Alterations in children and the integument

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  • 1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1 Alterations of the Integument in Children
  • 2. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2 Acne Vulgaris  Most common skin disease  Affects 85% of the population between ages 12 and 25 years  Develops at sebaceous follicles located primarily on the face and upper parts of the chest and back
  • 3. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3 Acne Vulgaris (cont’d)  Noninflammatory acne  Blackheads  Whiteheads  Inflammatory acne  Caused by follicular wall rupture in closed comedones  Cystic nodules develop when inflammation is deeper
  • 4. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4 Acne Vulgaris (cont’d)  Physiologic factors:  Follicular hyperkeratinization  Excessive sebum production  Colonization of Propionibacterium acnes  Inflammation secondary to the action of inflammatory products produced by P. acnes  The excessive production of sebum is related to androgenic hormones
  • 5. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5 Acne Vulgaris (cont’d)  Clinical management:  Topical treatments  Systemic therapies  Surgery  Scarring treated with dermabrasion, lasers, and resurfacing techniques
  • 6. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6 Cystic Acne
  • 7. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7 Acne Vulgaris  Acne conglobata  Highly inflammatory form of severe acne  Characterized by the formation of communication cysts and abscesses beneath the skin
  • 8. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8 Atopic Dermatitis  Most common form of eczema in children  The cause is unknown, but 80% of individuals demonstrate a personal or family history of asthma or allergic rhinitis
  • 9. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9 Atopic Dermatitis (cont’d)  Manifestations:  Increased IgE levels  Elevated interleukin-4  Positive allergen skin tests  Eosinophilia  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
  • 10. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10 Atopic Dermatitis (cont’d)  Clinical management:  Accurate diagnosis and identification  Elimination of exacerbating factors  Reduction of emotional stresses  Hydration of skin  Anti-inflammatory agents  Immunomodulator and systemic therapies
  • 11. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 Atopic Dermatitis (cont’d)
  • 12. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12 Diaper Dermatitis  Group of inflammatory disorders affecting the lower abdomen, genitalia, buttocks, and upper thigh
  • 13. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13 Diaper Dermatitis (cont’d)  Diaper dermatitis is an irritant contact dermatitis  Inflammation encouraged by prolonged exposure to irritation by urine and feces, maceration by wet diapers, airtight plastic diaper covers, and possible association with intercurrent illness and early introduction of cereals
  • 14. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14 Diaper Dermatitis (cont’d)  Clinical manifestations:  Vary from mild erythema to erythematous papular lesions  Treatment:  Frequent diaper changes to keep area clean and dry  Frequent exposure of perineal area to air  Topical antifungal medications  Short-term topical steroids  Barrier creams or pastes
  • 15. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15 Diaper Dermatitis (cont’d)
  • 16. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16 Infections of the Skin  Bacterial infections:  Impetigo contagiosum • Superficial skin infection usually caused by Staphylococcus or group A streptococci • High incidence in hot, humid climates  Bullous impetigo  Vesicular impetigo
  • 17. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17 Impetigo
  • 18. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18 Infections of the Skin  Bacterial infections  Staphylococcal scalded-skin syndrome (SSSS) • Serious skin infection caused by exfoliative toxin producing group II staphylococci • The exfoliative toxin causes separation of the skin just below the granular layer of the epidermis • Manifestations:  Fever, malaise, rhinorrhea, and generalized erythema and skin tenderness, skin sloughing, and secondary infections • Treatment with oral and intravenous antibiotics, and aseptic technique to prevent infection
  • 19. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19 Infections of the Skin (cont’d)  Fungal infections:  Tinea capitis (scalp) • Most common fungal infection of childhood • Causative organisms found on cats, dogs, and rodents • Lesions circular and manifested by broken hairs at site, 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 with antifungals
  • 20. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20 Tinea Capitis
  • 21. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21 Infections of the Skin  Fungal infections  Thrush • The presence of Candida in the mucous membranes of the mouths of infants, and less commonly in adults • Characteristics:  White plaques or spots in the mouth that lead to shallow ulcers  Tongue appears to have white covering • Thrush can spread to the groin, buttocks, and other parts of the body • Treatment with oral antifungal suspension
  • 22. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22 Infections of the Skin (cont’d)  Viral infections  Molluscum contagiosum • Highly contagious viral infection of the skin • Transmission is skin to skin and contact with contaminated items • The virus encourages epidermal cell proliferation • Lesions slightly umbilicated dome-shaped papules primarily on the face, trunk, and extremities • No specific treatment but self-limiting and clears in 6 to 9 months
  • 23. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23 Molluscum Contagiosum
  • 24. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24 Infections of the Skin  Viral infections  Rubella (German measles or 3-day measles) • RNA virus • The disease is mild in most children • 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 the skin • Vaccination for rubella combined with mumps and rubeola (measles) (MMR)
  • 25. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25 Rubella
  • 26. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26 Infections of the Skin  Viral infections  Rubeola • RNA paramyxovirus • High fever, malaise, enlarged lymph nodes, runny nose, conjunctivitis, barking cough • Koplik spots over buccal mucosa  Roseola • Characterized by fever and an erythematous macular rash that lasts about 24 hours
  • 27. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27 Infections of the Skin (cont’d)  Viral infections (cont’d)  Chickenpox (varicella) • Highly contagious DNA virus • Spread by close person-to-person contact and airborne droplets • First signs of illness include fever, itching, and appearance of vesicles on face, trunk, and scalp • Uncomplicated infection requires no therapy • Vaccine available
  • 28. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28 Chickenpox
  • 29. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29 Infections of the Skin  Viral infections  Herpes zoster (shingles) • Occurs mainly in adults • Varicella virus persists for life in sensory nerve ganglia and reactivates • Lesions consist of groups of vesicles situated on an inflammatory base and follow the course of a sensory nerve • Therapy similar to that for chickenpox
  • 30. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30 Infections of the Skin (cont’d)  Viral infections (cont’d)  Smallpox • Highly contagious and deadly • Caused by poxvirus variolae • Eradicated in 1977 and vaccines discontinued in 1972 • Concern that bioterrorists have virus led to implementation of vaccination and isolation criteria by the CDC
  • 31. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31 Insect Bites and Parasites  Scabies  Contagious disease caused by the itch mite Sarcoptes scabiei  Transmitted by personal contact and infected clothing and bedding  Female mite tunnels millimeters to 1 cm into the stratum corneum, deposits eggs, and over a 3-week period the eggs mature into adult mites
  • 32. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32 Insect Bites and Parasites (cont’d)  Scabies (cont’d)  The primary lesions are burrows, papules, and vesicular lesions with severe itching  Patient is at risk for secondary infections from scratching  Treated with application of scabicide and linen cleaning
  • 33. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33 Scabies
  • 34. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34 Insect Bites and Parasites  Pediculosis  Pediculus capitis (head), pediculus corporis (body), and Phthirus pubis (crab or pubic)  Highly contagious parasite that survives by sucking blood • Acquired through personal contact and shared clothing, combs, or brushes  Treated with pediculicides; all clothes, towels, bedding, and brushes should be washed in hot water
  • 35. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35 Insect Bites and Parasites (cont’d)  Flea bites  Cat, dog, and human fleas  Bites occur in clusters along the arms and legs  The characteristic lesion is an urticarial wheal with a central hemorrhagic puncture  Treatment includes: • Spraying home • Treating infected animals • Washing clothing and bedding in hot water
  • 36. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 36 Insect Bites and Parasites (cont’d)
  • 37. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 37 Insect Bites and Parasites (cont’d)  Lyme disease  Multisystem inflammatory disease  Spirochete, Borrelia burgdorferi causative agent transmitted by tick bite  Occurs in stages: • Localized infection • Disseminated infection 9 months after bite • Late persistent infection continuing for years  Treatment with antibiotics
  • 38. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 38 Insect Bites and Parasites (cont’d)  Bedbugs  Cimex lectularius  Live in the crevices and cracks of floors, walls, and furniture and in bedding or furniture stuffing  3 to 5 mm long and reddish brown  Bedbugs feed in the darkness • Attach to the skin, suck blood, and leave  Lesions are red macules that develop into nodules
  • 39. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 39 Hemangiomas  Strawberry hemangiomas  Raised vascular lesions that usually emerge 3 to 5 weeks after birth  The lesions proliferate, become bright red, and elevate with small capillary projections  Cavernous hemangiomas  Present at birth  Cavernous hemangiomas involve larger and more mature vessels than strawberry hemangiomas
  • 40. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 40 Strawberry and Cavernous Hemangiomas
  • 41. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 41 Vascular Malformations  Port-wine stains  Congenital malformation of dermal capillaries  Flat, pink, to dark reddish purple lesions  Salmon patches  Macular, pink lesions resulting from distended dermal capillaries • Usually fade by 1 year of age  Common on the nape of the neck, forehead, upper eyelids, or nasolabial folds
  • 42. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 42 Port-Wine Hemangioma
  • 43. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 43 Miliaria  Vesicular eruption after prolonged exposure to perspiration, with subsequent obstruction of eccrine ducts  Miliaria crystallina • Ductal rupture within the stratum corneum • Clear vesicles without erythema  Miliaria rubra (prickly heat) • Erythematous papules and papulovesicles
  • 44. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 44 Miliaria Rubra
  • 45. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 45 Other Skin Disorders  Erythema toxicum neonatorum  Benign, erythematous accumulation of macules, papules, or pustules  Cause is unknown  No treatment is required