Transcript Slide 1
Skin problems
Dermatitis Bacterial Viral Fungal Infestations Age specific Burns General principles Pages 753-763 1
Learning Objectives
Identify Signs /Symptoms/Treatment for: Contact Dermatitis Atopic dermatitis Impetigo Cellulitis Herpes Simplex Varicella Zoster Tinea capitis Ringworm Scabies Head lice Acne Steven-Johnson Syndrome Pediatric burns 2
Contact dermatitis
Localized irritation caused by direct, external contact with a foreign substance 2 types Irritant Allergic Hockenberry p777 3
Contact dermatitis
Causes
Plants Nickel/other metals Topical medications Rubber Cosmetics Fabrics Detergents Solvents Fragrances Sun On & on 4
Contact dermatitis
Symptoms
Pruritis Redness/inflammation Skin tenderness Local swelling Local warmth to exposed area Rash/lesion 5
Contact dermatitis
Treatment
Wash affected area-lots of water Soap may irritate the skin even more, don’t use it Avoid scratching Keep fingernails trimmed Medications Topical Corticosteroids Oral Lotions Antihistamines Steroids Skin patch testing Make sure to avoid that thing that gave you the contact dermatitis in the first place 6
Contact Dermatitis
Prevention
Avoid offending agent Protective clothing Sunscreen
Expectations
Usually resolves in 2-3 weeks 7
Atopic dermatitis (eczema)
Affects 3-5% of children before the age of 5 Genetic component- 70% have 1 st degree relative with some form of AD 50-80% will develop allergic rhinitis or asthma 8
Atopic dermatitis
Symptoms
Dry, scaly, pruritic lesions Weeping, oozing, crusting lesions Often erythematous Chronic relapse/remission pattern Tend to be more susceptible to viral skin infections http://www.riskindoc.com/dermatitis_eczema.html
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Atopic dermatitis
Symptoms
Typically seen on the
face, inside the elbows, and behind the knees
Appearance of rash will depend on the amount of scratching Worse in fall/winter Secondary infection 10
Atopic dermatitis
Treatment
Topical medications Systemic medications Other topicals Other treatments Sometimes use phototherapy (about 12 y/o and older) Avoid triggers Tepid water for bathing Increase humidity in winter months 11
Impetigo
http://www.cgh.com.sg/caring/issue82/Pg_6_7_8.asp
Common, infection contagious, superficial, bacterial Group A β- hemolytic streptococcus Brown crusty blisters Staphylococcus aureus Clear then cloudy blisters Hockenberry p767 12
Impetigo
Preschoolers/ school age Those In Close Physical Contact Day care Warm, Moist Climate Poor Hygiene https://mayoclinic.com/health/medical/IM00401 13
Impetigo
Spread by direct contact Can be itchy Can occur on any part of the body Usually hands, forearms, nose, & mouth Copyright Mosby 2002 14
Impetigo
Treatment
Antibiotics Topical, sometimes use systemic if it’s a huge area that is affected Gentle cleansing of crusted areas With warm soapy water, but don’t want to break the blisters. It doesn’t speed up healing and opens up the way for infection Cover infected areas Don’t rupture the blisters
Prevention
Good hygiene Regular hand washing Separate towels/linens Keep fingernails cut short 15
Cellulitis
Inflammation of the skin and subcutaneous tissues Associated with pain, swelling, intense redness Opportunistic Any area of broken skin Immunocompromised/diabetics NOT contagious page 767 16
Cellulitis
Bacterial infection
Staph Strep Pasteurella multocida Animal bites Pseudomonas Puncture of foot through sneakers 17
Cellulitis
Symptoms
Inflammation with redness Pain Swelling Warm to touch Lymphangitis- streaking Fever, malaise Swollen regional lymph nodes 18
Cellulitis
Treatment (mild/treated at home) Antibiotics Oral Elevation, immobilization Warm, moist compresses Pain relievers Close monitoring Hospitalization, if necessary 19
Herpes Simplex
Type I Usual exposure- preschool years Typically found above the waist, but can be anywhere Type II Sexually transmitted Typically found below the waist, but can be anywhere Once exposed always present Outbreaks Very contagious Spread by direct contact No cure 20
Herpes Simplex
Triggers
Stress Increased exposure to sun Viral infections Food high in arginine http://www.minarsdermatology.com/medical/coldsores.asp
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Herpes Simplex
Symptoms
Tingling, numbness, burning, itching Small erythematous, tender area blisters clusters of Blisters begin to dry yellow crusting Possible regional lymphadenopathy Usual coarse 7-10 days 22
Herpes Simplex
Complications
Possible scarring Blindness (ocular) If it gets into the eye Depression (type 2 HSV) 23
Herpes Simplex
Treatment
Goal - control outbreaks Medication Pain relievers Compresses Other Antivirals need to be given in the first 24 hours after the first lesion 24
Varicella zoster
Shingles Same virus that causes chicken pox Anyone who has had chicken pox or the vaccine can have varicella zoster Chickenpox may follow exposure to shingle 25
Varicella zoster
Causes
Stress Fatigue Weak immune system Cancer Radiation 26
Varicella zoster
Symptoms
Pre-eruption Intense, localized pain along a dermatome Fever/malaise Lesions occur 1-7 days Progress thru rupture, crusting, and healing over 2-3 weeks 27
Varicella zoster
Is unilateral Follows dermatomes 28
Varicella zoster
Complications
Scarring Secondary infection Hearing\vision loss (facial) Postherpetic neuralgia (PHN) Pain persists after the rash has completely healed, can last a long time (months or years). Rare in children, but it can happen 29
Varicella zoster
Treatment
Avoid scratching Keep fingernails trimmed Medication Antivirals In first 24 hours! Can slow down the shingles or prevent them from popping up in the first place Pain Cool compresses/ baths Good hygiene 30
Dermatophytoses- Tinea
(aka.- Ringworm) Fungal Infection That Lives On , Not In, The Skin, Or Nails Spread by: Direct contact Indirect contact Contact with soil rare www.emedicinehealth.com/slideshow_ringworm_pictures/article_em.htm
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Tinea capitis (head)
Symptoms
Begins as small lesion Enlarges, leaving scaly patch Alopecia Worst case, develops into kerion Like a boggy gross thing, immune response to the ringworm Hair usually grows back kerion 32
Tinea capitis
Treatment
Griseofulvin Topical antifungal Selenium sulfide shampoo Corticosteroids (kerion) 33
Tinea corporis (body)
Symptoms
Begins as small lesion Enlarges, leaving scaly patch Center usually clears leaving the “ring” appearance Copyright Mosby 2004 34
Tinea corporis (body)
Treatment
Griseofulvin Topical antifungal 35
Tinea cruris (‘jock itch’)
Symptoms
Pruritic Medial proximal aspect of thigh/ crural fold (may involve scrotum in males) 36
Tinea cruris
Treatment
Topical antifungal Compresses/ sitz baths (comfort) 37
Tinea pedis (athlete’s foot)
Symptoms
Pruritis Lesions to plantar surface of foot, between toes 38
Tinea pedis
Treatment
Griseofulvin Topical antifungal Severe cases- topical glucocortical cream Eliminate causes 39
http://www.emedicinehealth.com/slideshow_ringworm_pictures/article_em.htm
Sarcoptes scabei (Scabies)
Skin infestation with microscopic mite Spread skin to skin Crowded conditions If you got one today it would take a couple of months before you began to feel the effects http://www.dermisil.com/products/what/scabies.asp
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Sarcoptes scabei (Scabies)
Female burrows under the skin Lays 2-3 eggs/day Eggs hatch and in 10 days—adult mites!
http://www.dermnetnz.org/common/image.php?path=/arthropods/img/s/scabies3.jpg
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Sarcoptes scabei (Scabies)
Symptoms
Severe pruritis Small, tiny lesions develop into blisters Usually on hands or feet http://www.dermnetnz.org/common/image.php?path=/arthropods/img/s/scabies2.jpg
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Sarcoptes scabei (Scabies)
Treatment
?Whole family?
Yes!! Spread by close, prolonged contact. The mite takes about 45 mins to burrow under your skin Scabicide - Permethrin (Elimite) Treat personal items Clothes, bedding, towels, wash in hot water Lotions Topical steroid for itch Antibiotics- secondary infections 44
Pediculosis capitus (head lice)
Very common, parasitic infestation Typically affects ages 3 12 Very contagious, very annoying http://www.haircareguide.com/lice.htm
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Pediculosis capitus
Person to person contact Object to person contact Not carried by animals 46
Pediculosis capitus
Adult Louse Small, grayish-tan, wingless insect Visible Can live up to 3 days away from a human host Life span of female is 1 month In this time can lay 100-200 eggs… eww Use claws to hold to hair shaft http://www.msmosquito.com/headli ce.html
http://bioweb.uwlax.edu/bio203/s2008/koc h%5Fsama/Nutrition.htm
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Pediculosis capitus
Feed on small amounts of blood from the scalp every 4-6 hours Eggs will hatch 1-2 weeks after being laid 48 http://www.msmosquito.com/headlice.html
Pediculosis capitus
Symptoms
May note small, red lesions Persistent pruritis Nits on hair shafts Visible adult lice Regional lymphadenopathy Secondary infection 49
Pediculosis capitus
Treatment
Medicated shampoos Mechanical removal of nits Wash all linens Vacuum/ dry clean non laundry items Repeat treatment in 7-10 days Treat secondary infection as needed 50
Acne vulgaris (acne)
Hockenberry p 849-852 Most common skin problem of adolescence 50% of adolescent population will experience acne Not caused/worsened by foods Has a hereditary factor 51
Acne vulgaris (acne)
Causes
Hormones Increased sebum (oil) gland activity Comedone formation Overgrowth of Propionibacterium acnes 52
Acne vulgaris (acne)
Treatment
Wash-don’t scrub Oil-free make-up Keep your hands off!!
Lotions/creams Medications Retinoids Topical Antibacterial Agent Systemic Antibiotics Oral Contraceptives If using topicals, AVOID SUN, or AT LEAST USE SUN SCREEN 53
Stevens-Johnson Syndrome (SJS)/ Toxic Epidermal Necrosis (TEN)
Severe manifestation of erythema multiforme Mortality can be as high as 25%-35% (TEN) emedicine.medscape.com/article/756523-media 54
Stevens-Johnson Syndrome (SJS)/ Toxic Epidermal Necrosis (TEN)
Causes
Infections 50% of patients report recent URI Drug induced Sulfa, Penicillin, cocaine Malignancy (adults) Idiopathic 55
Stevens-Johnson Syndrome (SJS)/ Toxic Epidermal Necrosis (TEN)
Signs/symptoms
Cough Headache Malaise Arthralgia Mucocutaneous lesions 56
Stevens-Johnson Syndrome (SJS)/ Toxic Epidermal Necrosis (TEN)
Treatment
Support symptoms Many times we don’t know what’s caused it Remove offending agent Treat lesions as burns May get care from burn units in the hospital Cover denuded skin Cover with gauze wet with solution Prevent secondary infection 58
Pediatric Burns - Causes
Extreme heat sources Cold Chemicals Electricity Radiation Accidental – inadequate supervision, curiosity, inability to escape burning agent Intentional (Child Abuse) 59
Guides to Treatment
Extent Depth Severity Percentage of total body surface area (TBSA) burned Location Child’s age General health 60
Extent - Total Burn Surface Area (TBSA) Rule of Nines Lund Browder 61
Rule of Nines
http://emedicine.medscape.com/article/769193-print http://www.medtrng.net/efmb/tasks/081-833-0070.htm
Depth and Severity
Depth Superficial (1 st degree ) Only epidermis, blisters, gone in days, not scarring Partial thickness (2 nd degree ) sensory is intact, moist skin, scarring is low, but takes longer to heal Full thickness (3 rd and 4 th degree) Dermis, epidermis, and subq grafts and what not tissue, if you burn thru this then it’s not painful because you’ve killed all the nerve cells. Don’t usually heal, may need skin 63
Second degree burn
http://emedicine.medscape.com/article/769193-media 66
3rd degree burns
http://emedicine.medscape.com/article/769193-media 67
Burn Unit Referral Criteria
1. Partial-thickness burns > 10% TBSA 2. Burns involving face, hands, feet, genitalia, perineum, or major joints 3. 3rd degree burns 4. Electrical burns, including lightning injury 5. Chemical burns 6. Inhalation injury 7. P reexisting medical disorders that could complicate management, prolong recovery, or affect mortality 8. Concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. 9. Burned children in hospitals without qualified personnel or equipment for the care of children 10. Special social, emotional, or rehabilitative intervention requirements She won’t test us on this but it’s just good to know or whatever…
Burn Care
Superficial burns (sunburn) Avoid sun, wear protective clothing, sunscreen Minor burns Apply cold compress Analgesia Cleanse with soap /water – avoid friction Tetanus Antimicrobial ointment Loose clothing 69
Care of Moderate and Severe Burns
Maintain airway, Oxygen IV access/ fluids Observe closely for s/s shock Pain management Wound care Nutritional support Skin and musculoskeletal care Emotional/psychosocial support 70
Parkland Formula
Fluids for 24 hours = (4 х kg х % burn) [2nd & 3rd degree burns added together] 1 st 50% given over 8 hours Followed by 2 nd 50% given over 16 hours Example 4 X 20kg X 35% = 2800 Give 1400 in 8 hours = 175 ml/hr Remaining 1400 over next 16 hours at 88 ml/hr 71
Systemic Responses/Complications
Cardiovascular system Burn shock From loosing fluids Hemoconcentration/hyperviscosity Treatment - Fluid resuscitation Watching urine output is key, you know they’re hydrated if their I&O is even Commonly use Parkland formula Maintain urine output 1-2 ml/kg Renal System Immature infant renal system Fluid loss reduces renal blood flow 72
Responses/Complications
Metabolism Hypermetabolism Pulmonary Injury 2 ndary to smoke/carbon dioxide, heat Pulmonary edema Wound Sepsis GI System Stress ulcer 73
Burn Wound Management
Excision/Debridement Topical antimicrobial agents Temporary skin substitute Synthetic Skin coverings Artificial skin Permanent skin coverings Cultured epithelium 74
Complications
Long term Contracture deformities Body image 75
Prevention/Parent Education
Never leave child alone Install smoke alarms – check monthly Lower hot water setting to <120 degrees Keep matches, gasoline, candles away from children Use stove back burners and turn pot handles 76
Prevention/Education
Keep hot foods/liquids away from table edge Keep electrical cords out of reach Practice fire escape Teach - Stop, drop, and roll Place microwave at safe height (higher than children’s faces but low enough to reach easily) 77