Skin Conditions in Children

Skin Differences in Children

• Infant epidermis is thinner and blood vessels are closer to the surface
• Infants lose heat more readily through skin surface
• Substances are more easily absorbed into infants' skin
• Infants' skin contains more water
• Infant's epidermis are loosely bound to the dermis
• Friction more easily result in blistering or skin breakdown in infants
• Infants and children are less pigmented
• There is an increased risk of UV damage
• Adult thickness of skin is reached in late teen years
• Darker skin has more hypertrophic scarring and keloids

Causes of Integumentary Disorders

• Exposure to infectious microorganisms can cause integumentary disorders
• Hypersensitivity reactions can cause integumentary disorders
• Hormonal influences can cause integumentary disorders
• Genetic predisposition can cause integumentary disorders
• Injuries can cause integumentary disorders

Common Laboratory and Diagnostic Tests

• Blood tests can be used to diagnose integumentary disorders; including complete blood count (CBC), erythrocyte sedimentation rate (ESR), immunoglobulin E (IgE)
• Culture and sensitivity of wound drainage can be performed
• Potassium hydroxide (KOH) prep can be performed
• A Patch or skin allergy test can be performed
• A Wood lamp can be used
• A skin biopsy can be performed, but is less common

Terms to Describe Skin Findings

• Macule
• Papule
• Annular
• Pruritus
• Vesicle, pustule
• Scaling, plaques
• Hypo-, hyperpigmented
• Erythematous

Types of Infections of the Skin

• Infections of the skin can be bacterial, fungal, or viral
• Examples of bacterial infections include impetigo, folliculitis, cellulitis, methicillin-resistant Staphylococcus aureus (MRSA), and staphylococcal scalded skin syndrome
• Examples of fungal infections include tinea (pedis, corporis, versicolor, capitis, and cruris) and Candida albicans
• Examples of viral infections include viral exanthems and herpes simplex

Risk Factors for CA-MRSA

• Turf burns
• Towel sharing
• Participation in team sports
• Attendance at day care or outdoor camps

Tinea (Fungal Infection)

• Tinea Capitis affects the scalp
• Tinea Cruris affects the groin
• Tinea Pedis affects the feet
• Tinea Corporis affects any parts of the body
• Tinea Versicolor presents differently
• Tinea Versicolor presents with hypopigmented lesions on the upper body

Types of Inflammatory Skin Conditions

• Acute hypersensitivity reactions include diaper dermatitis, contact dermatitis, erythema multiforme, and urticaria
• Chronic hypersensitivity disorder: Atopic dermatitis
• Chronic inflammatory skin disorders not from hypersensitivity: Seborrhea and Psoriasis

Contact Dermatitis

• Contact dermatitis results from antigenic substance exposure, allergy to nickel or cobalt in clothing, hardware, or dyes, and exposure to highly allergenic plants
• Complications are secondary to bacterial skin infection and lichenification or hyperpigmentation
• Treatment includes identifying and stopping exposure to the allergen, oatmeal baths, calamine lotion, hydrocortisone 1% cream, and wet/damp dressings soothes itching and reduces redness
• Inflammatory reaction to natural or synthetic chemicals causes redness, itching and/or scale
• Irritant dermatitis are products used daily, including soap, cleansers, alcohol, perfumes and cosmetics, rubber (latex), nickel jewelry, and chemicals in shoes

Atopic Dermatitis (Eczema)

• Eczema is itchy, scaling, crusting, serous discharge and erythema
• Emollient treatments, lukewarm baths or showers, bleach baths twice per week, hydrocortisone, UV light therapy, wet dressings, and oral antihistamines can be used to treat eczema
• Identify triggers such as such as cold and dry weather, fragrances, wool, smoke, dust, and stress

Impetigo

• Impetigo presents with raised yellow fluid-filled areas and honey-colored crusted lesions
• Lesions can be itchy and/or painful on the face and extremities
• Can be caused by Staphylococcus aureus or Streptococcus pyogenes
• Mupirocin 2% cream or ointment TID X 14 days, amoxicillin/clavulanate (Augmentin), clindamycin (MRSA and Strep), cephalexin (Keflex) is a treatment
• Wash hands and lesions with soap and water

Cellulitis

• Cellulitis presents as a full-thickness acute bacterial infection caused by streptococci or staphylococci
• Symptoms are pain, warmth, rapidly spreading erythema, and edema
• Fever may occur, and regional lymph nodes may enlarge in more serious infections
• Can be diagnosed by diagnosis appearance
• Treatment for cellulitis is Antibiotics
• May cause lymph node enlargement and fever
• Hospitalization, IV antibiotics, Tylenol, and warm moist packs are treatments
• Assess for spread and ocular movement

Classification of Acne

• Mild acne primarily involves noninflammatory lesions(comedones)
• Moderate acne: Comedones plus inflammatory lesions localized to face or back
• Severe acne: Lesions similar to moderate acne, widespread, and/or presence of cysts or nodules

Classification Criteria for Burns

• Superficial: Epidermis only
• Partial thickness: Involves epidermis and portions of dermis
• Deep partial thickness: Extends deeper into dermis
• Full thickness: Extends through the epidermis, dermis, and hypodermis

Thermal Injuries

• Severely burned young children have a higher mortality rate than adults
• Shorter exposure to chemicals or temperature can injure children sooner
• The risk for for fluid and heat loss is increased due to larger body surface area
• Immature immune system can lead to increased risk of infection
• Delay in growth may follow extensive burns
• Burns involving more that 10% of TBSA require fluid resuscitation
• Infants and children are at increased risk for protein and calorie deficiency due to decreased muscle mass and poor eating habits
• Interventions for thermal injuries include: airway management, large bore needle for fluids, nasogastric tube to maintain gastric decompression, foley catheter for urine specimen and monitor output, evaluate burn area, and accurate weight

Degree of Burns

• First-degree burn: involves only the epidermis and part of the underlying skin layers.
• A first-degree burn is hot, red, and painful, but without swelling or blistering (sunburn)
• Second-degree burn: Involves the epidermis and part of the underlying skin layers, pain is severe, area is pink or red or mottled and moist and seeping, swollen with blister
• Third-degree or full thickness burn: involves injury to all layers of skin and destroys the nerve and blood vessels
• Initially there is no pain, the area may be white, yellow, black or cherry red, and the skin may appear dry and leathery
• Wound Care includes removing dead skin and debris, dressings, skin grafts, escharotomy, and fasciotomy

Medical Treatments for Skin Issues:

• Wet dressings
• Occlusive dressings
• Emollient lotions and creams
• Therapeutic bathing

Common Medications

• Antibiotics (topical, systemic)
• Corticosteroids (topical)
• Antifungals (topical, systemic)
• Topical immune modulators (moderate to severe atopic dermatitis)
• Antihistamines
• Isotretinoin (cystic or severe acne)
• Coal tar preparations (psoriasis, atopic dermatitis)
• Silver sulfadiazine 1% (burns)

Nursing Assessment for Urticaria

• Assess detailed patient history: new foods, new medications, symptoms of a recent infection, changes in environment, and any unusual stress
• Inspect the skin and mucous membranes for raised edematous hives
• Assess airway and breathing because hypersensitivity may affect respiratory status

Causes of Urticaria

• Foods
• Drugs
• Animal stings
• Infections
• Environmental stimuli
• Stress

Nursing Interventions for Children with Extensive Burns

• Promoting oxygenation and ventilation
• Restoring and maintaining fluid volume
• Preventing hypothermia
• Cleansing the burn
• Preventing infection
• Managing pain with atraumatic care
• Treating infected burns
• Providing burn rehabilitation

Diaper Dermatitis

• Change diapers frequently
• Avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives
• Allow the infant to go diaperless
• Blow-dry diaper area/rash area on warm setting for 3-5 minutes
• Medications such as water/mild soap, Nystatin powder, and barriers paste
• Use Home care, and hypoallergenic diapers
• Educate caregiver about ABCDE, air out the skin, use barriers, clean skin frequently, use disposable diapers, no cloth diapers
• Educate about how to prevent a recurrence of diaper rash
• Do not use baby powder or cornstarch due to accidental inhalation

Teaching Points for Avoiding Animal Bites

• Never provoke a dog with teasing or roughhousing
• Get adult permission before interacting with a dog, cat, or other animal that is not your pet
• Do not bother an eating, sleeping, or nursing dog
• Avoid high-pitched talking or screaming around dogs
• Display a closed fist first for the dog to sniff
• Keep ferrets away from the face
• If a cat hisses or lashes out with the paw, leave it alone