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Pediatric Skin Disorders
Compare skin differences
 Infant: skin not mature at birth
 Adolescence: sebaceous glands become
enlarged & active.
Skin Assessment
 Assess history
 Assess exposure
 Assess character
 Assess sensation
Dermatitis
Dermatitis
 Inflammation of the skin that occurs
in response to contact with an allergen
or irritant; also referred to as “contact
dermatitis”
Dermatitis
 Common irritants:
Soap, fabric softeners, lotions, urine and
stool
♦ Common allergens
poison ivy, poison oak
lanolin, latex, rubber
nickel, fragrances
Dermatitis: signs and symptoms
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Erythema
Edema
Pruritus
Vesicles or bullae
that rupture, ooze and crust
Dermatitis: Treatment
 Medications
– Application of a corticosteroid topical agent:
remind pt to continue use for 2-3 wks after
signs of healing
– Application of protective barrier ointments
Oatmeal baths, cool compresses
Antihistamines given for sedative effect
Eczema
 Chronic superficial skin disorder
characterized by intense pruritis
Eczema: signs and symptoms
 Erythematous patches with vesicles
 Pruritis
 Exudate and crusts
 Drying and scaling
 Lichenification
(thickening of the skin)
Eczema, cont.
Goal of Treatment
Hydrate the skin
Treatment of Eczema
 Emollients (creams which lubricate the
skin)
 Oral antihistamines (control itching)
 Antibiotics (treat superinfections)
 Corticosteroids (anti-inflammatories)
 Immunomodulators (inhibit T lymphocyte
activation)
 AVOID SOAPS!
Acne
Acne
 Inflammatory disease of the skin involving
the sebaceous glands and hair follicles.
 Contributing factors include: heredity,
hormonal influences and emotional stress
Acne: Three main types
 Follicular plugs
 Pustular papules
 Cystic nodules
Patient teaching
 Do not pick! This increases the bacterial
count on the surface of the skin and opens
lesions to infection which worsens scarring
 Remind patients that the treatment will not
show improvement until about 4-6 weeks
but they must consistently follow the
regime set up by the physician
Medical treatment for acne
 Topical (Benzoyl peroxide, Tretinoin
(RetinA), topical preferred to systemic;
however, both may be needed
 Oral: Tetracycline, minocycline,
erythromycin; estrogen for female pts.,
Accutane
Acne: Nursing care
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Avoid picking and squeezing
Use gentle skin cleansers
Avoid use of astringents containing ETOH
Avoid hats or abrasive rubbing of the skin
Wash hands after handling greasy foods
Limit use of petrolatum-based hair products; hair
away from face
 Use oil-free makeup, protections from windy,
cold weather
 Continue therapy even when improved
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
 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
Therapeutic Management
 Apply moist soaks of Burrow’s solution
 Antibiotic therapy: Keflex for 10 days
 Patient education
Therapeutic Interventions for
impetigo
 Goal: prevent scarring and promote + self
image.
 Individualize treatment to gender, age, and
severity of infection
 Takes 4-6 wks to improve
 What is the major nursing implication
here?
Candiditis- Thrush
Overgrowth of Candida albicans
Acquired through delivery
Thrush
 Characterized by white patches in the
mouth, gums, or tongue
 Treated with oral Nystatin suspension:
swish and swallow
Dermatophytosis (Ringworm)
 Tinea Capitis fungal
infection known as
“ringworm”
 Transmission:
– Person-to-person
– Animal-to-person
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)
http://www.ecureme.com/quicksearch_reference.asp
Clinical manifestations
 Fungal infection of the stratum corneum,
nails and hair (the base of hair shaft
causing hair to break off…rarely
permanent)
 Scaly, patches
 Pruritis
 Generally asymptomatic, but severe
reactions may appear as encrusted lesions
Tinea: signs and symptoms
Therapeutic Interventions
 Transmitted by clothing, bedding, combs
and animals (cats especially)
 May take 1-3 months to heal completely,
even with treatment
 Child doesn’t return to school until lesions
dry
Diagnosis
 Potassium hydroxide examination
 Black Light
Medication Therapy
 Antifungals:
– Oral griseofulvin (Lamisil)
• Give with fatty foods to aid in absorption
• Treatment is 4-6 wks
• Can return to daycare when lesions are dry
Pediculosis Capitis (lice)
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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
Diagnosis
 Direct identification of egg (nits)
 Direct identification of live insects
Pediculosis
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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.
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 corneumnot 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
http://www.aad.org/pamphlets_spanish/sarna.html
Scabies between thumb and index finger
On foot
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)
Care:
 Fresh laundered linen and underclothing
should be used.
 Contacts should be reduced until treatment
is completed.