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Skin Problems. Paediatric Palliative Care For Home Based Carers. Funded by British High Commission, Pretoria Small Grant Scheme. Skin Problems. Common in children with HIV Often conditions common in all children but more severe Often first sign of HIV infection / HIV disease progressing

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skin problems

Skin Problems

Paediatric Palliative Care

For Home Based Carers

Funded by

British High Commission, Pretoria

Small Grant Scheme

skin problems1
Skin Problems
  • Common in children with HIV
  • Often conditions common in all children but more severe
  • Often first sign of HIV infection / HIV disease progressing
  • Include:

Rashes Slow Healing

Itchy skin Boils or abscesses

Painful sores Drug reactions

Dry skin

issues for a child
Issues for a Child
  • Hygiene dependent on carer
  • ‘Pick up’ infections
  • Distressing symptoms
  • Secondary infections (scratching, picking)
  • May infect others
  • Increased risk of skin infections as HIV disease progresses
preventing skin problems
Preventing Skin Problems
  • Daily washing with soap and water
  • Dry skin well
  • Moisturise skin
  • Wash nappies and clothes regularly
  • Keep Nails short and clean
  • Expose skin to sun and air when



  • Extremely common in children with HIV
  • Caused by Candida infection
  • Commonly found in nappy area or skin folds
  • May be painful for a child
  • May lead to secondary infection


managing thrush
Managing Thrush
  • Expose skin to sun and air
  • Clean area with water
  • Gentian Violet or Nystatin
  • Pain relief (Paracetamol)
  • Wash nappies and clothes well
  • Refer for medication if no improvement


seborrhoeic dermatitis
Seborrhoeic dermatitis
  • Infection/ Inflammation of the skin
  • Highly suggestive of HIV infection
  • Thick, yellow scales on scalp, face, nappy area, behind ears
  • May be itchy and sore
  • May become secondarily infected


managing seborrhoeic dermatitis
Managing Seborrhoeic Dermatitis
  • Ensure child has clean, short nails
  • Wash skin using aqueous cream
  • Moisturise skin
  • Pain relief (Paracetamol)
  • Refer for Chlorpheniramine maleate
  • Refer as antibiotics or steroids may be required
fungal infections
Fungal Infections
  • Tinea Infections (e.g. Ringworm)
  • Flat, round, scaly, dry patches
  • Commonly found on face, trunk, extremities and head (with loss of hair)
  • May become severe, large, pus-filled patches
  • Common and highly infectious


CDC Dr Georg

management of ring worm
Management of Ring Worm
  • Wash infected area with soap and water
  • Ensure thorough hand washing
  • Apply Whitfield’s Ointment
  • Refer for oral Griseofulvin treatment

(1-3 months!)

dry skin and itching
Dry Skin and Itching
  • Extremely common in children with HIV
  • May be very distressing to child
  • May lead to skin infections
  • Avoid use of soaps
  • Bath child in bath oils
  • Moisturise skin with emulsifying ointments in stead
  • South Coast Hospice’s ‘Itch cream’
  • Keep child’s nails clean and short
chicken pox
Chicken Pox
  • Caused by Varicella Zoster virus
  • Rash, developing to crusts
  • Found all over body, particularly on trunk
  • Commonly itchy and painful
  • Highly contagious (spread by contact with sores and secretions)
  • Much more severe than usual chicken pox

CDC/J.D. Millar

managing chickenpox
Managing Chickenpox
  • Pain relief
  • Thorough hand washing
  • Keep child away from young, sick, or elderly people
  • Acyclovir treatment
  • Symptom relief with Calamine, Chlorpheniramine maleate
  • Wash clothes well
  • Antibiotic treatment if infected
complications of chicken pox
Complications of Chicken pox

Complications may occur

  • Secondary bacterial infections
  • Haemorrhagic chickenpox
  • Pneumonia
  • Encephalitis

Refer to Clinic/Hospital depending

on presence of danger signs


shingles herpes zoster
Shingles (Herpes Zoster)
  • Child has had chicken pox before
  • If immune system weakens, the chicken pox virus returns as shingles
  • Extremely painful blisters, in cluster

or line along the line of a nerve

  • Usually down leg, arm, neck, chest,

face, may involve eye

  • Suggestive of HIV in a child



management of shingles
Management of Shingles
  • Analgesia (Paracetamol, Codeine)
  • Oral/IV acyclovir
  • Isolate child from sick, young, elderly
  • Hand washing
  • For itch: Calamine, Chlorpheniramine maleate
  • If infected: Antibiotic treatment (Amoxycillin / Flucloxacillin)
  • Common in all children
  • Very itchy bumps all over body
  • Caused by tiny mites which tunnel under the skin
  • Commonly between fingers and toes, in wrist-folds, around waist, on genitals, palms & soles of feet
  • Scratching causes infection, producing sores with pus
  • Symptom relief with Calamine/Chlorpheniramine maleate
  • Children with HIV commonly get abscesses
  • Any child with an abscess must be referred

for investigation and treatment



  • Flesh-coloured, dome-shaped growths
  • Vary in size from 3mm – 1cm
  • Often indicate advanced HIV disease
  • Commonly occur on the face and can be extremely disfiguring
  • Refer child
drug reactions
Drug Reactions

Children with HIV take lots of drugs

A child may react to these drugs:

  • Exfoliating skin rash
  • Fever
  • Severe pain
  • Risk of dehydration and malnutrition

More common in infected children:

  • Taking Co-trimoxazole
  • Taking anti-TB therapy
  • Starting ARVs (e.g. Nevirapine, Abacavir)   

Refer immediately


skin breakdown
Skin Breakdown

Children with HIV are are more

likely to get skin breakdown

Due to:

  • Malnutrition
  • Immobility
  • Skin infections

This can be prevented through:

  • Good nutrition
  • Regular turning and good skin care for immobile, bed ridden children
  • Treatment of skin infections

Picture of Skin Breakdown


kaposi s sarcoma
Kaposi’s Sarcoma
  • Most common type of cancer affecting people with HIV
  • Less common in children than adults but still seen
  • Pink, red, purple or brown/black, painless, lesions
  • May start on face, mouth, gums, palate or penis


kaposi s sarcoma1
Kaposi’s sarcoma

May lead to skin infections and painful ulcers

May spread to:

  • GI tract ( assess for blood in stool or abdominal pain)
  • Lungs (assess for dry, productive cough)

Care is usually palliative

ARVs may be of benefit

management of skin problems
Management of Skin Problems
  • Good Hygiene
  • Symptom Relief (Paracetamol, Calamine, Chlorpheniramine maleate)
  • Antibiotic and Antifungal treatment
  • Prevent secondary infections (short nails, Gentian Violet)
  • Treatment for secondary infections
  • Children with HIV commonly get a wide range of skin problems
  • These can cause intense itching, pain and distress
  • Preventing skin problems through good hygiene and care is extremely important
  • Delaying treatment for skin problems makes treatment more difficult and complications may occur