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Skin Disorders. Impetigo. Vesicles or pustule surrounded by edema and redness. Impetigo. 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

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Vesicles or pustule surrounded by edema and redness

  • 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

Impetigo became infected

group a hemolytic strep infection of skin.

Incubation period is 2-5 days after contact

Easily spread merely by touching another part of skin after scratching infected area.

therpeutic management
Therpeutic Management

Apply warm, moist soaks to soften lesions, remove crusts

Apply Bactroban TID to cleaned lesions

Cephalexin (keflex) for 10 days

Teach good handwashing and hygiene to prevent spread, keep fingernails short


Be alert for signs of acute glomerulonephritis,

If the impetigo was caused by beta-hemolytic streptococci

therapeutic interventions
Therapeutic Interventions
  • Goal - prevent scarring and promote positive self-image.
  • Individualize treatment to gender, age, and severity of infection.
  • It takes 4-6 weeks to begin to see improvement, with optimal results in 3-5 months.

What is the major nursing implication here?

oral candidiasis

Oral Candidiasis

Fungal or yeast infection also known as Thrush

oral candidiasis causes
Oral Candidiasis - causes
  • Passing through an infected birth canal
  • Child who is on immunosuppressant's
  • Exposure to mothers infected breasts
  • Unclean bottles and pacifiers
oral candidiasis manifestations
Oral Candidiasis - Manifestations
  • White curdlike plaques on tongue, gums, and buccal mucosa
  • How to differentiate from milk
    • Thrush is very difficult to remove and bleeding of the area when plaques are removed.
oral candidiasis treatment
Oral Candidiasis – Treatment
  • Oral Nystatin suspension
    • Swish and swallow
    • Rub medication on the area with gloved hands
    • Apply after meals
  • Oral fluconazole administed 1/day orally
  • Clean pacifiers, bottles, etc.
  • Provide cool liquids for the older child
tinea ringworm

Tinea / Ringworm

Caused by a group of fungi called dermatophytes

clinical manifestations
Clinical Manifestations

fungal infection of the stratum corneum, nails and hair(the base of hair shaft causing hair to break off-rarely permanent.

Scaly, circumscribed patches to patchy, gray scaling areas of alopecia.

Pruritic itching

Generally asymptomatic, but severe, deep inflammatory reaction may appear as boggy, encrusted lesions (kerions)

Tinea capitis

Tinea corpus

Tinea cruis

Tinea pedis or athletes foot

drug therapy
Drug Therapy:

Antifungal Medication:

Oral griseofulvin

Give with fatty foods to aid in absorption

Treatment is for 6- 8 weeks

Can return to day care when lesions are dry

Avoid sun exposure

Nizoral, Diflucan, Lamisil – used only in older children because of risk of hepatoxicity


transmitted by clothing, bedding, combs and animals (cats)

may take 1-3 months to heal completely, even with treatment

Child doesn't return to school until lesions dry.

See Home Care for Child with Tinea infection on

page 1347.



Lice infestation

pediculosis capitis lice or cooties
Pediculosis Capitis (lice or cooties!)

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

lice assessment
Lice assessment

Close examination of scalp reveals (nits) firmly attached to hair shafts.

Easily transmitted by clothing towels, combs, close contact, unrelated to hygiene.

treatment and nursing care
Treatment and Nursing Care

pediculicide, permethrin (NIX) crème rinse

Applied to washed and towel dried hair. Massage into the hair and scalp one section at a time.

**Wet hair dilutes the product and may contribute to treatment failure.

Leave in place for 10 minutes and rinse

Towel dry

Comb hair with a fine-tooth comb to remove any remaining nits.

Repeat in 1-2 weeks

treatment and nursing care1
Treatment and Nursing Care
  • Ovide
    • Approved for treatment in older children only.
    • Must have prolong contact (8-10 hrs) to be effective
    • Lindane (Kwell) is no longer approved for treatment


Mite infestation


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 corneum- not 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

  • Scabies is spread from person to person mainly by prolonged direct skin-to-skin contact, such as touching a person who has scabies. In rare cases, scabies can spread by contact with clothes, towels, bedding, and other personal items that were recently in contact with an infected person.
  • The mites live on human blood and need the warmth

of the human body to survive. Away from the body, they die within 48 hours.


Scabies between thumb

and index finger

On foot

therapeutic interventions1
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)


Fresh laundered linen and underclothing should be used.

Contacts should be reduced until treatment is completed.



Inflammation of the skin that occurs in response to contact with an allergen or irritant


Common Irritants

Soap, fabric softeners, lotions, urine and stool

Common Allergens

Poison ivy, Poison oak


Latex, rubber



dermatitis signs and symptoms
Dermatitis – Signs and Symptoms




Vesicles or bullae that rupture, ooze and crust

dermatitis treatment
Dermatitis - Treatment


Application of a corticosteroid topical agent – remind to continue use for 2-3 weeks after signs of healing

Application of protective barrier ointments

Oatmeal baths, Cool compresses

Antihistamines given for sedative effect



Chronic superficial skin disorder characterized by intense pruritis

  • Immune disorder of the skin
  • Influenced by genetic predisposition and external triggers
  • Tends to occur in children with hereditary allergic tendencies
eczema signs and symptoms
Eczema – Signs and Symptoms

Erythematous patches with vesicles


Exudate and crusts

Drying and scaling

Lichenification (thickening of the skin)

goal of treatment

Goal of Treatment

Hydrate the Skin

Reduce the amount of allergen exposure

Relieve Pruritis



Inflammatory disease of the skin involving the sebaceous glands and hair follicles.

acne three main types
Acne- Three Main Types


Comedomal- noninflammatory follicular plug

Cystic- nodules and cysts

Papulopustular- papules and pustules

precipitating factors
Precipitating factors
  • Heredity
  • Hormonal influences
  • Emotional stress
  • Heat and Humidity
patient teaching
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 therapy for acne
Medical Therapy for Acne

Topical: Benzoyl Peroxide, Tretinoin (RetinA), tetracycline and erythromycin. Topical agents are preferred treatment to systemic antibiotics, however increases in antibiotic resistant bacteria may require use of systemic antibiotics.

Oral: Tetracycline, minocycline, erythromycin and clindamycin- used for severe inflammatory acne or resistant to topical medications. Estrogen may also work for female patients. Isotretinoin (Accutane)- side effects include cataracts, dry skin, pruritius, conjunctivitis, nosebleeds and depression. Also a teratogen!