Skin Infections & Infestations - PEDS

Define Impetigo Contagiosa (Impetigo) (3)

• Caused by Staphylococcus & spreads via direct contact & peripherally

• Lesions typically around mouth, nose, or face

• Very contagious

Impetigo - Expected Findings (3)

• Reddish macule becomes vesicular

• Erupts easily leaving moist erosion on the skin → secretions dry & form honey-colored crusts

• Pruritic

Impetigo - Treatment (4)

• Topical bactericidal or triple antibiotic ointment - Slough off tissue & then apply

• Oral/parenteral antibiotics - Severe cases

• Vancomycin for MRSA

• Keep child nails short, frequent hand hygiene, avoid sharing items, avoid spreading by avoiding touch

Define Folliculitis (3)

• Pimple

• Caused by Staphylococcus & MRSA

• Infection of hair follicle

Define Furuncle (3)

• Boil

• Caused by Staphylococcus & MRSA

• Larger swollen, red lesion of a single hair follicle

Define Carbuncle (3)

• Multiple boils

• Caused by Staphylococcus & MRSA

• More extensive swollen, red lesions involving multiple hair follicles on face, buttocks, neck

Folliculitis, Furuncle, Carbuncle - Treatment (4)

• Warm moist compress

• Clean skin often

• Topical antibiotics or systemic antibiotics for severe case

• Incision, draining & irrigation of severe lesions

Cellulitis - Expected Findings (3)

• Caused by streptococcus, staphylcoccus, & heamophilus infuenzae

• Firm swollen red area of skin & subcutaneous tissue

• Possible systemic effects - fever, malaise

Cellulitis - Treatment (3)

• Oral or parenteral antibiotics

• Rest & immobilize affected area

• Acute care (hospitalization) for systemic manifestations

Scalded Skin Syndrome - Expected Findings (4)

• Caused by staphylococcus

• Rough textured skin with macular erythema

• Epidermis becomes wrinkled within 2 days

• Large bullae appears

Scalded Skin Syndrome - Treatment (5)

• Systemic antibiotics

• Burrow’s solution or saline for gentle cleansing

• Compresses of 0.25% silver nitrate

• Acute hospitalization & wound care consult

• IVFs, analgesics, bandaging

Define Verruca (3)

Warts

Caused by HPV

Elevated gray-brown firm papules

Verruca - Treatment (6)

1. Individualized destructive therapy

2. Surgical removal

3. Electrocautery

4. Cryotherapy

5. Laser caustic solutions

6. Curretage

Cold Sores - Causative Organism (2)

• Fever blister near mouth & nose (mucocutaneous area)

• Caused by HSV type 1

Genital Herpes - Causative Organism (2)

Caused by HSV type 2

On genitals or buttocks

Cold Sores & Genital Herpes - Expected Findings (4)

Group of vesicles that itch & burn

After drying - Form a crusty area followed by exfoliation

Healing in 8-10 days

Possible lymphadenopathy

Cold Sores & Genital Herpes - Treatment (3)

• Oral antiviral (acyclovir) to reduce duration

• Oral antiviral (valacyclovir) for genital herpes

• Burrow solution during weeping stage

Define Herpes Zoster

Caused by reactivated varicella zoster virus (chicken pox)

Define Shingles

Lesion occurs on one side of the body (unilateral)

Herpes Zoster & Shingles - Expected Findings (3)

• Neurologic pain, hyperesthesias, or itching

• Rash, vesicular lesions appear near afferent nerve endings

• Dermatomal pattern - One side of body, no crossing of midline

Herpes Zoster & Shingles - Treatment (3)

• Oral or topical analgesics

• Moist compresses

• Zoster vaccine for clients > 50 years old

Define Molloscum Contagiosum (3)

Caused by pox virus

Flesh colored papules with dimple in center

Occur on extremeties, face & trunk

Molloscum Contagiosum - Treatment (2)

• Resolve spontaneously in 18 months

• Complicated Cases - Remove pox chemically or with curettage, cryotherapy or electrodessication (cauterize)

Define Tinea Capitis (2)

• Ringworm of the scalp

• Scaly, circumscribed lesion with alopecia on scalp that is pruritic

Tinea Capitis - Treatment (5)

1. Selenium sulfide shampoo

2. Oral Griseofulvin (intense med, taken up to 1 year, empty stomach with fat)

3. Kerion-Griseofulvin & oral corticosteroids for 2 weeks

4. Complicated Cases - Oral ketoconazole

5. Treat infected pets (cats)

Define Tinea Corporis (3)

• Ringworm of the body

• Round/oval erythematous scaly patches

• Spread peripherally & unilaterally, clears centrally

Tinea Corporis - Treatment (5)

• Oral griseofulvin

• Topical antifungal - Tolnaftate, clotrimazole

• Treat pets

• Clotrimazole or ciclopirox 2x/day for 2-4 weeks

• Ciclopirox or clotrimazole griseofulvin for severe infections

Define Candidiasis (Moniliasis) (4)

• Caused by candida albicans (yeast)

• Found in moist areas of skin surface

• White exudate, peeling, inflamed & easily bleeding area

• Pruritic

Candidiasis - Treatment (2)

• Topical antifungal ointment (miconazole, nystatin) skin lesions

• Miconazole, clotramizole (vulvovaginal)

Scabies Mites (Sarcoptes Scabiei) (4)

• Spread by direct contact & are intensely itchy especially at night

• Rash between fingers, popliteal folds, & inguinal regions

• Thin pencil like marks on skin

• Mites look like black dot on end of a grayish-brown burrow

Scabies - Infants (2)

• Widespread on body

• Pimples on trunk, blisters on palms & soles

Scabies - Young Children

Most common on head, neck, shoulders, palms & soles

Scabies - Older Children

Most common on hands, wrists, genitals, abdomen

Scabies - Treatment (5)

1. Apply scabicide (5% permethrin cream) over entire body to remain on skin for 8 -14 hrs & repeat in 1-2 weeks.

2. Treat ENTIRE family & people in contact with infected person during & 60 days after infection.

3. Wash underwear, towels, clothes in hot water

4. Calamine lotion, cool compresses

5. Difficult cases - Oral ivermectin

Pediculosis Capitis (3)

• Head lice spread by direct contact with person, bedding, objects

• Intense itching & small red bumps on scalp

• Nits (white specks) viewed on hair shaft

Pediculosis Capitis - Treatment (6)

• 1% permethrin shampoo

• Spinosad 0.9% topical suspension for children 4 years & older

• Benzyl alcohol 5% in infants 6 months & older.

• Remove nits with comb & repeat in 7 days after shampoo treatment

• Boil combs, brushes and hair accessories for 10 min or soak in lice-killing products for 1 hr.

• Difficult cases - Malathion 0.5%

Client Education - Bite Prevention (7)

• Avoid areas of tall grass.

• Use insect repellent.

• Avoid contact with insects.

• Avoid wood piles.

• Inspect & treat pets, carpets, furniture.

• Avoid flowery prints and bright clothing.

• Avoid perfumes & colognes.