Dermatologic Diseases in Children

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Dermatologic Disease in Children

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Composed of : Skin Skin Appendages a. sweat glands b. sebaceous glands c. hairs d. nails I. Anatomy of Integumentary System

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Functions : Protection Sensation Heat Regulation Control of Evaporation Storage and Synthesis Absorption Water Resistance 2 Principal Layers Epidermis Dermis

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Skin Disorders

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Contact Dermatitis an inflammation of the skin caused by direct contact with an irritating substance . Irritant Dermatitis Allergic Contact Dermatitis Overtreatment Dermatitis Types of Contact Dermatitis

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Common Allergens : Poison ivy, poison oak, poison sumac Other plants Nickel or other metals Medications Antibiotics, especially those applied to the surface of the skin (topical) Topical anesthetics Other medications Rubber Cosmetics Fabrics and clothing Detergents Solvents Adhesives Fragrances, perfumes Other chemicals and substances

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Symptoms : Itching (pruritus ) of the skin in exposed areas Skin redness or inflammation in the exposed area Tenderness of the skin in the exposed area Localized swelling of the skin Warmth of the exposed area (may occur) Skin lesion or rash at the site of exposure Lesions of any type: redness, rash, papules (pimple-like), vesicles, and bullae (blisters) May involve oozing, draining, or crusting May become scaly, raw, or thickened

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Diagnostic test : Patch Testing Skin Biopsy Culture Skin Lesion Thorough washing with lots of water Corticosteroid skin creams Tacrolimus ointment or pimecrolimus cream Treatment :

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Prevention : Avoid contact with known allergens. Use protective gloves or other barriers. Wash skin surfaces thoroughly after contact with substances . Avoid over treating skin disorders.

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Scabies an infestation of the skin with the Sarcoptes scabiei mite. Skin to skin contact with the infected person. Sleeping in the bed of someone who has scabies. spread through pets and animals. spread by the ff. : A swimming pool Contact with the towels, bedding, and clothing of someone who has scabies , unless the person has what is called "crusted scabies”. Causes :

Sarcoptes scabiei (var hominis):

Sarcoptes scabiei (var hominis)

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Symptoms : Itching , especially at night Rashes, especially between the fingers Sores (abrasions) on the skin from scratching and digging Thin, pencil-mark lines on the skin Mites may be more widespread on a baby's skin, causing pimples over the trunk, or small blisters over the palms and soles. In young children, the head, neck, shoulders, palms, and soles are involved. In older children and adults, the hands, wrists, genitals, and abdomen are involved.

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Diagnostic test : Skin scrapings after application of mineral oil to look for eggs under the microscope.

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Treatment : Permethrin 5% Benzyl Benzoate Sulfur in Petrolatum Crolamiton - applied 1 time treatment / may be repeated 1 wk. Wash underwear, towel, sleepwear in hot water. Vacuum carpet and upholstered furniture. Difficult Cases: - Ivermectin Cool Soaks and Calamine Lotion

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Complication: Intense scratching can cause a secondary skin infection, such as impetigo. Avoid contact with infected persons. Prevention :

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Atopic Dermatitis Is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency(atopy).

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Infantile eczema – usually begins @ 2-6mos.of age & generally undergoes spontaneous remission by 3yrs.of age. Childhood –may follow infantile form; occurs @ 2-3yrs.of age & 90% of children w/AD will manifest the disease by age 5 yrs. Pre-adolescent & Adolescent – begins @ about 12 yrs. of age & may continue into early adult yrs. or indefinitely. Forms of ATOPIC DERMATitis :

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Pathophysiology :

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Clinical Manifestation : Distribution of lesions Infantile form – generalized, esp. cheeks, scalp, trunk, & extensor surfaces of extremities. Childhood form – flexural areas (antecubital & popliteal fossae, neck), wrists, ankles & feet. Pre-adolescent & Adolescent form – face, sides of neck, hands, feet, face, and antecubital & popliteal fossae. Appearance of Lesions: Infantile – erythema, vesicles, papules, weeping, oozing, crusting, scaling, often symmetric.

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Childhood form – symmetric involvement, clusters of small erythematous /flesh-colored papules/minimal scaling patches. Dry & may be hyper pigmented Lichenification – thickened skin w/accentuation of creases Keratosis pilaris – follicular hyperkeratosis (common) Adolescent/adult form – same as child, dry thick lesions, confluent papules. Intense itching Unaffected skin dry & rough Black children likely to exhibit more papular /follicular lesions.

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May exhibit 1 or more of the ff: lymphadenopathy increased palmar creases atopic pleats prone to cold hands pityriasis alba facial pallor (around nose, mouth, & ears) bluish discoloration beneath eyes (“allergic shiners”). increased susceptibility to unusual cutaneous infections (especially viral),

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Diagnostic Exam : N o specific laboratory findings or histologic features. History Physical Examination exposure to skin irritants. overheating. Therapeutic Management :

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Improve skin hydration by moisturizing substances Administration of meds. such as antihistamines, topical steroids, sometimes mild sedatives as indicated Differing philosophies regarding cleansing & hydrating the skin of the child w/AD focus on 2 methods: Dry method –baths are infrequent, skin is cleansed by nonlipid , hydrophilic agent, cetaphil Wet method – consists of frequent baths (up to 4/day) followed immediately by the application of a lubricant (while skin is still damp), no soap or a very mild, non-perfumed soap (Dove, Lowila, Neutrogena) is used Advocate or oilated oatmeal baths w/light drying for protection Showers then application of moisturizer within 3 min.

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Colloid baths, such as addition of 2cups cornstarch to a tub of warm water provides temporary relief of itching & may help child in sleeping, given before bedtime. Cool wet compresses for soothing and provides antiseptic protection. Moderate or severe pruritus – relieved by antihistamine drug such as hydoxyzine or diphenhydramine . Nonsedating such as fexofenadine or loratidine may be preferred for daytime. Occasional flare-ups require the use of topical steroids to diminish inflammation. Potency may depend on the degree of involvement, age, & type of vehicle to be used. Alternating corticosteroids w/lubricants will reduce the risks associated w/prolonged steroid use. Antibiotic therapy for secondary infection.

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Prevention : Identify children at risk Family history of allergy IgE in record , blood & postnatal serum Dry, flaky skin Pre-natal precautions (last trimester) any known food allergens milk & other dairy products, peanuts, & eggs ingestion of other hyperallergenic foods

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Postnatal precautions Breast milk/casein hydrolysate formula exclusively for at least 6 mos. solid foods for 6 mos. cow’s milk/soy formula for 12 mos. eggs, fish, corn, citrus, peanuts, nuts, or chocolate for 12 mos. One new food added at 5-day intervals to identify possible reaction. Environmental Control Limited to dust, molds, animals, and cigarette smoke.

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Seborrheic dermatitis a chronic, inflammatory reaction of the skin. It is most common in the scalp(cradle cap) but may involve the eyelids (blepharitis), external ear canal (otitis externa), nasolabial fold and inguinal region .

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Clinical Manifestation : Oily, waxy appearance to the skin Flaking skin with scale that ranges in color from white to yellowish brown. Reddish, somewhat swollen patches of skin — often resembling atopic dermatitis (another type of eczema) or psoriasis. Patches can appear on these areas of the body: scalp, hairline, upper lip, beneath the eyebrows, inside and behind the ears, eyelids, creases near the mouth, around the nose, armpits, groin, navel, buttocks, underneath the breasts, and upper back. These areas contain oil-producing glands called sebaceous glands. Skin may itch constantly. Itching and burning are most common when a skin infection develops. When the skin is infected, skin becomes extremely inflamed and itchy.

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Diagnostic exam : Visual examination of the skin and complete medical history. Skin biopsy or other laboratory testing .

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Therapeutic Management : You can treat flaking and dryness with over-the-counter dandruff or medicated shampoos. Shampoo the hair vigorously and frequently (preferably daily). Loosen scales with the fingers, scrub for at least 5 minutes, and rinse thoroughly. Active ingredients in these shampoos include salicylic acid, coal tar, zinc, resorcin, ketoconazole, or selenium. Shampoos or lotions containing selenium, ketoconazole, or corticosteroids may be prescribed for severe cases. To apply shampoos, part the hair into small sections, apply to a small area at a time, and massage into the skin. If on face or chest, apply medicated lotion twice per day. Seborrheic dermatitis may improve in the summer, especially after outdoor activities.

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Nursing Care management : Parents are taught to the appropriate procedure to clean the scalp. Education may need to include a demonstration. Shampooing should be done daily with a mild soap or commercial baby shampoo; medicated shampoos are not necessary., but an antiseborrheic shampoo containing sulphur and salicylic acid may be used. A fine tooth comb or a soft facial brush after shampooing help to remove the loosened crusts from strand of hair after shampooing.

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Impetigo is a superficial infection of the skin, caused by bacteria. The lesions are often grouped and have a red base. The lesions open and become crusty and have a "honey-color," which is typical of impetigo. Impetigo is contagious and can be spread throughout a household, with children reinfecting themselves or other family members.

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Pathophysiology : Organism Damage Skin Infection GABHS

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Clinical manifestation : Most frequently on the face (around the mouth and the nose) or at a site of trauma. Impetigo in an atypical location, such as the scalp, should warrant further investigation for head lice. Red macule or papule as early lesion Lesions with ruptured bullae and crusted edges Lesions with honey- colored crusts Thin-roofed vesicle or bullae (usually nontender) Pustules Weeping, shallow, erythematous ulcer Satellite lesions (often at multiple sites) Bullae on the buttocks, trunk, and face.

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Diagnostic exam : Complete medical history Physical examination Oral antibiotics may be prescribed-For a child with many lesions Prescribe a topical antibiotic applied directly to the lesions. Therapeutic management :

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Nursing care management : Proper hand washing technique by everyone in the household Keep your child's fingernails short to help decrease the chance of scratching and spreading the infection. Avoid sharing of garments, towels, and other household items to prevent the spreading of the infection.

Thermal injury:

Thermal injury

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Burns an injury caused by an exogenous agent that produces a characteristic reaction to local tissues which may vary from mild erythema to full thickness destruction of the skin and deeper tissues . Injuries that result from contact with or exposure to thermal agents, chemical agents, electric, light, and radiation. Thermal agents can be hot liquids or object and flames. Radiation can be sunburn, ionizing radiation, or nuclear radiation. Chemicals like strong acids or alkalis can induce burns. Electric burns can be caused by lightning or from any electrical source.

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Pathophysiology :

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Types and clinical manifestation : First Degree Burns – “Superficial”. Affects the epidermis only. It is erythematous, dry, and painful. Heals 3-6 days. Second Degree Burns – “Superficial partial-thickness”. Affects the epidermis and a part of the dermis. It is moist, pinkish in color, is more painful than the first degree burn, and has vesicles or blisters. Heals 7-20 days. Third Degree Burns – “Deep partial-thickness”. Affects the epidermis, dermis, and subcutaneous tissue. It is pearly white in color, with eschar, and in painless. Heals >21 days. Fourth Degree Burn – “Full thickness”. Affects the epidermis, dermis, subcutaneous tissue, muscle and bone. It is charred and painless. Requires surgical treatment.

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Diagnostic exam : Complete Blood Count Urinalysis, BUN & Serum Creatinine Baseline electrolytes Arterial blood gas determination X-rays (Chest, other areas) Electrocardiography

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Therapeutic management : Output vs. input vs. burn center Increase Fluids / calories intake Pain management Infection prevention Surgical implications Debridement Fasciotomy Escharotomy If circulation or ventilation is compromised Chest burns or circumferential extremity burns Skin grafts / skin substitutes

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Nursing care management : Maintain a patent airway and breathing Administer 100% oxygen via face mask. Place in Fowler’s position. Assess for difficulty of breathing. Check for sooty sputum, erythema, blisters, and singed hair; this indicates inhalation injury . 2. Prevent burn shock Infuse Intravenous fluid (isotonic) Prevent Aspiration Place in Fowler’s Position 3. Wound Care Do daily cleaning and dressing. Irrigate with Normal Saline Solution.

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