2. The Child with an Integumentary Alteration Chapter 49

3. Streptococcal diseases –Impetigo Characterized by honey-colored lesions Usually are secondary to insect bites If only one or two, may use ointment but for more, oral antibiotic must be used –Cat-scratch disease Characterized by lymphadenopathy, fever, and malaise Gives lifetime immunity

4. Fungal infections –Superficial fungal infections Tinea cruris – jock itch Tinea pedis – athlete's foot Tinea capitis - ringworm Tinea corporis – fungal infection of the epidermis –Candidiasis Orally in babies, called thrush and treated with oral Nystatin Orally in adults, think HIV In diaper area, characterized by satellite lesions and treated with Nystatin cream

5. Herpes Simplex Virus Infection –Herpes simplex types 1 and 2 are responsible –Types Herpes labialis (cold sores, fever blisters) Herpetic gingivostomatitis Herpetic ocular infection Herpetic whitlow Genital herpes (rare in children, suspect child abuse) –Diagnostic Evaluation Usually inspection but can do Tzank smear –Intervention Symptomatic, if early in outbreak, Zovirax may be given

6. Lice Types –Pediculosis Capitis –Pediculosis Corporis –Pediculosis Pubis Management –Kwell Can be neurotoxic if left on too long –OTC meds Effective and safer to use –Ovide Good but flammable

7. Scabies Caused by a mite that burrows under the skin Extremely pruritic, especially at night Look for intradigital infestation Treated with Elimite or Kwell –Must be left on overnight –Pruritis may continue

8. Atopic Dermatitis In infants, associated with formula feedings and early introduction of solid foods S/S –Red, bumpy, itchy skin –Lichenification –Often found behind the ears, cheeks, & extensor/flexor surfaces

9. Therapeutic management –Reduce exposure to allergen –Reducing pruritis Topical corticosteroids…must be careful with this, especially on the face due to scarring and may only use for 14 days Elidel Avoidance of hot baths, restrictive clothing, soaps Must stay moisturized at all times

10. CONTACT DERMATITIS Assessment –S/S…pruritic fluid filled vesicles Therapeutic management –Hydrocortisone cream, Elidel, Benedryl, Calamine lotion, Aveeno Baths –Avoid allergens –Common offenders Poison Ivy Soaps Latex Disposable Diapers Nickel

11. Insect bites and stings Assessment –0.5-5% of population have anaphylactic response –May take 10-12 stings to reach anaphylactic reaction –Time from sting to death is ~10 minutes Therapeutic management –EpiPen will last 20 minutes, then to hospital –Responsible adult assigned to administer –Ice applied reduces venom absorbed –Avoid scented lotions, etc, outside chores, garbage cans

12. Viral infections of the integumentary system –Warts (Verrucae) Human Papillomavirus causes abnormal epidermal growth –Verrucae vulgaris (common wart) –Plantar wart –Verrucae plana (flat wart) –Verrucae filiform (genital wart) All warts are hard to get rid of! –Things that look like warts but are not: Molluscum Contagiosum –Caused by a virus but will spontaneously disappear within six months –Have an indented or umbilicated center –Not on palms or soles

13. Viral infections of the integumentary system –Pityriasis rosea “Christmas tree” rash, has an initial lesion called a herald patch Lasts for 6-8 weeks and is pruritic

14. Acne More common in boys than girls, can have severe social consequences for adolescents New research shows the acne is not affected by food Treatment –OTC remedies –Rx remedies

15. Burns Burn injuries can be intentional or unintentional For minor burns and scalds, stop the burning by immersing into cold water Most superficial burns are sunburns See Figure 49-4 for depth of burn injury chart Severe scarring is the rule for burns so psychological factors must be part of the plan of care

16. Burns Management –Topical…Silvadene is applied to prevent secondary infections and to keep the eschar soft –Debridement Very painful but reduces infection Child must be premedicated with Morphine –Grafting Homografting comes from donors, dead and alive Heterografting comes from animal donors Autografting comes from another site on the patient