the child with an integumentary alteration chapter 49
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The Child with an Integumentary Alteration Chapter 49. Streptococcal diseases Impetigo Characterized by honey-colored lesions Usually are secondary to insect bites If only one or two, may use ointment but for more, oral antibiotic must be used Cat-scratch disease

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Streptococcal diseases
    • Impetigo
      • Characterized by honey-colored lesions
      • Usually are secondary to insect bites
      • If only one or two, may use ointment but for more, oral antibiotic must be used
    • Cat-scratch disease
      • Characterized by lymphadenopathy, fever, and malaise
      • Gives lifetime immunity
Fungal infections
    • Superficial fungal infections
      • Tinea cruris – jock itch
      • Tinea pedis – athlete\'s foot
      • Tinea capitis - ringworm
      • Tinea corporis – fungal infection of the epidermis
    • Candidiasis
      • Orally in babies, called thrush and treated with oral Nystatin
      • Orally in adults, think HIV
      • In diaper area, characterized by satellite lesions and treated with Nystatin cream
Herpes Simplex Virus Infection
    • Herpes simplex types 1 and 2 are responsible
    • Types
      • Herpes labialis (cold sores, fever blisters)
      • Herpetic gingivostomatitis
      • Herpetic ocular infection
      • Herpetic whitlow
      • Genital herpes (rare in children, suspect child abuse)
    • Diagnostic Evaluation
      • Usually inspection but can do Tzank smear
    • Intervention
      • Symptomatic, if early in outbreak, Zovirax may be given
  • Types
    • Pediculosis Capitis
    • Pediculosis Corporis
    • Pediculosis Pubis
  • Management
    • Kwell
      • Can be neurotoxic if left on too long
    • OTC meds
      • Effective and safer to use
    • Ovide
      • Good but flammable
  • Caused by a mite that burrows under the skin
  • Extremely pruritic, especially at night
  • Look for intradigital infestation
  • Treated with Elimite or Kwell
    • Must be left on overnight
    • Pruritis may continue
atopic dermatitis
Atopic Dermatitis
  • In infants, associated with formula feedings and early introduction of solid foods
  • S/S
    • Red, bumpy, itchy skin
    • Lichenification
    • Often found behind the ears, cheeks, & extensor/flexor surfaces
Therapeutic management
    • Reduce exposure to allergen
    • Reducing pruritis
      • Topical corticosteroids…must be careful with this, especially on the face due to scarring and may only use for 14 days
      • Elidel
      • Avoidance of hot baths, restrictive clothing, soaps
      • Must stay moisturized at all times
contact dermatitis
  • Assessment
    • S/S…pruritic fluid filled vesicles
  • Therapeutic management
    • Hydrocortisone cream, Elidel, Benedryl, Calamine lotion, Aveeno Baths
    • Avoid allergens
    • Common offenders
      • Poison Ivy
      • Soaps
      • Latex
      • Disposable Diapers
      • Nickel
insect bites and stings
Insect bites and stings
  • Assessment
    • 0.5-5% of population have anaphylactic response
    • May take 10-12 stings to reach anaphylactic reaction
    • Time from sting to death is ~10 minutes
  • Therapeutic management
    • EpiPen will last 20 minutes, then to hospital
    • Responsible adult assigned to administer
    • Ice applied reduces venom absorbed
    • Avoid scented lotions, etc, outside chores, garbage cans
Viral infections of the integumentary system
    • Warts (Verrucae)
      • Human Papillomavirus causes abnormal epidermal growth
        • Verrucae vulgaris (common wart)
        • Plantar wart
        • Verrucae plana (flat wart)
        • Verrucae filiform (genital wart)
      • All warts are hard to get rid of!
    • Things that look like warts but are not:
      • Molluscum Contagiosum
        • Caused by a virus but will spontaneously disappear within six months
        • Have an indented or umbilicated center
        • Not on palms or soles
Viral infections of the integumentary system
    • Pityriasis rosea
      • “Christmas tree” rash, has an initial lesion called a herald patch
      • Lasts for 6-8 weeks and is pruritic
  • More common in boys than girls, can have severe social consequences for adolescents
  • New research shows the acne is not affected by food
  • Treatment
    • OTC remedies
    • Rx remedies
  • Burn injuries can be intentional or unintentional
  • For minor burns and scalds, stop the burning by immersing into cold water
  • Most superficial burns are sunburns
  • See Figure 49-4 for depth of burn injury chart
  • Severe scarring is the rule for burns so psychological factors must be part of the plan of care
  • Management
    • Topical…Silvadene is applied to prevent secondary infections and to keep the eschar soft
    • Debridement
      • Very painful but reduces infection
      • Child must be premedicated with Morphine
    • Grafting
      • Homografting comes from donors, dead and alive
      • Heterografting comes from animal donors
      • Autografting comes from another site on the patient