THE CHILD WITH INTEGUMENTARY DYSFUNCTION

CARE OF THE
PEDIATRIC CLIENT
WITH
DERMATOLOGIC
PROBLEMS
A. Review of the Anatomy and
Physiology of The
Integumentary System
1. Physical Assessment
2. Diagnostic Procedure
3. Therapeutic Management
4. Nursing Management
B. Preliminary Skin Lesions
C. Secondary Skin Lesions
D. Eczematous Reaction
E. Atopic Dermatitis
F. Seborrheic Dermatitis
G. Lyme Disease
H. Scabies
I. Diaper Rash
J. Burns
K. Psoriasis

INTEGUMENTARY DYSFUCNTION

SKIN LESIONS
- Lesions of the skin result from a variety of etiologic factors.
- Skin lesions originate from:
1. Contact with injurious agents
A. infective organisms
B. toxic chemicals
C. physical trauma
2. Hereditary factors
3. External factors
A. allergens
4. Systemic diseases
A. measles
B. lupus erythematous
C. nutritional deficiency diseases
- An agent that may be harmless to one individual may be damaging
to another, and a single agent may produce different responses in
different individuals
- An important factor in the etiology of the skin manifestations is the
age of the child.
- Infants are subject to these that appear early in life:
• Birthmark
• Malformations
• Atopic dermatitis
- School age child is susceptible to ringworm of the scalp
- Acne is a characteristic skin disorder of puberty
- contact dermatitis, such as poison ivy, is seen only when noxious
agent id found in the environment
- Tension and anxiety may produce, modify or prolong skin condition

Skin of Younger Children

The major skin layers arise from different embryonic origins.

Early in embryonic period, a single layer of epithelial forms from
ectoderm, while simultaneously the corium develops from the
mesenchyme. In the infant and small child the epidermis is loosely
bound to the dermis.
This poor adherence causes the layers to separate easily during
an inflammatory process to form blisters. This is especially true in
preterm infants, who have propensity to blister formation and
separation of the skin during careless handling (such as removal of
adhesive tape). In contrast, the skin of the older child is thinner and
the cells of all the strata are more compressed.

Pathophysiology of Dermatitis

• Inflammatory changes in the skin

• Acute responses produce intercellular and intracellular edema
• Formation of intradermal vesicles
• Initial filtration of inflammatory cells into the epidermis
• Edema of the dermis
• Vascular dilation
• Early perivascular cellular infiltration

The location and manner of these reactions produce the lesions

characteristic of each disorder. The changes are usually reversible, and
the skin ordinarily recovers without blemish unless complicating
factors such as ulceration from the primary irritant, scratching and
infection are introduced or underlying vascular disease develops. In
chronic conditions permanent effects are seen that vary according to
the disorder, the general condition of the affected individual & the
available therapy.

Diagnostic Evaluation

HISTORY AND SUBJECTIVE SYMPTOMS

• PRURITUS - itching
- the common local symptom
• Pain or tenderness accompanies some skin lesions
• Burning, prickling, stinging or crawling sensations
• ANESTHESIA – absence of sensation
• HYPERESTHESIA – excessive sensitiveness
• HYPESTHESIA or HYPOESTHESIA – diminished sensation
• PARESTHESIA - abnormal sensation(burning or prickling)

These symptoms may remain localized or migrate, may be

constant or intermittent and may be aggravated by a specific activity
such as exposure to sunlight.

• Check if the child has allergic conditions such as asthma or

fever or history of previous skin disease

Objective Findings

Provide significant formation:

• Distribution
• Size
• Morphology
• Arrangement

Cause:
EXTRINSIC CAUSES
• Physical
• Chemical
• Allergic irritants
• Infectious agent
1. fungi
2. viruses
3. animal parasite

INTRINSIC CAUSES
• Infection (measles or chicken pox)
• Drug sensitization
 • Other allergic phenomena

LESION

1. ERYTHEMA – a reddened area caused by increased amounts of

oxygenated blood in the dermal vasculature
2. ECCHYMOSES (Bruises) – Localized red or purple
discolorations caused by the extravasations of blood into dermis
and subcutaneous tissues
3. PETECHIAE – pinpoint, tiny and sharp circumscribed spots in
the superficial layers of the epidermis
4. PRIMARY LESIONS – skin changes produced by a causative
factor; common primary lesions in pediatric skin disorders are
macules, papules & vesicles
• MACULE – flat, non palpable, circumscribed, less than 1 cm
in diameter, brown, red, purple, white or tan in color
(eg: freckles, flat moles, rubella, rubeola)
• PATCH – flat, non palpable, irregular in shape, macule that
is greater than 1 cm in diameter
(eg: Virtiligo, port wine marks)
• PLAQUE – elevated, flat topped, firm, rough, superficial
papule greather than 1 cm in diameter, may be coalesced
papules
(eg: Psoriasis, seborrheic and actinic keratoses)
• WHEAL – elevated, irregularly shaped area of cutaneous
edema, solid, transient, changing, variable diameter, pale
pink with lighter center
(eg: Urticaria, insect bites)
5. DISTRIBUTUION PATTERN – the pattern in which lesions are
distributed over the body, whether local or generalized and the
specific areas associated with the lesions
6. CONFIGURATION AND ARRANGEMENT – the size, shape &
arrangement of a lesion or groups of lesions (eg: discrete,
clustered, diffuse of confluent)

Laboratory Studues
• Microscopic examinations
• Cultures
• Skin scraping
• Biopsy
• Cytodiagnosis
• Patch testing
• Wood light examination
• Allergic skin testing
 • Other laboratory test such as blood count and sedimentation
rate

WOUNDS

- structural or physiologic disruptions of the skin that are

activate normal or abnormal tissue repair responses.
• ACUTE WOUND – those that heal uneventfully within 2-3
weeks
• CHRONIC WOUND – those that do not heal in expected time
frame or are associated with infections

Cofactors that disrupt or delay wound healing:

Epidermal Injuries

Abrasions are the most common epidermal wounds in children,

usually in the form of skinned knee or elbow. Epithelial tissue is
composed of labile cells, which are constantly destroyed and replaced
throughout the lifespan.

• Papule-elevated; palpable; firm; circumscribed; less than 1cm

in diameter ; brown , red, pink, tan, or bluish red color
Examples: warts; drug-related eruptions; pigmented nevi

• Nodule- elevated; firm; circumscribed; palpable; deeper in

dermis than papule; 1 to 2cm in diameter
Examples: Erythema nodosum; lipomas

• Vesicle- elevated; circumscribed; superficial; filled with serious

fluid; less than 1cm in diameter
Examples: Blister, varicella

• Pustule- elevated; superficial; similar to vesicle but filled with

purulent fluid
Examples: Impetigo; acne; variola

• Bulla- vesicle greater than 1 cm in diameter

Examples: Blister; pemphigus vulgaris

• Cyst- elevated; circumscribed; palpable; encapsulated; filled

with liquid or semisolid material
Examples: Sebaceous cyst
Injury to Deeper Tissues

Tissues composed of permanent cells such s muscle and nerve

cells re unable to regenerate. These tissues repair themselves by
substituting fibrous connective tissues for the injured tissue. This
fibrous tissue, or scar, serves as a patch to preserve or restore the
continuity of the tissue. Wounds involving permanent cells include
surgical incisions, lacerations, ulcers, evulsions, and full-thickness
burns.

Process of Wound Healing

When the skin is injured, its normal protective barrier function is

broken. In the healthy immunocompetent individual, acute traumatic,
abrasions, lacerations, and superficial skin and soft-tissue injuries heal
spontaneously without complications. The four stages of wound
healing include hemostasis, inflammation, proliferation and
remodeling. Some authorities combine the first two phases. In the
hemostasis phase, platelets act to seal off the damaged blood vessels
and to form a stable clot.

Inflammation, the second stage of wound healing, presents a

clinical picture that involves erythema, swelling and warmth often
associated with pain at the wound site. The inflammation phase
involves whit blood cells such as the neutrophils, monocytes, and
macrophages.
The proliferative phase, which includes granulation and
contracture, is the third stage of healing. This phase lasts from 4 to 21
days in acute wounds depending on the size of the wound. The phase
is characterized clinically by the presence of granulation tissue, the
“beefy,” pebbled red tissue in the wound base. Fibroblasts or
immature connective tissue cells secrete collagen, which provides the
foundation for dermal regeneration. Angiocytes regenerate the outer
layers of capillaries and endothelial cells produce the lining in a
process called angiogenesis. The keratinocytes are responsible for
epithelialization. In the final stage of epithelialization, contracture
occurs as the keratinocytes differentiate and form the protective outer
layer or stratum corneum of the skin.
 • Scale- heaped-up keratinized cells; flaky exfoliation; irregular;
thick or thin; dry or oily; varied size; silver, white, or tan in
color
Examples: psoriasis; exfoliative dermatitis

• Crust- dried serum blood, or purulent exudate; slightly

elevated; and varies; brown, red, black, tan or straw in color
Examples: Scab in abrasion

• Lichenification- rough, thickened epidermis; accentuated skin

markings caused by rubbing or irritation; often involves flexor
aspect of extremity
Example: chronic dermatitis

• Scar- thin to thick fibrous tissue replacing injured dermis ;

irregular; pink, red, or white in color; may be atropic or
hypertrophic
Example: healed wound or surgical incision

• Keloid- irregularly shaped, elevated, progressively enlarging

scar; grows beyond boundaries of wound; caused by excessive
collagen formation during healing
Example: Keloid from ear piercing or burn scar

• Excoriation- loss of epidermis; linear or hallowed-out crusted

area; dermis exposed Exmples: Abrasion; scratch

• Fissure- linear crack or break from epidermis to dermis; small;

deep; red
Examples: Athlete’s foot; cheilosis

• Erosion- loss of all or part epidermis; depressed; moist;

glistening; follows rupture of vesicle or bulla; larger than
fissure
Examples: Varicella; variola following rupture

• Ulcer- loss of epidermis and dermis; concave; varies in size;

exudative; red or reddish blue
Examples: Decubiti; stasis ulcers

Remodeling or maturation is the final phase of the healing

process. This phase occurs in the dermis as fibroblasts increase the
tissue tensile strength and gradually replace Type 3 collagen in the
scar tissue with Type 1 collagen, thicken the collagen fibers, and
reorient the collagen fibers long the lines of tissue tension. Remodeling
and maturation occurs over several months and can take up to 2
years. The phases of wound healing are complex and may be
interrupted by disease conditions, medications, and other systemic and
local factors that influence the healing process. When a wound does
not follow the “normal wound healing trajectory,” it may become stuck
in one of the stages and become a chronic wound.

Factors that influence Healing

A revolution in wound healing has occurred in the last two

decayed. Emphasis has shifted from interventions aimed at
maintaining a dry environment to those promotes a moist, crust free
environment that enhances the migration of the epithelial cells across
the wound and facilitates remodeling. An acute full-thickness wound
kept in a moist environment usually re-epithelializes in 12 to 15 days,
were us the same wound when kept open to the air heals in about 25
to 30 days.

Factors That Delay Wound Healing

Factors Effect on Healing

Dry wound environment Allows epithelial cells to dry out and die;
impairs migration of epithelial cells
across wound surface

Nutritional deficiencies

Vitamin A Results in inadequate inflammatory

response

Vitamin B1 Results in decreased collagen formation

Vitamin C Inhibits formation of collagen fibers and

capillaries development

Protein Reduces supply for amino acids for tissue

repair

Zinc Impairs epithelialization

Immunocompromise Results in adequate or delayed

inflammatory response
Impaired circulation Inhibits inflammatory response and
removal of debris from wound area
Reduces supply of nutrients to wound area

Stress (Pain, poor sleep) Releases catecholamines that cause

vasoconstriction

Antiseptics

Hydrogen peroxide Toxic to fibroblasts; can cause

subcutaneous gas formation (mimics
gas-forming infection)

Povidone-iodine Toxic to white and red blood cells and

fibroblasts

Chlorhexidine Toxic to white blood cells

Medications
Corticosteroids Impair phagocytosis
Inhibits fibroblasts proliferation
Depress Formation of granulation tissue
Inhibit wound contraction

Chemotherpy Interrupts the cell cycle, damages DNA

Antiinflammatory drugs decrease the inflammatory phase

Foreign bodies Increase inflammatory response

Inhibit wound closure

Narcotics Increases inflammatory response

Increases tissue destruction

GENERAL THERAPEUTIC MANAGEMENT

 Some skin disorders demand aggressive therapy, but by and
large the major aim of the treatment is to prevent further damage,
eliminate the cause, prevent complications & provide relief discomfort
while tissues undergo healing. Factors that contribute to the
development of dermatitis and that prolong the course of the disease
should be eliminated when possible.

- The most common causative agent of dermatitis in infants, children

and adolescents are Environmental factors:
• Soaps
• Bubble baths
• Shampoos
• Rough or tight clothing
• Wet diapers
• Toys
• Blankets

Natural elements:
• Dirt
• Sand
• Heat
• Cold
• Moisture
• Wind

- Dermatitis may also result from home remedies and medications.

Dressings

No one dressing meets the needs of all wounds.

-The traditional dry gauze dressing should not be used on open

wounds, because:
• it allows the wound surface to dry,
• does little to prevent bacterial invasion,
• adheres to the dried scab so that removal disturbs the newly
regenerating epithelial

In most instances, traditional gauze dressings have been

replaced with moist wound healing dressings.

MOIST WOUND HEALING- increases the rate of collagen synthesis &

reepithelialization & decreases pain and inflammation.
 Dressing should always be changed when they are loose or
soiled. They should be changed more frequently in areas where
contamination is likely:

• sacral area
• the buttocks
• the tracheal area
• or when the infection is suspended or present

Topical Therapy

- Several agents and methods are available for treatment.

- In selecting a therapeutic regimen, the practitioner considers:
1. The choice of active ingredient
2. the proper vehicle or base
3. the cosmetic effects
4. the cost
5. instructions for use

Over treatment is avoided. For example, when dermatitis is

acute, topical applications should be mild and bland to avoid further
irritation. Broken or inflamed skin, especially in children is more
absorbent than intact skin, and chemicals that are nonirritating to
intact skin may be quite irritating to inflamed skin.

Topical Corticosteroid Therapy

Glucocorticoids are the therapeutic agents used most frequently

for skin disorders. Their local anti-inflammatory effects are merely
palliative, so the medication must be applied until the condition
undergoes a remission or the causative agent is eliminated.
Corticosteroids are applied directly to the affected area, are essentially
nonsensitizing, and have only minor side effects. As with the use of
any steroids, their use in large amounts may mark signs of infections.

Most parents and children apply too much topical

hydrocortisone; therefore, they should be counseled that it is both
effective and economical to apply only a thin film and to massage it
into the skin. Parents and children should also be advised to use the
application for no more than 5 to 7 days because these agents may
cause depigmentation and other changes the skin

Other Topical Therapies

 • chemical cautery (especially useful for warts)
• cryosurgery
• electrodesiccation (chiefly used for warts, glaucomas & nevi)
• ultraviolet therapy (especially for birthmarks)
• acne therapies such as dermabrasion and chemical peels

Systemic Therapies

Systemic drugs may be used as an adjunct to topical therapy in

some dermatologic disorders. The drugs most frequently used are:
• corticosteroids
• antibiotics
• antifungal agents

Corticosteroids are valuable because of their capacity to inhibit

inflammatory and allergic reactions. Dosage is carefully adjusted and
gradually tapered to the minimum dose that is effective and tolerated.
Antibiotics are used in severe or widespread skin infections.
Antifungal agents are the only means for treating systemic
fungal infections.

NURSING CARE OF THE CHILD

- Signs of wound infection are
o Edema
o Purulent exudates
o Pain
o Increased temperature

- The frequency of wound assessment depends on the severity and

complexity of the wound
- wound bed is assessed for:
o Color
o Drainage
o Odor
o Necrosis
o Granulation tissue
o Fibrin slough
o Undermining
o Condition of the wound edges
o Color condition of the surrounding skin
Wound care

- the parents are instructed to wash their hands and then wash the
wound gently with mild soap and water or with normal saline
- open wounds are covered with a dressing, such as a commercial
adhesive bandage, although larger wounds may benefit from the use
of occlusive dressings.
- Dressings are removed carefully to protect intact skin and the
epithelial surface of the wound
- pull parallel

Relief of symptoms

-Most therapeutic regimes for skin lesions are directed toward relief of
pruritus, the most common subjective complaint
- Anti pruritic medications such as dephenhydramine (benadryl) or
hydroxyzine (atarax) may be prescribed for severe itching, especially
if it disturbs the child’s rest

Topical Therapy

- wet compress or dressings cool the skin by evaporation, relieve

itching and inflammation and cleanse the area by loosening and
removing crusts and debris.
- A variety of ingredients, such as plain water or burrow solution
(available without prescription) can be applied on kerlix gauze, plain
gauze
-soaks are often used for removal of crusts and for their mild
astringent action
- baths are useful in the treatment of widespread dermatitis evenly
distributing the soothing antipruritic and anti inflammatory effects of
the solution,usually oatmeal or mineral oil preparations
- topical applications are applied to skin lesions to ease discomfort,
prevent further injury and facilitates healing

HOME CARE AND FAMILY SUPPORT

-Parents of other children may fear that their children will “catch” the
disorder. Occasionally the affected child’s own family members
reduce their interaction or physical contact with the child.

- Normally, the skin harbors a variety of bacterial flora, including the

major pathogenic varieties of staphylococci. The degree of
pathogenecity of the organism depends on its invasiveness and
 toxicity, skin integrity of the skin and the immune and cellular
defenses of the host. Children with congenital or acquired
immunodeficiency disorders (such as AIDS), those in debilitated
condition, those with generalized malignancy such as leukemia
lymphoma are at risk for developing bacterial infections

BACTERIAL INFECTIONS
DISORDERS/ORGANISM MANIFESTATIONS MANAGEMENT COMMENTS
Impetigo contagiosa - Begins as a reddish - careful removal - tends to heal
- staphylococcus macule of undermined without scaring
- becomes vescicular skin, crusts & unless secondary
- ruptures easily, debris by infection
leaving superficial, softening with -
moist erosion 1:20 burow autoinoculateble
- tends to sprea solution and contagious
peripherally in compresses - very common in
sharply marginated - topical toddler,
irregular outlines application of preschooler
- exudates dries to bactericidal - may be
form honey-colored ointment superimposed on
crusts - systemic eczema
- pruritus common administration of
- systemic effects: oral or pareteral
minimal or antibiotics
asymptomatic (penicillin) in
severe or
- extensive lesions

pyoderma- staphylocossus deeper extension of soap and water inoculable and

- strephtococcus infection into dermis cleansing contagious
- tissue traction more - wet compresses - may heal with
severe - bathing with or without
- systemic effects: antibacterial soap scarring
fever. Lymphagitis as prescribed

- folliculitis: infection skin cleanliness - autoinoculable

FOlliculitis (pimple),
furuncle (boil),
carbuncle (multiple boils)
– staphylococcus aureus
of hair follicle - local warm, and contagious
- furuncle: larger moist compresses - furunclea and
lesion with more - topical carbuncle tend to
redness and swelling application of heal with scar
at a single follicle antibiotic agents foramation
- carbuncle: more - systemic - a lesion
extensive lesion with antibiotics in should \never be
widespread severe cases squeezed
inflammation and - incision and
pointing at several drainage of
follicular orifices severe lesion,
-systemic effects: followed by
malaise, if severe wound irrigations
with antibiotics or
suitable drain
implantation

Cellulitis – streptococcus, inflammation of skin oral or pareteral hospitalization

staphylococcus, and subcutaneous antibiotics may be
haemophilus influenzae tissues with intense - rest and necessary for
redness, swelling and immobilization of child with
firm infiltration both affected are systemic
- lymphagitis “ and child symptoms
streaking” frequently - hot moist - otitis media
seen compresses to may be
VIRAL INFECTIONS

- viruses
o Intracellular parasites
o Produce their effect by using the intracellular substances of
the host cells
o Composed of only DNA or RNA core enclosed in an
antigenic protein shell, unable to provide for their own
metabolic needs to provide for their own metabolic needs
or to reproduce themselves

DERMATOPHYTOSES (FUNGAL INFECTIONS)

- (ringworm) are infections caused by a group of closely related

filamentous fungi that invade primarity the :
o Stratum
o Corneum
o Hair
o Nails

- these are superficial infections that live on but not in, the skin.
- designed by the latin word tinea, with further designation related to
the area of the body where they are found.
Example: tinea capilis (ringworm of the scalp)
- Infections are most often transmitted from one person to another or
from infected animals to humans.

Nursing Considerations

- when teaching families how to care for ringworm, the nurse should
emphasize good health and hygiene. Because of the disease,
affected children should not exchange grooming items, headgear,
scarves or other articles of the apparel that have been in proximity to
the infected area with other children.
- treatment with the drug griseofulvin frequently continues for weeks
or months and because subjective symptoms subside, children or
parents may be tempted to decrease or discontinue the drug.

Viral Infections

INFECTION MANIFESTATION MANAGEMENT COMMENTS

Verruca - usually well - not uniformly - common in
(warts) circumscribed gray successful children
Cause: or brown, - local destructive - tend to
human elevated, firm therapy, disappear
papillomavirus papules with a individualized spontaneously
(various roughened finely according to - course
types) papillomatous location, type & unpredictable
texture number- surgical - most
- occur anywhere, removal, destructive
but usually appear electrocautery, techniques
on exposed areas curettage, tend to leave
such asfingers, cryotherapy (liquid scars
hands, face and nitrgogen) caustic -
soles solutions (lactic autoinoculable
- may be single acid and salicylic - repeated
ormultiple acid in flexible irritation will
– asymptomatic collodion, retinoic cause to
acid, salicylic acid enlarge
plasters)x-ray - apply topical
treatment, laser anesthetic
EMLA

- Verruca - located on the -apply caustic - destructive

plantaris plantyar surface of solution to wart, techniques
(plantar wart) feet and because wear foam insole tend to leave
of pressure are with hole cut to scarsm which
practically flat; relieve pressure on may cause
may be wart; soak 20 problems with
surrounded by a minutes after 2-3 walking
collar of days; repeat until
hyperkeratosis wart comes out
- Herpes - grouped, burning - avoidance of - heal without
simplex virus & itching vescicles secondary scarring unless
Type I (cold on inflammatory infection secondary
sore, fever, base. Usually on - burrow solution infection
blister) near mucotaneous compresses during - Type I cold
Type II junctions (lips, weeping stages sores can be
(genital) genitals, buttocks) - topical therapy prevented by
- vesicles dry, (penciclovir) can using
forming a crust, shorten duration of sunscreens
followed by cold sores protecting
exfoliation - oral antiviral against
andspontaneous (acyclovir) for ultraviolet A
helaing in 8-10 initial infection or (UVA) and
days to reduce severity ultraviolet B
- may be in recurrence (UVB) light to
accompanied by - Valacyclovir prevent hip
egional (Valtrex), an oral blisters
lymphadenopathy antiviral used for - aggravated
episodic herpes, by
reduces pain, corticosteroids
stops viral - positive
shedding & has a physiologic
more convenient effect from
administration treatment
schedule than - may be fatal
acyclovir in children with
depressed
immunity

-Varicella - caused by same - symptomatic - pain in

zoster virus virus that caused - analgesics for children
(herpes varicella (chicken pain usually
zoster; pox) - mild sedation minimal
shingles) - virus has affinity sometimes helpful - postherpetic
for posterior root - local moist pain does not
ganglia, posterior compresses occur in
horn of spinal cord - drying lotions children
and skin crops of may be helpful - chicken pox
vesicles usually - ophthalmic may follow
confined to variety; systemic exposure;
dermatone corticotrophin isolate affected
following along (adenocorticotropic child from
course of affected hormones{acth}) other children
nerve corticosteroids in a hospital or
 - usually precede - acyclovir school
by neurologic - lidoderm topical - may occur in
pain, anesthetic children with
hyperparesthesias depressed
oritching immunity; can
- may be be fatal
accompanied by
constitutional
symptoms
MOlluscum - cases in well
contaglosum - fleshed colored children resolve
Cause: pox papules with a pontaneously in
virus central caseous about 18 months
Small benign plug (umbilicated) - treatment - common in
tuomors - usually resrved for school age
asymptomatic troublesome cases children
- apply topical - spread by
anesthetic EMLA skin to skin
and remove with contact
curette including
- use tretinoin gel autoinoculation
0.01% or and fomite to
catharidin skin contact
(cantharone) liquid
- curettage or
cryotherapy

SYSTEMIC MYCOTIC (FUNGAL) INFECTIONS

- Viruses (systemic or deep fungal) infections have a capacity to

invade the viscera, as well as the skin. The most common infections
are the lung diseases, whicha are usually acquired by inhalation of
fungal spores.
- produce a variable spectrum of disease
- they are not transmitted from person to person but appear to reside
in the soil from which their spores are airborne.

SKIN DISORDERS RELATED TO CHEMICAL OR PHYSICAL

CONTACTS

CONTACT DERMATITIS
- is an inflammatory reaction of the skin to chemical substances,
natural or synthetic, that evokes a hypersensitivity response or direct
irritation
- the cause maybe a primary irritant or a sensitizing agents
- A primary irritant is one that irritates the skin
- A sensiztizing agent produces an irritation on those individuals who
have met the irritant or something chemically related to it
- the major goal in treatment is to prevent further exposure of the skin
to the offending substance

Nursing Considerations

- skin manifestations in specific areas suggest limited contact, such as

around the eyes (mascara), areas of the body covered by clothing
but not protected by undergarments (wool), or areas of the body not
covered by clothing (ultraviolet injury)

POISON IVY, OAK & SUMAC

- contact with the dry od succulent portions of any of the three

poisonous plants
o Ivy
o Oak
o Sumac

- produces localized, streaked or spotty, oozing and painful

impetigenous lesions.

Therapeutic Management

- treatment of the lesions includes calamine lotion, soothing.

- Burrow solution compresses or Aveeno baths to relieve discomfort

Nursing Considerations

- the area is immediately flushed (15 minutes) with cold running water
to neutralize the urushiol not yet bounded to the skin
- Harsh soap is contraindicated because it removes protective skin oils
and dilutes the urushiol, allowing it to spread hard scrubbing irritates
the skin

Prevention: is best accomplished by avoiding contact and removing

the plant from the environment.
DRUG REACTIONS

- adverse reactions to drugs are seen more often in the skin than in
any other organ, although any organ of the body can be affected
- The manifestations may be associated with the side effects or
secondary effects of a drug, either of which are unrelated to its
primary pharmacologic actions
- manifestations of drug reactions may be delayed or immediate
- A period of 7 days is usually required for a child to develop
sensitivity to a drug that has never been administered previously.

FOREIGN BODIES

- parents remove small wooden splinters with a needle and tweezers

that have been sterilized with alcohol or a flame
- the area around the silver is washed with soap and water before
removal is attempted.

-small cactus prickles or spines are troublesome to remove, but the

following methods may prove helpful
o Apply a thin layer of water soluble household glue and cover with
gauze; when the glue dries, peel off the gauze
o Apply hair removal was or body sugar (Aplon), let dry, and
remove
o Place the cellophane tape, sticky side down, over the spines and
lift off

SKIN DISORDERS RELATED TO INSECT AND ANIMAL CONTACTS

SCABIES

- is an endemic infestation caused by the scabies mite, sarcoptes

scabies. Lesions are created as the impregnated female burrows into
the stratum conreum of the epidermis (never into living tissue) to
deposit her eggs and feces

Nursing Considerations

- the treatment of scabies is the application of a scabicide

- currently, permethrin 5% cream (Elimite) is the drug
- Permethrin is preffered because it is safer, it avoids the risk of
neurotoxicity and it is more eefective than lindane.
Clinical Manifestations of Scabies

LESION

Children – minute grayish-brown, threadlike (mite burrows), pruritic

black dot at end of burrow (mite)
Infants – eczematous eruption, pruritus

DISTRIBUTION
Generally in intertriginous areas-interdigital, axillary-cubital, popliteal,
inguinal
Children older than 2 years of age – primarily hands and wrist
Children younger than 2 years – primarily feet and ankles

PEDICULOSIS CAPITIS

- (head lice) is an infection of the scalp by Pediculous humanus capitis

- a common parasite in school age children
- the adult louse lives only about 48 hours when away from a human
host and the lifespan of the average female is 1 month.
- the female lay eggs at night at the junction of a hair shaft and close
to the skin because the eggs need a warm environment
- the nits or eggs, hatch in approximately 7-10 days. Itching is usually
the only symptom.

Diagnostic Evaluation

- diagnosis is is made by observation of the white eggs (nits) firmly

attached to the hair shafts
- adult lice are more difficult to locate
- nits must be differentiated from dandruff, lint, hair sprays and other
item of similar size and shape

Therapeutic management

- treatment consists of the application of pediculicides and manual

removal of nit cases
- the drug of choice in infantrs and children is permethrin1 % crème
rinse (Nix), which kills adult lice and nits
-Malathion, 0.5 % (Ovide) approved for treatment for treatment of
head lice is available only by prescription

Nursing Consideration

-An important nursing role is providing the parents with education

about pediculosis
- anyone can get pediculosis
- it has no respect for age, socio economic level or cleanliness

Preventing the Spread and Reoccurence of Pediculosis

- machine wash all washable clothing, towels and bed linens in hot,
water and dry dryer for at least 20 minutes. Dry clean nonwashable
items
- Throroughly vacuum carpets, car seats, pillows, stuffed animals,
rugs, mattresses and upholstered furniture
- seal nonwashable items in plastic bags for 14 dyas if unable to dry
clean or vacuum
- soak combs, brushes and hair accessories in lice killing products for 1
hour or in boiling water for 10 minutes
- in day care centers, store children’s clothing items such as hats and
scarves and other headgear in separate cubicles
- discourage the sharing of items such as hats, scarves, hair
accessorie, combs and brushes among children in group in groups
settings such as day care centers
- avoid physical contact with infested individuals and their belongings
especially clothing and bedding
- inspect children in a group setting regularly for head lice

ANTROPOD BITES AND STINGS

- bites and stings account for a significant amount of mild to moderate

discomfort in children
- most bites and stings are managed by simple symptomatic
measures, such as compresses , calamine lotion& prevention of
secondary infection
- anthropods include insects and arachnids, such as mites, tiks, spiders
and scorpions