The document discusses various skin disorders in children. It covers layers of the skin, functions of skin, types of primary and secondary skin lesions, and classifications of skin infections including bacterial, fungal, viral and parasitic. Specific conditions are described such as impetigo, cellulitis, warts, ringworm, scabies and their signs, causes, and management. Diagnostic evaluation involves medical history, physical examination, skin scrapings, cultures and treatment includes antibiotics, antifungals, antivirals and ointments.

1. SKIN DISORDERS
PRESENTED BY:
M.VIJIYALAKSHMI
MSC NURSING
DEPT. OF CHN
CON -PIMS

2. INTRODUCTION
SKIN IS THE LARGEST AND MOST SUPERFICIAL ORGAN OF THE BODY. NEARLY
ONE THIRD OF THE PAEDIATRICS OUT PATIENTS VISIT INVOLVES
DERMATOLOGICAL CONDITIONS. IN ADDITION TO WIDE VARIETY OF PRIMARY
CHILDHOOD, SKIN IS A MARKER OF UNDERLYING SYSTEMIC DISEASE.

3. LAYERS OF SKIN
• EPIDERMIS
• DERMIS
• HYPODERMIS

4. FUNCTION OF SKIN
• SENSATION
• HEAT REGULATIONS
• ABSORPTION
• PROTECTION
• EXCRETION
• VITAMIN D PRODUCTION
• SECRETION

5. BASIC OF CLINICAL DERMATOLOGY
1. MORPHOLOGY OF LESIONS
• PRIMARY LESIONS
• SECONDARY LESIONS
• SPECIFIC LESIONS
2. ARRANGEMENT OF LESIONS

6. PRIMARY LESIONS
1) MACULES :
HYPERPIGMENTATION
(EG:CAFE AU LAIT MACULE)

7. HYPOPIGMENTATIO
N
(EG: LEPROSY)
DEPIGMENTATION
(EG: VERTILIGO)
ERYTHEMATOUS
(EG:DRUG RASH)

8. 2) PAPULES AND NODULES
A) PAPULES
B) NODULES
3) PLAQUE

9. 4)WHEAL 5) BLISTER

10. SECONDARY LESIONS
B)CRUSTS
C) EROSION
A)SCAL
ES
D)LICHENIFICATION

11. SPECIFIC LESIONS
1) BURROW 2) COMEDONES

12. ARRANGEMENT OF LESIONS
Arrangement Example
Linear Verrucous epidermal
nevus
Grouped Herpes simplex
Dermatomal Herpes zoster
Arcuate Granuloma annulare

13. TYPES OF SKIN INFECTION
• BACTERIAL INFECTION
• FUNGAL INFECTION
• VIRAL INFECTION

14. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Bacterial infection
The skin is the body’s first barrier against
bacteria that cause infection. Bacterial skin
infection can affect a small spot or may spread
affecting a large area. They can range from a
treatable infection to a life threatening skin
condition.
Impetigo
Impetigo is a superficial infection of the skin,
caused by bacteria.
The lesions are often grouped and have a red
based.
The lesions open and become crusty and have a
‘honey- color’ , which is typical of impetigo.
It is contagious and can spread throughout a
Household, with children reinfecting themselves
or other family members.
1) Group a beta hemolytic
streptococcus
2) Staphylococcus Aureus
Lesions seen in face, neck, arm and limbs
Starts as a small vesicle
lesion ruptures and fluid drains leaving
areas covered with crusts
Swollen lymph nodes seen

15. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Cellulitis
It is a deep bacterial infection of the skin.
The infection usually involves the face, arms or
legs.
It may happen in normal skin, but it usually
occurs after some type of trauma causing an
opening in skin. This opening can lead to
infection.
1) group a beta- hemolytic
streptococcus
2) streptococcus pneumonia
3) staphylococcus Aureus
• Swelling of the skin
• Tenderness
• Warm skin
• Pain
• Bruising
• Blisters
• Fever
• Headache
• Chills
• Feeling week
• Red streaks from the original site of
cellulitis
Some cases are considered emergency
with following symptoms:
• A very large is affected, causing
numbnes and tingling sensation
• The skin appear black
• If the inflammation is Near to the eyes
Or ears
• If the child has diabetes or weakened
immune system and develops cellulitis

16. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Folliculitis, boil and carbuncles
• Folliculitis is the inflammation of hair
follicles due to an infection, injury or
irritation.
• It is characterized by tender, swollen areas
that form around hair follicles, often on the
neck, breast, buttocks and face.
• Boils are pus filled lesions that are painful
and usually firm. Boils are usually located in
the waist area, groins, buttocks and under the
arm
• Carbuncles are cluster of boils. These are
usually found in the back of the neck or thigh.
• infection
• injury
Symptoms for folliculitis :
• Pus in the hair follicles
• Irritated and red follicles
• Damaged hair
Symptoms for boils :
Pus in the center of the boil
Whitish, bloody discharge from the boil
Symptoms of carbuncles:
• Pus In center of the boil
• Whitish, bloody discharge from the
boils
• Fever
• Fatigue

17. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Staphylococcal scaled skin syndrome
• Staphylococcal scaled skin syndrome is the
response to a staphylococcal infection and is
characterized by peeling skin.
• These disease mostly affects infants, young
children and individual with a depressed
immune system Or renal insufficiency.
staphylococcal infection Fever
Redness of skin
Fluid filled blisters
Crusted infection site
Red, painful areas around infection site
ChilLs
Weakness
Fluidloss
nikolsy’s sign

18. DIAGNOSTIC EVALUATION
• MEDICAL HISTORY
• PHYSICAL EXAMINATION
• UNIQUE PATCHES ARE IDENTIFIED ON PHYSICAL EXAMINATION
• THE PHYSICIAN MAY USE AN ULTRAVIOLET LIGHT TO SEE THE PATCHES
• SKIN SCRAPING ARE DONE
• BLOOD AND SKIN SAMPLE
• WOUND CULTURE

19. MANAGEMENT
IMMEDIATE TREATMENT CAN HELP TO PREVENT THE SPREAD OF CELLULITIS.
MAY INCLUDE:
• ORAL OR IV ANTIBIOTICS
• WARM, WET DRESSING
• SURGICAL INTERVENTION
• OF THE CHILD‘S EXTREMITY IS AFFECTED, ELEVATE THE EXTREMITIES AND
DECREASE THE AMOUNT OF ACTIVITY
• FOR CARBUNCLES AND BOILS, A WARM COMPRESS MAY BE USED TO HELP
PROMOTE DRAINAGE OF THE LESION.

20. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Fungal infection
• Skin fungi live in the dead top layer of the
skin cells in moist areas of the body, between
toes, groin and diaper area.
• Some infection cause small amount of
irritation. Other types of fungal infection
penetrate deeper and may cause itching,
swelling, blistering and scaling.
Candidiasis (yeast infection)
• Candidiasis, sometimes called moniliasis, is
an infection caused by yeast on the skin or
mucous membrane.
• Although yeast is normally a harmless , it
cause infection when the skin is damaged or
when the child has depressed immune system.
infection caused by yeast

21. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Tinea infections (Ringworm)
• Different fungi depending on
their location on the children’s
body, cause ringworm. Ringworm
is characterized by Ring-shaped,
red, scaly patches with clear
center.
Athlete’s foot
(tinea pedis or foot ringworm)
• This common mostly affect teen
and adult males. Less frequently
affect children before puberty.
Causes includes sweating, not
drying feet well.
1) whitening of the skin between toes
2) scaling of the feet
3) itchy rash on the feet
4) blisters on the fee

22. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Jock itch
( tinea cruris or groin ringworm)
This condition is also common in males and
occurs more often during warm weather.
Scalp ringworm ( tinea capitis)
• Scalp ringworm is highly contagious,
especially among children. It mainly occurs
in children between ages of 2 -10 years and
rarely in adults
Nail ringworm ( tinea unguium)
• It is an infection of the finger or toe nail,
characterized by a thickened and deformed
nail. This condition more often affects the
toe nails than the fingernails.
• More often occurs in adolescent and adult
1) red, ring- like patches in the groin
2) itching in the groin
3) pain in the groin
1) red scaly rash on scalp
2) itching of scalp
3) hair loss on scalp
4) rash elsewhere on the body
5) it Also develop into kerion .
This is caused by hypersensitivity to the
ringworm and associated with rash
elsewhere and tender lymph nodes.
1) thickening of the end of nails
2) yellow color of the nails

23. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Body ringworm
( tinea corporis)
• This skin infection is characterized by a ring-
like rash anywhere on the body or the face.
May occur In all the ages but seen frequently
in children. More common in wamer climate.
Tinea versicolor
It is the most common fungal skin infection
Characterized by light or dark patches on the
skin, patches are most often found on the chest
or back .
Caused by fungi pityrosporum
orbiculare
1) red, circular lesion with raised edge
2) middle of lesion may become less red
as lesion grows
3) itching at the affected area.
• White, pink or brown patches mostly
noticeable in summer
• Infection only on the top layer of the
skin
• The rash usually occur on the trunk
• The rash does not usually occur on the
face
• Patches worsen in heat, humidity or if
the child is on steroid therapy or has a
weakened immune system

24. DIAGNOSTIC EVALUATION
• MEDICAL HISTORY
• PHYSICAL EXAMINATION
• UNIQUE PATCHES ARE IDENTIFIED ON PHYSICAL EXAMINATION
• THE PHYSICIAN MAY USE AN ULTRAVIOLET LIGHT TO SEE THE PATCHES
• SKIN SCRAPING ARE DONE
• BLOOD AND SKIN SAMPLE
• CULTURE OF THE SKIN

25. MANAGEMENT
• MEDICAL OINTMENT
• TROPICAL ANTI-FUNGAL AGENT
• INFECTIONS IN VAGINA OR ANUS ARE TREATED WITH MEDICATED
SUPPOSITORY.
• ORAL THRUST TREATED WITH MOUTH WASH
• IMMUNOCOMPROMISED CHILD MAY BE TREATED WITH ORAL ANTI-NATIONAL
YEAST MEDICATION.
• USE SPECIAL SHAMPOO
• REMOVAL OF LESION

26. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Viral skin infection
• Many viral infection in childhood are called
‘viral Exanthems‘. Exanthem is another
name for a rash or skin eruption. This type of
rash are caused by viruses. It may also be
caused by medication, especially antibiotics
Warts
• Warts are non – cancerous skin growth caused
by the papilloma virus.
• Warts can spread to other parts of the body
and to other person.
• Warts are not painful, except when located on
the feet. Most warts go away, without
treatment, over an extended period of time.
Common warts
growth around nails and the back of hands,
caused by the papilloma virus.

27. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Foot warts
• Located on the soles of feet (plantar warts)
with black dots (clotted blood vessels that
once fed them). Cluster of plantar warts are
called mosaic. These warts may be painful
Flat warts
• Small, smooth growths that grow in group up
to 100 at a time, most often appears on
child’s face.
Genital warts:
• Grow on the genitals, are occasionally
sexually transmitted, soft and do not have a

28. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Filiform warts :
• Small, long, narrow growth that usually
appear on eyelids, face or neck.
Molluscum contagiosm
• Molluscum contagiosm is a viral disease of
skin that causes small pink or skin-colored
bumps on the child’s skin.
• The virus is inside the bumps and is mildly
contagious. These bumps usually clear over
an extended period of time.
• Molluscum contagiosm is
caused by a virus called the
poxvirus.
• It is most common in children
and adolescents, although it
can affect adults
• groups and clusters of lesions are
seen
• pink or skin colored lesion
• suken at the center

29. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Rubella (German measles)
• Rubella is a viral illness that results in a viral
exanthem. It spreads from one child to
another through direct contact with discharge
from nose and throat.
• Infants and children who develop the disease
usually have mild rash and side effects.
• A fetus that contracts rubella from his or her
mother while she is pregnant can have severe
birth defects and consequences.
• Caused by a virus called
rubivirus
• Pregnant mother to unborn
• From secretions of another
infected person
• The disease itself doesn’t have any
long-term consequences.
• It may take between 14 and 21 days
for the child to develop signs of
rubella after coming in contact with
the disease.
• The Child may be contagious 7 days
before the onset of the rash and 5-7
days the rash has appeared.

30. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Rubeola ( measles)
• Rubeola also called measles, is a viral illness
that results in viral exanthem.
• It spreads from one child to another through
direct contact with discharge from nose and
throat of infected child. Sometimes spreads
through air-borne from an infected Child
Chickenpox
• Chicken pox is a highly infectious diseases
caused by varicella zoster virus, form of
herpes virus.
• Transmisson occurs from person-to-person by
direct contact or through the air by coughing
or sneezing.
• The virus that causes measles,
is classified as morbillivirus
belonging to paramyxoviridae
family.
During the early phase of the disease,
symptoms include
• Hacking cough
• Redness and irritation of the eyes
• Fever
• Small red spots with white center
(koplik’s) appears on the inside of
cheek
• Red-deep, red, flat rash that starts on
the face and spreads down to the trunk,
arms, legs and feet
• Fatigue and irritability, one to two days
before the rash begins.
• Itchy rash on the trunk, face, scalp,
armpits, upper arms, legs and inside
the mouth.
• Fever
• Feeling ill

31. DIAGNOSTIC EVALUATION
• MEDICAL HISTORY
• PHYSICAL EXAMINATION
• UNIQUE PATCHES ARE IDENTIFIED ON PHYSICAL EXAMINATION
• THE PHYSICIAN MAY USE AN ULTRAVIOLET LIGHT TO SEE THE PATCHES
• SKIN SCRAPING ARE DONE
• BLOOD AND SKIN SAMPLE
• WOUND CULTURE

32. MANAGEMENT
• MEDICAL OINTMENT
• ACETAMINOPHEN FOR FEVER
• CALAMINE LOTION (RELIEVE ITCHING)
• BED REST AND INCREASED FLUID INTAKE
• CHILDRENS ARE NOT SENT TO SCHOOLS OR DAY CARE CENTER
• ANTI-VIRAL DRUGS (FOR SEVERE CASES)

33. TYPES OF INFECTION ETIOLOGY CLINICAL FEATURES
Parasitic skin infection
• Parasites on the skin are usually small inset or
worms that burrow into the skin to live there
or lay their eggs.
Scabies
• Scabies is an infestation of mites
characterized by small ref bumps and intense
itching.
• This highly contagious infection often spreads
from person to person while they are sleeping
together in the same bed or have close
personal contact.
• The itching is caused by the mites burrowing
into the skin where they lay eggs that hatch a
few days later.
• Itching, usually severe
• Rash, with pimples or red bumps
• Scaly or crusty skin

34. DIAGNOSTIC EVALUATION
• MEDICAL HISTORY
• PHYSICAL EXAMINATION
• UNIQUE PATCHES ARE IDENTIFIED ON PHYSICAL EXAMINATION
• THE PHYSICIAN MAY USE AN ULTRAVIOLET LIGHT TO SEE THE PATCHES
• SKIN SCRAPING ARE DONE
• BLOOD AND SKIN SAMPLE
• WOUND CULTURE

35. MANAGEMENT
• MEDICAL OINTMENT
• INFECTIONS IN VAGINA OR ANUS ARE TREATED WITH MEDICATED
SUPPOSITORY.
• ORAL THRUST TREATED WITH MOUTH WASH
• IMMUNOCOMPROMISED CHILD MAY BE TREATED WITH ORAL ANTI-NATIONAL
YEAST MEDICATION.

36. CARE OF CHILD WITH SKIN DISORDERS
• BATH THE CHILD WITH AN ANTIBACTERIAL SOAP TO PREVENT
SPREADING.
• CUT THE NAILS OF THE CHILD
• PROPER HAND WASHINGS SHOULD BE TAUGHT
• AVOID SHARING GARMENTS AND WASH SEPERATELY AND DRY IN
HOT DYRER.
• INCREASE CHILD’S FLUID INTAKE AND CPMPLETE REST.
• ADMINISTER MEDICATION AS PER THE ORDER
• EDUCATE THE PARENTS SKIN DISORDERS AND RISK OF
INFECTIONS.

37. NURSING DIAGNOSIS
• ACUTE PAIN RELATED TO BLISTERING AND EROSION
• FLUID VOLUME DEFICIT AND ELECTROLYTE IMBALANCE RELATED TO FLUID
DISCHARGE FROM THE SKIN.
• IMPAIRED SKIN INTEGRITY RELATED TO RUPTURED BLISTERS
• DISTURBED BODY IMAGE RELATED TO APPEARANCE OF THE SKIN.
• RISK FOR INFECTION RELATED TO LOSS OF THE PROTECTIVE BARRIER OF THE
SKIN.
• ANXIETY RELATED TO PHYSICAL APPEARANCE OF THE SKIN AND PROGNOSIS.

38. BIBLIOGRAPHY-BOOK REFERENCE
BOOK REFERENCE
• “WONG’S ESSENTIAL OF PEDIATRIC NURSING “ 2ND SOUTH ASIAN EDITION,
ELSEVIER PUBLISHER, PAGE NO: 783-790
• “PARUL DUTTA” PEDIATRIC NURSING 3RD EDITION PUBLISHED BY SAGS, NEW
DELHI, PAGE NO: 852-856
• RIMPLE SHARMA, “ESSENTIAL OF PEDIATRIC NURSING”, 2ND EDITION, JAYPEE
PUBLICATION, PAGE NO: 496-501
NET REFERENCE
WWW.SLIDESHARE.NET “DISORDER OF SKIN IN CHILDREN “

39. ASSIGNMENT
• WRITE AN ASSIGNMENT ON COMMON BACTERIAL INFECTION IN CHILDREN?