Integumentary
Congenital Malformations, Acquired Conditions or Contagions of the Skin:

Newborn rashes and Mongolian spots


Stork bites

Ring worm
Fungus: hair (tinea capitis), trunk (tinea corporis), genital area (tinea cruis, jock itch), feet (tinea pedis, athletes foot)

Treatment depends on area affected
Topical antifungals - Selenium Sulfide 2-3 times a week, topical creams clotrimazole, micronazole, tolnaftate, naftifine
Oral products may be perscribed for resistant cases Griseofulvin or terbinafine

Nursing education:
May be spread from person to person, animal to person, or indirectly by contact with affected linens
Continue to take medicine until gone
*Id reaction may occur after oral medication this is a reaction to the fungus antigen not the medication


Eczema (Atopic Dermatitis)


Chronic skin disorder characterized by intense itching
Affects up to 20% of children with 60% of these cases showing up in the first year
Source is unknown
Combination of genetics, environmental influences, infectious agents, skin defects and immunologic responses contribute
Most have T-cell activation and elevated IgE levels

Triggers include: temperature, stress, humidity, allergens

Generally also have xerosis (dry skin) which cracks and allows allergens to penetrate
Papulovesicular and erythematous lesions, exudate, crusts
Intense itching
Chronic darkened thickened skin with prominent skin lines (lichenification) often seen in creases and behind the knees
No definitive test, history of above symptoms
No cure

Treatment:
Hydrate and lubricate the skin with occlusive topical emollients within 3 minutes of leaving the bath
Further apply creams and moisturizers 3-4 Xs a day
Topical Corticosteroids may help with flare ups
Ointments are preferred over creams
*Prolonged use of topical corticosteroids can lead to adrenal suppression
Oral steroids only used for severe exacerbations




Diaper dermatitis:
Usually 9-12 months but can occur at any time
Urine, feces irritants
Candida albicans (yeast) secondary infection of severe diaper rash or if on antibiotics
Antifungal topical Nystatin or Myconazole are used then a barrier agent such as zinc oxide is applied.
Avoid over washing or commercial wipes alternatives include using a moisturizer, nonsoap cleanser (cold creme) or dove soap and water to clean the skin.

Seborrheic dermatitis:
Chronic inflammatory reaction of the skin. Most common on the scalp of newborns - cradle cap. Thought to be due to the over production of sebum in the infant. Can also occur on the eyelids, external ear canal, nasolabial folds or the inguinal region. Can be removed with baby oil or shampoo which is allowed to soften the crusts. The head is then rinsed and a comb is used to remove the remaining crusts from the scalp.

Pediculosis Capitis - Lice ...
Most common in ages 3-12 years
Less common in AA children
Live and reproduce on humans
Do not jump or fly but do move quickly
Hair to hair contact or indirect with brushes, hats...
(Nits) eggs laid on hair shaft
Lice can only live for 3 days off a live host but the eggs hatch in 8-10 days
Wash clothes in hot water and dry in the dryer for 20 minutes.
If things cannot be washed bag them for 2-3 weeks

Treatment:
Permethrin (Nix) cream rinse or pyrethrin shampoos (Rid), repeat in seven days
Malathion (not as effective), repeat in seven days
Invermectin (oral agent) days 1 and 8.

The lice lady...




Scabies...


Infestation of the mite Sarcoptes Scabiei
Highly contagious, skin to skin
Female mite burrows into the upper epidermis to lay eggs which hatch in 3-4 days
The larvae then come to the surface mature, mate and then burrow again
Cycle repeats every 14-17 days
Reaction to the mites and feces occurs

Symptoms:
Rash
Itching which is worse at night
Burrow lesions may appear like a line
Scratching may obscure
Lesions often between fingers, toes, behind knees, in elbows, inner thighs...warm areas

Treatment:
Bathe then cover the child in 5% permethrin lotion or Lindane from the neck down, especially hands, fingers, toes, under nails
Leave this in place for 8-12 hours then wash off
Use benadryl or atarax for itching which may persist for 6 weeks
Wash clothes and linens in hot water and dry in hot dryer for 40 minutes
Bag other items for 2 weeks


Impetigo...
Bacterial infection
Most common bacterial skin infection
Highly contagious
Face, mouth, nose and hands common
Staph and strep usual culprits
Honey crusted lesions
Topical antibiotics unless extensive (mupirocin)
Child can return to school 24 hours after treatment started






Acne


MRSA (Methicillin-Resistant Staphylococcus Aureus)




Viral Infectious skin disorders:

Molluscum Contagiosum
Caused by the pox virus. Flesh colored papules with a central caseous plug. Will resolve in 18 months or be treated with tretinoin gel or cantharidin liquid curettage or cryotherapy. Spread by skin to skin contact and autoinnoculation.

Warts - (Papillomavirus)
Common in children usually on exposed areas such as fingers, hands, face or feet. Can resolve spontaneously but can autoinoculate. Removal by surgery, electrocautery, cryotherapy, salicylic or retinoic acid.


Vitiligo





















Insect bites and stings:
Occur frequently in children
Concerns are insects that carry disease, are venomous, or can cause an allergic reaction

Anaphylactic Reaction - anaphylaxis
Assist child to remain calm, remove insects or bees, remove stingers, administer benadryl.
If a food stuff is suspected observe for signs and symptoms of severe allergic reaction i.e. swelling, difficulty breathing.
Epinephrine may be necessary.
Once an allergy is known about an epi-pen may be needed.

Lyme Disease
Most common tick borne disease in the US. Caused by spirochete Borrelia burgdorferi which enters through the saliva or feces of ticks.

Stage 1: Tick bite is followed by erythema migrans in 3-31 days.
Stage 2: Systemic involvement of cardiac, neurologic and musculoskeletal systems.
Stage 3: Musculoskeletal pain and neurological symptoms.

Treatment is amoxicillin if <8 and doxycycline if >8.
Erythromycin if allergic to penicillins.

Parental education most important:
Avoid tick areas, wear light colored clothing
Perform tick checks
Be alert to skin rashes
Use insect repellant with permethrin or DEET.
Do not apply these to the face, hands or open sores.
Wash off once inside.

Rocky Mountain Spotted fever
Caused by the dog tick which harbors R. rickettsii.

To remove the tick, grasp with tweezers as close as possible to the point of attachment. Pull straight up.
Must have been on for at least two hours to transmit infection.
Wash hands thoroughly to prevent disease transmission
*Mark day of bite on calendar.
Educate parents to signs and symptoms of disease

Symptoms can occur gradually or suddenly: fever, malaise, anorexia, myalgia, vomiting, severe headache.
Treatment with tetracycline or chloramphenicol.
This disease can be mild in intensity or fulminating and fatal.




Mosquitos, Fleas
Rarely systemic reactions - cool compresses and antihistamines
Can carry West Nile Virus

Bees, Wasps -
Remove stinger
Cool compress
Rub meat tenderizer and drop of water into site for pain, 'After Bite'
Antihistatmines
Severe reactions may need glucocorticosteroids and epinephrine
In case of severe rx keep child calm and get emergency tx

Fire Ants -
Cool compress
Antihistamine
Severe reaction same as for bees

Black widow spider -
Initial sting, can see two fang marks
Apply ice
Antihistamine, opioids, benzodiazepines for muscle spasms,
Hydrocortisone
Antivenom IV for severe reaction (if not allergic to horse serum)

Brown Recluse spider -
Apply ice, cool compresses, cleanse wound
Analgesics for pain
Anti-inflammatory medication
Antibiotics as needed for secondary infection

Snake bites -
Keep below level of heart,
Keep calm (faster heart rate spreads venom faster)
Ice or cool compress to slow spread
Help child identify snake
Remove constricting clothing
Take off rings, jewlry
Antivenom is diluted in IV fluids and administered slowly

Dog bites -
Occur most often with ages 5-9
Report
Rabies investigation

Cat scratch disease -
Caused by the bite or scratch of a cat or kitten.
Positive bite or scratch history
Regional lymphadenitis
Serological identification.
Antibiotics may speed recovery.

Contact Dermatitis:
Poison ivy, oak or poison sumac
Leaves of 3 let me be, leaves of five, let me thrive
Nickle in jewelry, snaps
Wool, feathers, dyes, soaps etc.
Mild cases are treated with topical corticosteriods
More severe cases with systemic corticosteroids.

Urushiol is the oil from poison oak, ivy and poison sumac.
It can be picked up directly from the plant or indirectly from pets or clothes that have come in contact with the plant.
Wash the skin as soon as exposure is suspected.
Ivy block is a creme that can protect the skin from the oil...a general lotion barrier has proved as useful
















Newborn rashes:
https://youtu.be/jQ4mq2PnrrE

Eczema video located at
http://youtu.be/MJEIscWQXLo

MRSA video located at
http://youtu.be/gU7hrtxBWmA

Eczema
https://youtu.be/bfczyQbWzP4

Scabies
https://youtu.be/C-YJMO0Ks7Q

Tick removal
http://youtu.be/0wotB38WrRY

Vitiligo
http://youtu.be/za6nv-CK4xQ

Insect and snake bites
http://www.healthline.com/health/first-aid/bites-stings#Overview1