Dermatitis, Miscellaneous Skin Disorders, Bacterial Skin Disorders, Viral Skin Disorders, and Fungal Skin Disorders

Why do babies have lighter skin when they are born?

their skin is lighter due to less melanin in their skin at birth

What are the types of dermatitis?

• contact

• diaper

• seborrheic

What is contact dermatitis?

it is an acute inflammatory reaction of skin to chemicals with initial reaction in the exposed area

What are some common irritants that can cause contact dermatitis?

• soaps

• detergents

• fabric softeners

• lotions

• jewelry

What are some symptoms of contact dermatitis?

• sharp delineation between inflamed & normal skin

• redness

• blistered appearance

• affected area is painful

• irritation om affected area

• rash is present in a linear fashion

What are some teachings for contact dermatitis?

• identify what they are allergic to and remove irritant

• tell them they can apply steroid or anti-itch cream to affected area (use for 2-3 weeks)

• tell them to use mild soaps to cleans skin

• tell parents to use weed killer for common areas that have poison ivy

• tell parents to wipe clothes down with alcohol wipes if they come in contact with poison ivy or other irritant plants

• tell parents oatmeal bath can help with irritation (makes bath slippery so be careful)

• tell parent to pat skin dry with towel after bath

• tell parents to not burn plants like poison ivy due to plant chemicals going into the air and they can inhale it

Sweat and friction can do what to contact dermatitis?

they can enhance contact dermatitis reaction

What are some nursing interventions for children with contact dermatitis?

• apply sub-topical ointments (caladryl lotion) onto affected area

• apply steroid treatment (hydrocortisone cream) onto affected area

• administer systemic steroids (prednisone, steroid injections) for bad reaction

What are some parent teachings for diaper dermatitis?

• tell the parent to wash child’s skin with warm water or use waterless cleansers (Cetaphil) after child has a bowel movement

• tell the parent to use nonalcohol wipes to clean child’s skin

• tell parents to expose child’s skin to air

• tell parents to use Desitin A + D and zinc oxide creams on rash

• tell parent to use hydrocortisone creams for severe rashes

• tell parents to apply hydrocortisone creams on affected area for 1-2 times a day for no more than 3 days

• tell parents to apply nystatin before barrier ointment for yeast infection

• tell parents to change child’s diapers every 3-4 hours

What are some manifestations for diaper dermatitis?

• inflammation in diaper region

• irritation in diaper region

• satellite bumps/ raised bumps in diaper region is yeast infection occurs

What is seborrheic dermatitis?

it is a chronic, recurrent inflammatory reaction of the skin

What are the common sites for seborrheic dermatitis?

• scalp (“cradle cap” in babies)

• eyelids

• nasolabial folds

• around the ears

What are the manifestations of seborrheic dermatitis?

• flaky/ waxy lesions

• mildly red areas

• pruritus

What are some teachings for seborrheic dermatitis?

• tell parents to remove lesions with Petroleum jelly/ baby oil and let it sit for 20 minutes before removing

• tell parents to remove lesions with a soft baby brush, soft toothbrush, or fingertips gently

• tell parents to wash child’s scalp daily with baby soap

• tell parents if baby soap does not work, they can use anti-savoric or anti-dandruff shampoos

• tell parents of dermatitis is on eyelids, use baby shampoo

What are some common drug allergies?

• aspirin

• sedatives

• antibiotics

What are some teachings for drug reactions?

• tell parents that it may take up to 7 days for allergic reaction to present if child is exposed for the first time

• tell parents they can give antihistamines (Benadryl) to help with drug reactions

• tell parents they can apply topical corticosteroids (hydrocortisones) on rashes

• tell parents they can give oral steroids for severe reactions

• tell parents to apply cold compress on rashes to soothe the skin

What are some parent teachings for vascular tumors?

• tell the parent that the tumor will decrease on their own (no interventions needed)

• tell parents that by the age of 9, 90% of tumors disappear

• tell parents that by adolescents, 95% of tumors disappear

• tell parents they can put topical corticosteroids on tumor if it gets irritated

• encourage parents to regularly take photos of the tumor to see the tumor improving and decreasing in size throughout time

What causes impetigo?

• strep infection

• staph infection

What are the common sites for impetigo?

• face

• mouth

• hands

• neck

• extremities

What are some manifestations of impetigo?

• papule that turns into vesicles

• formed erosions with honey-colored crusts

• pruritis

• regional lymphadenopathy

• rash may spread by self-inoculations

What are some teachings for impetigo?

• tell parents to soak crusts in warm water then gently scrub with antiseptic soap

• tell parents their child needs to take antibiotics 2 time a day for 3-5 days

• tell parents to observe s/s due to it being contagious

• tell parents to keep child’s fingernails short and clean to decrease spread from scratching

• tell parents to inform daycare/ school so they can sanitize common toys

• discourage sharing of toys, towels, personal clothing and items to help decrease spread

What is folliculitis?

it superficial inflammation of hair follicles

• caused by trauma & irritation

• very common in teens & children

What is folliculitis associated with due to exposure to poorly chlorinated pools or hot tubs?

it is associated with pseudomonas exposure in poorly chlorinated pools or hot tubs

What are some manifestations of folliculitis?

• painful localized swelling

• tiny some-shaped yellowish pustule at follicle opening

• red papule at follicular opening

• can become abscessed and lead to fever and flu-like symptoms

• if from pool or hot tube, it can be present in areas covered by bathing suit

What are some teachings for folliculitis?

• tell pt. to wash with topical antibiotic cleanser and water

• tell parents the child/ teen may need to use benzoyl peroxide gel or other drying agents

• tell parents the child may need oral antibiotics

• tell parents if abscess develops, it may need to be incised & drained

• teach children to shower with antibacterial soap after exercising

• tell children to wear loose cotton clothing'

• tell parents to wash and dry bathing suits after wearing & before next use

What is molluscum contagiosum?

it is a viral skin infection caused by pox virus

How is molluscum contagiosum transmitted?

it is transmitted by direct contact

• skin to skin

• contact with contaminated toys

• sexual contact

What are some manifestations of molluscum contagiosum?

• multiple flesh-colored smooth papules (2-5mm)

• central depression

• plug of cheesy material that can be expressed when punctures

• may be in trunk, face, and extremities (adolescents can have them appear in genital mucus membrane)

• may be pruritic

What are some teachings for molluscum contagiosum?

• tell parent each lesion can last up to months

• tell parent new lesions can appear over 2-4 years

• tell parent lesions can cause scars'

• tell parent they can apply emollients and topical steroids for itching

• tell parents their child can take oral antihistamines for itching

• tell parents the lesions are treated by a dermatologist with blister agents, nitrogen, or cutterage

• tell parents to have their child avoid public pools & hot tuns to decrease spread of infection

• tell parents to not allow child to share towels or sponges

• tell parents to use fragrance-free cleansers then moisturizer

What are warts?

they are viral lesions commonly transmitted by direct skin to skin contact or mucous membrane contact

• virus can survive on various surfaces

What are manifestations of warts?

• skin-colored bumps

• rough, scaly papules and nodules on exposed skin surface

• can be individual or multiple lesions in one area

• on feet, they may have small, black dots from thrombosed vessels (b/c of weight-bearing)

What are some teachings for warts?

• tell parents and pt. they often resolve spontaneously over a couple of years

• tell parent/pt. they can put duct tape on area and change every 1-3 days for a few months

• tell parent/pt. that they can be removes with cryotherapy, caustic substances, electrocautery, and laser

• tell parent/pt. that they may cause scaring

• tell pt. to not pick or chew on lesions

What is oral candidiasis thrush?

it is when good, normal flora in the mouth gets wiped out and yeast takes over

What are some risk factors for oral candidiasis thrush?

• use of corticosteroid inhalers

• use of antibiotics

• immune disorders

• in newborns, mother may pass vaginal yeast infection on baby during pass through vaginal canal during birth

• mom and baby passing thrush infection back & forth from mouth to mom’s nipple during breastfeeding

• poor maternal handwashing

What are some manifestations of oral candidiasis thrush?

• white patches on oral mucosa

• may bleed when removed

• infants may refuse to nurse or feed due to pain

• may also see diaper dermatitis

What are some teachings for oral candidiasis thrush?

• teach parents that if the white substance wipes off easily with gentle swabbing, then it is just old milk residue

• teach parents if white substance does not wipe off easily with gentle swabbing, then it is most likely thrush

• teach parents about use of oral antifungal suspension (nystatin)- apply to mouth and tongue after feeding for infants

• teach adolescents to swish and swallow antifungal suspension (nystatin)

• teach parents with children with inhalers to rinse mouth after using inhaler

• teach parents how sterilize bottles, nipples, and pacifiers

• tell parents that their child may need oral or IV meds if thrush is severe or is the child is immunocompromised

What are tineas dermatophytosis?

they are fungal infections on skin

• ringworms

• jock itch

• athletes foot

What are some manifestations of tineas dermatophytosis?

• scaly patches

• often circular shaped

What are some teachings for tineas dermatophytosis?

• tell parents it is contagious, so family members also need to be treated

• tell parent is capitis (occurs on scalp), then the child needs to be treated with oral griseofulvin

• tell parent child needs to take oral griseofulvin with fatty foods (whole milk) to increase absorption

• teach parents that some children develop an itchy rash similar to eczema and that it is a hypersensitivity to the fungal & not the medication

• teach parent that while child in on medication, hair growth may slow

• tell pt. to wear loose fitting clothes and keep area dry if it is cruris (jock itch)

• tell pt. to keep feet clean & dry, clip nails short, wear 100% cotton socks, wear shower shoes in public showers and locker rooms if pedis (athletes’ foot) occurs