Impetigo
Vesicles or pustule surrounded by edema and
redness
Impetigo

Begins as a reddish macular rash, commonly seen on
face/extremities

Progresses to papular and vesicular rash that oozes
and forms a moist, honey colored crust.

Pruritis of skin

Common in 2-5 year age group
Impetigo
Impetigo became infected

group a hemolytic strep infection of skin.
 Incubation period is 2-5 days after contact
 Easily spread merely by touching another part
of skin after scratching infected area.
Therpeutic Management

Apply warm, moist soaks to soften lesions,
remove crusts

Apply Bactroban TID to cleaned lesions

Cephalexin (keflex) for 10 days

Teach good handwashing and hygiene to
prevent spread, keep fingernails short
Impetigo
Be alert for signs of acute
glomerulonephritis,
If the impetigo was caused by
beta-hemolytic streptococci
Therapeutic Interventions

Goal - prevent scarring and promote positive
self-image.
 Individualize treatment to gender, age, and
severity of infection.
 It takes 4-6 weeks to begin to see
improvement, with optimal results in 3-5
months.
What is the major nursing implication here?
Oral Candidiasis
Fungal or yeast infection also known as Thrush
Oral Candidiasis - causes

Passing through an infected birth canal

Child who is on immunosuppressant's

Exposure to mothers infected breasts

Unclean bottles and pacifiers
Oral Candidiasis - Manifestations

White curdlike plaques on tongue, gums, and buccal
mucosa

How to differentiate from milk
 Thrush is very difficult to remove and bleeding of
the area when plaques are removed.
Oral Candidiasis – Treatment

Oral Nystatin suspension



Swish and swallow
Rub medication on the area with gloved hands
Apply after meals

Oral fluconazole administed 1/day orally

Clean pacifiers, bottles, etc.

Provide cool liquids for the older child
Tinea / Ringworm
Caused by a group of fungi called
dermatophytes
Clinical Manifestations

fungal infection of the stratum corneum, nails and
hair(the base of hair shaft causing hair to break off-rarely
permanent.

Scaly, circumscribed patches to patchy, gray scaling
areas of alopecia.

Pruritic itching

Generally asymptomatic, but severe, deep inflammatory
reaction may appear as boggy, encrusted lesions
(kerions)
Tinea capitis
Tinea corpus
Tinea cruis
Tinea pedis or athletes foot
http://www.ecureme.com/quicksearch_reference.asp
Drug Therapy:

Antifungal Medication:
 Oral griseofulvin
Give with fatty foods to aid in absorption
 Treatment is for 6- 8 weeks
 Can return to day care when lesions are dry
 Avoid sun exposure


Nizoral, Diflucan, Lamisil – used only in
older children because of risk of
hepatoxicity
Teaching



transmitted by clothing, bedding, combs and animals
(cats)
may take 1-3 months to heal completely, even with
treatment
Child doesn't return to school until lesions dry.
See Home Care for Child with Tinea infection on
page 1347.
Pediculosis
Lice infestation
Pediculosis Capitis (lice or
cooties!)


a parasitic skin disorder caused by lice
the lice lay eggs which look like white flecks, attached
firmly to base of the hair shaft, causing intense pruritus
Lice assessment

Close examination of scalp reveals (nits) firmly
attached to hair shafts.

Easily transmitted by clothing towels, combs, close
contact, unrelated to hygiene.
Goals of Care
Kill the active lice
Remove Nits
Prevent Spread
Treatment and Nursing Care

pediculicide, permethrin (NIX) crème rinse
 Applied to washed and towel dried hair. Massage
into the hair and scalp one section at a time.
**Wet hair dilutes the product and may contribute
to treatment failure.
 Leave in place for 10 minutes and rinse
 Towel dry
 Comb hair with a fine-tooth comb to remove any
remaining nits.
 Repeat in 1-2 weeks
Treatment and Nursing Care

Ovide
 Approved for treatment in older children only.
 Must have prolong contact (8-10 hrs) to be effective

Lindane (Kwell) is no longer approved for treatment
Scabies
Mite infestation
Scabies
Sarcoptes scabei mite. Females are 0.3 to 0.4 mm long
and 0.25 to 0.35 mm wide. Males are slightly more than
half that size.



a parasitic skin disorder (stratum corneum- not living
tissue) caused by a female mite.
The mite burrows into the skin depositing eggs and
fecal material; between fingers, toes, palms, axillae
pruritic & grayish-brown, thread-like lesion
Scabies

Scabies is spread from person to person mainly by
prolonged direct skin-to-skin contact, such as touching
a person who has scabies. In rare cases, scabies can
spread by contact with clothes, towels, bedding, and
other personal items that were recently in contact with
an infected person.

The mites live on human blood and need the warmth
of the human body to survive. Away from the body,
they die within 48 hours.
Scabies
Scabies between thumb
and index finger
On foot
Therapeutic Interventions

transmitted by clothing, towels, close contact
 Diagnosis confirmed by demonstration from
skin scrapings.
 treatment: application of scabicide cream
which is left on for a specific number of hours
(4 to 14)to kill mite
 rash and itch will continue until stratum
corneum is replace (2-3 weeks)
Care:
Fresh laundered linen and underclothing
should be used.
 Contacts should be reduced until
treatment is completed.

DERMATITIS
Inflammation of the skin that occurs in
response to contact with an allergen or irritant
Dermatitis

Common Irritants
 Soap, fabric softeners, lotions, urine and stool

Common Allergens
 Poison ivy, Poison oak
 Lanolin
 Latex, rubber
 Nickel
 Fragrances
Dermatitis – Signs and Symptoms
Erythema
 Edema
 Pururitus
 Vesicles or bullae that rupture, ooze and
crust

Dermatitis - Treatment

Medications



Application of a corticosteroid topical agent –
remind to continue use for 2-3 weeks after signs of
healing
Application of protective barrier ointments
Oatmeal baths, Cool compresses
 Antihistamines given for sedative effect
Treatment of Dermatitis
Eczema
Chronic superficial skin disorder characterized
by intense pruritis
Eczema

Immune disorder of the skin

Influenced by genetic predisposition and
external triggers

Tends to occur in children with hereditary
allergic tendencies
Eczema – Signs and Symptoms

Erythematous patches with vesicles

Pruritus

Exudate and crusts

Drying and scaling

Lichenification (thickening of the skin)
Goal of Treatment
Hydrate the Skin
Reduce the amount of allergen exposure
Relieve Pruritis
Acne
Inflammatory disease of the skin involving the
sebaceous glands and hair follicles.
Acne- Three Main Types
Comedomalnoninflammatory
follicular plug
ACNE
Papulopustularpapules and
pustules
Cysticnodules
and cysts
Precipitating factors

Heredity

Hormonal influences

Emotional stress

Heat and Humidity
Patient Teaching

Do not pick! this increases the bacterial count
on the surface of the skin and opens lesions to
infection which worsens scarring.

Remind patients that the treatment will not
show improvement until about 4-6 weeks but
they must consistently follow the regime set up
by the physician.
Medical Therapy for Acne

Topical: Benzoyl Peroxide, Tretinoin (RetinA),
tetracycline and erythromycin. Topical agents are
preferred treatment to systemic antibiotics, however
increases in antibiotic resistant bacteria may require
use of systemic antibiotics.

Oral: Tetracycline, minocycline, erythromycin and
clindamycin- used for severe inflammatory acne or
resistant to topical medications. Estrogen may also
work for female patients. Isotretinoin (Accutane)- side
effects include cataracts, dry skin, pruritius,
conjunctivitis, nosebleeds and depression. Also a
teratogen!
Acne – Nursing Care
THE END