Pediatric Skin Disorders

Compare skin differences

Infant: skin not mature at birth Adolescence: sebaceous glands become

enlarged & active.

Skin Assessment

Assess history Assess exposure Assess character Assess sensation

Dermatitis

Dermatitis

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

Dermatitis

Common irritants:

Soap, fabric softeners, lotions, urine and stool

♦ Common allergens

poison ivy, poison oak

lanolin, latex, rubber

nickel, fragrances

Dermatitis: signs and symptoms

Erythema Edema Pruritus Vesicles or bullae

that rupture, ooze and crust

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

Eczema

Chronic superficial skin disorder characterized by intense pruritis

Eczema: signs and symptoms

Erythematous patches with vesicles Pruritis Exudate and crusts Drying and scaling Lichenification

(thickening of the skin)

Eczema, cont.

Goal of Treatment

Hydrate the skin

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!

Acne

Acne

Inflammatory disease of the skin involving the sebaceous glands and hair follicles.

Contributing factors include: heredity, hormonal influences and emotional stress

Acne: Three main types

Follicular plugs Pustular papules Cystic nodules

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

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

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

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

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

Therapeutic Management

Apply moist soaks of Burrow’s solution Apply moist soaks of Burrow’s solution Antibiotic therapy: Keflex for 10 days Patient education

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?

Candiditis- Thrush

Overgrowth of Candida albicans

Acquired through delivery

Thrush

Characterized by white patches in the mouth, gums, or tongue

Treated with oral Nystatin suspension: swish and swallow

Dermatophytosis (Ringworm)

Tinea Capitis fungal

infection known as

“ringworm”

Transmission: – Person-to-person – Animal-to-person

S&S:

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)

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

Clinical manifestations

Fungal infection of the stratum corneum, nails and hair (the base of hair shaft causing hair to break off…rarely permanent)

Scaly, patches Pruritis Generally asymptomatic, but severe

reactions may appear as encrusted lesions

Tinea: signs and symptoms

Therapeutic Interventions

Transmitted by clothing, bedding, combs and animals (cats especially)

May take 1-3 months to heal completely, even with treatment

Child doesn’t return to school until lesions dry

Diagnosis

Potassium hydroxide examination

Black Light

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

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

Diagnosis

Direct identification of egg (nits)

Direct identification of live insects

Pediculosis

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.

Scabies

http://www.nlm.nih.gov/medlineplus/scabies.htmlSarcoptes 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

http://www.aad.org/pamphlets_spanish/sarna.html

Scabies between thumb and index finger

On foot

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)

Care:

Fresh laundered linen and underclothing should be used.

Contacts should be reduced until treatment is completed.