Rashes and the School Nurse Suzey Delger RN, MSN, FNP-c There is no conflict of interest-rats

HISTORY, HISTORY & MORE Get a history: MOST IMPORTANT! Location? Localized or generalized? Where on body? Frequency? Has it happened before Quantity? Can you count the bumps? Quality? Describe the lesion. Associated Phenomenon: Serious rashes kids will appear ACUTELY ILL!

History Aggravating factors: what made it worse? Alleviating factors: what made it better?

Arrangement Discrete: distinct and discretely separate from each other Linear: Straight line Annular: Circle Grouped: closely adjacent to each other, herpes will always be grouped. Serpiginous: wave/snake like eg. scabies

Macule: <1.0 cm Flat Color Changes Café-au-lait Vitiligo Fifths Disease This is a picture of 5ths disease, lacy rash

Patch >1.0cm Large macule Flat > 1 cm Port Wine Stain Diffuse vitilligo Peri-anal strep Vitilligp

Papule < 1.0 cm Solid, raised Roseola Molluscum* Lichen Planus

Pityriasis

Pityriasis can look like chickenpox

Plaque >1.0cm Solid Raised Flat top Distinct borders Ecema Psoriaisis* Severe psoriasis

Nodule Raised Solid lesions Indistinct borders Palpable This is a wart Picture of a severe wart

Wheal or Uticaria Can be associated with allergy, strep, & viral illness. Virtually anything can cause HIVES Uticaria=HIVES

Vesicles Raised Lesions Clear Fluid <1.0 cm Chicken Pox* This is chickenpox

Bullae >1.0 cm Raised lesion filled with clear/bloody fluid Staph These are treated warts with Blister Beetle Juice. Treated wart with blister beattle juice

Cyst Raised lesion that contains a palpable sac filled with more solid fluid. Gangilion cyst not pus filled but fiberous that can be broken down with pressure. Cyst, of some kind.

Pustules Raised lesions filled with fluid or excudate. Can be benign or sign of infection. These are pimples up close.

Petechiae/Purpura Always worrisome if they appear for no apparent reason. r/o leukemia, but can be simply a decrease in platelets/viral infection caused.

Dermatitis: What does it mean to you? Dermatitis to most of us means a “rash”, associated with Itchy Skin Visible Flexural dermatitis/ecema Onset under age of 2

Contact Dermatitis Intense,redness, blisters. Allergic reaction to metals. SNAPS ON PANTS. Or it can be contact with Poison Ivy.

Contact Dermatitis cont. This is Poison Ivy exposure.

Common childhood skin disorders/ Scabies This is a picture of highly contagious scabies. Must be treated with Ovide or Lindane. Do not touch with bare hands.

Chiggers Chiggers are more common in the south. What can you teach me about these bugs? How do you treat them?

Bed Bugs are BACK! There has been an increase in bed bugs in the USA. These bugs can live in the WOOD of the bed frame for months. Treatment is a PESTICIDE.

Ticks and diseases. Can cause many different diseases, such as Lymes disease, Rocky Mtn. Spotted Fever, and Tulermia.

Lymes disease. Target lesions. Spirochete that mimicks syphillis. Can cause permanent brain damage. Important part of “rash surveillance”

Hand, Foot and Mouth Disease Common among elementary, especially primary grades. No known treatment caused by Coxsaxie virus. Avoid exposure newly pg. women.

Toxic Shock Syndrome Don’t forget about this life threatening disease among young teen girls and boys too. Caused usually by Staph, can occur post-partum.

From the SEA! This is a lesion caused from a Man-o-war, sting ray. Very painful, No antidote.

Continued from the Sea! Jelly fish bite, again very painful. Treatment? I learned from my Alabama friends that ‘ammonia’, urine, and meat tenderizer is the most common cure!

Impetigo Our favorite! Usually caused by strep or staph. Can be tx. With antibiotic ointment, or oral antibiotics.

What could this possibly be? What is this critter that is spread by brushes, hats, and mostly sleep-over’s and MAKE SCHOOL NURSE’S NUTTY?

Web sites that work for you! What is this? www.dermnet.com www.dermatlas.com Click on photo gallery and be ready to be entertained! Thanks for having me! What is this mystery slide? Fire Ant bites!

One more fun thing!