1102 Test 5 Integumentary

Acute- heal uneventfully within 2-3 weeks
Chronic- do not heal in expected time frame or without complications

Go back to last semester and review your notes on the wound healing process.

caused by staphylococcus
very common in toddlers and preschoolers
Bacteria enter thru a break in the skin
Highly contagious
Seen on face, neck, extremities

Because of the walling off process seen in the inflammatory process these can easily develop into an abcess, making the staph very difficult to treat which can lead to secondary infections.
Lesions start as reddish macule then progress to vesicular lesion with red halo. The lesion ruptures easily leading to moist erosions. The fluid initially is clear and then changes to cloudy.
It spreads peripherally. Exudate dries into heavy, honey colored crusts. Itching is very common.
Removal of the crusts is done by applying a 1:20 Burrows solution. Allowing the crusts to soften then gently remove.

May need topical application of bactericidal ointment or systemic antibiotics if severe , extensive lesions.
They must remain at home until they have been on antibiotics for 48 hours.
3. To prevent the spread must use:
good handwashing
give the child separate towels and washcloths
change clothes daily and wash in HOT water
make no attempt to rupture lesions
teaching
keep nails clean and short
Burrow's Solution

Inflammation of the skin and subcutaneous tissues with intense redness, swelling, and firm infiltration.
“Streaking” of tissues not uncommon.
May progress to abcess formation
Management

Treat: antibiotics, hot compress

Management
Oral or parenteral antibiotics
rest and immobilization of the child and the affected area.
hot, moist compresses
May require hospitalization if systemic symptoms occur
Facial cellulitis frequently leads to Otitis Media.

Fungal infection of the hair, skin or nails
Affects all age groups
Transmitted from person to person or
Animal to person
Highly contagious
4 types

Affects the scalp and hair ( may extend to neckline)
characteristic configuration of scaly, circumscribed patches or patchy, scaly areas of baldness
itchy

Affects smooth, hairless areas of body
generally round or oval erythematous scaling patch that spreads peripherally and clears centrally

“Jock Itch”
Similar skin reaction to corporus
Usually lesions are found on inner aspects of the thighs, and scrotum

Athlete’s foot
Lesions may be found between toes and on plantar surface of the foot.
Lesions vary from macular lesions > fissures to patches with pinpoint vesicles

Wood’s Lamp
microscopic exam
culture
Treatment

Griseofulvin,

Wood’s lamp is an ultraviolet lamp When shined on the lesions if it is fungal it will flourese.
Can also take scrapings from the lesions and identify under microscopic exam.

Treatments: Oral Griseofulvin, topical agents, wet compresses or sitz baths.
may need systemic antibiotics if severe

Inflammatory response of the skin to a primary irritant or allergen.
primary irritant- one that irritates the skin
Sensitizing agent- been in contact prior to and developed a sensitivity
Causes pain, itching, and burning
Major goal- prevent exposure
Treatment

Inflammatory response of the skin to a primary irritant or allergen.
primary irritant- one that irritates the skin
Sensitizing agent- been in contact prior to and developed a sensitivity
Causes pain, itching, and burning

Treatment
Mild to moderate use topical steroids
Severe- systemic steroids

Major goal- prevent exposure
Treatment

Grows in chronically moist environment
Inflamed areas with white exudates, peeling and easy bleeding
Itchy
Diagnosed- characteristic appearance
Treatment- Amphotericin B, Nystatin ointment
Common form of diaper rash
Thrush in Infants
Vaginal forms in women.

Usually caused by prolonged and repetitive exposure to an irritant.
Prolonged contact with diaper wetness produces a higher friction, greater abrasive damage, and increased transepidermal permeability and increased microbes.
3 Factors:_____, ______, _____

Occurs on convex surfaces or in the folds of the diaper

3 Factors: Wetness, Increase in pH, fecal irritants

Goal: prevent further exposure
Tx: keep diaper area clean and dry; if possible leave open to air

Chronic, recurrent inflammation of the skin
May occur on numerous areas
Cause is unknown
Lesions- thick, adherent, yellow, scaly, oily patches that may or may not itch
Nasal Folds

Treatment: Cradle cap
adequate scalp hygiene
need to remove crusts ( shampoo daily)
leave the shampoo in place until the crusts soften, then rinse out.
remove the crusts with a soft comb or brush.

3 types
a.) infantile- begins around 2-6 months and usually will go into spontaneous remission by age 3.
lesions are generalized and found mainly on cheeks, face, and scalp.
lesions are red, oozing, crusting, scaly and may be either vesicles or papules.
Childhood: may follow infantile and occurs around age 2-3 years. 90% will be symptomatic by age 5.
lesions are found in antecubital and popliteal fossae, wrist, ankles and feet. They are symmetrical,
small red clusters or papules with scaly patches. Skin is dry and may be hyperpigmented.
Preadolescent/adolescent- usually around age 12. seen on face, neck, ahnds and feet. Lesions are dry, thick with confluent papules.
Treatment: Major goals
hydrate skin
relieve itching
decrease flare-ups
prevent secondary infections

Management: avoid exposure to skin irritants, and avoid overheating.
Tepid baths with either mild soap or no soap followed by application of an emollient to trap the moisture.
May need the baths 1-2x per day.
Wet Compresses are useful to relieve the itching in some
Clothing should be cotton, cool and non irritating.
No scratching- keep nails short with no edges. May need to use gloves or socks to prevent scratching.
Stress- can lead to exacerbations.
Medications: may be treated with antihistamines, topical steroids, or antibiotics if needed.

Account for significant amount of mild to moderate discomfort in children.
Require immediate medical attention.
Arthropods
black widow spider
Calcium gluconate or sedative
brown recluse spider
scorpions

Black widow spider- likes to nest in wood piles
release neurotoxin> so need to administer antivenin.
Symptoms:area becomes swollen, painful and red. If left untreated may lead to delirium, paralysis, seizures and death.
Tx: cleanse area, apply cool compress, antivenin.
Brown Recluse: Likes dark secluded areas
releases necrotoxin > antivenin, antibiotics, paim medication, and steroids. May need skin graft.
Symptoms: redness>bleb>blister> 2-8hours severe pain>purple shaped area by day 3-4> necrotic ulceration by day 7-14.
treatment: Cool compresses, antivenin, pain meds, steroids, antibiotics.
Scorpions: Found mostly in southwestern US
venom contains hemolysins and neurotoxins.
Symptoms: intense local pain, numbness, burning. If severe could cause ascending paralysis, with seizures, tachcardia, increased salivation, thirst, pulmonary edema, coma and death.
if less than 4 years old usually die within first 24 hours.
Treatment: keep child quiet, and affected area dependant. Give antivenin, pain meds and admit to
PICU (pediatric Intensive Care Unit

Often acquire from other children in rough play, fights or as victims of abuse.
Some preschoolers use as ways of dealing with frustration.
Mouth harbors pathological organisms and all should receive treatment

Treatment:
If bite <6mm in size may treat at home by washing with soap and water and applying pressure dressing to stop bleeding if needed.
If >6mm need immediate medical attention,

Common in childhood
Usually from family pet or neighbors pet
Boys more often

Treatment:
Rinse with saline or LR under pressure
apply clean dressing
If puncture in area that may be functionally or cosmetically affected then antibiotics are given

Venom contains histamines, allergenic proteins and often hyaluronase ( a spreading factor

Local: small red wheal, itching, heat
Systemic: may be mild to severe
symptoms could range from generalized edema, pain, N&V, confusion, to shock and death.
Treatment: remove stinger
clean with soap and water
cool compresses
antihistamines.
Children with a known allergic reaction to bee stings need to try to stay away from areas where they are likely to be, cautioned to wear socks and shoes outdoors, and carry an epipen if needed along with a medi-alert bracelet.

Endemic infection caused by the scabies mite.
Lesions form as the impregnated female burrows into the stratum epidermis
( never into living tissue) to deposit her eggs
Causes intense inflammatory response and itching

Symptoms:
Infants: eczematous eruption and itching
Children: minute grayish, threadlike burrow and itching. Black dot at end of burrow is mite.
Treatment: Scabicide currently used is Permethrin 5% cream. The cream is applied to all skin surfaces from the neck to the toes, between fingers and toes, and cleft of buttocks. The cream remains on the skin 8-14 hours> then rinsed off in the bath. Usually requires a second treatment in 7-10 days.

Infestation of the scalp by parasite common to school age children.
Female louse lays her eggs at the base of the hair shaft next to the skin, (needs warm environment)
NITS- hatch in 7-10 days
Itching usually only symptom

To tell the difference you can pick up the hair. Try to flick the area off by tapping. If it is dandruff it will fall off, if it is a NIT it will not move.
Management:
Application of a pediculocide and removal of the NITs. Drug of choice if Permethrine 1% (NIX)
It kills both adult lice and nits. Available without a prescription, followed by manual removal of the nits.
LICE do not JUMP or FLY, but can be transmitted from person to person through personal items like hats, scarfs, combs etc.
Prevention of Spread and Reoccurence: Major task. Must treat entire family and all household items.
See Community Focus for details on page 1081.

NITS are observable on hair shaft
Seen in occipital area, behind ears, nape of neck, eyebrows, eyelashes, pubic areas.
Must differentiate from dandruff

Acne vulgaris is the most common skin problem treated by physicians during adolescence.
Affects both boys and girls
Peak incidence occurs in middle/ late adolescence.

Excessive sebum production

Comedogenesis

Overgrowth of propioibacteriun acnes
Comedogenesis results in a non inflammatory lesion that may be open (blackhead) or closed (whitehead)
Overgrowth draws in neutrofils > inflammatory process> papules, pustules, and cysts.

General: Make sure they have a nutritionally sound diet, adequate rest, moderate exercise, and decreased stress
Cleansing: use mild cleanser 1-2x daily. Antimicrobial soaps are not effective. Girls should use water based cosmetics.

Medications: Retin A- only drug that effectively interrupts the abnormal follicular keritanization >forms microcomedomes.
avoid sun and use sunscreen of at least SPF 15.
apply at night
Benzly Peroxide- is effective for both inflammatory and non inflammatory acne.

Effective first line med.
If comedomes are accompanied by inflammation may need to add topical antibacterial agent to prevent new lesions and treat existing ones.

Systemic antibiotics may be needed if severe and not responding to routine treatment.

Accutane- used with severe cystic acne that has not responded to routine therapy.