what is acne?
*chronic inflammatory skin condition affecting mainly the face, back and chest
- Lesions are caused by blockage and inflammation of the pilosebaceous unit in the skin - comedones - increased production of sebum, trapping keratin and causes blockage
what management options are available for acne?
- topical benzoyl peroxide - reduce inflammation, helps unblock skin and toxic to bacteria
- topical retinoids (chemicals related to vitamin A) - slow sebum production, give child bearing aged contraceptions
- oral antibiotics - lymecycline
- oral contraceptive pill - females stabilise hormones and slow production of sebum
- oral retinoids like isotretinoin for severe - highly teratogenic, reducing production of sebum, reducing inflammation and reducing bacterial growth
what are the common patterns of eczema in children?
- Flexural– creases at the elbows, knees, wrists and neck
- Discoid– coin-sized areas of inflammation on the limbs
- Follicular– small circular bumps around hair follicles
how might eczema present?
Infants - generally affected around thescalp, face, and flexures. Hair loss may be noticed where the infant has excessively rubbed their skin
toddlers - increasing age, the distribution of childhood eczema changes. Usually, the distribution becomesflexural
how would you manage eczema?
- bathing with emollients
- moisturisers
- avoid skin trauma
- topical corticosteroids
- topical cacineurin inhibitors
- education
- flares managed with steroids
what is contact dermatitis?
delayed type hypersensitivity reaction in the skin following contact with allergen
why is atopic dermatitis common in children?
- skin thinner
- can absorb more applied substances
- higher surface area to body weight ratio
- more likely to have atopic dermatitis which facilitates sensitisation due to impaired barrier
- newborns and those aged 0-3y
- causes - nickel from piercings, preservatives, fragrance mix, colophonium in tape
how might allergic dermatitis present?
allergic
- red, itchy and scaly skin
- blisters
- in hands, feet, arms, legs and face
- resolution with allergen removal
how might contact dermatitis present?
- dry, peeling skin with bullous eruptions
- well demarcated and rarely spreads
how would you manage atopic dermatitis?
- avoid exposure
- wash with soap and water after contact
- nappy change regularly
- topical corticosteroid, emollient
what is impetigo?
- superficial bacterial skin infection usually caused by staphylococcus aureus - “golden crust”
- occurs when bacteria enter via break in skin
- can be bullies or non
how does impetigo appear on examination?
- non-bullous around nose or mouth with dried exudate appearing like the goden crust, potential systemic illness
- 1-2cm fluid filled vesicles to form on skin —> burst and form golden crust which heal without scarring
what are some complications of impetigo?
- Cellulitis if the infection gets deeper in the skin
- Sepsis
- Scarring
- Post streptococcal glomerulonephritis
- Staphylococcus scalded skin syndrome
- Scarlet fever
- staphylococcus scalded skin syndrome
how is impetigo managed?
- non-bullous
- topical fusidic acid first line, oral flucloxacillin for more widespread
- advice to reduce spread, don’t scratch, hand hygeine, avoid sharing towels, cutlery
- stay off school until healed over or 48h antibiotic treatment
- bullous
- antibiotics - flucloxacillin oral or IV
- isolate where possible
what is psoriasis?
- chronic autoimmune condition that causes recurrent symptoms of skin lesions
- skin lesions caused by rapid generation of new skin cells, resulting in abnormal buildup and thickening of skin
how does psoriasis look?
- patches of dry, erythematous, raised rough plaques on extensor surfaces or scalp
- Auspitz - small points of bleeding when plaques scraped off
- Koebner phenomenon - development of psoriatic lesions to areas of skin affected by trauma
- residual pigmentation - skin after the lesions resolve
what are some associated condition with psoriasis?
- nail psoriasis - pitting, thickening, discolouration
- psoriatic arthritis - middle age
- psychosocial - self esteem, social acceptance, depression and anxiety
- CVS risk - obesity, hyperlipidaemia, hypertension, T2DM
how is psoriasis diagnosed?
clinical
- The plaques tend to be distributed symmetrically
- They favour certain sites such asscalp, elbows and knees; or; skin folds such as behind ears, armpits and groin
- They are well-circumscribed, red and scaly
- There is often a family history of psoriasis
how is psoriasis managed?
- topical steroids
- topical vitamin D analogues - calcipotriol
- topical dithranol
- topical calcineurin inhibitors - tacrolimus adults
- phototherapy - narrow band UV light in extensive guttate
*specialist guidance for systemics
what are cutaneous warts?
- cutaneous warts are small, rough growths that are caused by infection of keratinocytes with human papilloma virus (HPV)
- they can appear anywhere on the skin but are commonly seen on the hands and feet
- a verruca (also known as a plantar wart) is a wart on the sole of the foot
what is erythema multiforme?
immune mediated reaction of skin and mucous membrane to medication, malignancy, viral infection or inflammatory bowel disease
usually secondary to viral infection
