1. Integumentary system
Dr: SAHAR Anwar rizk

2. Anatomy and physiology :
Dermis: consists largely of fibroblasts
Sebaceous gland: are active at birth due to influence of maternal hormone
Apocrine glands: become functional around 8-10 years

3. Skin disease in children may be due to any of the following:
Bacterial infection: as impetigo contagiosa or cellulitis
fungus: as Candida
Skin Parasites: in scabies or pediculoses

4. A-Bacterial infection: 1- (impetigo contagiosa)
It is a highly contagious superficial skin bacterial disease (staphylococcus aureus, bacteria hemolytic streptococci)
IT characterized by localized inflammation and infection in epidermis
There is two major disease cause impetigo
1-characterized by crusted lesion
2-characterized by fragile bulla( brown shriner)

5. Incidence and Etiology
It is more prevalent during mid to late summer& humid climate
Peak incidence among children 2-6 years,
Causes :
poor sanitation
It most commonly spread by direct contact

6. Clinical manifestations
Lesion that begin as small red macules and progress to small, thin vesicles or pustules that rupture easily and exposed weeping .The crusts fall &no traces.
Systemic symptoms such as : weakness, fever & diarrhea
It appear in the face, around the mouth
Pruritus is associated with child scratches

7. Treatment and Nursing Management
Eliminating the causative organism:
1- By topical antibiotic therapy in case of few lesions
2-If lesion wide spread or don’t respond, administer oral systematic antibiotics.
3-Nursing Assessment :
Observe for presence of high temp, respiratory rate, heart rate, dermatitis,
lymphadenopathy .

8. Teach the care giver to :
Prevent the spread of infection & complication& isolate the child
Careful hand washing before and after contact with the child
Ask the child to don’t touch the lesion when awake
Use comfort measure :
-such as genital soaking & remove the crust with warm soapy water.
-Keep the child nail cut short

9. 2-Cellulitis
Cellulites : is a bacterial infection involving the dermis and subcutaneous gland
Incidence and Etiology:
-occur at any age
-1-2 days following trauma that disrupt the skin
-Streptococcus pyogenes &staphylococcus
-children with cellulites of head have incident of trauma
Path physiology :bacteria inter the skin ,
after minor trauma
infection in connective tissue

10. Clinical manifestation
Erythema, swelling, warmth, and pain
Lymphangitis , lymphadenopathy,
Systemic symptoms as: fever, chills, malaise
Child with facial erythema due to influenza type B are at risk for meningitis

12. Treatment& Nursing management
Systemic antibiotic
Hospitalization in case of febrile & acutely ill & use IV antibiotic
COMFORT Measure:
Warm compresses to increase circulation
Cold compresses used to relive pain
Immobilization is recommended for comfort and decrease edema

13. B-Fungal infection The body has several defense mechanisms:
Nutritional status
General health
Skin properties: as PH, Rate of epithelial turn over inhibit fungal infection

14. 1-Candidiases
Candidiases & moniliases are the most common type of infection
Candida albicance a commensally fungal of the mouth & gastroenteritis
It exist in 2 form yeast and spore
Incidence and Etiology:
Incidence of thrush in infant 2-4%

15. candidiasis

16. Candidia diaper

17. Etiology :
A-Causes related to child :Alteration in immune system & from vaginal canal& bottle nipple
Use of antibiotic therapy &endocrine disease & immunosuppressive therapy
Child with anemia &asthma (corticosteroid)
B-Causes related to diaper:
have macerated mucous membrane
Improper use of diaper
Wear of nylon

18. Clinical manifestation
Thrush:
Creamy whit plaque on mucus membrane and lateral border of the tongue
Lesion cover the oral cavity &cause mild discomfort
Candidal diaper :
Acute onset of erythema begin in perineal area
erythematous skin occur in apposed surface as axillae

19. Treatment& Nursing management
Candidal diaper:
change diaper as soon as soiled
Avoid over washing the skin
Apply ointment as Zink oxide nystatine cream & or 1%hydrocortisone
keep the area dry and exposed to air
Thrush:
Oral nystatin 4-6 hrs interval &continue 48hrs after resolution of the symptom
nystatin cream to nipple with Candida

20. 2- tinea
Definition:
It is a superficial fungus infection of the skin. It is highly contagious
Classification: according to part affected
worm of Ring scalp (Tinea Capital)
worm of Ring of skin (Tinea corporis)
worm of Ring of feet (Tinea pedis)

21. Tinea Capital
It is the most common dermal infection children & occur frequently at school age
It transmitted more often from contact with fomites than direct contact
Clinical manifestation:
Lesion inform of circular patch about 2inch in diameter with or without alopecia
Alopecia are demarcated with or without erythema
Skin become scaly & black dotes result from broken hair
crusting, pustules ,and lymphadenopathy
Kerions ,are moist, boggy, scalp nodule

22. Tinea capital

23. Treatment& Nursing management
Oral administration of grisefofulvin +the use of shampoos containing 1%selenium sulfide help to limit the spread of spores.
Terbinafine & fluconazole help in short treatment
Head should covered with skull cap that must be washed daily
All object that have come into contact with the infected child must clean thoroughly.

24. Infestation A-scabies : -caused by scabies mite
-it transmitted from person to person
- Incubation period 2-6 week during this period the infection can transmitted
-Parasite burrows itself in the skin for depositing egg

26. Clinical Manifestation
Parts that involved are moist, wet skin i.e, axilla, between fingers, toes, around umbilicus, genitalia.
Lesions appear as dark blue lines indicating the path used by the itch mite to burrow itself& color due to fecal deposition
Sever itching
in second infection ,papules, vesicles, pustules occur

27. Treatment& Nursing management
Permethrin or preparation contain DDT as benzyle
The child should bathe in tepid water the skin dry, the scabicide applied
Attention should given to folded area
Then child put in clean clothes
All child clothes and bedding should be washed in hot water and dried in a hot dryer
Cut the nail &prevent the scratch.

28. pediculosis It is infestation of child with pediculi
There are three types:
Pediculosis Capital
Pediculosis pubic : pubic in old, in eyelashes in young children
Pediculosis corporis (body)
Each type caused by different louse

29. Pediculosis capitis Incidence and Etiology :
It is a head lice, it is common in children 3-10 years.
The risk increase in girls ,at school age.
It transmitted through head to head contact.
The classroom considered as a primary source of infestation.

30. Path physiology
Head lice can crawl quickly on dry hair. The female lives on scalp and lay 4-10 egg, it attached to end of hair (nit), water insoluble substance holds the nits to hair

31. Treatment& Nursing management
Use of pediculocides to remove the nit
A solution of 1% permethrin for killing pediculosis
Combing hair with fine toothcomb dipped in hot
Antibiotics if pustules appear in neck
Clothes and head cover should cleaned boiled and dried

32. Clinical Manifestation
Persistent itching , pruritus in the occipital area.
Persistent scratching result in excoriation & secondary infection.
Enlargement of posterior cervical gland

33. Intestinal parasite 1-Ascariases: Etiology: Ascariases lumbricoides
Clinical manifestation :
Abdominal pain, distention
Enlarged abdomen, anorexia, fever
Diagnoses: egg can be detected by stool analysis

34. complication
Intestinal obstruction, pneumonia, cough with blood stain, peritonitis.
Transmission:
Contact with contaminated stool
Food can be contaminated when feces used as fertilizer.

35. incidence Most common in warm climate
Poor sanitary area, in children 1-4 year
Incubation: 4-8 week
Control: -sanitary disposal of feces
-treatment of feces before using as
a fertilizer
-vegetables must thoroughly cooked
or soaked in diluted iodine
Treatment: mebedazole

36. 2-pinworm(enterobius)
It is a nocturnal and itching sleeplessness.
Diagnoses :direct visualization of worm
Complication: move of worm to appendix,
female genital tract, peritoneal
cavity
Transmission: fecal- oral, ingestion or inhalation of egg
egg contaminated any thing as toys.
Incidence: most common in preschool and school child ,in crowded place
Incubation:1-2 months

37. control Good hand washing: After contact with infected child
Bed linen, clothes, after toilet
Keep the child nail short
Treatment:
mebedazole