Paediatric Dermatology
Summary
This is an educational session about Dermatology in Paediatrics by a final year medical student, Alfie Lee. Attendees will learn about the description of skin lesions, common skin conditions in children like eczema, impetigo, and Henoch Schonlein Purpura, their diagnosis, treatment and possible complications. Soft tissue injuries and non-accident injuries will also be discussed. Various childhood viral exanthems including measles, scarlet fever, rubella, erythema infectiosum, roseola, chickenpox, and hand-foot-mouth disease, their causes, symptoms, and treatments will also be covered in detail. The session includes detailed case-based questions for better understanding. It's a perfect refresher course for medical professionals interested in pediatric dermatology.
Learning objectives
- To understand the different types of skin lesions and rashes commonly found in paediatric patients.
- To identify and effectively diagnose common paediatric dermatological conditions, including eczema, impetigo, and Henoch Schonlein Purpura (HSP), through patient history, physical examination, and necessary laboratory testing.
- To provide appropriate management strategies for diagnosed dermatological conditions, including both non-pharmaceutical and pharmaceutical interventions.
- To discuss complications and long-term effects associated with paediatric dermatological conditions and how they can be managed or prevented.
- To recognize warning signs or symptoms suggesting non-accident injuries, viral exanthem, or other serious conditions, and to make appropriate referrals for further treatment.
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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