Dermatology > Module 2: Paediatrics > Flashcards

Module 2: Paediatrics Flashcards

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1
Q

Which skin conditions affect >15% of SA children?

A

• Insect bites
• Tinea capitis
• Xerosis (dry skin)
• Impetigo

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2
Q

Which skin conditions affect ~85% of SA children?

A

• Eczema
• Warts (verruca vulgaris)
• Molluscum contagiosum
• Herpes simplex
• Vitiligo
• Tinea corporis
• Scabies
• Urticaria

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3
Q

What is the significance of knowing prevalence of skin diseases in children?

A

Helps prioritize diagnosis, treatment, and public health interventions, and guides common differentials in paediatric dermatology.

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4
Q

Which fungal infections are most common in SA children?

A

• Tinea capitis – scalp infection
• Tinea corporis – body/ringworm

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5
Q

Which viral skin conditions are common in SA children?

A

• Warts (HPV)
• Molluscum contagiosum
• Herpes simplex

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6
Q

What is the essential feature required to diagnose atopic eczema?

A

Pruritus (itching) – the hallmark symptom of AE.

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7
Q

What are supportive features that help confirm AE?

A

• Age of onset: usually infancy or early childhood.
• Typical morphology and distribution:
• Infants: face, scalp, extensor surfaces.
• Children & adults: flexural surfaces (elbows, knees, neck).
• Chronic cases: lichenification (thickened skin, increased markings, hyperpigmentation).
• Personal or family history of atopy (asthma, allergic rhinitis, eczema).
• Xerosis (dry skin).

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8
Q

What laboratory or diagnostic tests may support AE diagnosis?

A

• Serum IgE: often elevated in atopic individuals.
• Skin prick test: identifies allergen triggers.
• Patch testing: considered if contact allergy is suspected.

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9
Q

How does the morphology of AE differ by age?

A

• Infants: rash commonly on face, scalp, and extensor surfaces.
• Older children/adults: rash commonly on flexural areas like elbows, knees, and neck.

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10
Q

What skin changes occur in chronic atopic eczema?

A

Lichenification (thickened, rough skin), hyperpigmentation, and exaggerated skin markings due to chronic scratching.

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11
Q

What is the typical shape/morphology of AE lesions?

A

Erythematous, ill-defined, sometimes vesicular or oozing lesions in acute stages; lichenified and thickened in chronic stages.

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12
Q

What is the hallmark symptom of AE?

A

Pruritus (itching) – constant or intermittent, often worse at night.

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13
Q

Where are AE lesions typically located by age?

A

• Infants: face, scalp, extensor surfaces.
• Children & adults: flexural surfaces (elbows, knees, neck, wrists, ankles).

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14
Q

What are common triggers of AE?

A

Allergens (dust mites, pollens, pets), irritants (soaps, detergents), heat, sweating, stress, infections, and sometimes food in infants.

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15
Q

How is AE characterized in terms of chronicity

A

Chronic, relapsing-remitting course with periods of flares and partial remission.

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16
Q

What family history is commonly associated with AE?

A

Personal or family history of atopy: asthma, allergic rhinitis, or eczema.

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17
Q

What is the typical shape/morphology of nummular eczema lesions?

A

Round or oval (coin-shaped) erythematous plaques, often with scaling, crusting, or weeping in acute stages.

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18
Q

What is the hallmark symptom of nummular eczema?

A

Intense pruritus (itching), often leading to scratching and excoriation.

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19
Q

Where are nummular eczema lesions typically located?

A

Limbs (especially legs and arms), sometimes trunk; usually symmetrical.

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20
Q

What are common triggers of nummular eczema?

A

Dry skin (xerosis), irritants (soaps, detergents), environmental allergens, cold or dry weather, stress, or minor skin trauma.

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21
Q

How is nummular eczema characterized in terms of chronicity?

A

Chronic or relapsing, with frequent flares and periods of partial resolution.

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22
Q

Is family history of atopy commonly associated with nummular eczema?

A

Less commonly than atopic eczema, but some patients may have a personal or family history of atopy.
Worse in winter

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23
Q
A
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24
Q

What is the typical shape/morphology of seborrhoeic eczema lesions

A

Greasy, yellowish-orange, poorly demarcated patches with fine scaling; may be mildly erythematous.

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25
What is the hallmark symptom of seborrhoeic eczema?
Mild itching; often less severe than atopic eczema
26
Where are seborrhoeic eczema lesions typically located?
Areas rich in sebaceous glands: • Infants: scalp (“cradle cap”), face, behind ears, sometimes trunk (pigeon chest distribution). • Adults: scalp, nasolabial folds, eyebrows, chest, and upper back.
27
What are common triggers of seborrhoeic eczema?
Malassezia yeast overgrowth, stress, cold/dry weather, and hormonal changes.
28
How is seborrhoeic eczema characterized in terms of chronicity?
Chronic with intermittent flares; often improves spontaneously in infants.
29
Is family history of atopy associated with seborrhoeic eczema?
Not typically; unlike atopic eczema, seborrhoeic eczema is usually not linked to personal or family history of atopy.
30
What is the typical shape/morphology of contact dermatitis lesions?
Erythematous, sometimes edematous patches or plaques; may have vesicles, bullae, oozing, or crusting in acute cases; chronic cases may show lichenification.
31
What is the hallmark symptom of contact dermatitis?
Pruritus (itching); may also have burning or stinging sensations.
32
Where are contact dermatitis lesions typically located?
Confined to areas in direct contact with the irritant or allergen, e.g., hands, wrists, forearms, face, neck.
33
What are common triggers of contact dermatitis?
• Irritant CD: soaps, detergents, solvents, chemicals, friction. • Allergic CD: nickel, fragrances, rubber, topical medications, plants (poison ivy).
34
How is contact dermatitis characterized in terms of chronicity?
Acute CD resolves when exposure stops; chronic or repeated exposure can cause persistent eczematous changes.
35
Is family history of atopy associated with contact dermatitis?
Not directly, but atopic individuals may be more prone to irritant contact dermatitis.
36
Which bacterial infections commonly complicate eczema?
• Staphylococcus aureus – most common; causes impetiginization (yellow crusting, weeping). • Streptococcus pyogenes – can cause secondary infection. • Cellulitis – spreading redness, warmth, and swelling.
37
What is eczema herpeticum and what causes it?
• Caused by Herpes Simplex Virus (HSV). • Presents with painful, punched-out vesicles, fever, and systemic symptoms. • Can lead to serious systemic infection in immunocompromised patients.
38
Which viral infection is most relevant in complicated eczema?
Herpes Simplex Virus (HSV) → eczema herpeticum.
39
Which fungal infections can complicate eczema?
• Dermatophytes (tinea infections): may worsen eczema, especially with topical steroid use. • Candida: affects moist, intertriginous areas (e.g., under breasts, skin folds).
40
How does impetiginization present in eczema?
Yellow crusting, oozing lesions, often localized over eczematous areas.
41
Why are eczema patients prone to infections?
Skin barrier disruption, chronic scratching, and local immunologic defects increase susceptibility to bacterial, viral, and fungal infections.
42
What is the typical distribution of atopic eczema in infants (birth to 2 years)
• Face: cheeks, chin (cheilitis), sparing perioral and perinasal areas. • Scalp. • Extensor surfaces of limbs. • Spares nappy area.
43
What is the typical distribution of atopic eczema in childhood (2–12 years)?
• Face: eyelids, perioral area, neck. • Flexural areas: armpits, elbows, knees. • Postauricular fissures. • Allergic shiners (dark circles), Dennie-Morgan lines (fold beneath eyes). • Central face sparing (headlamp sign) and perioral dermatitis. • Allergic salute (transverse nasal crease from nose rubbing).
44
What are characteristic facial signs in childhood AE?
• Allergic shiners: dark circles under eyes. • Dennie-Morgan lines: extra fold beneath lower eyelid. • Allergic salute: transverse nasal crease from frequent rubbing.
45
Which areas are typically spared in infant AE?
• Nappy area. • Perioral and perinasal regions.
46
How does AE distribution change from infancy to childhood?
• Infants: extensor surfaces and cheeks. • Children: flexural surfaces and periorbital/perioral areas; signs of chronic rubbing appear (e.g., Dennie-Morgan lines).
47
What are the most common infections that can complicate eczema?
Bacterial infections, particularly Staphylococcus aureus and Streptococcus pyogenes, are the most common.
48
What is impetiginization in the context of eczema?
It is a bacterial complication characterized by yellow crusting and weeping of the eczema lesions.
49
What causes eczema herpeticum?
It is caused by Herpes Simplex Virus (HSV) infection.
50
What are the clinical features of eczema herpeticum?
Painful, punched-out vesicles, often with fever and systemic symptoms
51
Why is eczema herpeticum particularly serious in some patients?
It can lead to serious systemic infection, especially in immunocompromised individuals.
52
What is cellulitis as a complication of eczema?
It is a spreading bacterial infection presenting with redness, warmth, and swelling of the affected skin.
53
Which organisms commonly cause cellulitis in eczema patients?
Staphylococcus aureus and Streptococcus pyogenes.
54
What type of fungal infections can complicate eczema?
Dermatophyte and Candida infections.
55
How does tinea infection present when complicating eczema?
Eczema may worsen with topical steroid use, indicating possible tinea (dermatophyte) infection.
56
Where is Candida infection most likely to occur in eczema patients?
In moist, intertriginous areas such as under the breasts or between skin folds
57
What age group does the infant phase of atopic eczema refer to?
The face, scalp, and extensors of the limbs
58
Which specific part of the face is typically involved in infantile atopic eczema?
The cheeks are commonly affected.
59
Which areas of the face are usually spared in infantile atopic eczema?
The perioral (around the mouth) and perinasal (around the nose) regions are usually spared.
60
What additional facial area can be affected in infants with atopic eczema?
The chin, often with cheilitis (inflammation of the lips).
61
Is the nappy area usually affected in infantile atopic eczema?
No, the nappy area is typically spared.
62
What age group does the childhood phase of atopic eczema refer to?
From 2 to 12 years.
63
What are the common sites affected by atopic eczema in the childhood phase?
The face, eyelids, perioral area, neck, armpits, and flexor surfaces (e.g., elbows and knees).
64
What are allergic shiners in atopic eczema?
Dark circles around the eyes due to venous congestion from chronic rubbing or allergy.
65
What are Dennie–Morgan lines?
Additional skin folds beneath the eyes, often seen in children with atopic eczema.
66
What does muddy sclera refer to?
A slightly discolored or dull appearance of the sclera (white part of the eye), associated with allergy.
67
What is a postauricular fissure?
A crack or fissure behind the ears, commonly seen in children with atopic eczema.
68
What is an allergic salute?
A habitual upward rubbing of the nose with the palm, leading to a transverse nasal crease.
69
What is the headlamp sign in atopic eczema?
Sparing of the central face while the surrounding areas are affected
70
What is perioral dermatitis in the context of atopic eczema?
Inflammation and rash around the mouth, often with sparing of the lips themselves.
71
What are the main clinical features of acute eczema?
Erythema, weeping, vesiculation, and crusting.
72
What is the characteristic feature of chronic eczema?
Lichenification – thickened, leathery skin due to chronic scratching or rubbing.
73
What is nummular eczema?
A form of eczema that presents as round or coin-shaped lesions, often on the limbs.
74
What is seborrhoeic eczema?
Eczema that occurs in seborrhoeic (oil-rich) areas such as the scalp, face, and upper chest, often associated with Malassezia yeast.
75
What is contact eczema (napkin irritant dermatitis)?
Eczema caused by irritation or allergic reaction to external substances (e.g., soaps, detergents, urine, faeces), commonly affecting the nappy area.
76
What is pityriasis sicca alba (PSA)?
A mild phenotype of eczema presenting as white, scaly patches—often on the face of children.
77
Is pityriasis sicca alba a fungal infection?
No, it is not a fungal infection.
78
What is impetiginized atopic eczema?
It is atopic eczema with bacterial superinfection, most commonly caused by Staphylococcus aureus.
79
What are the typical features of impetiginized eczema?
Yellow crusting and weeping lesions due to bacterial infection.
80
What organism most commonly causes impetiginized eczema?
Staphylococcus aureus.
81
What is eczema herpeticum?
A superinfection of eczema with Herpes Simplex Virus (HSV)
82
What are the characteristic lesions of eczema herpeticum?
Painful, punched-out erosions or vesicles, often with fever or systemic symptoms.
83
What are the key components of managing atopic dermatitis?
Education, avoidance of triggers, soap substitutes, optimal topical care with emollients, and specific therapy (topical/systemic).
84
Why is patient education important in atopic dermatitis management?
It helps patients and caregivers understand the chronic nature of the disease, importance of adherence, and how to avoid triggers.
85
What should be used instead of regular soaps in atopic dermatitis?
Soap substitutes (mild, fragrance-free cleansers) to prevent skin dryness and irritation.
86
What is the role of emollients in atopic dermatitis?
They restore the skin barrier, reduce dryness, and prevent flare-ups when applied regularly.
87
What is the mainstay of specific therapy for atopic dermatitis?
Topical corticosteroids, used to reduce inflammation and itching during flares.
88
What is the role of antihistamines in atopic dermatitis?
They help relieve itching and improve sleep quality, especially during acute flares.
89
When is systemic therapy indicated in atopic dermatitis?
In severe or refractory cases not controlled by topical treatments
90
What are examples of systemic agents used in atopic dermatitis?
Azathioprine and methotrexate.
91
What is the role of ultraviolet light therapy in atopic dermatitis?
It can help reduce inflammation and itching in chronic, widespread eczema.
92
What are wet wraps, and when are they used?
Used in severe atopic eczema, they involve one wet layer and one dry layer to rehydrate the skin, enhance topical absorption, and reduce itching.
93
What is psoriasis?
A chronic inflammatory skin disorder characterized by erythematous (red), scaly plaques, most commonly found on extensor surfaces.
94
Which areas of the body are most commonly affected by psoriasis?
The extensor surfaces such as the elbows, knees, and scalp.
95
What are the typical features of psoriatic plaques?
Well-demarcated red plaques with silvery-white scales
96
What is congenital psoriasis?
A rare form of psoriasis that is present at birth or develops shortly after, due to genetic predisposition.
97
How does congenital psoriasis typically present?
With generalized erythematous, scaly lesions resembling severe psoriasis seen in older patients.
98
In which body area can psoriasis and seborrhoeic dermatitis be difficult to distinguish?
In the nappy area (diaper region).
99
Why are psoriasis and seborrhoeic dermatitis difficult to differentiate in the nappy area?
Because both can present with red, scaly lesions, and the moist environment may obscure typical scaling.
100
What clinical clue can help distinguish psoriasis from seborrhoeic dermatitis in infants?
The presence of psoriatic plaques elsewhere on the body, such as elbows, knees, or scalp, supports a diagnosis of psoriasis.
101
What is the term sometimes used for overlapping features of psoriasis and seborrhoeic dermatitis?
Sebopsoriasis — when features of both conditions are present.
102
What is molluscum contagiosum?
A viral skin infection characterized by flesh-coloured papules with central umbilication.
103
What virus causes molluscum contagiosum?
The pox virus (a DNA virus).
104
How does molluscum contagiosum typically present clinically?
With small, dome-shaped, flesh-coloured papules that have a central dimple (umbilication).
105
Is treatment always required for molluscum contagiosum?
No, most children will clear the infection spontaneously without treatment.
106
What topical treatments can be used for multiple molluscum contagiosum lesions?
Benzoyl peroxide (Benzac) or topical retinoids
107
What are procedural treatment options for molluscum contagiosum?
Curettage (scraping out lesions with a curette) Cryotherapy (freezing with liquid nitrogen) Cantharidin (a topical keratolytic agent) Imiquimod – immunomodulator
108
Why might treatment be considered even though the infection is self-limiting?
To reduce spread, prevent autoinoculation, and improve cosmetic appearance or comfort.
109
What are warts?
Benign skin growths caused by human papillomavirus (HPV) infection.
110
How do warts typically appear clinically?
As multiple papules or plaques that are verrucous (rough and warty in texture).
111
What does verrucous mean?
It refers to a rough, wart-like surface of the lesion.
112
What does confluent mean in the context of warts?
Individual warts merging together to form larger plaques
113
Where on the body are warts commonly found?
On the hands, feet (plantar warts), knees, and elbows, but they can occur anywhere on the skin or mucosa.
114
What virus is responsible for warts?
The Human Papillomavirus (HPV).
115
How does a typical HSV (herpes simplex virus) infection present on the skin?
As grouped vesicles on an erythematous (red) base.
116
What is congenital disseminated HSV?
A rare, severe form of HSV infection present at birth, affecting multiple organs and skin, often with systemic symptoms.
117
What is eczema herpeticum?
A HSV superinfection in patients with pre-existing eczema, characterized by painful, punched-out vesicles with fever or systemic illness.
118
Why is eczema herpeticum clinically significant?
It can lead to serious systemic infection and requires prompt antiviral therapy.
119
How can you distinguish HSV infection from other vesicular rashes?
By grouped vesicles on an erythematous base, rapid onset, pain, and sometimes systemic symptoms in severe cases.
120
What is the classic appearance of tinea on the skin?
Annular (ring-shaped) plaque with central clearing and a scaly edge.
121
What is tinea capitis?
A fungal infection of the scalp caused by dermatophytes.
122
How does tinea capitis typically present?
With nonscarring alopecia, scaling, and sometimes broken hairs
123
What does nonscarring alopecia mean in tinea capitis?
Hair loss occurs but the hair follicles are not permanently destroyed, so hair can regrow after treatment.
124
What are the common causative organisms of tinea infections?
Dermatophytes, including Trichophyton, Microsporum, and Epidermophyton species.
125
What is the first-line treatment for localized tinea corporis?
Topical antifungal agents applied twice daily (BD) for up to 2 weeks or until clinical resolution.
126
Give examples of topical antifungal agents for localized tinea corporis.
Imidazole creams (e.g., clotrimazole) Benzoic acid with salicylic acid (e.g., Whitfield’s ointment) Zinc undecanoate (e.g., Mycota)
127
What is the treatment for extensive or refractory tinea corporis?
Oral griseofulvin, 10–20 mg/kg/day for 6 weeks.
128
How should griseofulvin be taken for optimal absorption?
With milk or at mealtime, as it is fat-soluble.
129
When should topical therapy be switched to systemic therapy for tinea corporis?
In extensive disease, resistant lesions, or involvement of hair-bearing areas where topical therapy is insufficient.
130
What is scabies?
A parasitic skin infection caused by the Sarcoptes scabiei mite, leading to intense itching and skin lesions.
131
What are the characteristic skin lesions of scabies?
Burrows, papules, and vesicles.
132
Where does scabies typically present in infants and babies?
Often on the palms, soles, and sometimes the face and scalp
133
Where does scabies typically present in older children and adults?
In the webspaces of fingers, axillae, wrists, and umbilicus.
134
Why is scabies distribution different in infants vs older children?
Infants have thinner skin and may have wider distribution, while older children show the classic predilection for interdigital spaces and flexural areas.
135
What is papular urticaria?
A hypersensitivity reaction to insect bites, commonly seen in children.
136
What is the typical morphology of papular urticaria lesions?
Papules or vesicles, often linear or grouped.
137
What general preventive measures are recommended for papular urticaria?
Treat pets regularly for fleas Check mattresses for bedbugs Fumigate the home if necessary
138
What are the specific treatments for papular urticaria?
Topical corticosteroids, including wet wraps for severe lesions 5% LPC in HEB (for inflammation/itching) Antihistamines for itching Topical or systemic antibiotics if lesions are infected
139
Why are antibiotics sometimes needed in papular urticaria?
To treat secondary bacterial infection from scratching.
140
What is an infantile haemangioma?
A benign vascular tumour of infancy, commonly known as a strawberry naevus.
141
How does an infantile haemangioma typically appear?
As a raised, bright red lesion with a strawberry-like appearance.
142
When do infantile haemangiomas usually appear?
Typically within the first few weeks of life, often growing rapidly during the first 6–12 months.
143
What is the natural course of infantile haemangiomas?
They usually proliferate in infancy and then spontaneously involute over several years, often by age 5–10.
144
When is treatment indicated for infantile haemangiomas?
if there is ulceration, bleeding, functional impairment, or risk of disfigurement.
145
What are treatment options for infantile haemangiomas?
Topical or oral beta-blockers (e.g., propranolol) Laser therapy for superficial lesions Surgery in selected cases
Dermatology
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