Integumentary

Skin Disturbances in Children

General Considerations

  • Understanding skin disturbances in pediatric patients is crucial for effective management of health issues, as these conditions can significantly impact children's quality of life and overall health.

  • This course (RNSG 2201) emphasizes nursing considerations for accurately assessing and managing skin disorders in children.

Pediatric Differences

Skin Structure Variations

  • Thinner Epidermis: A thinner epidermis in children increases the permeability to topical treatments and leads to a greater risk of transepidermal water loss, making proper skin care essential.

  • Larger Surface Area: Children’s larger body surface area relative to their volume enhances the absorption of topical medications, which can lead to systemic effects if dosages are not properly adjusted.

  • Developing Eccrine Sweat Glands: Immature function of these glands results in ineffective thermoregulation, necessitating careful monitoring of body temperature in infants.

  • Lower IgA Levels: Infants and toddlers typically have lower levels of Immunoglobulin A (IgA), resulting in increased susceptibility to infections, underscoring the importance of vigilant hygiene practices.

Impetigo

Overview

  • Impetigo primarily manifests as crusty lesions around the mouth and nose, with spontaneous regression possible but also prone to spreading without treatment.

  • Types: It includes Bullous Impetigo, which features fluid-filled blisters, and Scalded Skin Syndrome, which is a more severe form resulting in extensive exfoliation of the skin.

Characteristics

  • Impetigo often arises from secondary infections at sites of broken skin or bug bites. Scratching exacerbates the condition, making it essential to maintain short and clean nails in affected children.

  • The primary infectious agents responsible for Impetigo are Staphylococcus Aureus (accounting for about 90% of cases) and Group A Streptococcus.

  • Symptoms typically include honey-colored crusting, significant contagiousness, and an incubation period that lasts between 7-10 days.

Management

  • Treatment usually involves topical antibiotics such as Bactroban (mupirocin) or Baciguent (bacitracin).

  • To prevent the spread of infection, the child should sleep alone, and all linens must be washed in hot water.

  • Schools or daycare facilities should be notified to manage outbreaks effectively.

  • The duration of treatment is generally 7-10 days, though more severe cases may require longer duration or even oral antibiotics.

Cellulitis

Overview

  • Cellulitis represents a secondary bacterial infection that affects the dermis and subcutaneous tissue beneath the skin.

  • Common pathogens for cellulitis are Staphylococcus Aureus and Group A Streptococcus, which are frequently encountered in pediatric populations.

Characteristics

  • Symptoms include localized warmth, redness, and tenderness, particularly critical if the infection spreads to joint or facial areas which may have more serious consequences.

Treatment Protocols

  • Treatment is generally initiated with oral antibiotics for a period of 10 days following an initial IM (intramuscular) or IV (intravenous) dose, with IV therapy indicated for severe cases.

  • Close monitoring for progression of cellulitis is necessary; marking the area can help assess changes in symptoms over time.

  • Warm compresses can be applied to alleviate pain, enhance circulation, and promote healing in the affected area.

Diaper Dermatitis

Overview

  • Diaper dermatitis is a common skin irritation affecting the diaper-clad area, primarily due to prolonged exposure to moisture and urine.

  • Gentler modalities may propose that it can arise from the introduction of new products or detergents, increasing the risk for Candida overgrowth in sensitive skin areas.

Treatment and Prevention

  • Treatment options include antifungal creams such as Nystatin and barrier creams containing zinc oxide to protect the skin.

  • Preventive measures include frequent diaper changes, gentle cleaning techniques, and immune health practices such as strict handwashing protocols for caregivers.

  • Education for parents on the importance of maintaining a clean and dry diaper area helps reduce the incidence of dermatitis.

Eczema/Atopic Dermatitis

Overview

  • Eczema is classified by recurring episodes of chronic inflammation of the skin, resulting in significant discomfort.

  • Related conditions often include allergies and asthma; eczema often emerges in early life, commonly in the first two years after birth.

Pathophysiology

  • The condition is associated with elevated T-cells, IgE, and eosinophils that contribute to the ongoing inflammation; genetic predisposition plays a critical role too.

  • Emotional triggers, including stress, can exacerbate symptoms due to the cycle of itching and scratching, leading to further skin damage.

Management Strategies

  • Key management strategies involve the use of topical steroids to reduce inflammation, immune modulators for moderate to severe cases, and regular application of moisturizers after bathing to restore skin integrity.

  • It is emphasized to avoid irritants such as harsh soaps, fragrances, and certain fabrics, along with daily bathing with mild, fragrance-free soaps.

Acne

Overview

  • Acne affects approximately 85% of adolescents and young adults, often prompted by hormonal changes which lead to expanded sebaceous glands and increased bacterial proliferation.

Treatment Goals

  • Treatment aims to control bacterial growth using agents like benzoyl peroxide and antibiotics, along with reducing inflammation using retinoid medications such as Retin-A.

  • In severe cases, medications like Accutane may be prescribed, necessitating strict protocols to prevent pregnancy during treatment.

Home Management Tips

  • Recommended practices include gentle cleansing of the skin twice daily while avoiding aggressive scrubbing and minimizing excessive use of topical products.

  • A balanced diet rich in fresh produce and hydration plays a significant role in maintaining skin health.

Head Lice (Pediculosis Capitis)

Overview

  • Lice infestations are common, especially in children, and spread easily through direct contact, making monitoring and management essential.

  • Symptoms predominantly include significant itching of the scalp, which may lead to secondary infections due to scratching.

Treatment Recommendations

  • Effective treatment includes the use of pediculicides; however, caution is advised, as these are not recommended for children under 2 years due to potential neurotoxicity.

  • Follow-up measures must include vacuuming of living spaces and washing of contaminated items to combat reinfestation.

  • It is critical to notify schools and close contacts to control the spread within the community.

Scabies

Overview

  • Scabies is caused by mites that burrow beneath the skin, resulting in intense itching, particularly at night when symptoms exacerbate.

  • Diagnosis typically requires the use of skin scrapings to confirm the presence of the mites.

Treatment Protocols

  • The first line of treatment is the application of Permethrin 5% cream; alternative options such as Ivermectin may be considered if initial treatment proves ineffective.

  • Retreating after one week is often recommended to ensure eradication of scabies, and it is vital to educate families on treating all close contacts simultaneously to prevent reinfestation.

  • Post-treatment care may include management of itching through antihistamines and cortisone creams to alleviate discomfort during the recovery phase.