1. Marlene Meador RN, MSN, CNE
Skin Disorders
Marlene Meador RN, MSN, CNE

2. Compare skin differences
Infant: skin not mature at birth
Adolescence: sebaceous glands become enlarged & active.

3. Topical Medications
Infants & <2 years-Topical medications should not be used without a physician’s order (due to greater absorption through skin and larger skin to body mass ratio)
Iga does not reach adult levels until 2 to 5 years of age. Infants less resistant to organisms.

4. Skin Assessment Assess history Assess exposure Assess character
Assess sensation

5. Impetigo Hemolytic Strept infection of the skin
Incubation period is 7-10 days after contact

6. 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

7. Therapeutic Management
Apply moist soaks of Burrow’s solution
Antibiotic therapy- both topical and systemic
Patient education

8. Key Nursing Care Prevent secondary glomerulonephritis
Stress teaching to parents:
Soak prior to applying topical antibiotic
Keep child away from anyone <2 years of age
Prevent scratching lesions (spreading)
Keep toys, towels, linens, clothing separate
Clean personal items with bleach solution
May return to public 24 hours after start of antibiotic treatment

9. Cellulitis

10. Cellulitis
Causative organisms- most commonly group A streptococci and S. aureus
Priority Nursing Interventions:
Antibiotic therapy (pt/family teaching)
Warm compresses (why?)
Control of fever and pain
Monitor for sepsis

11. Candiditis- Thrush
Overgrowth of Candida albicans Acquired through delivery

12. Assessment Inspect mouth Assess for difficulty eating
Assess diaper area

13. Therapeutic Interventions
Medication
Oral- for thrush-nystatin suspension or fluconazole
Clotrimazole topically for diaper area
Nursing Care
Sequence of medication and feeding
Treatment of mother if breastfeeding
Care of bottles/nipples and pacifiers

14. Dermatophytosis (Ringworm)
Tinea Capitis
Transmission:
Person-to-person
Animal-to-person

15. 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)

16. (

17. Potassium hydroxide examination
Diagnosis
Potassium hydroxide examination
Black Light

18. Medication Therapy
Oral- systemic- grieseofulvin daily for at least 6 weeks (insoluble in water- take with high-fat meal or with milk products)
Topical-alone not effective for tinea capitis:
Clotrimazole (Lotrimin®)
Miconazole (Monistat®)

19. transmitted by clothing, bedding, combs and animals
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
**child should not return to school until lesions are dry

20. Other Tinea Infections
Tinea Corporis- ringworm not located on the scalp (local topical treatment usually effective)
Tinea Crusis- (athletes get this) similar to corporis, treated topically
Tinea Pedis (any guess what this is?)

21. Herpes Simplex Virus

22. Herpes Simplex Priority nursing interventions:
Prevent secondary infections
Maintain adequate nutrition (if oral outbreak)
Prevent spread to others
Universal precautions
Isolation from susceptible individuals

23. What should the nurse report?
“Child sexual abuse should be considered in any child with a genital herpes infection.”

24. Pediculosis Capitis (lice or cooties!)
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

25. Diagnosis
Direct identification of egg (nits)
Direct identification of live insects

26. 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

27. Scabies http://www.nlm.nih.gov/medlineplus/scabies.html
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

28. Scabies between thumb and index finger
Scabies between thumb and index finger
On foot

29. 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 replace (2-3 weeks)

30. Fresh laundered linen and underclothing should be used.
Care:
Fresh laundered linen and underclothing should be used.
Contacts should be reduced until treatment is completed.
Treat all members of the family

31. Contact Dermatitis
A former student sent these to Marlene when her son accidently used a Clorox® magic eraser to clean his face and arms. The bleach caused 2nd and 3rd degree burns to his skin.
A graphic example of the fragile nature of a young child’s skin.

32. Atopic –vs- 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

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

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

35. Acne
ACNE

36. Assessment
Closed lesions
Open lesions
Inflamed lesions

37. Medication Therapy: Topical- need to reduce bacteria on skin
Benzoyl peroxide
Tretinoin (Retin-A)-avoid exposure to sun
Oral- antibiotics
Tetracycline, minocycline, erythromycin
Isstretinoin (Accutane-no longer available)
Dietary
Hygiene

38. 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)

39. Nursing Implications
Provide information regarding the treatment regimen (don’t forget side effects of antibiotic therapy and relationship to oral birth control)
Provide support and promote positive self image
Provide accurate information on the length of time required for effective treatment

40. Thank you, Please contact Marlene Meador RN, MSN, CNE if you have questions or concerns regarding this lecture content. >^,,^<