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


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  • 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


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  • 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


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Lice

  • 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


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Scabies

  • 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


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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


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  • 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


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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


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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


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  • 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


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  • Acne

  • 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


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Burns

  • 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


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Burns

  • 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