1. Lice, Scabies, Pinworm, Ringworm, Impetigo
Infections of the Skin
Lice, Scabies, Pinworm, Ringworm, Impetigo

2. Bacterial p. 694 IMPETIGO CONTAGIOSA—
Appearance: maculovesicular lesion; ruptures easily; crusts form; itchy!
Etiology: Staphylococci
Management: carefully remove crusts with solution; apply topical antibiotic ointment; may need PO or IV antibiotics.
Contagious!--CONTACT precautions indicated if hospitalized.

3. Bacterial MRSA: http://www.cdc.gov/mrsa /
Appearance:often appears as atopic dermatitis in nares and under fingernails Furuncle or Carbuncle
Etiology: Methicillin Resistant Staph Aureus
Management: provide washcloths & towels separate from other family members. Soak in tub with ½ c bleach w/ 5inches of water. Apply mupirocin (Bactroban) to nares bid for 2-4 wks. May require I&D and hospitalization

4. Viral Infections p. 696 Warts Herpes Simplex type 1
Herpes zoster, Shingles
Molluscum contagiosum
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5. Fungal infections
Dermatophytoses—Ringworm also referred to as Tinea Capitis, or Tinea Corporis, or Tinea cruris, or Tinea Pedis
Appearance: ring-like shape, scaly, unilateral, non-pruritic except tinea cruris
Etiology: filamentous fungi— Trichophyton, Microsporum, & Epidermophyton
Management: Oral GRISEOFULVIN, topical antifungal creams e.g. clotrimazole; nystatin, or miconazole, wet compresses or soaks

6. Scabies
Appearance: maculopapular lesions in any skin fold: between fingers, inside elbow, axilla, inguinal area. Watch for discrete papules, burrows, or vesicles
Etiology: scabies mite, Sarcoptes scabiei. Mite burrows into stratum corneum of epidermis.
Management:Apply scabicide—drug of choice is permethrin 5% cream (Elimite). 2oz for adults and 1oz for children. Massage into all skin surfaces. May use lindane 1% cream—only if others are ineffective.
Ivermectin—PO used if topical is not effective. It is NOT recommended for children <5 yrs or <15kg. Treat all family members and friends who have been in contact.
Wash all linens in hot water and dry in hot setting of dryer.
Itching will persist for 2-3 weeks so lotions and antihistamines may be helpful

7. ENTEROBIASIS—Pinworms p.620-1
Diagnosis: Tape test: clear, transparent tape is placed around the end of a tongue depressor. Press firmly against perianal region early in the morning before bath or BM. Place specimen in jar or plastic bag for examination.
Treatment: Anthelmintics are med of choice. (If pyrantel pamoate is RX, teach parents that BM & emesis will be bright red.) Treat ALL family members with oral med and repeat dose in 2 weeks to eradicate eggs.
Wear pajamas and underwear to sleep, take a bath every day, and wash (not shake) all bedding in HOT water and nightclothes (pajamas) after treatment to help prevent reinfection. .
Appearance: Etiology: nematode Enterobius vermicularis. Crowded conditions, in classrooms and daycare centers favor transmission.
Manifestations: gen’l irritability, restlessnes, poor sleep, bed-wetting, distractibility, short attention span, peranal dermatitis and pruritis,

8. PEDICULOSIS CAPITIS (Head Lice)
Appearance:see photos
Etiology:Pediculosis humanus capitis—a common parasite in school-age children. Louse is blood-sucking. Eggs(nits) are laid at night and attach to the hair shaft
Manifestations: itching is only symptom. Often seen in occiput of scalp, behind the ears, nape of neck.
Management:Apply pediculicides and manual removal of nits. Drug of choice: permethrin 1% cream rinse (Nix)— kills lice and nits. No RX needed. Retreat in 7-10 days. Daily removal of nits with metal nit comb essential. Wash all clothing and bedding in HOT WATER and DRY setting on Dryer. Vacuum everything. See p. 699 for more

9. Aren’t you glad to have healthy skin??
The End