1. Skin Disorders

2. Vesicles or pustule surrounded by edema and redness
Impetigo
Vesicles or pustule surrounded by edema and redness

3. Impetigo
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
Describe the appearance of impetigo.

4. Impetigo group a hemolytic strep infection of skin.
Impetigo became infected
group a hemolytic strep infection of skin.
Incubation period is 2-5 days after contact
Easily spread merely by touching another part of skin after scratching infected area.
What is the causative organism for impetigo?

5. Therpeutic Management
Apply warm, moist soaks to soften lesions, remove crusts
Apply Bactroban TID to cleaned lesions
Cephalexin (keflex) for 10 days
Teach good handwashing and hygiene to prevent spread, keep fingernails short
What is the treatment?
Topical-
Systemic-
What information must the nurse include when providing instructions for hygiene and contagion for this condition?

6. Impetigo Be alert for signs of acute glomerulonephritis,
If the impetigo was caused by beta-hemolytic streptococci
What serious condition occurs as a secondary infection related to impetigo?

7. Therapeutic Interventions
Goal - prevent scarring and promote positive self-image.
Individualize treatment to gender, age, and severity of infection.
It takes 4-6 weeks to begin to see improvement, with optimal results in 3-5 months.
What is the major nursing implication here?
See caring for child with impetigo on page 1343.

8. Fungal or yeast infection also known as Thrush
Oral Candidiasis
Fungal or yeast infection also known as Thrush
What is the causative organism of thrush?

9. Oral Candidiasis - causes
Passing through an infected birth canal
Child who is on immunosuppressant's
Exposure to mothers infected breasts
Unclean bottles and pacifiers
How does the newborn/infant contract this condition?

10. Oral Candidiasis - Manifestations
White curdlike plaques on tongue, gums, and buccal mucosa
How to differentiate from milk
Thrush is very difficult to remove and bleeding of the area when plaques are removed.
What are the signs and symptoms? How would the nurse differentiate between thrush and milk curds?

11. Oral Candidiasis – Treatment
Oral Nystatin suspension
Swish and swallow
Rub medication on the area with gloved hands
Apply after meals
Oral fluconazole administed 1/day orally
Clean pacifiers, bottles, etc.
Provide cool liquids for the older child
What are treatment measures? When is the preferred time of medication?
What teaching is important to include in preventing reoccurrence?

12. Caused by a group of fungi called dermatophytes
Tinea / Ringworm
Caused by a group of fungi called dermatophytes
What is the causative organism?

13. Clinical Manifestations
fungal infection of the stratum corneum, nails and hair(the base of hair shaft causing hair to break off-rarely permanent.
Scaly, circumscribed patches to patchy, gray scaling areas of alopecia.
Pruritic itching
Generally asymptomatic, but severe, deep inflammatory reaction may appear as boggy, encrusted lesions (kerions)
What are the signs and symptoms?

14. Tinea pedis or athletes foot
Tinea capitis
Tinea corpus
Tinea cruis
Tinea pedis or athletes foot
What are common sites for infection?

15. Drug Therapy: Antifungal Medication: Oral griseofulvin
Give with fatty foods to aid in absorption
Treatment is for weeks
Can return to day care when lesions are dry
Avoid sun exposure
Nizoral, Diflucan, Lamisil – used only in older children because of risk of hepatoxicity
What is the treatment?

16. See Home Care for Child with Tinea infection on
Teaching
transmitted by clothing, bedding, combs and animals (cats)
may take 1-3 months to heal completely, even with treatment
Child doesn't return to school until lesions dry.
See Home Care for Child with Tinea infection on
page 1347.
What are treatment measures?

17. Pediculosis
Lice infestation

18. Pediculosis Capitis (lice or cooties!)
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
What are characteristic features of head lice?
What are the signs and symptoms?

19. Lice assessment
Close examination of scalp reveals (nits) firmly attached to hair shafts.
Easily transmitted by clothing towels, combs, close contact, unrelated to hygiene.
What is the most common mechanism of detection?

20. Goals of Care
Kill the active lice
Remove Nits
Prevent Spread

21. Treatment and Nursing Care
pediculicide, permethrin (NIX) crème rinse
Applied to washed and towel dried hair. Massage into the hair and scalp one section at a time.
**Wet hair dilutes the product and may contribute to treatment failure.
Leave in place for 10 minutes and rinse
Towel dry
Comb hair with a fine-tooth comb to remove any remaining nits.
Repeat in 1-2 weeks

22. Treatment and Nursing Care
Ovide
Approved for treatment in older children only.
Must have prolong contact (8-10 hrs) to be effective
Lindane (Kwell) is no longer approved for treatment

23. Scabies
Mite infestation

24. Scabies
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

25. Scabies
Scabies is spread from person to person mainly by prolonged direct skin-to-skin contact, such as touching a person who has scabies. In rare cases, scabies can spread by contact with clothes, towels, bedding, and other personal items that were recently in contact with an infected person.
The mites live on human blood and need the warmth
of the human body to survive. Away from the body, they die within 48 hours.

26. Scabies
Scabies between thumb and index finger On foot

27. 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 replace (2-3 weeks)

28. Care: Fresh laundered linen and underclothing should be used.
Contacts should be reduced until treatment is completed.

29. DERMATITIS
Inflammation of the skin that occurs in response to contact with an allergen or irritant

30. Dermatitis Common Irritants
Soap, fabric softeners, lotions, urine and stool
Common Allergens
Poison ivy, Poison oak
Lanolin
Latex, rubber
Nickel
Fragrances

31. Dermatitis – Signs and Symptoms
Erythema
Edema
Pururitus
Vesicles or bullae that rupture, ooze and crust

32. Dermatitis - Treatment
Medications
Application of a corticosteroid topical agent – remind to continue use for 2-3 weeks after signs of healing
Application of protective barrier ointments
Oatmeal baths, Cool compresses
Antihistamines given for sedative effect

33. Treatment of Dermatitis

34. Chronic superficial skin disorder characterized by intense pruritis
Eczema
Chronic superficial skin disorder characterized by intense pruritis
7. What is the etiology an d

35. Eczema Immune disorder of the skin
Influenced by genetic predisposition and external triggers
Tends to occur in children with hereditary allergic tendencies

36. Eczema – Signs and Symptoms
Erythematous patches with vesicles
Pruritus
Exudate and crusts
Drying and scaling
Lichenification (thickening of the skin)

37. Reduce the amount of allergen exposure
Goal of Treatment
Hydrate the Skin
Reduce the amount of allergen exposure
Relieve Pruritis

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

39. Acne- Three Main Types ACNE Comedomal- noninflammatory follicular plug
Cystic- nodules and cysts
Papulopustular- papules and pustules

40. Precipitating factors
Heredity
Hormonal influences
Emotional stress
Heat and Humidity

41. 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.

42. Medical Therapy for Acne
Topical: Benzoyl Peroxide, Tretinoin (RetinA), tetracycline and erythromycin. Topical agents are preferred treatment to systemic antibiotics, however increases in antibiotic resistant bacteria may require use of systemic antibiotics.
Oral: Tetracycline, minocycline, erythromycin and clindamycin- used for severe inflammatory acne or resistant to topical medications. Estrogen may also work for female patients. Isotretinoin (Accutane)- side effects include cataracts, dry skin, pruritius, conjunctivitis, nosebleeds and depression. Also a teratogen!

43. Acne – Nursing Care

44. THE END