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The Child with an Integumentary Alteration Chapter 49

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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The Child with an Integumentary Alteration Chapter 49

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  1. The Child with an Integumentary AlterationChapter 49

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

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