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Pediatric Derm III
Treatment of Pediatric Dermatologic Conditions
| Condition | Cause/Etiology | Signs/Symptoms | Treatment | Pt Education | Complications |
|---|---|---|---|---|---|
| Atopic Dermatitis | Chronic allergic skin inflammation, hereditary | Usually begins in childhoold, resolves by age 30. Phases: Infant 0-2, Childhood: 2-12, Adolescent-Adult. Periods of remission/exacerbation. Abnormally dry skin. Itch scratch cycle. Weeping, crusting, lichenification | Bathing and lubrication. Hydrocortison 1% or 2.5% BID x 7days. Antihistamines (Bendadryl, Zyrtec, Claritin), Topical antipruritics, topical immunodulators (protopic, elidel) | Stop scratching,reduce dryness and irritiation, avoid drying soaps, eliminate allergens, "soap then grease" | related to itching and damaging the skin (infections, changes from all the scratching) |
| Seborrheic Dermatits | "cradle cap" Inflammatory skin disorder, usually develops in first 3 montsh | White/yellow greasy scales on erythematous base. Flaky. NOT ITCHING. Dull red plaques. Resolve in about 12 months | Mild shampoo, medicated shampoo, Low potency steroid Hydrocortisone 1% BID x 2 weeks | Use soft brush to loosen the flakes | What for secondary infections scratchin the upper layer of the epidermis. |
| Irritant dermatitis | skin inflammation due to irritan. results from direct injury to the skin. It affects individuals exposed to specific irritants and generally produces discomfort immediately following exposure. | Acute: papules or vesicles, patchy, weeping, edema, burning. Persistent: patchy, lichenification, fissures | Identify and eliminate exposure, Topical steroid, occlusive ointment (A&D ointment) | identify and eliminate the exposure | (blank) |
| Allergic dermatitis | inflammation of the skin manifested by varying degrees of erythema, edema, and vesiculation. It is a delayed type of induced sensitivity (allergy) resulting from cutaneous contact with a specific allergen | (blank) | Calamine Lotion, Aveeno bath, oatmeal to control the itching. Benadryl (don't use benadryl in kids <1 | Wash area, cold we compress. itching stops in about 10-14 days | (blank) |
| Diaper dermatitis | Most common type of irritant dermatitis in children. Irritants: stool, urine. Candida | Peaks 7-9 months, Glistening erythema or beefy red eruptions. | Get good history. Frequent Diaper changes, expose bottom to air, cleasne bottom with water.No heat lamps. Barrier ointment (A&D, Desitin, Zinc oxide). Hyrdocortisone 1% (if bottom very red). Miconazole (if yeast infection suspected). | Frequent diaper changes, expose bottom to air, cleanse bottome with water | (blank) |
| Acne | multifactorial (increase sebum production, environment - fast food restaurant) | Increases during puberty (2nd to increased sebum production). Comedonal acne (blackheads, whiteheads) not inflammed but more pustule. Mild inflammatory (looks redder). Severe: inflammatory, cystic | Get a good hx. Treatments, Exacerbations, Med Hx, Personal habits, menstruation OCPs. 1st appearance. Benzoyl peroxide, Retin-A, topical or oral antibiotics (erythromicy, tetracylcline) Hormonal therapy (orthotrycycline) Accutane (Rx per dermatologist). | If no improvement in 10-12 weeks refer to dermatologist | (blank) |
| Herpes Simplex | HSV1: orolabial HSV2: usually genital. Spread by contact with active lesions, fluid that's infected with HSV. Can spread during vaginal both | Recurrent Painfuld vesicles, erode and then crust over. Dx Test: viral culture for herpes, HSV1 IgG, Elisa | Oral: acyclovir, valcyclovir, Famciclovir. Topical: Abreva, Dinivir | Protect lilps with chapstick, don't pick at it. Good hand hygiene. Cool compress | (blank) |
| Varicella (Chicken Pox) | Highly contagious, spread by either airborne or direct contact (usually need a negative pressure room) | Incubation 10-21 days. communicable 2 days before rash, then contagious until after vesicles have crusted. Mild prodrome, then eruption of lesions. Hallmark: lesions can be in different stages at the same time. | Rarely treated. Control pruritus (Aveeno, oatmeal baths). Tylenol for fever, pain control. No ASA | Prevention: varicella vaccine | Sever skin infections, sepsis and thrombocytopenia |
| Rubella | RNA virus,spread by direct or droplet | Maculopapular rash (discreet and pink) lympadenopathy. Starts on the face then spreads to the trunk and extremities. Resolve in 3 days | (blank) | (blank) | Congential rubella: casues serious congential defects |
| Rubeola | RNA virus, spread by direct or airborne | Macular, deep pink, salmon color rash. Fever, cough, coryza, conjunctivitis. Koplik spots on buccal mucosa. Lasts about 3 days. confluent rash. doesn't crop up in lesions like varicella. | (blank) | Rule out if effectively immunized | (blank) |
| Warts | Human Papilloma virus | epithelial tumors common on hands and plantar surfaces. resolve without treatment 12-24 months | Salicylic acid, liquid nitrogen, duct tape | Referrals for incision | (blank) |
| Impetigo | Bacterial skin infection. Most common culprits S. aureus and S. pyogenes | Vesicles erput into honey colored, moiste, cursted erosion, usually on face, but can also be in the diaper area. Can be related to poor hygiene and warm moist climate. | Keflex or Dicloxacillin. Topical Bactroban (kills s. aureus) for mild infections | highly contagious. children can return to school 24 hours after antibiotics are started | (blank) |
| Tinea capits | Dematophyte fungal infection: scalp | varies from a scaly noninflamed dermatosis resembling seborrheic dermatitis to an inflammatory disease with scaly erythematous lesions and hair loss or alopecia | Griseofulvin 20-25 mg/Kg/24h PO divided qd or BID | take for 8 weeks and with high fat foods (for increased absorption) | (blank) |
| Tinea coporis | Dematophyte fungal infection: ringworm | Round scaly area, well demarcated. | Topical antifungal- miconazole, coltrimazole, terbinafine (takes about 2 weeks to resolve) | (blank) | (blank) |
| Tinea cruris | Dematophyte fungal infection: AKA jock itch | Adolescent boys c/o of groin itching. Sharp borders. well demarcated redness. Spares the scrotum. Consider Candida infection | topical antifungal: miconazole, clotrimzole and terinafine | (blank) | (blank) |
| Tinea pedis | Dematophyte fungal infection: athletes feet. | Important to look between the toes. | topical antifungal: miconazole, clotrimzole and terinafine | (blank) | (blank) |
| Tinea Versicolor | Dematophyte fungal infection: widespread | Widespread macular eruptions on the skin of various colors, depending on what the color of your skin. It can be white, pink or blue. The skin pigmentation comes back to normal after treatment | selenium sulfide, sodium sulfacetamine, ciclopiroxolamine, as well as azole and allylamine antifungals | versicolor is caused by a fungus that is normally present on the skin surface and is therefore not considered contagious. The condition does not leave any permanent scar or pigmentary changes, and any skin color alterations resolve within 1-2 months after | (blank) |
| Candiasis: oral | Yeast lik fungus caused by candida albicans | Oral: white plaques that do not scrape off the tongue. Milk curds scrape off | Oral: Nystatin PO | Make sure the medication touches the surface of the infected area | (blank) |
| Candiasis: diaper | yeast like fungus caused by C. albicans | Beefy red lesions. Satellite lesions. This is the difference between contact diaper dermatits and a dermatitis from candida | Nystatin cream. | Don't cover the rash with another medication. Nystatin should be close to the skin | (blank) |
| Pediculosis capitis | Eggs attach to the hair shaft near the scalp | Pruritus is the major symptom, and parents may note the lice and nits in the hair of the child | Nix OTC, Ovide, RID OTC | Use nit comb. Clean combs/brushes. REturn to school day after treatment | (blank) |
| Pediculosis corporis | body lice (less common in children) | Pruritus may lead to secondary excoriations that predispose to secondary skin infection and regional lymph node enlargement.Bites from body lice can be found in any area of the body. | Nix OTC, Ovide, RID OTC | (blank) | (blank) |
| Pediculosis pubis | Lice are ectoparasites that die of starvation within 10 days of removal from their human host. Lice feed on human blood after piercing the skin and injecting saliva. A mature female lays 3-6 eggs, also called nits, per day. Nits are white and less than 1 | Pubic lice can be found in hairy areas throughout the body, but they prefer the perineum and pubic areas. Occasionally, the infestation may be present in the eyebrows and eyelashes | Nix OTC, Ovide, RID OTC, Kwell (Lindane) | (blank) | (blank) |
| Scabie | Mites: spread by personal contact | Intense pruritus. Burrows which may get destroyed because the pt has been scratching so much). Vesicles, papules with erythema from scratching. Infants: head and neck. Children: hands most common. also seen: wrists, belt line axilla | Elimite cream (permehtrin). Kwell (Lindane) not approved for children < 2 years old. Ivermecting PO (for severe cases) | put on entire body, leave Elimite on for 8-14 hours. Won't kill if it's washed off. Launder clothing and bedding. Wrap mattress in plast bag for 1 wk. Return to school following rx. Treat all household members. | (blank) |
| Lyme disease | Borrelia burgdorferi, Ticks | Get hx Yard work, camping, pets. First stage: erythema migrans red macule/papule round lesion with central clearing (bullseye) | outpatient antibiotics | (blank) | (blank) |
| Enterobiasis | Enterobius vermicularis (pinworm) is the most common intestinal parasite in the United States. Fecal oral transmission. Common in toddlers. | The most common chief complaint is anal itching (pruritus), but most patients are asymptomatic | Antihelmintics: pyrantel pamoate, mebendazole or albendazole | Visualize worm (white, threadlike) 2-3 hours after child falls asleep. may use adhesive tape first thing in the morning | (blank) |
Created by:
lknightly
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