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Skin Disorders
Marlene Meador RN MSN
Compare skin differences

Infant: skin not mature at birth
 Adolescence: sebaceous glands become
enlarged & active.
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.
Skin Assessment

Assess history
 Assess exposure
 Assess character
 Assess sensation
Impetigo
 Hemolytic

Strept infection of the skin
Incubation period is 7-10 days after contact
 Page 1365 McKinney

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- both topical and
systemic
 Patient education

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
Cellulitis
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
Candiditis- Thrush
Overgrowth of Candida albicans
Acquired through delivery
Assessment
 Inspect
mouth
 Assess
for difficulty eating
 Assess
diaper area
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
Dermatophytosis (Ringworm)

Tinea Capitis

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
Diagnosis
 Potassium
 Black
hydroxide examination
Light
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®)
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
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?)
Herpes Simplex Virus
Herpes Simplex

Priority nursing interventions:
– Prevent secondary infections
– Maintain adequate nutrition (if oral outbreak)
– Prevent spread to others
 Universal precautions
 Isolation from susceptible individuals
What should the nurse report?
“Child sexual abuse should be
considered in any child with a genital
herpes infection.”
Pediculosis Capitis (lice or
cooties!)


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
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
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 replace (2-3 weeks)
Care:
Fresh
laundered linen and
underclothing should be used.
Contacts should be reduced
until treatment is completed.
Treat all members of the family
Contact Dermatitis
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 Dermatitisskin inflammation
from skin-to-irritiant
contact
– Soaps/detergents
– Clothing dyes
– Lotions, cosmetics
– Urine ammonia
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
Interventions & Nursing Care

Prevent secondary infection- control itching
 Moisturize skin
 Remove irritants
 Medication
 Parent teaching- long term
Acne
http://www.pathology.iupui.edu/drhood/acne.html
ACNE
Assessment
Closed
Open
lesions
lesions
Inflamed
lesions
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
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)
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
Thank you,
let me know if you have any
questions regarding my
lectures.
>^,,^<
[email protected]