Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, everyone. If you can just let me know in the chart if you can hear me. Ok. In fact, um thank you for joining me on a Friday evening. I know this is different to our normal time. Um I'm gonna get started cause it's a Friday and no one wants to stay that late. Um As always, there'll be my email address at the end of the presentation as well as um a feedback form. So you can let me know anything that you want to see coming up next or you can email me any questions that you have. Ok. So for this session, we're gonna cover some of the pediatric dermatology conditions that you need to be aware of for your final exams. And this week we're jumping straight in with a question. So I'm just gonna mute myself. Give you a minute to read through this and then I'll pop up a poll um, for you to click on the answer that you think is correct and then we'll work through it. You should hopefully now be able to see the poll in the chart. So if you get that go at answering that, when you've had a chance to read through. All right. Uh Want to run a bit static, so I'm gonna move on. So the correct answer is dermatitis, herpetiformis so well done to those of you who got that right. Um And kind of the key things that we're pulling out from this question is that it's an intensely itchy rash, um the vesicles as well, quite characteristic and also the history of celiac disease. That was quite a big hint for this question if you were aware of that link, um slightly harder if you sort of haven't heard of that link before. So a bit of an explanation. So um this is a chronic pruritic blistering skin condition that has a strong association with celiac disease. So um for your exams, if you kind of try and remember that link, look out for clues, you might not get the nice bit that I put at the end about having a history of celiac disease. But you might have a hint towards it as though it occurs mostly after eating certain foods or has recently eaten XYZ on holiday. And now has this rash and it presents with group B called papules and excoriations often on the extensive surfaces. Um excoriations, especially in younger Children who sort of don't realize that sort of by itching a rash, they might be making it worse. The itchiness is severe. Um and does typically fiber gluten diagnosis is confirmed with a skin biopsy and direct immunofluorescence. And that shows the iga deposition in the dermal papillae. Um Treatment is a strict gluten-free diet and you can also use Dapsone as well. So you just remember that link celiac um rash that's very itchy is dermatitis, piti fors to treat it. Take away the trigger, which is the gluten. So moving swiftly on um Again, I'll mute myself. So you have a chance to read through this, I'll then flash up the pole and we'll go through the answers. OK. So just a chance to get your last answers in. Now. Um So you split between a couple on this one, a lot of you opting for D but also a couple for B and E as well. So the correct answer for this one is um the hints that you're looking for within the questions um For this one is the fact that this is a widespread rash. Um Also the skin peeling and the perioral crusting and fissuring when I sort of reveal what this is, is um big hints towards this one. So this is Staphylococcal scalded skin syndrome or SSSS. Um and this is caused by staph aureus, the exfoliative toxins that are in Staph aureus, it presents with this widespread erythema tenderness, skin peeling and the positive Nikolsky sign. So that sort of points you towards that diagnosis, if you are aware of that. Um the perioral crusting and fissuring is also very characteristic of this. Um in terms of treatment, you'll need IV flu clocks to cover the staph aureus and then supportive care. So, in this instance, supportive care is um mostly to do with fluid replacement and wound care. If you kind of think of it a bit like burns, um cause it uh the appearance is kind of the same. Um the patient could become very dehydrated very quickly. So you want to make sure that you're replacing those fluids that they're using. Um Nikovski sign, that's a dermatological sign that indicates separation of the epidermis from lower layers of skin when the skin is rubbed or shed. So, in these patients, it wouldn't take much force at all for the that skin layer to just start peeling away. So usually, um this will start with a generalized erythematous patches um all over the body and then the skin can start to look very thin and wrinkled. That's sort of starting to give you that impression that the skin might be peeling away. Um You get bullet that form and burst and it leaves the skin very sore and that's what gives you the appearance that may look like a scold or burn. So your history is very important as to you see, a child presenting with this, has this come from a skin rash or have they been burnt by something? Um Most or almost all will require admission and IV antibiotics and fluids, um monitoring and managing those fluids and electrolytes is key these patients are very prone to dehydration and electrolyte imbalances which can cause further complications. OK. Our next one again, I'll mute myself for a little bit so you can have a read through, pop up the pole and then we'll go through the answers.