Alterations of the Integument in Children (Chapter 42) PDF

Alterations of the Integument in Children Chapter 42 Acne Vulgaris Most common skin disease , occurs primarily between the ages of 12 & 25 years. Develops at sebaceous follicles located primarily on the face and upper parts of the chest and back Non Inflammatory acne: blackheads (open) &...

Alterations of the Integument in Children Chapter 42 Acne Vulgaris Most common skin disease , occurs primarily between the ages of 12 & 25 years. Develops at sebaceous follicles located primarily on the face and upper parts of the chest and back Non Inflammatory acne: blackheads (open) & whiteheads (closed) Inflammatory (cystic) acne: cystic nodules develop when inflammation is deeper Physiological factors - Follicular hyperkeratinization - Excessive sebum production; related to androgenic hormones - Follicular proliferation of Propionibacterium acnes; inflammation secondary to the action of inflammatory products produced by P. acnes Clinical management - Topical treatments - Systemic therapies - Scarring treated with dermabrasion, lasers, and resurfacing techniques Atopic Dermatitis - Most common form of eczema in children - Genetic link, altered immunity, and immune responses - Clinical manifestations - Severe pruritus, eczematoid appearance, and age-dependent distribution of skin lesions - Young: rash to face, scalp, trunk, arms, and legs - Older: rash to neck, antecubital and popliteal fossae, hands and feet - Treatment: avoid triggers, keep skin hydrated Diaper Dermatitis (Diaper Rash) - Form of irritant contact dermatitis - Prolonged exposure to irritation by urine and feces, maceration by wet diapers, airtight plastic diaper covers - Often secondarily infected with Candida albicans - Affects the lower aspect of the abdomen, genitalia, buttock, and upper portion of the thigh - Clinical manifestations - Vary from mild erythema to erythematous papular lesions - Treatment - Frequent diaper changes to keep area clean and dry - Regular exposure of perineal area to air - Use of superabsorbent diapers - Topical treatment with petroleum or zinc oxide - Topical antifungal medications if C. albicans present Impetigo Most common bacterial skin infection in children age 2-5 years old Caused by Staphylococcus aureus or Streptococcus pyogenes High incidence in hot, humid climates Particularly infectious among people living in crowded conditions with poor sanitary facilities, or daycares S/S Blister formation Honey-coloured lesions on the face, around the nose and mouth Treatment Topical mupirocin or fusidic acid Antibiotics for complicated infections Fungal Infections Tinea capitis (scalp ringworm): Most common fungal infection of childhood, causative organisms found on cats, dogs, and rodents; lesions circular and manifested by broken hairs 1 to 3 mm above the scalp, scaling, and raised borders Tinea corporis (ringworm): Kittens and puppies common source; lesions erythematous, round scaling patches that spread peripherally with clearing in the center Treatment for both is with topical antifungals Thrush: Presence of Candida albicans in the mucous membranes of the mouths of infants and less commonly in adults; can spread to the groin, buttocks, and other parts of the body Characteristics include white plaques or spots in the mouth that lead to shallow ulcers & the tongue appears to have white covering Treatment with oral antifungal suspension  Viral Infections: Rubella Rubella: caused by an RNA virus that enters the bloodstream through the respiratory route Clinical Manifestations - Enlarged cervical and postauricular lymph nodes, low-grade fever, headache, sore throat, runny nose, cough - Faint-pink to red maculopapular rash caused by virus dissemination to trunk and extremities *vaccination for rubella is often combined with the vaccines for measles and mumps NO specific treatment, other than supportive therapy which includes rest, fluids, and a humidifier  Viral Infections: Chickenpox (Varicella) & Shingles (Herpes Zoster) Chickenpox and Shingles are both produced by the varicella-zoster virus Chickenpox Shingles - Early childhood disease - Occurs mainly in adults - Spread by close person-to-person contact and - Occurs in individuals who had varicella in the airborne droplets past - Occurs in people not previously exposed to VZV - Therapy similar to that for chickenpox; may - First signs of illness include fever, itching, and need antivirals and pain management appearance of vesicles on face, trunk, or scalp medication - Uncomplicated infection requires no therapy - Vaccine available - Vaccine available  Insect Bites and Parasites Scabies: Contagious disease caused by the itch mite Sarcoptes scabiei; transmitted by personal contact and infected clothing and bedding primary lesions are burrows, papules & vesicular lesions with severe itching risk of secondary infections from scratching! Treatment is application of scabicide & disinfecting linens Lice (pediculosis): Highly contagious parasite that survives by sucking blood; acquired through personal contact and shared clothing, combs, or brushes pruritus is the major symptom. Treatment is pediculicides & all clothes, towels, bedding, and brushes should be washed in boiling water Flea bites: Bites occur in clusters along the arms and legs or where clothing is tight fitting urticarial wheal with a central hemorrhagic puncture. Treatment includes spraying the home, treating infected animals and washing clothing and bedding in hot water Bedbugs: Cimex lectularius live in bedding feed in the darkness; attach to your skin, suck blood and leave lesions are red macules that develop into nodules. Treatment is by cleaning or disposing contaminated items and using insecticides Cutaneous Hemangiomas Benign tumors that form from the rapid growth of endothelial cells, which results in the formation of extra blood vessels Superficial hemangiomas or capillary or strawberry hemangiomas (top) Deep hemangiomas are known as cavernous or congenital hemangiomas (bottom) Can be treated with a beta-blocker (ie. propranolol) as a first line, but other treatments include steroids, cryosurgery, laser surgery, and radiotherapy Cutaneous Vascular Malformations Rare congenital anomalies of blood vessels present at birth Grow proportionally with the child and never regress Can be classified as Low flow: involving only capillaries, veins, and lymphatics High flow: involving arteries Types include Port-wine stains: flat, pink to dark reddish-purple lesions; can be treated with a pulsed dye laser Salmon patches (stork bites): macular pink lesions that usually fade by 1 year of age  Happy Thanksgiving! What are you grateful for? See you next week :)