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common skin condition in children..pptx
- 1. COMMON SKIN CONDITION IN CHILDREN SUPERVISED BY DR NADIA
- 2. ATOPIC DERMATITIS Atopic Dermatitis or Eczema • “Dermatitis” and “eczema” used interchangeably • •A genetic defect in the proteins supporting epidermal barrier • •A chronic inflammatory skin condition • •Eczema, asthma, and allergic rhinitis (triad of atopies) • Trigger factors: (Infection such as bacterial, viral or fungal), emotional stress, sweating and itching, irritants: hand washing soaps , detergents, extremes of wathers, allergens, food: egg, peanuts, milk fish, soy wheat, aeroallegerns: house dust mites, pollen , animal dander and molds.
- 3. Erosion (from scratching) Lines of skin stress are prominent (lichenification ) Hanifin and rajka criteria (Must have 3)
- 4. DIAGNOSTIC AND STEP UP TREATMENT ACCORDING TO PHYSICAL SEVERITY
- 5. Prevention is the best treatment Patients with atopic dermatitis have abnormal skin barrier function • Ointments or creams emolliate better than lotions • Moisturizers may help repair the skin barrier Promote skin hydration, Decrease pruritus • Bathing:in lukewarm water for 5–15 min followed by applicationof an emollient (within 2–3 min of leaving the water) improves hydration of the skin. • Avoids soap and substitute such as aqueous cream emulyising ointment or Vaseline
- 6. • Topical corticosteroids :is anti-inflammatory agent and the mainstay of treatment for acute dermatitis. • Apply steroid cream once or twice daily • Use milder steroids for face , flexures and scalp • Amount of topical must used by technique the finger tip (FTU) applying method • -1 hand/foot/face: 1ftu, 1 arm: 3 FTU, 1 Leg: 6ftu, front and back: 14 ftu • Local affects: skin atrophy , telangiectasia, pupura, atria, acne, hirutisme and secondary infection • Systemic affects: adrenal axis, suppression, cushing syndrom
- 7. Relief in puritus Antihistamine to help control pruritus and aid in sleep -do not use routinely -review every 3 months Secondary infection -may cuase acute exacerbation eczema -commonly staphylococcus aureus -abx: 1.Oral cloxacillin 15mg/kg 6 hourly for 7- 14 days 2. Oral erythromycin/ cephalosprin -from herpes simplex virus can cause eczema Herpiticum-antiviral needed
- 9. SCABIES
- 10. DEFINTION Scabies is an intensified Pruritis skin problem caused by the Sarcotes scabiei hominis (Mite) Transmission by skin contact to skin contact
- 11. • It causes itchy rash on hands and wrists • It not affects scalp/ face Itchy, raised bumps/ lumps especially in the genital areas, armpits/ groin CRUSTED SCABIES/ NORWEGIAN SCABIES • More severe and extremely contagious type of Scabies • People develop thick crusts of skin that contain thousands of mites and eggs • It develops in people with weak immune system
- 12. PATHOHENESIS
- 13. DIAGNOSIS • Clinical presentation • Microscopic examination of skin TREATMENT ALGORITHM
- 14. DRUGS USED IN TREATMENT OF SCABIES Drug Category Mode of action Dose Adverse affects Permethrin Topical Scabicidal Kills parasite by affectingtheir nerve cells 5% cream-BD for 7days Burning Stinging Pruritis Hypersensitivity Crotamiton Topical antipruritic agent Counter irritant effect bycooling the skin 10% lotion-OD for 7days Allergic contact dermatitis Rash Pruritis Hypersensitivity Warm sensation Sulfur Topicalanti acne agent It shows keratolytic action and also have Scabicidal action 5-10% -HS-for 3 days Erythema Excessive desquamation Skin irritation Skin inflammation Hypersensitivity
- 15. Lindane Topical Scabicidal Kills parasite by affecting their nerve cells 1% lotion-BD Local irritation Contact dermatitis Alopecia Conjunctivitis Rash Ivermectin Anti helmenthic agent Kills parasite by affecting their nerve cells 200mcg/kg/day for 3 days like 1,2, and 8 th day-PO Asthenia Hypotension Peripheral oedema Transient tachycardia Insomnia Benzyl benzoate Topical Scabicidal Kills parasite by affecting their nerve cells 5% lotion-BD for 7 days Application site irritation Pruritis Erythema Ocular irritation Dandruff
- 16. NON PHARMACOLOGICAL TREATMENT • Avoid sharing of clothes and towels • Treat everyone at home in the household and close contactcs • Use properly washed clothes • Wash clotting and bedding in hot water or dry cleaning. Cloth that cannot wash may be stored in sealed plastic for three days • Apply soothing lotion like Calamine • Allow to school after 24 hours
- 17. STEVEN JOHNSON SYNDROME Life-threatening mucocutaneous diseases Within the spectrum of SCAR • Resemble erythema multiforme majus (EMM) • Mucosal involvement • Epidermal necrosis when <10% is called Steven Johnson Syndrome when 10-30% bullae called Steven Johnson Syndrome-Toxic Epidermal- Necrolysis (SSJ- TEN) when the bullae> 30% is called ToxicEpidermal Necrolysis (TEN).
- 18. SIGN SYMPTOMS • Flulike symptoms: -cough -fatigue -fever -headache -muscle & joint pains -sore throat • Three-ringed sores (shades of pink and red) develop on skin • Sores & blisters spread to skin (possibly eyes, genitals, lungs, stomach & colon as well) • Skin eventually dies and falls off (you can lose 10-30% of your body’s epidermis) • Esophagus, small bowel, colon involvement very common – Esophageal strictures, impair enteral nutrition, can casue diarrhea • absorption of oral medications. • Tracheobronchial mucosa shedding – Respiratory failure 20% mechanical ventilation • Vaginal stenosis and penile scarring • PTSD in survivors • Renal complications (rare) -raised blood urea, hyperkalemia and creatinine • Glucose-hypohlycemia
- 19. BASIC LESION IS ERYTHEMA EXUDATIVUM MULTIFORME. LOOKS SOME "TARGET LESION". Prof DR Dr Ariyanto Harsono SpA(K) 19
- 20. • skin can be pushed slightly aside by pressure of fingers • refer to the base of the blister, and thus to the level of epidermal separation NIKOLSKY SIGN
- 21. Mucosal Lesion at mouth, eyes, genitals, and maybe anal (minimal 3 mucosa) Prof DR Dr Ariyanto Harsono SpA(K) 21
- 22. • Detachment of large epidermal sheets in SJS/TEN overlap
- 23. ETIOLOGY • Drugs 1.Antibitics: sulphonamides, amoxicillin, ampicillin, ethambutol, isoniazid 2.Anticonvulants: phenobarbitone, carbamazepine, phenytoin 3.Non steroidal anti-inflammatory drugs: phenybutazone, salicylates • Infection 1. virus: herpes simplex, enteroviruses, adenoviruses, measles, mumps 2. Bacteria: streptococcus, salmonella typhi, mycoplasma penumoniae
- 24. MANAGEMENT • Supportive care -admit to isolation room where possible -may need IV resuscitation for shock -good nursing care(barrier bnursing and hand washing) -use of air fluidized bed, avoid bed sores -adequate nutrition-nasogastric tube, IV lines, parenteral nutrional, severe mucosal involvement • Specific treatment -eliminate suspected offending drugs -IV imunnoglobulin at a dose of 0.4 Gm/kg/per day for 5 days. IVIG is a safe and effective in treatment for SJS /TEN in children, it arrects the progression of the disease and helps complete re-epithelialization of lesions • Monitoring -maintenance body temp ,avoid excessive cooling or overheating -carefull monitor of fluid and electrolytes -i/o cahrting daily weighing and renal profile PREVENTION • Skin care -cultures skin, mucutaneous erosions,tips of foley’s catheter -treat infections with abx -topical antiseptics preparations :saline wash or KMNo4 wash -dressing of denuded areas with paraffin gauze/soffra-tulle • Eye care -Frequent eye assement -Abx or antiseptic eye drops 2 hourly • Oral care -good oral hygiene
- 25. PROGNOSIS • Death (due to infections, lung problems, disorders of fluid and electrolyte imbalance, bronchopneumonia and sepsis.) • Possible skin scarring and pigment changes • Difficulty with swallowing, vision, urinating and skin life • May lose nails and hair foreverf
- 26. Staphylococcal Scalded Skin Syndrome Prof DR Dr Ariyanto Harsono SpA(K) 26
- 27. STAPHYLOCOCCAL SCALDED SKIN(4S) • Caused by Staphylococcal exfoliative toxin • Erythematous tender skin, progressing to desquamation after 24-48hrs • Nikolsky sign • 62% < 2yrs, 98% < 5yrs • BCs usually negative in children • Usually febrile, may rapidly progress to dehydration/shock • Rx. Systemic antistaphylococcal abx., emollients, may need IV fluids
- 28. • Systemic therapy, either orally, in cases of localized involvement, or parenterally, with a semisynthetic penicillinase-resistant penicillin, should be prescribed because the staphylococci are usually penicillin resistant • Clindamycin may be added to inhibit bacterial protein (toxin) synthesis • First Line Treatment: – Flucloxacillin, – Clindamycin: may be given orally or parenterally either alone (or in combination with rifampicin or tetracyclines), – Temocillin, – Tigecycline – Daptomycin If MRSA is suspected: – vancomycin or – tobramycin • The skin should be gently moistened and cleansed. • Application of an emollient provides lubrication and decreases discomfort. • Topical antibiotics are unnecessary. Prognosis • Recovery is usually rapid, but complications such as excessive fluid loss, electrolyte imbalance, faulty temperature regulation, pneumonia, septicemia, and cellulitis may cause increased morbidity.