W7 - Paediatric Dermatology

Question 1

how do you describe morphology

Answer 1

Question 2

what is the birthmark?
small red mark at a few weeks of life - getting bigger

Answer 2

strawberry haemangioma

Question 3

what is this

Answer 3

Strawberry Naevus/ Capillary Haemangioma

Question 4

what is the aetiology of Strawberry Naevus/Capillary Haemangioma

Answer 4

Not present at birth - appear first month of life.
Get bigger until 6-10 months -> resolve.
Most fully resolve by 5-7 years.
Treatment: usually not needed. Near eye or obstructing airway = propranolol.
Complications: ulceration, bleeding + infection.

Question 5

when would you treat starwberry naevus

Answer 5

over the eye - obstruct vision
in nappy area - get infected

Question 6

what is the management of strawberry haemangioma

Answer 6

propranolol

Question 7

what is the rash
2 day old gets spots - concern over chicken pox
baby well

Answer 7

Erythema Toxicum Neonatorum

Question 8

what is the aetiology of Erythema Toxicum Neonatorum

Answer 8

Occurs in neonatal period (up to 28 days)
Raised yellow vesicles on an erythematous base
Occurs in 50% of babies, particularly term+
Completely benign
Settles in a few weeks

Question 9

what is the rash
1 day old baby
has spots on head
mum has 2 ulcers
baby lethargic and not feeding

Answer 9

neonatal herpes simplex

Question 10

what is the aetiology of neonatal herpes simplex

Answer 10

Very serious condition
Tends to affect babies whose mum has had this primary infection in pregnancy and gave birth vaginally
Usually occurs on scalp
Can disseminate to multiple organs including the brain
Needs urgent treatment with IV aciclovir
33% mortality rate (despite treatment)

Question 11

why is neonatal herpes simplex so serious

Answer 11

urgent IV aciclovir
33% mortality even with treatment

Question 12

what is primary herpes and why is that important

Answer 12

mums first infection with herpes - only primary herpes can be given to baby

Question 13

what is the rash

Answer 13

stork mark \ naevus simplex

Question 14

what is the aetiology of stork mark

Answer 14

Always midline
40% of neonates
Often: neck or forehead
A delay in the maturation of skin cells during embryonic development – dermal capillary dilatation
Usually disappears with time

Question 15

what is this

Answer 15

milia

Question 16

what is the aetiology of milia

Answer 16

Tiny white bumps on the nose, chin or cheeks.
Dead skin cells get trapped under the skin and form tiny cysts.
50% of neonates, but can also occur any age.
Treatment = not needed -> disappear on their own in a few weeks or months.

Question 17

what is this

Answer 17

‘Cradle Cap’/Infantile seborrheic dermatitis

Question 18

what is cradle cap

Answer 18

10% of infants
3 weeks -> 12 months
Cause unknown - ? Hyperactivity of sebaceous glands secondary to maternal androgens
Self limiting
Baby shampoo/oil, gentle brushing

Question 19

what is this

Answer 19

infantile acne

Question 20

why does this look odd for infantile acne

Answer 20

darker skin - harder to see

Question 21

what is the aetiology of infantile acne

Answer 21

Affects cheeks, chin and forehead
Boys > girls
6w - 12 months
Papules, pustules, nodules, cysts + comedones
Aetiology unknown ? Genetic (normal hormone levels)
Benzoyl peroxide or erythromycin gel
Oral antibiotics

Question 22

what antibiotics MUST NOT be used to treat infantile acne

Answer 22

tetracyclines - doxycycline
causes dental scaring

Question 23

what is this

Answer 23

mongolian blue spot OR
slate grey naevus

Question 24

what is blue spot

Answer 24

Very common birth mark in babies with darker skin tones
Occurs in 90% of east Asian babies
Area of darker pigmentation often on buttocks but can occur in thighs and arms
Doesn’t cause any harm will usually fade by 4 years of age
Always document if you see on a baby check

Question 25

what is this

Answer 25

measles

Question 26

what is the signs symptoms and presentation of measles

Answer 26

Maculopapular + starts behind ears Prodromal phase: fever, corysa and conjunctivitis Complications = encephalitis and subacute sclerosing panencephalitis

Question 27

what are these lesions

Answer 27

coplic spots

Question 28

what is this

Answer 28

varicellar zoster

Question 29

what is the aetiology of varicella zoster rash

Answer 29

Papules which progress to vesicles Often occur in crops Infectious from 2 days before rash, until all lesions crusted over Symptomatic management Immunocompromised = zoster immunoglobulin

Question 30

what is the treatemnt for varicella zoster

Answer 30

calamine/emollient, sedating antihistamine, paracetamol.

Question 31

why must you NOT give ibuprofen

Answer 31

increased scarring and necrosis, increased risk chickenpox pneumonitis

Question 32

what is this

Answer 32

hand foot and mouth

Question 33

what is the aetiology of hand foot and mouth

Answer 33

Caused by Coxsackie virus Tends to occur in children under 5y Blisters on hands and feet and in mouth Symptomatic Management

Question 34

what could cause hand foot and mouth to be more severe

Answer 34

if parents get infected if baby has eczema

Question 35

what is this

Answer 35

Molluscum Contagiosum

Question 36

what is aetiology of Molluscum Contagiosum

Answer 36

Caused by pox virus Umbilicated centre Contagious Self limiting: can take up to 2 years to clear

Question 37

how is molluscum contagiosum spread

Answer 37

normally scratching

Question 38

what associated condition MUST you consider

Answer 38

a compromised immune system consider HIV

Question 39

what is this

Answer 39

parvovirus B19

Question 40

what MUST be considered with parvo virus

Answer 40

stay away from pregnant women - can cause miscarriage

Question 41

what is the aetiology of parvovirus B19

Answer 41

Common in children + can occur adults Fifths disease Fever, runny nose, sore throat, headache Can cause miscarriage in pregnancy Aplastic crises in haemolytic anaemia

Question 42

how would pityriasis rosacea present

Answer 42

starts with herald patch

Question 43

what is this

Answer 43

Guttate Psoriasis

Question 44

what is the aetiology of Guttate Psoriasis

Answer 44

developed widespread rash over trunk. He is systemically well. 2 weeks ago he had antibiotics for tonsillitis. A throat swab grew Strep

Question 45

what is this

Answer 45

Staph Scalded Skin

Question 46

what is aetiology of Staph Scalded Skin

Answer 46

Caused by a toxigenic strain of bacteria Two exotoxins are produced which breakdown desmoglein 1 This results in separation of the skin through the granular cell layer Tends to affect under 5 years Skins looks red and blistered like a burn Treat IV antibiotics

Question 47

what is this

Answer 47

axillary freckling

Question 48

what is this

Answer 48

cafe au late spot

Question 49

what is this

Answer 49

neurofibromas

Question 50

what is this

Answer 50

lisch nodules

Question 51

what links these images together

Answer 51

Neurofibromatosis Type 1

Question 52

what is the genetic inheritance of neurofibromatosis type 1

Answer 52

Autosomal Dominant

Question 53

what is this

Answer 53

adenoma sebaceum

Question 54

what is this

Answer 54

Ash Leaf patches

Question 55

what is this

Answer 55

Shagreen patches

Question 56

what condition link all 3 of these images

Answer 56

Tuberous Sclerosis

Question 57

what are some other features of Tuberous Sclerosis

Answer 57

Polycystic kidneys Infantile spasms Epilepsy Learning difficulty

Question 58

what is this

Answer 58

port wine stain (in ophthalmic division of trigeminal nerve)

Question 59

what is this

Answer 59

congenital vascular lesion in brain

Question 60

what condition links these 2 images

Answer 60

Sturge Weber syndrome

Question 61

what is Sturge Weber syndrome associated with

Answer 61

epilepsy, learning difficulty and hemiplegia

Question 62

what is this

Answer 62

Epidermolysis bullosa

Question 63

what is aetiology of Epidermolysis bullosa

Answer 63

A rare genetic condition causing blistering of the skin and mucous membranes Epidermis and dermis not adequately attached, so minor trauma causes separation. Increased risk of skin cancer due to chronic inflammation. Reduced life expectancy due to infections.

Question 64

what is this

Answer 64

meningococcal scepticaemia

Question 65

what is aetiology of meningitis scepticaemia

Answer 65

Caused by Neisseria Meningitidis, common nasal organism. Meningococcal septicaemia occurs when the organism gets into the blood stream. It can kill a well child in hours. Children present unwell with fever. The rash can start as blanching but usually becomes non blanching. Lesions become non blanching + irregular with necrotic centres.

Question 66

what is the treatment for meningococcal septicaemia

Answer 66

80mg/kg of ceftriaxone IV.

Question 67

what vaccination is used for meningococcal disease

Answer 67

Men ACBWY

Question 68

what should be considered for family and close contacts

Answer 68

prophylactic antibiotics rifampicin or ciprofloxacin.

Question 69

what is this

Answer 69

Henoch-Schonlein Purpura

Question 70

what is aetiology of Henoch-Schonlein Purpura

Answer 70

Raised palpable purpura on buttocks and extensor surfaces. Most common vasculitis in children. No fever + Child systemically well. Associated with joint pain, joint swelling, abdominal pain and glomerulonephritis

Question 71

who gets henoch-schonlein purpura

Answer 71

Peak incidence: 4-10yrs. M:F = 2:1 Recurrence in 1/3 patients in future.

Question 72

what is the risk in henoch-schonlein purpura

Answer 72

Risk of IgA nephropathy and renal failure.

Question 73

what should you do as an investigation for Henoch-schonlein purpura

Answer 73

Check urine for blood and protein. Measure BP – protocol.

Question 74

what is this

Answer 74

Immune Thrombocytopenic Purpura

Question 75

what is aetiology of Immune Thrombocytopenic Purpura

Answer 75

Petechial rash is caused by low platelets Often associated with easy bruising and bleeding from mucosa Systemically well Tends to occur 1-2 weeks after a viral infection due to cross reacting antibodies

Question 76

what is overall treatment and management

Answer 76

Check FBC and film Most don’t need treatment. Treatment options include steroids and IVIG Usually resolved in 6-8 weeks Avoid contact sports until platelets >50