1. Pediatric Skin Disorders Revised Summer 2007

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

3. Skin Assessment  Assess history  Assess exposure  Assess character  Assess sensation

4. 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

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

7. 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

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

9. Diagnosis / Assessment  Infancy  Childhood

10. Tzanck test 

11. Impetigo http://www.emedicine.com/emerg/topic283.htm Impetigo became infected  Hemolytic Strep infection of the skin  Incubation period is 2-5 days after contact

12.  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

13. Therapeutic Management  Apply moist soaks of Burrow’s solution  Antibiotic therapy  Patient education

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

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

16. Therapeutic Interventions  Medication  Nursing Care

17. Dermatophytosis (Ringworm)  Tinea Capitis  Transmission: – Person-to-person – Animal-to-person

18. 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)

19. http://www.ecureme.com/quicksearch_reference.asp

20. Diagnosis  Potassium hydroxide examination  Black Light

21. Medication Therapy  Oral- systemic  Topical

22. 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

23. Pediculosis Capitis (lice)  http://www.emedicine.com/emerg/topic409.htm  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

24. Diagnosis  Direct identification of egg (nits)  Direct identification of live insects

25. Pediculosis 

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.

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

28. 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

29. http://www.aad.org/pamphlets_spanish/sarna.html Scabies between thumb and index finger On foot

30. 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)

31. Care:  Fresh laundered linen and underclothing should be used.  Contacts should be reduced until treatment is completed.

32. Acne

33. Assessment  Closed lesions  Open lesions  Inflamed lesions

34. Medication Therapy:  Topical  Oral

35. Acne vulgaris treatment

36. 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)

37. 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