YEAR 4 PAEDS > Derm > Flashcards

Derm Flashcards

(58 cards)

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1
Q

What is Impetigo?

A
  • superficial bacterial skin infection usually caused by either Staphylcoccus aureus or Streptococcus pyogenes
  • can be primary infection or complication of an existing skin condition such as eczema, scabies or insect bites
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2
Q

Who is most likely to get Impetigo?
Where does it typically occur?

A
  • More common in children
  • Particularly during warmer weather
  • Tend to occur on the face, flexures and limbs no covered by clothing
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3
Q

How is Impetigo spread?

A
  • Direct contact with discharge from the scabs of infected person
  • Bacteria enter skin through minor abrasions
  • Infection is spread mainly by hands but can spread via toys, clothing, equipment and the environment may occur
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4
Q

Incubation period for Impetigo?

A
  • Golden crusted lesions, typically found around the mouth
  • Very contagious

4-10 days

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5
Q

Management of limited, localised disease - impetigo?

A
  • 1st line: Hydrogen peroxide 1% creams- for people who are not systemically unwell or at high risk of complication
  • Topical abx creams: Topical fusidic acid, topical mupirocin should be used if fusidic acid resistance is suspected
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6
Q

Management of extensive Impetigo?

A
  • Oral flucloxacillin
  • Oral erythromycin if penicillin allergic
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7
Q

Do children who have Impetigo need to be excluded from school?

A
  • Children should be excluded from school until lesions are crusted and healed
  • OR 48 hours after commencing abx treatment
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8
Q

What is infantile acne?

A
  • < 3months of life,
  • Transient
  • Usually due to maternal androgens
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9
Q

What is the pathophysiology of adolescent acne?

A
  • Increased sebum production: androgenic stimulation of hyper-responsive pilosebaceous units
  • Impaired flow of sebum: Obstruction of the pilosebaceous duct by hyperkeratosis
  • Propionobacterium acnes: gram postive anaerobe is implicated in the inflammation
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10
Q

Risk factors for adolescent acne?

A
  • Puberty
  • May increase pre-menstrually
  • POS
  • Excess cortisol
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11
Q

Presentation of acne?

A
  • Greasy skin- may be painful
  • Open comedones: whiteheads
  • Closed comedones: blackheads
  • Other features: pustules, nodules, cysts, scarring, seborrhoea
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12
Q

Investigations for Acne?

A
  • Usually clinical diagnosis, unless other signs of andorgen excess e.g. pre-pubertal body odour, axillary/pubic hair or genital maturation; postpubertal infrequent menses, hirsuitism, or truncal obesity
  • If androgen excess suspected: Bloods (free testosterone), FSH, LH
  • Urine: 24 hour urinary cortisol (if suspect Cushings)
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13
Q

General Mangement for Acne?

A
  • Non-greasy cosmetics
  • Daily face wash
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14
Q

Complications of Acne treatment?

A
  • Facial scarring
  • Hyperpigmentatio
  • Secondary infection
  • Fistulas
  • Psychosocial: Lack of self-confidence
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15
Q

What are abx available for acne management?

A
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16
Q

What are topical preparations available for acne management?

A
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17
Q

What is atopic Eczema?

A
  • Chronic inflammatory itchy skin condition
  • Same as atopic dermatitis: except atopic dermatitis has more clear trigger
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18
Q

Environmental factors that can trigger atopic ezcema?

A
  • Irritants
  • Infections
  • Contact with food or inhalant allergens
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19
Q

Presentation of Atopic Ezcema?

A
  • Majority begins first year of life
  • Intense itchy skin
  • Chronic relapsing inflammation of skin are cardinal features
  • Infantile: affects face and extensor surfaces and spares the nappy area
  • Older children: Flexural involvement more common
    *
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20
Q

Presentation of ezcema herpeticum rash?

A
  • Widespread, painful, vesicular rash- vesicles filled with pus: when they burst they leave:
  • Small uniform circular ‘punched out erosions’
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21
Q

Investigations of ezcema

A
  • Usually clinical
  • Infants w moderate- severe ezcema w history of immediate reaction to food: Need skin prick testing to common food allergens
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22
Q

What is Ezcema Herpeticum?

A
  • Viral skin infection caused by herpes simplex virus or varicella zoster virus
  • Usually occurs in a pt with pre-existing skin condition e.g. atopic ezcema or dermatitis
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23
Q

Symptoms of Ezcema Herpeticum?

A
  • Rash: widespread- erythematous, painful with pus filled vesicles
  • Systemic symptoms: fever, lethargy, irritability and reduced oral intake
  • Lymphadenopathy
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24
Q

Investigations for Ezcema Herpeticum?

Study These Flashcards
A
  • Can do viral swabs to confirm the diagnosis
  • Usually not needed: clinical diagnosis
25
Management of Ezcema Herpeticum?
* Aciclovir * Mild or moderate: oral * Severe: IV
26
Complications of ezcema herpeticum?
* Can lead to life-threatening infection: esp if immunocomprised * Bacterial superinfection can occur - this will need abx
27
Managment of atopic ezcema?
* Assess eczema severity and quality of life, incl everyday activities and sleep, and psychosocial well-being. Identify and manage any trigger factors. Give advice on prompt recognition and treatment of infection (in particular eczema herpeticum) and provide a written eczema management plan. * Emollients: ‘ Total emollient care ’ includes liberal application of creams and ointments, using a soap substitute and bath oil. * Topical corticosteroids: Use a stepwise approach to topical steroids depending on the severity of eczema. Use mild steroids for the face. In children with recurrent flares, use a topical steroid for 2 consecutive days/week. * Topical calcineurin inhibitors: Can be used as second-line treatment of moderate to severe atopic eczema in children 2 years that is not controlled by topical corticosteroids, or where there are adverse effects to topical steroids. * Wet wraps: May be particularly effective for troublesome areas (feet/hands). Not to be used over infected skin, topical potent steroids or calcineurin inhibitors. * Dietary manipulation: In bottle-fed infants 6 months with moderate to severe eczema not controlled by optimal treatment, 6 – 8-week trial of an extensively hydrolysed or amino acid formula in place of cow ’ s milk formula. * Antihistamine: If children suffer from severe itching, trial a non-sedating antihistamine.
28
Complications of Ezcema?
* Skin infections leading to cellulitis * Residual pigmentations * Lichenification or skin atrophy related to long- term potent steroid use * Psychosocial issues
29
What are the 2 main types of contact dermatitis?
* Irritant * Allergic
30
What is irritant contact dermatitis?
* more common * non- allergic reaction due to weak acids or alkalis * Often seen on hands * Erythema is TYPICAL * Crusting and vesicles are RARE
31
What is allergic contact dermatitis?
* Type IV hypersensitivity reaction * Uncommon * Most common: hair following hair dyes * Presents as acute, weeping ezcema- affecting margins of hairline rather than hairy scalp * Topical treatment with potent steroid is indicated
32
What is Psoriasis?
Chronic autoimmune condition that causes symptoms of psoriatic skin lesions
33
Describe psoriatic skin lesions
* Dry, flaky, scaly, faintly erythematous skin lesions * Appear raised and rough plaques * Commonly over extensor surfaces of the elbows and knees and on the scalp
34
What is the pathophysiology of psoriatic plaques?
* Rapid generation of new skin cells, resulting in an abnormal build up and thickening of the skin in those areas
35
What is plaque psoriasis?
* Most common form in adults * Thickened erythematous plaques with silver scales * commonly seen on extensor surfaces and scalp
36
What is guttate psoriasis?
* commonly occurs in children * small raised papules across trunk and limbs * Papules are mildly erythematous and can be lightly scaly * Over time the papules can turn into plaques * Often triggered by a strep throat infection, stress or medications * Often resolves spontaneously within 3-4 months
37
What is pustular psoriasis?
* rare and severe form * pustules form underneath areas of erythematous skin * Pts can be systemically unwell * Treated as medical emergency * Need hosp admission
38
What is Erythrodermic Psoriasis?
* rare, severe form of psoriasis * extensive erythematous inflamed areas covering most of the surface are of the skin * Skin comes away in large patches- exfoliation and results in many exposed areas * Medical emergency- pts need admission
39
Child has a throat infection, 2 weeks later they develop small raised papules across they trunk and limbs. What is this?
* Guttate psoriasis
40
How do psoriatic plaques differ in children compared to adults?
Plaques are * smaller * softer * less prominent
41
What are the specific signs for psoriasis?
* Auspitz sign- small points of bleeding when the plaques are scraped off * Koebner phenomenon- refers to development of psoriatic lesions to areas of skin affected by trauma * Residual pigmentation- of the skin after lesions resolved
42
Diagnosis of psoriasis?
* Clinical, based on appearance of lesions
43
Managment of psoriasis in children?
* In children ususally managed and followed up by a specialist Treatment options: * Topical steroids * Topical vitamin D analogues (calcipotriol) * Topical dithranol * Phototherapy with narrow band ultraviolet B light is particularly useful in extensive guttate psoriasis If treatment fails children may be trialled on unlicensed systemic treatment e.g. methotrexate, retinoids | Topical calcineurin inhibitors (tacrolimus) are usually only used in adu
44
Associations with psoriasis?
* Nail psoriasis- can occur at any age: changes incl pitting, thickening, discolouration, ridging and onycholysis * Psoriatic arthritis- occurs within 10 years of developing skin changes- usually affects middle age but can occur at any age * Psychosocial
45
What is a cutaneous common wart?
* firm, raised papules with a rough surface that resembles a cauliflower * Usually asympotmatic but may be tender
46
How do you diagnose cutaneous common warts?
* Usually clinical * If doubt, light paring of the wart will reveal a tiny black dots on the surface (thrombosed capillaries)
47
Managment of cutaneous warts?
* Most people not a strong care for treating warts * Do not usually cause symptoms and in most cases will resolve within months or at most 2 years * Treatments incl: * Cyrotherapy * Topical salicylic acid * Curettage and cautery
48
Adverse affects of cryotherapy for cutaneous common warts?
* Several treatments * Can be painful * May cause pain, blistering, infection, scarring and depigmentation
49
Adverse effects of topical salicylic acid for cutaneous common warts?
* May require administration for up to 12 weeks * Can cause local skin irritation
50
When should you consider treatment for cutaneous common warts?
* Wart is painful * Wart is cosmetically unsightly * Person requests treatment, and the wart is persisiting * Immunosupressed patient
51
What is a viral wart?
* Benign lesion caused by HPV infection * Can be classified as cutaneous or mucosal * Cutaneous wart are your common warts, verrucas
52
Who gets cutaneous warts?
* School- aged kids * Dermatitis * Drug induced immunosupression * HIV patients
53
What type of virus is HPV?
* Double stranded DNA
54
How does HPV cause cutaneous warts?
* Infection begins in basal layer of epidermis * This causes proliferation of keratinocytes and hyperkeratosis and production of infectious viral particles- the wart
55
Most common HPV types affecting the skin?
* 1,2,3,4,10,27,29 and 57
56
How are cutaneous warts spread?
* direct skin-skin contact * autoinoculation
57
What is a cutaneous plantar wart?
* Two types: * Myrmecial type: Caused by HPV 1: typically tender * Mosaic warts: caused by HPV 2
58
What is a cutaneous plane wart?
* Typically multiple flat topped skin coloured papules located most commonly on face, hands and shins * Caused by HPV type 3 and 10
YEAR 4 PAEDS
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