringworm

A

topical anti fungal e.g. terbinafine, clotrimazole

+ hydrocortisone 1% if lots of inflammation

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16
Q

Tx for severe or widespread ringworm

A

Systemic anti fungal e.g. oral terbinafine, itraconazole

NOTE: also used if affecting scalp - can be difficult to apply topicals

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17
Q

Pityriasis rosea key clinical features

A 
Herald patch - single patch on abdomen
THEN widespread (itchy) rash
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18
Q

Tx needed for pityriasis rosea

A

No Tx needed

Unless itchy –> emollients, topical steroids, antihistamines

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19
Q

Pityriasis veriscolor clinical presentation

A

Pale patches in pigmented skin
Pink patches in unpigmented skin

Often noticed after holiday (when usual skin tone changes colour)

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20
Q

Triggers for erythema multiforme

A

Viral infections - Herpes simplex
Bacteria - mycoplasma
Sulphonamide Abx

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21
Q

Triggers for Guttate psoriasis

A

Streptococcal throat infection

Viral URTI

22
Q

Guttate psoriasis typical presentation

A

Raindrop-like small scaly patches

Affects trunk & upper limbs

23
Q

Miliaria clinical presentation

A

Neonates
Small clear blisters
widely spread - head, neck, trunk
(Rubra ‘heat rash’ type more likely to affect covered skin)

24
Q

When is treatment require for labial fusion?

A

If significant Sx

25
Q

Indications for surgical separation of labial fusion?

A

Topical oestrogen failure (after 4-6 weeks Tx)
Severe fusion
Trapped urine –> vulval inflammation or terminal dribbling

26
Q

Bacteria implicated in acne vulgaris

A

Propionibacterium acnes

27
Q

Mild to moderate acne - Tx options

A

Topical retinoid (Adapalene) +/- benzoyl peroxide

Topical Abx (clindamycin 1%) + benzoyl peroxide

Azelaic acid 20%

28
Q

Tx for Moderate acne (not responding to topicals)

A

Oral Abx (max 3 months) + Benzoyl peroxide / retinoid

  • 1st line = tetracycline e.g. lymecycline
  • 2nd line = erythromycin

COCP + benzoyl peroxide / retinoid

29
Q

Roaccutance side effects/warning

A 
Very teratogenic - 2 contraceptives needed
Dryness, pruritis
Muscle aches
Deranged LFTs
?low mood & suicidal ideation
30
Q

Mechanism of roaccutane

A

synthetic form of vitamin A

31
Q

Clinical features of Mongolian Blue spot

A

Blue/black macular discolouration
at base of spine & on buttocks
Afro-Carribbean or Asian

32
Q

Appearance of erythema toxicum

A 
Erythematous 2-3mm macules and papules
Evolve into pustules
Surrounded by blotchy area of erythema 'flea-bitten'
Face, trunk & proximal extremities
NOT palms/soles
33
Q

Types of vascular malformations

A

Naevus flammeus = port wine stain

Naevus simplex = salmon patch / stork bite / angel’s kiss

34
Q

Associations/conditions with Port wine stain:

A

Sturge-Weber syndrome

Parkes Weber syndrome

Kippel-Trenaunav syndrome

Proteus syndrome

35
Q

Ix needed for vascular malformation?

A

Clinical Dx

1st line = USS
+ MRI for Sturge Weber (identify intracranial lesions)

36
Q

Risk factors for infantile haemangioma

A

LBW
Premature
Female
Multiple gestation

37
Q

Natural history / clinical course of infantile haemangioma

A

Develop few days/weeks after birth
Last for 6-10 months
Shrink

EXCEPT: capillary haemangioma - present at birth

38
Q

Features of superficial (infantile) haemagioma

A

Bright red area of skin
Feels warm
Upper eyelids, mid-forehead or nape of neck

39
Q

Features of deep (infantile) haemangioma

A

Blue
Forms lump
Appears few weeks after birth

40
Q

Important syndromes/conditions related to infantile haemagiomas?

A

Kasabach-Meritt
- haemagioma + thrombocytopenia

PHACES syndrome

LUMBAR syndrome

41
Q

Potential Ix for infantile haemagiomas

A

Clinical Dx

USS

MRI / MRA - gold standard for complex vascular tumours, done if:

  • deep
  • multiple
  • single large capillary haemagiona
  • near eye
42
Q

Medical management of infantile haemagiomas

A

Topical or intra-lesional steroid

Topical timolol
- if small superficial near eyes, nappy area, lips, nasal tip, ear

Oral propanolol - large lesions

43
Q

When to refer an infantile haemagioma?

A

Threaten function - periocular, nasal tip, ear, lips, genitalia

Large facial, anogenital or perineal

Lumbosacral

Ulcerating

‘Beard’ distribution - may have laryngeal haemangioma, need ENT

Multiple lesions (>5) - need liver USS

44
Q

Types of congenital haemagiomas

A

Rapidly involuting - RICH

Non-involuting - NICH

(Partially involuting) - PICH

45
Q

Natural Hx of rapidly involuting congenital haemangioma (RICH)

A

Max size by birth

Involute by 12-18 months old

46
Q

Natural HX of non-involuting congenital haemagiomas (NICH)

A

Continue to grow as baby grows

Do not shrink after birth

47
Q

Presentation of a congenital haemangioma

A

Raised or flat
Pink or purple
+ transient thrombocytopenia

48
Q

Management for congenital haemangioma

A

Conservative

Embolisation (if they need removal)
- propanolol not effective

49
Q

Potential complication of congenital haemangioma?

A

Heart failure - if large enough, can generate high blood flow

50
Q

Causes of erythema nodosum

A

drugs (e.g. COCP, NSAIDs, sulphonamides)

systemic (e.g. sarcoidosis, pregnancy, IBD)

infectious (e.g. streptococcal infection, tuberculosis, and mycoplasma infection).

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