REVIEW OF SKIN DISORDER

1. MS.LINCY SAMSON .S
NURSING TUTOR
GANGA COLLEGE OF NURSING
COIMBATORE

2. REVIEW OF SKIN DISORDER

3. Learning Objectives
The students will be able to
 define the common skin disorders in children
 list out the types of skin disorders in children
 discuss the epidemiology/Etiology related to skin disorder
in children
 explain the source of Transmission of skin disorder in
children
 enumerate the diagnostic evaluation for skin disorders in
children
 explain the management of skin disorders in children

4. INTRODUCTION
• Skin act as a barrier
- to retain body fluids and electrolytes
- a regulator of bodyheat
- a receptor of sensory stimuli
• Appearance reflects the general health of an infant or
child
• Common skin conditions of childhood are infections,
lesions, wounds and dermatitis disorders

5. TYPES OF INFECTIONS
• Bacterial Infections
• Viral Infections
• Fungal Infections

6. BACTERIAL INFECTIONS
• Impetigo
• Cellulitis
• Furuncles and Carbuncles
• Cutaneous Tuberculosis
• Orificial Tuberculosis

7. IMPETIGO
• Contagious acute pyrogenic infection
• Superficial infection of the upper layers of the
epidermis
• Apperance:
–Small red blemishes form
which starts to weep and spread.
– Honey coloured crust then form.

8. Etiology
• Staphylococcus aureus, Group A beta
Hemolytic streptococci or by both.
• Affects infants, preschool children and young
adults
• Predisposing factors:
– Crowded living conditions
– Poor Hygiene
– Neglected minor trauma

9. Sub types
• Nonbullous (Impetigo Contagiosa)
• Bullous impetigo
• Ecthyma

10. Pathophysiology

11. Clinical Features
• Classic signs and symptoms include
– Red sores that quickly rupture, ooze for a few days and
then form a yellowish-brown crust.
– Itching and soreness are generally mild.
seen with
– Regional lymph nodes enlarged and tender.
– Weakness, fever, diarrhea sometimes is
bullous impetigo.
– Face is the commonest site but lesion also occur on the
scalp, arms, legs and buttocks.

12. Investigations
• Complete History collection
• Physical Examination
• Gram stains or swab taken for culture

13. Management
• Good skin hygiene isessential
• Systemic Antibiotics needed for severe cases
– Erythromycin (30-50 mg/kg/day) in divided doses for 5-7 days or
– Cloxacillin (25-50 mg/kg/day) in divided doses for 5-7 days
• Removal of the Crusts for minor cases by compressing them
• Application of topical antibiotics such as mupirocin 2%onitment /
Gentamycin 0.% cream is administered 3-4 times daily

14. CELLULITIS

15. Description
• Cellulitis is an acute, spreading infection of dermal
and subcutaneous tissues.
• Characterized by red, hot, tender area of skin, often
at the site of bacterial entry.
• Most common in the lower legs, but it may affect any
part of the body.
– upper skin layer, it may be called erysipelas (more
common in children)
– If affected around the eyescalled periorbital
cellulitis

16. Etiology
• Affects children less than 3 years old and also older
individuals.
• The most common organism are
– Group A β Hemolytic Streptococcus Pyogenes
• In children common organism include
– Hemophilus Influenzae (periorbital cellulitis)
– Group AStreptococci
– Streptococcus aureus

17. Risk Factor
• Local trauma (e.g., lacerations, insect bites, wounds,
shaving)
• Skin infections such as impetigo, scabies, furuncle, tinea
pedis
• Underlying skin ulcer
• Fragile skin
• Immuno compromised host
• Diabetes mellitus
• Chronic lymphedema

18. Pathophysiology
• Break in the skin, such as a fissure, cut
laceration, insect bite or puncture wound causes
entry of bacteria in to the subcutaneous tissue.
• Deep inflammation of subcutaneous tissue from
enzymes produced bybacteria.

19. Clinical manifestation
• Swelling of the skin
• Local Tenderness
• Warm skin
• Pain
• Bruising
• Blisters
• Fever
• Headache
• Chills
• Feeling weak
• Red streaks

20. Investigations
• Thorough History Collection
• Physical Examination
• Complete Blood Count (WBC & ESR may
elevated)
• Culture and Sensitivity

21. Management
• Supportive measures include rest, immobilization,
elevation, moist heat and analgesics
• For mild early Cellulitis:
– Use of oral Cloxacillin 0.5 to 1gm every 6hours
– For penicillin allergic patient is oral erythromycin
0.5gm every 6hours
• For severe infections:
– Penicillin 10 million units + Cloxacillin 2 g t.i.d IV
– Penicillin allergic patient Vancomycin 1.0 to 1.5 g
per day IV

22. FURUNCLES AND CARBUNCLES

23. Description
• Furuncle also called acute deep folliculitis and
boil.
• Acute deep-seated, red, hot very tender,
conglomerate or multiple
inflammatory nodule.
• Carbuncle is a
coalescing furuncles.

24. Etiology
• Common cause of carbuncle staphylococcus
aureus

25. Clinical features
• Most common symptoms of folliculitis and carbuncles are
– Pus in the hair follicle
– Irritated red follicles
– Damaged hair
– Pus in the centre of the boil b) Whitish, bloody discharge
from the boils
– Fever
– Fatigue

26. Investigations
• Thorough medical history
• Physical examination
• Blood (Wound) culture

27. Management
• Warm compresses and Systemic antibiotics may
arrest early furuncles
• Furuncle localised , showing definite fluctuation
– free incision with drainage should bedone
• Topical antibiotic should applied
• Oral and IV antibiotics

28. NURSING DIAGNOSIS
• Impaired skin integrity
• Impaired tissue integrity
• Risk for infection

29. References
• Vicky R.Bowden, Cindy Smith Greenberg (2010) Children and
their Families: The Continuum of Care, II Edition, Wolter
Kluwer, Lippincott Publication
• A. Parthasarathy (2019)., IAP Textbook of Pediatrics, 7th
Edition, Jaypee Publication
• Suraj Guptae(2019) , The short Textbook of Pediatrics, 12th
Edition, Jaypee brothers Medical Publication
• Parul Datta(2015), Pediatric Nursing by Jaypee brothers
Medical Publishers
• https://childrensnational.org/visit/conditions-and-
treatments/skin-disorders/noninfectious-skin-conditions
• https://childrensnational.org/visit/conditions-and-treatments/skin-
disorders/viral-exanthems-rashes