Pediatric Skin Disorders Revised Summer 2007

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

Atopic / Contact Dermatitis  Atopic/Eczema – Cause unknown – Genetic family hx – Develop asthma or allergic rhinitis later – Symptoms begin age 1 to 4 months  Contact Dermatitis- skin inflammation from skin-to-irritiant contact – Soaps/detergents – Clothing dyes – Lotions, cosmetics – Urine ammonia

Atopic dermatitis  Prevalence increasing  Some immune dysregulation  3 stages: infancy, childhood, adult  Secondary infections common – Staph aureus most common – Hyperpigmentation may occur

Assessment & Diagnosis  Infants- Papulovesicular rash and scaly red plaques  Extremely pruitic and dry skin  Childhood- increases with emotional upset, sweating, irritating fabrics  Other triggers- milk, eggs, wheat, soy, peanuts, fish

Interventions & Nursing Care  Prevent secondary infection- control itching  Moisturize skin  Remove irritants  Medication  Parent teaching- long term

Diagnosis / Assessment  Infancy  Childhood

Tzanck test 

Impetigo 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  Antibiotic therapy  Patient education

Candiditis- Thrush Overgrowth of Candida albicans Acquired through delivery

Assessment  Inspect mouth  Assess for difficulty eating  Assess diaper area

Therapeutic Interventions  Medication  Nursing Care

Dermatophytosis (Ringworm)  Tinea Capitis  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)

Diagnosis  Potassium hydroxide examination  Black Light

Medication Therapy  Oral- systemic  Topical

Patient Teaching  transmitted by clothing, bedding, combs and animals  may take 1-3 months to heal completely, even with treatment  Child doesn't return to school until lesions dry

Pediculosis Capitis (lice)   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.

Patient Teaching  Follow directions of pediculocide shampoos  Comb hair with fine-toothed comb to remove nits  Transmission, prevention, and eradication of infestation

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

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.

Acne

Assessment  Closed lesions  Open lesions  Inflamed lesions

Medication Therapy:  Topical  Oral

Acne vulgaris treatment

Therapeutic Management  Goal- to prevent scaring and promote positive self image in the adolescent  Individualized according to the severity of the condition  3 to 5 months required for optimal results (4 to 6 weeks for initial improvement)

Nursing Implications  Provide information regarding the treatment regimen  Provide support and promote positive self image  Provide accurate information on the length of time required for effective treatment