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Dermatology in Paediatrics Alfie Lee Year 5 MBBS student 1. Agenda 2. 3. 4. 5. 6. 2Describing Lesions Skin – General ApproachT erms to Know ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪5Macule = flat area of Papule = solid raised lesion altered colour (< 1 cm) < 1 cm in diameter Vesicle = Small fluid containing lesion that is < 0.5 cm Pustule = Vesicles that Petechiae = redness that does is filled with PUS NOT blanch on pressure HTTPS://STEP2.MEDBULLETS.COM/DERMATOLOGY/120040/TERMINOLOGY -OF-SKIN-LESIONS 6EczemaQuestion 1: ▪ A mother brings her 3-year-old girl to the clinic because of recurrent pruritic and erythematous plaques in the popliteal and antecubital fossae. As an infant, the girl had similar patches on her cheeks and scalp. These signs are most suggestive of which one of the following diagnoses? a) Psoriasis. ▪ b) Dermatitis herpetiformis. ▪ c) Tinea corporis. ▪ d) Atopic dermatitis. ▪ e) Seborrheic dermatitis.Question: ▪ A mother brings her 3-year-old girl to the clinic because of recurrent pruritic and erythematous plaques in the popliteal and antecubital fossae. As an infant, the girl had similar patches on her cheeks and scalp. These signs are most suggestive of which one of the following diagnoses? a) Psoriasis. ▪ b) Dermatitis herpetiformis. ▪ c) Tinea corporis. ▪ d) Atopic dermatitis. ▪ e) Seborrheic dermatitis.Pathophysiology ▪ ▪ ▪ ▪ ▪ 10Atopic T riad • • • • 11Clinical Presentation • Itchy, oozing, weepy skin • Excoriation (“scratch”) • Inflammation – SHARP = Swelling, Heat, Ache, Redness, Pus • Lichenification = Dry, rough patches on the skin • Discoloured skin 12 Clinical Presentation ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ 13Management – Non-drug measures 3/1/20XX SAMPLE FOOTER TEXT 14Management – Non-drug measures 3/1/20XX SAMPLE FOOTER TEXT 15T reatment - Medications ▪ ▪ 16Corticosteroid – Potency Avoid highly potent steroids on THIN skin! Mild – hydrocortisone Moderate – clobetasone, betamethasone valerate, triamcinolone, mometasone Strong: Betamethasone dipropionate, Clobetasol 3/1/20XX SAMPLE FOOTER TEXT 17Question 2 a. b. c. d. 18Question a. b. c. d. 19ImpetigoQuestion 3 a) b) c) d)Question a) b) c) d)Background ▪ ▪ ▪ ▪ ▪ ▪Clinical Presentation - Bullous: ▪ ▪ ▪ ▪ ▪ ▪ ▪ 3/1/20XX SAMPLE FOOTER TEXT 24Clinical Presentation – Non-Bullous: ▪ ▪ ▪ ▪ ▪ 3/1/20XX SAMPLE FOOTER TEXT 25T reatment ▪ ▪ ▪ 26Complications ▪ ▪ ▪ ▪ ▪ ▪ 27Henoch Schonlein Purpura (HSP) • MOST COMMON vasculitis of childhood • IgA vasculitis (IgAV) – small vessel • Deposition of IgA immunoglobulin within the blood vessel walls. • Peak incidence aged 4-6Question 4 a) b) c) d)Question a) b) c) d)Clinical Presentation 1) 2) 3) 4) 31Differential Diagnosis: 32Investigation 1. 2. 3. 4. 5. 6. 7. 8. 33T reatment ▪ ▪ ▪ ▪ 34Complications & Follow-up ▪ ▪ ▪ 35Soft Tissue InjurySoft Tissue Injuries ▪ ▪ ▪ ▪Question 5 a) b) c) d) 38Question a) b) c) d) 39Non-Accident Injury (NAI) 1. 2. 3. 4. 5. 3/1/20XX SAMPLE FOOTER TEXT 40Viral ExanthemMany …Too man… 42Question 6 a) b) c) d) e) 43Question a) b) c) d) e) 44Question 7 a) b) c) d) e) 45Question 7 a) b) c) d) e) 46Measles ▪ ▪ ▪ ▪ ▪ 47Scarlet Fever ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ 48Scarlet Rash – the Rash ▪ ▪ ▪ ▪ 3/1/20XX SAMPLE FOOTER TEXT 49Scarlet Fever – Complications & T reatment ▪ ▪ ▪ ▪ ▪ 50Rubella (“German Measles”) • • • • • • 51Erythema infectiosum ▪ ▪ ▪ ▪ ▪ ▪ ▪ 52No problem until…. 1. ▪ 2. 3. ▪ ▪ 53Roseola (Exanthema subitum) ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ 54Chickenpox – itchy ,itchy ,itchy! ▪ ▪ ▪ ▪ ▪ ▪ ▪ 55Chickenpox – Progression 56Chickenpox ▪ ▪ ▪ ▪ 57Hand,Foot and Mouth disease 58 FEVER + RASH – KEY AGENTS 59 Measles (rubeola) Scarlet Fever Roseola infantum Rubella Chickenpox (German measles) Causative Paramyxoviridae family GroupAStreptococcus Human Herpesvirus 6 Rubivirus, matonaviridae Varicella Zoster Virus (VZV) agent (-ssRNA) (Streptococcus pyogenes) (HHV6) (dsDNA) (+ssRNA) Herpesviridae (dsDNA) Incubation 13 days (6-19) 2-5 days ~10 days 14-21 days 10 -21 days Isolation Requirem From 4 days before to 4 st ent (if days after rash onset Until 24 hours after 1 None From 7 days before Until all lesions are crusted any) dose of antibiotics to 7 days after rash (usu 5 days after rash onset) Distinction High fever + URTI, Lymph node swelling Features then Koplik spots, Sandpaper texture rash High fever,then around neck Fever + URTI,then itchy maculopapular (fine papular) + rash (not (occipital region) rash [rash progresses in rash (fever coexist Strawberry tongue + + rash + fever (‘3- stages,from flat with rash) Lymphadenopathy simultaneous) day measles’) (macule) to raised Common cause of + sore throat febrile seizure! - Congenital cataract, (papular,vesicular) to SNHL,patent crusting] ductus arteriosus, Rash at all stages are seen learning simultaneously difficulties • Phone local Health Protection Team (HPT) – speak to a consultant for: measles, mumps, rubella, scarlet fever • Duty to notify suspected disease, infection or contamination in patients (both suspected & definitive cases)Sign up link:Thank you P.lee2@ncl.ac.uk 3/1/20XX SAMPLE FOOTER TEXT 62