Pediatric Skin Disorders

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• Pediatric Skin Disorders

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Compare skin differences

• Infant skin not mature at birth
• Adolescence sebaceous glands become enlarged
  active.

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Skin Assessment

• Assess history
• Assess exposure
• Assess character
• Assess sensation

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Dermatitis
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Dermatitis

• Inflammation of the skin that occurs in response
  to contact with an allergen or irritant also
  referred to as contact dermatitis

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Dermatitis

• Common irritants
• Soap, fabric softeners, lotions, urine and
  stool
• ? Common allergens
• poison ivy, poison oak
• lanolin, latex, rubber
• nickel, fragrances

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Dermatitis signs and symptoms

• Erythema
• Edema
• Pruritus
• Vesicles or bullae
• that rupture, ooze and crust

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Dermatitis Treatment

• Medications
• Application of a corticosteroid topical agent
  remind pt to continue use for 2-3 wks after signs
  of healing
• Application of protective barrier ointments
• Oatmeal baths, cool compresses
• Antihistamines given for sedative effect

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Eczema

• Chronic superficial skin disorder characterized
  by intense pruritis

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Eczema signs and symptoms

• Erythematous patches with vesicles
• Pruritis
• Exudate and crusts
• Drying and scaling
• Lichenification
• (thickening of the skin)

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Eczema, cont.
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Goal of Treatment

• Hydrate the skin

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Treatment of Eczema

• Emollients (creams which lubricate the skin)
• Oral antihistamines (control itching)
• Antibiotics (treat superinfections)
• Corticosteroids (anti-inflammatories)
• Immunomodulators (inhibit T lymphocyte
  activation)
• AVOID SOAPS!

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Acne

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Acne

• Inflammatory disease of the skin involving the
  sebaceous glands and hair follicles.
• Contributing factors include heredity,
  hormonal influences and emotional stress

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Acne Three main types

• Follicular plugs
• Pustular papules
• Cystic nodules

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Patient teaching

• Do not pick! This increases the bacterial count
  on the surface of the skin and opens lesions to
  infection which worsens scarring
• Remind patients that the treatment will not show
  improvement until about 4-6 weeks but they must
  consistently follow the regime set up by the
  physician

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Medical treatment for acne

• Topical (Benzoyl peroxide, Tretinoin (RetinA),
  topical preferred to systemic however, both may
  be needed
• Oral Tetracycline, minocycline, erythromycin
  estrogen for female pts., Accutane

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Acne Nursing care

• Avoid picking and squeezing
• Use gentle skin cleansers
• Avoid use of astringents containing ETOH
• Avoid hats or abrasive rubbing of the skin
• Wash hands after handling greasy foods
• Limit use of petrolatum-based hair products hair
  away from face
• Use oil-free makeup, protections from windy, cold
  weather
• Continue therapy even when improved

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Impetigo

• http//www.emedicine.com/emerg/topic283.htm
• Impetigo became infected
• Hemolytic Strep infection of the skin
• Incubation period is 2-5 days after contact

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• Begins as a reddish macular rash, commonly seen
  on face/extremities
• Progresses to papular and vesicular rash that
  oozes and forms a moist, honey colored crust.
  Pruritis of skin
• Common in 2-5 year age group

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Therapeutic Management

• Apply moist soaks of Burrows solution
• Antibiotic therapy Keflex for 10 days
• Patient education

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Therapeutic Interventions for impetigo

• Goal prevent scarring and promote self image.
• Individualize treatment to gender, age, and
  severity of infection
• Takes 4-6 wks to improve
• What is the major nursing implication here?

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Candiditis- Thrush

• Overgrowth of Candida albicans
• Acquired through delivery

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Thrush

• Characterized by white patches in the mouth,
  gums, or tongue
• Treated with oral Nystatin suspension swish
  and swallow

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Dermatophytosis (Ringworm)

• Tinea Capitis fungal
• infection known as
• ringworm
• Transmission
• Person-to-person
• Animal-to-person

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SS

• Scaly, circumscribed patches to patchy, gray
  scaling areas of alopecia.
• Pruritic
• Generally asymptomatic, but severe, deep
  inflammatory reaction may appear as boggy,
  encrusted lesions (kerions)

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• http//www.ecureme.com/quicksearch_reference.asp

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Clinical manifestations

• Fungal infection of the stratum corneum, nails
  and hair (the base of hair shaft causing hair to
  break offrarely permanent)
• Scaly, patches
• Pruritis
• Generally asymptomatic, but severe reactions may
  appear as encrusted lesions

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Tinea signs and symptoms
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Therapeutic Interventions

• Transmitted by clothing, bedding, combs and
  animals (cats especially)
• May take 1-3 months to heal completely, even with
  treatment
• Child doesnt return to school until lesions dry

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Diagnosis

• Potassium hydroxide examination
• Black Light

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Medication Therapy

• Antifungals
• Oral griseofulvin (Lamisil)
• Give with fatty foods to aid in absorption
• Treatment is 4-6 wks
• Can return to daycare when lesions are dry

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Pediculosis Capitis (lice)

• 
  http//www.emedicine.com/emerg/topic409.htm
• a parasitic skin disorder caused by lice
• the lice lay eggs which look like white flecks,
  attached firmly to base of the hair shaft,
  causing intense pruritus

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Diagnosis

• Direct identification of egg (nits)
• Direct identification of live insects

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Pediculosis

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Medication Therapy

• Treatment shampoos RID, NIX, Kwell(or Lindane)
  shampoo is applied to wet hair to form a lather
  and rubbed in for at least amount of time
  recommended, followed by combing with a
  fine-tooth comb to remove any remaining nits.

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Scabies

• http//www.nlm.nih.gov/medlineplus/scabies.html
• Sarcoptes scabei mite.  Females are 0.3 to 0.4 mm
  long and 0.25 to 0.35 mm wide.  Males are
  slightly more than half that size.
• A parasitic skin disorder (stratum corneum- not
  living tissue) caused by a female mite.
• The mite burrows into the skin depositing eggs
  and fecal material between fingers, toes, palms,
  axillae
• pruritic grayish-brown, thread-like lesion

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• http//www.aad.org/pamphlets_spanish/sarna.html
• Scabies between thumb and index finger
• On foot

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Therapeutic Interventions

• transmitted by clothing, towels, close contact
• Diagnosis confirmed by demonstration from skin
  scrapings.
• treatment application of scabicide cream which
  is left on for a specific number of hours (4 to
  14)to kill mite
• rash and itch will continue until stratum corneum
  is replaced (2-3 weeks)

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Care

• Fresh laundered linen and underclothing should be
  used.
• Contacts should be reduced until treatment is
  completed.

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