Skin conditions - Coggle Diagram
Assess child for candida infection as could be causative in recurrence.
Assess for bacterial infection - folliculitis, exudate, papules etc
Assessment - Consider location, duration and nature of rash, previous treatment and nappy regime.
Contact dermatitis, eczema herpeticum, atpoic eczema, perianal streptococcal dermatitis, psoriasis etc.
Diagnosis - Rash - erythematous, papular, glazed appearance around nappy area, can develop oedema, ulceration, skin erosions.
Management - advice on cleaning and nappy regime. Consider emollients, topical hydrocortisone if 1m>, topical imidazoles for candida, if bacterial infection prescribe oral antibiotics.
Weals - check swelling size and colour, itch or burning, short lived attacks.
Alternative diagnoses? such as vasculitic urticaria.
If no identifiable triggers with history of urticaria consider investigations - bloods LFTs, TFTs, ESR, CRP, FBC, H. pylori.
Allergy testing, eliminating food or drug allergies, skin biopsy, urinalysis.
If triggers identified, suggest avoidance of triggers as treatment.
Onset, frequency, duration, severity, pattern of recurrence,
Use USA7tool to assess severity. Trigger factors, PMH, family history of atopy, allergies, alleviating factors.
Symptoms requiring treatment - anti-histamines, oral corticosteroid if severe
Staphylococcus whitlow - affects mainly thumb and index finger, injury present, abscess present, occasional spontaneous drainage of abscess,systemic symptoms uncommon.
Herpetic Whitlow - no hx of injury, Current or recent oral or genital herpetic lesions, a history of fever or malaise, hx of pain and parasthesia of finger prior to other symptoms, abrupt onset of pain, swelling redness to finger, recurrence of symptoms.
Management - staphylococcus - incision and drainage and/or antibiotics
Management - herpetic - consider viral swabbing, and anti-viral treatment.
Diagnosis - History of penetrating injury or untreated paronychia, tightness and pain, rapid onset of throbbing pain, redness and distal swelling of entire distal pulp of finger.
Management - consider treatment only if painful, cosmetically unsightly or person requests treatment.
Treatment - cryotherapy, salicylic acid.
Differential diagnosis - acitinic keratosis, Bowens disease, Seborrheic keratosis, Squamous cell carcinoma, Focal palmoplantar keratoderma, Lichen planus, Malignant melanoma.
Type - common, periungal, plane, filiform, plantar and palmar, mosaic.