Child with skin disorder

CHILD WITH
SKIN DIORDERS
Peer group presentation

INTRODUCTION
• Skin is the largest and most superficial organ of the body.
• Nearly one third(1/3rd) of the paediatric outpatient visits
involve a dermatology complaint.
• In addition to wide variety of primary skin disorder seen during
childhood, skin is a marker of underlying systemic disease and
many hereditary syndrome

SOME IMPORTANT FUNCTIONS OF SKIN
 Protection from wear and tear.
 Protection against infection and chemicals.
 Protection against ultraviolet rays.
 Maintaining body temperature.
 Response to increased temperature.
 Response to a fall in temperature.
 Receiving stimuli from the outside world.
 Absorption and excretion of waste
 Barriers to water loss

CHILDREN SKIN IN COMPARISON TO ADULT SKIN
 An adult’s skin is usually exposed to multiple things like harsh climate, environmental
changes, and chemicals. that tend to have an unwanted impact on it. On the other hand, a
baby's skin is delicate, tender and sensitive.
 The skin of an infant is still developing. The epidermis of a baby's skin is one third the
thickness of an adult skin. Hence, dirt and bacteria can easily penetrate through the
immature barrier of a baby's skin.
 The sweat glands of an infant are less effective, which means that the baby's skin absorbs
and loses moisture easily. Due to this the function of temperature regulation of a baby's
body is much lesser as compared to that of an adult.
 Sebum and Melanin are also produced less in a baby's skin. All this means that the baby’s
skin calls for more attention and care
 Increased susceptibility to external irritants and susceptibility to micrococcal infection

APPROACH TO THE CASE
1. HISTORY is important for diagnosing skin disease, may be crucial in complex cases.
2. EXAMINATION: - requires careful inspection of the entire cutaneous surface, many skin
diseases are diagnosed only by their morphologic appearance.
– identify the primary lesion,
– the size in millimeters,
– secondary changes,
– colour,
– arrangement and distribution of the lesion.
1. The entire body surface, all mucous membranes, conjunctiva, hair, and nails should always
be examined thoroughly under adequate illumination.
• PRIMARY SKIN LESIONS: Initial pathologic change
• SECONDARY SKIN LESIONS: Result from external forces such as scratching, picking,
infection, or healing of primary lesions.

Types of skin infection in children
oBacterial infection
oViral infection
oFungal infection

Common bacterial infection in children
•1.IMPETIGO CONTAGIOUS:

Manifestation: -
 Begins as a reddish macule
 Becomes vesicular
 Ruptured easily, leaving superficial, moist erosion
 Tends to spread peripherally in sharply marginated irregular outlines
 Exudate dries to form heavy, honey coloured crust
 Pruritis common
 It is contagious and can spread to all the members of the family and also
leads to re-infection of children
 Impetigo usually occurs on face, neck, arms and limbs.
 Very common in toddlers and pre-schoolers
Systematic effect: - minimal or asymptomatic

The most common causative organisms are-
1. Group A B hemolytic Streptococcus
2. Staphylococcus aureus.
Impetigo is most common in children, but adults
may also have it due to poor hygiene and warm
temperatures.

Diagnostic evaluation Management
o Diagnosed based on complete history
o Physical examination
o The lesions of impetigo are unique and are
clearly diagnosable.
o Culture of lesion can be done to confirm the
diagnosis and the type of bacteria.
Precautions: -
 Proper hand washing technique by everyone
in the house hold is very important to help
diagnosis the chance of spreading the
infection.
 Keep the child’s finger nails short to decrease
the chances of scratching and spreading the
infection.
 Avoid sharing of garments, towels and other
house hold items to prevent the spreading of
infection.
Specific treatment is given based on
1. Child’s age, overall health and medical history
2. Extent of condition
3. Child’s tolerance to specific medications Treatment:
1. For child with many lesions or serious lesions -oral
or parenteral antibiotics(penicillin) are given
2. If child has only few lesions, topical antibiotics
ointment mupirocin or triple antibiotic ointment are
applied directly on the affected area.
3. Bathe the child daily with an antibacterial soap to
help decrease the chance of spreading the infection.
4.vancomycine for methicillin-resistant
staphylococcus aureus.
5.Retapamulin 1% ointment, applied twice daily for 5
days

•PYODERMA
•Pyoderma means any skin disease that is pyogenic (has pus).
•It has deeper extension of infection into dermis and in this tissue, reaction is more
serious, its contagious.
•May heal with or without scarring
Systemic effects: - fever, lymphangitis, sepsis, liver disease and heart disease

Causative agent: Management:
Staphylococci
Streptococci
Soap and water cleansing
Topical antiseptic such as
chlorhexidine
Mupirocin
Antibiotics depending on
causative organism:
cephalexin, nafcillin
Bathing with antibacterial
soap as prescribed

FOLLICULITIS (pimple), FURUNCLE (boil),
CARBUNCLE (multiple boils)
 Folliculitis is the inflammation of hair follicles due to an infection, injury or irritation.
 It is characterized by tender, swollen areas that form around the follicles, often on the
neck, breast, buttocks and face.
 The following are the most common symptoms of folliculitis. However, each child may
experience symptoms differently.
a) Pus in the hair follicle
b) Irritated red follicles
c) Damaged hair

•Boils are pus filled lesions that are painful and usually firm. They are larger
lesion with more redness and swelling at a single follicle, (wbcs, bacteria and
protein)
•Boils are usually located on the waist area, groins, buttocks and under the arm.
The following are the most common symptoms of furuncle
a) Pus in the centre of boil
b) Whitish, bloody discharge from the boil

•Carbuncles are clusters of boils. They are more extensive lesions with widespread
inflammation and ‘pointing’ at several follicular orifices.
•These are usually found in the back of the neck or thigh. Symptoms of carbuncles
may include-
a) Pus in the center of the boil
b) Whitish, bloody discharge from the boils
c) Fever
d) Fatigue.
Systemic effects: malaise (feeling of discomfort, illness, or unease), if severe

Diagnostic evaluation
 Thorough medical history and physical examination
 Culture of wound
Management
Specific treatment-
1. Skin cleanliness
2. Local warm, moist compresses
3. Topical antibiotics agents
4. Systemic antibiotics in severe cases
5. Incision and drainage of severe lesions, followed by wound irrigations with antibiotics or suitable drain
implantation
MRSA infections: -
1. 5-inch soak of half cup bleach diluted in a standard 50-gallon tub ¼ filled with water once or twice weekly.
2. No sharing of towels or washed cloths, changing of clothes and underwear daily and laundering in hot water
3. Disposal of razors after one use
4. Application of mupirocin to nares bid for two to four weeks

•CELLULITIS
•Cellulitis is a deep bacterial infection of the skin.
•The infection usually involves the face, arms and legs.
•It may happen in normal skin, but it usually occurs after some types of trauma
causing an opening in the skin.
•This opening can lead to infection.

Etiology
•Cellulitis is caused by a bacterial infection of a wound area of skin that is no
longer intact.
•The most common bacterial cause of Cellulitis includes the following-
•Group A B – Hemolytic streptococcus
•Streptococcus pneumoniae
•Staphylococcus aureus.

Clinical features
 inflammation of skin and subcutaneous tissues with intense redness, Swelling, firm
infiltration of the skin
 Tenderness of skin
 Warm skin, Pain, Bruising, Blisters forming on the skin
 Fever, Headache, Chills and Feeling weak is common
 lymphangitis “streaking” frequently seen
 Involvement of regional lymph nodes are common
 May progress to abscesses formation
Systemic effects: - fever , malaise
Emergency manifestations of cellulitis
 Very large area of red inflamed skin
 Fever
 If the affected area has- 1. Numbness 2. Tingling
 If the skin appears black
 If the child has diabetes or weakened immune system.

 Diagnosis is usually based on medical history and physical examination of
the child.
 Blood and skin samples may be taken to confirm the diagnosis and the type
of bacteria that is present.
Management
 Oral or iv antibiotics
 Rest and immobilization of both effected area and child
 Warm, wet dressings on infection site
 Surgical intervention
-Elevate the effected part and reduce activity of that part.
Complications: 1) Meningitis 2) Septic arthritis 3) Glomerulonephritis

•STAPHYLOCOCCAL SCALDED SKIN SYNDROME
•Staphylococcal scaled syndrome is an infective response occurred due to
staphylococcus
•It is characterized by peeling of skin.
•This mostly affects infants, young children and individuals with depressed
immune response or renal insufficiency.
•This can be life threatening.

Clinical features
•This disease usually begins with fever and redness of skin.
•Macular erythema with “sandpaper” texture of involved skin.
•Epidermis becomes wrinkled (in two days or less) and large bullae appear
•Localized bullous impetigo in older child
•Then a fluid filled blister may form.
•This blister ruptures very easily leavening an area of moist skin

Other symptoms include:-
 Crusted infection site
 Red, painful areas around infection site
 Blistering, Chills, Weakness, Fluid loss,
 Top layer of skin slips off with rubbing or gentle pressure (Nikolsky’s Sign)
 After the top layer has peeled off- 1. Fever 2. Chills 3. Weakness 4. Fluid
loss.
In new-borns this infection is often observed in diaper area and around the
umbilical cord.
Older children most common have lesions on their arms, legs and trunk.
 Medical history and Physical examination
 Biopsy and skin culture and Blood tests.

Management
Treatment usually requires hospitalization, often in the burn unit of
hospital.
Treatment includes the following
1. Antibiotics (oral, IV) against staphylococcus
2. IV fluids to prevent dehydration.
3. gentle cleansing with saline, burrow solution (This solution relieves the
itching and stinging of irritated, inflamed skin and helps stop the growth of
bacteria and fungus) or 0.25% silver nitrate compresses

COMMON VIRAL SKIN INFECTIONS IN CHILDREN
Many childhood viral infections are called viral exanthems. Exanthem means rash or skin eruption,
it can also be caused by medications, specially antibiotics. Childhood viral exanthems include the
following:
 Measles or rubeola
 Rubella
 Varicella (or chickenpox)
 Fifth disease
 Roseola
Immunization has decreased the number of cases of measles, mumps, rubella and chickenpox
Three main groups of viruses cause the majority of viral skin infections, including the following:
 Human papillomavirus
 Herpes simplex virus
 Poxvirus

Common skin infections in relation to children-
1. Warts
2. Molluscum contagiosum
3. Rubella
4. Rubeola
5. Chickenpox

VERRUCA (WARTS)
Introduction-
 Warts are non-cancerous skin growths caused by Papilloma virus.
 Warts are more common in children than adults, although
 Warts can spread to other parts of the body and to another person.
 There are many different types of warts, due to many different
papilloma virus types. (more than 100_)
 Warts are not painful, except when located on the feet.
 Course unpredictable.
 Repeated irritation will cause to enlarge
 Most warts go away, without treatment, over an extended period.

Common types of warts- 1. Common warts: grows around the exposed areas
like nails and back of hands. Usually have rough surface, grayish yellow or
brown in color.

2. Foot warts- Located on the soles of feet (plantar warts) with black dots (clotted
blood vessels that once fed them), surrounds by a collar of hyperkeratosis. Clusters of
plantar warts are called mosaic. These warts are painful. Because of pressure, are
practically flat.
Treatment
•Caustic chemical solution applied to wart
•Foam insole worn with hole cut to relieve pressure on wart
•Soaked 20 min after 2-3 days
•Procedure repeated until wart comes out
•Destructive techniques tend to leave scars, which may cause problems with walking

3. Flat warts- Small, smooth growth that grow in group up to 100 at a
time. Most often appear on child’s face.
4. Genital warts- Grow on the genitals, are occasionally sexually transmitted. These are soft
and do not have a rough surface like other common warts.

5. Filliform Warts- These are small, long, narrow growth that
usually appear on eyelids, face or neck.

Management-
•Application of salicylic and lactic acid (which soften the infected area)
•Freezing with liquid nitrogen
•Electrodessication (using an electrical current to destroy the wart)
•Laser surgery
•Most destructive technique tend to leave scars

COLD SORE, FEVER BLISTER and GENITAL HERPES
A cold sore is a grouped burning and itching vesicles on inflammatory
base, usually near the mucocutaneous junctions (lips , nose, genitalia
buttocks) caused by the herpes simplex virus (HSV). They’re also
called fever blisters or herpes simplex labialis.
Up to 90% of people around the world have at least one form of HSV.
The symptoms are usually the most severe the first you time you get
cold sores. A first-time cold sore can make a child seriously ill.
After the first outbreak, your body should make antibodies, and you
may never have another infection. But many people get cold sores that
come back.

Cold Sore and genital herpes Symptoms
You may get cold sores as late as 20 days after you’re infected. The sore might
appear near where the virus entered your body.
IT happen in stages:
1. You have a tingling, burning, or itching feeling.
2. About 12 to 24 hours later, blisters form. The area becomes red, swollen,
and painful.
3. The blisters break open, and fluid comes out. This usually lasts 2 or 3 days.
4. A scab forms on the sore. It might crack or bleed.
5. The scab falls off.
You might also have red or swollen gums, swollen glands in your neck, fever,
or muscle aches.

First-time infections can also cause:
 Burning and pain inside your mouth
 Sore throat
 Pain when swallowing
 Headache
 Upset stomach

Cold Sore and GENITAL HERPES Causes
GENITAL HERPES IS CAUSED BY HSV II

You catch HSV when you come into contact with people or things that carry
the virus. For instance, you can get it from kissing someone who has the virus
or from sharing eating utensils, towels, or razors.
Certain things can trigger an outbreak, including:
 Some foods
 Stress
 Fever
 Colds
 Allergies
 Fatigue
 Sunburn or being in strong sunlight

TREATMENT
There’s no cure for cold sores. Once you have the virus, it stays in your body. The sores
themselves usually heal on their own in 1 or 2 weeks.
Antiviral medications can speed healing, especially if you take them at the first sign of an
outbreak. Your doctor might tell you to use:
 Cream that you apply on the sores. Acyclovir (Zovirax) and penciclovir (Denavir) need a
prescription, or you can get docosanol (Abreva) over the counter.
 Pills that you swallow, like acyclovir (Sitavig, Zovirax), famciclovir (Famvir), or
valacyclovir (Valtrex). You need a prescription to get these.
 Medicine injected into your bloodstream (called intravenous or IV) if you have a severe
case, such as cidofovir (Vistide) or foscarnet (Foscavir).
 HSV 1 cold sore can be prevented by using sunscreens protecting against ultraviolet A and
ultraviolet B light to prevent lip blister.
 It could be elevated by corticosteroids.

Some home remedies can help you feel better while
you heal:
 Cold, damp compresses
 Pain medicines like acetaminophen and ibuprofen
 Cream painkillers with benzocaine or lidocaine
 Treatments with alcohol to dry out the blisters
 Lip balms and creams to keep moisture in

Caused by same virus that causes varicella (chickenpox)
Shingles is a viral infection that causes a painful rash. Although
shingles can occur anywhere on your body, it most often appears as a
single stripe of blisters that wraps around either the left or the right
side of your torso.
After a client had chickenpox, the virus lies inactive in nerve tissue
near your spinal cord and brain. Years later, the virus may reactivate
as shingles.
While it isn't a life-threatening condition, shingles can be very painful.
Vaccines can help reduce the risk of shingles, while early treatment
can help shorten a shingles infection and lessen the chance of
complications.

Symptoms
The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs
and symptoms may include:
•Pain, burning, numbness or tingling
•Sensitivity to touch
•A red rash that begins a few days after the pain
•Fluid-filled blisters that break open and crust over
•Itching

Complications
 Postherpetic neuralgia. For some people, shingles pain continues long
after the blisters have cleared. This condition is known as postherpetic
neuralgia, and it occurs when damaged nerve fibers send confused and
exaggerated messages of pain from your skin to your brain.
 Vision loss. Shingles in or around an eye (ophthalmic shingles) can cause
painful eye infections that may result in vision loss.
 Neurological problems. Depending on which nerves are affected, shingles
can cause an inflammation of the brain (encephalitis), facial paralysis, or
hearing or balance problems.
 Skin infections. If shingles blisters aren't properly treated, bacterial skin
infections may develop.

Prevention: Two vaccines may help prevent shingles — the chickenpox
(varicella) vaccine and the shingles (varicella-zoster) vaccine.
TREATMENT
 Symptomatic treatment
 Analgesics for pain
 Drying lotions may be helpful
 Acyclovir
 Prevention vaccine

MOLLUSCUM CONTAGIOSUM
Mollusucm contagiosum is a viral disease of the skin that causes small pink or
skin coloured bumps on the child’s skin. It is not harmful and usually does not
have any other symptoms. The virus is inside the bumps and is mildly
contagious. These bumps are usually clear and extend on period of time.

Etiology
•Malluscum contagiosum is a viral disease caused by virus called the
poxvirus.
•It is most common in children and adolescents, although it can affect adults.
Clinical features
•Bumps are small and are usually pink or skin coloured.
•Eventually the bumps tend to have a small sunken centre.
•The number of lesions a child has is usually between 2 to 20.
•The lesion usually occurs in groups or clusters.
•They are not harmful but may cause some cosmetic concern for child if they appear on the face of other visible
areas.

Molluscum contagiosum is usually diagnosed based on medical
history and physical examination of the child.
The lesions are unique and usually are diagnosed on the basis of
physical examination. Additional test is not routinely required.
Management
Removal of the lesions
Use of topical medications.
Cryotherapy, curettage, electrodessication
Local anaesthesia

RUBELLA (GERMAN MEASLES)
•Rubella is a viral illness that results in a viral exanthema.
•It spreads form one child to other through direct contact with discharge from
the nose and throat.
•Infants and children who develop the disease usually have mild rash and side
effects.

Etiology
•Caused by virus- RUBVIRUS.
•It can spread from a pregnant mother to the unborn child, or form secretions
from infected person.
•It is most prevalent in late winter and early spring.
•Rubella is preventable by proper immunization with the rubella vaccine.

Clinical features
 14-21 days for child to develop signs and symptoms.
 Rash eruption
 Common symptoms are-
Begins with a period of not feeling well
A low-grade fever and diarrhoea.
Rash then appears as pink area of small, raised lesions.
Rash begins on face and then spreads down to the rams and legs.
Rash usually fades by 3rd to 5th day.
Lymph nodes in the neck may also become enlarged
Older children and adolescents may develop some soreness and
inflammation in their joints.

Diagnosis
 Based on medical history
 Physical examination
Management
 Increased fluid intake
 Rest Prevention-
 Children should not attend school up to seven days after onset of rash
 Children who are born with rubella are considered contagious for the first
year of life
Assure that all the child’s contact has been properly immunized

RUBEOLA (MEASLES)
•Rubeola also called measles.
•It is viral illness that results in a viral exanthema.
•Rubeola has a distinct rash that helps in the diagnosis.
•It spreads form one child to another direct contact with discharge form the
nose and throat of infected child.
•Sometimes it spreads through air-borne droplets from an infected child.

Etiology
The virus that causes measles, is classified as Morbillivirus belonging to
paramyxoviridae family.

Clinical features
 Hacking cough
 Redness and irritation of the eyes
 Fever
 Small red spots with white centres (KOPLICKS’S SPOTS) appear on the
inside of the cheek
 Rash- deep, red flat rash that starts on the face and spreads down to the
trunk, arms, legs and feet.
 The rash starts as small distinct lesions, which then combines as one big
rash.
 After three to seven days, the rash will begin to clear leaving brown
discoloration and skin peeling.

Serious complications-
Ear infections
Pneumonia
Croup
Inflammation of brain.
 Reubola is usually diagnosed based on complete medical history and physical examination  Lesions are
unique and allows for diagnosis.
Management
 Increased fluid intake
 Acentaminophen for fever
 WHO recommended two doses of vit-A for all children to prevent eye damage and blindness
Prevention
 Children should not attend school or daycare for four days after the rash is positive
 Assure that all child’s contacts have been properly immunized.

CHICKENPOX
Chickenpox is a highly infectious disease caused by Varicella- Zoster Virus
(VZV), a form of herpes virus.
Transmission occurs from person- person by direct contact or through the
air buy coughing and sneezing

Clinical features
•Fatigue and irritability
•Itchy rash on the trunk, face, scalp, armpits, upper arms, legs and inside the mouth.
•Fever
•Feeling ill
•Decreased appetite
•Muscle or joint pain
•Cough or running nose.

 Complete medical history
 Physical examination
Management
 Acetaminophen for fever
 Antibiotics for treating any bacterial infections
 Calamine lotion (to relieve itching)
 Antiviral drugs
 Bed rest
 Increased fluid intake
 Cool baths (to relieve itching)
 Do no let children scratch the blisters which could lead to secondary bacterial
infections
 Cut children’s fingernails' short.

Immunity from chicken pox
Once infections can give them immunity for the rest of their lives.
Complications
o Secondary bacterial infections
o Pneumonia
o Encephalitis
o Cerebellar ataxia
o Myelitis
o Reye’s syndrome (a serious condition that affects all major systems or
organs)
o death

COMMON FUNGAL SKIN INFECTIONS IN CHILDREN
Introduction
Skin fungi live in a deep top layer of skin in moist areas of the body, such as
between the toes, groin, diaper area.
Some fungi infections cause only a small amount of irritation.
Other types of fungi infections penetrate deeper any may cause itching,
swelling, blistering and scaling.
In some cases, fungal infections can cause reactions elsewhere in the body. Eg:
a child may develop a rash on the finger or hand associated with infection on
foot or scalp.

Types of fungal skin infections-
Candidiasis (Yeast Infection)
Tinea infections (Ring Worm)
oAthlets foot
oJocj itch
oScalp ringworm (Tinea Captis)
oNail ringworm (Tinea ungium)
oBody ringworm (Tinea Corpis)
Tinea versicolor

CANDIDIASIS (YEAST INFECTION)
Candidiasis, sometimes called moniliasis, is an infection caused by yeast on the skin and or mucus membranes.
Although yeast is normally a harmless inhabitant of the digestive system and vaginal area.
It causes infection when the skin is damaged or when conditions are warm and humid or when there is
depressed system.
Antibiotics can also cause yeast to grow.

Location Symptoms/ signs
Skin folds or navel
•Rash
•Patches
•Pimples
•Itching or burning
Vagina
 White or yellow discharge from vagina
 Itching
 Redness in the external area of vagina
 Burning
Penis
 Redness on the underside of the penis
 scaling on the inner side of the penis
 Painful rash on the underside of the penis

Mouth (thrush)
 White patches on tongue and inside cheeks
 Pain
Corners of mouth
 Cracks and or tiny cuts on the corner of the mouth
Nail beds
 Swelling
 Pain
 Pus
 White or yellow nail that separates from the nail bed.

Diagnosis
 Prompt medical history
 Physical examination of child’s skin scraping
 Culture of scrapped part
Management
•Treated highly with medicate ointments
•Yeast infections of vagina and anus are treated with suppositories
•Oral thrush is treated with medicated mouth wash.
•Severe infection in an immune compromised child may be treated with oral anti yeast
medication.

TINEA INFECTION (RING WORM)
Different fungi depending on their location causes ring worm.
Ring worm is characterized by ring shaped, red, scaly patches with clear centers.
There is an increased risk of contracting ringworm in child-
1. Who is malnourished
2. Has poor hygiene
3. Lives in warm climate
4. Has contact with other children or pets with ring worm infection
5. Immunocompromised due to disease or medication.

ATHLETE’S FOOT ( TINEA PEDIS/ FOOT RING WORM)
This common condition mostly affects teen and adult males.
It less frequency affects children before puberty
Contributing causes include-
1. Sweating
2. Not drying feet well after swimming or batching
3. Wearing tight socks and shoes
4. Warm weather conditions.

Symptoms
 Whitening of the skin between the toes
 Scaling of the feet
 Itchy rash on the skin
 Blisters over the foot

JOCK ITCH (TINEA CRURIS/ GROIN RINGWORM)
This condition is also more common in males and occurs more often during warm conditions.
It is very rare in females.
symptoms-
1. Red, ring like patches in the groin area
2. Itching in the groin area
3. Pain in the groin area

SCALP RING WORM (TIENA CAPITIS)
Scalp ringworm is highly contagious especially among children.
It occurs mainly in children between the ages 2-10 years.
It occurs very rarely in adults.
Symptoms-
1. Red, scaly rash on the scalp
2. Itching of the scalp
3. Hair loss on the scalp
4. Rash elsewhere on the body

NAIL WORM (TINEA UNGIUM)
It is an infection of the finger or toe nail, characterized by a thickened and deformed nail. This condition
is more often affects the toe nails than the finger nails.
Tinea ugium occurs more often in adolescents and adults rather than young children.
Symptoms-
1. Thickening of the ends of the nails.
2. Yellow color of the nails.

BODY RINGWORM (TINEA CORPORIS)
This skin infection is characterized by the ring like rash anywhere on the body or the face.
It occurs in all ages but is seen more frequently in children.
It is more common in warmer climates.
Symptoms-
1. red, circular lesion with raised edges.
2. The middle of the lesion may become less red as the lesion grows.
3. Itching at the affected are.

 Medical history
 Lesions of the ringworm are unique and allow for a diagnosis
simply based on basis of physical examination.
 Culture of skin is also advisable.
Management
 Oral anti-fungal medications
 Use of antifungal shampoos to eliminate fungus
 Topical anti-fungal ointments.

TINEA VERSICOLOR
Tinea versicolor is a common skin infection characterized by light or dark
patches on the skin.
Patches are more often found on the chest and prevent the skin from tanning
evenly.
It occurs mostly in adolescents and early adulthood.

Etiology
Caused by fungi pityrosporum orbiculate

Clinical features
•White, pink patches mostly noticeable in summer
•Infection only on the top layers of their skin
•The rash usually occurs on the trunk
•Rash does not usually occur on face
•Patches worsen in heat

 Medical history
 UV light is used to visualize the patches more clearly.
 Skin scraping can be taken for culture.
Management
 Medicated antimicrobial dandruff shampoo on the skin as prescribed by
doctor
 Shampoo is left on the skin overnight and washed off in the morning.
 To be effective, shampoo treatment is effective and may require for several
nights.
 Topical creams or oral antifungal medications may be prescribed.

OTHER PARASITIC SKIN INFECTIONS
Introduction
Parasitic are small worms that or insects that make a deep burrow on skin to live there or lay
their eggs.
•Includes scabies
Scabies is an infestation of mites characterized by small red 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 personal contact.
The itching is caused by the mites burrowing into the skin where they lay eggs that
hatch a few days later.
Scabies can affect of all ages.
Scabies occurs mostly in children and young adults.

Clinical features
 Itching, usually severe
 Rash with small pimples or red bumps
 Scaly or crusty skin
Diagnosis and management
Diagnosis of scabies, the skin and skin creases are examined by
the physician
A sample of skin obtained by scrapping the skin may be examined
under a microscope to confirm the presence of mites.

Management:
1. Application of prescribed creams and lotions (lindane
solution)
2. Oral antihistamines medications
3. Topical ointments
4. Wash all the cloths and bed sheets in hot water and dry in
hot dryer.
5. Itching may continue for several weeks.

Other disorders-
DIAPER RASH
Rash in the diaper region are common during early infancy.
It is more common un artificially fed infants, especially those in whom it is changed
infrequently.
Involves buttocks, scrotal sacs, Mons pubis or inner side of thigh.
Skin appears red like parchment which becomes infected giving rise to pustular erosions.
These are contact dermatitis secondary to detergents.

Management:
 Single layer porous diapers should be used
 Plastic diapers should not be used
 Wash with mild soap
 Cool wet compress on rash region
 Antimicrobial cream or lotions

Reference: -
Marilyn j. Hockenberry, Wong’s essentials
of paediatric nursing, second south Asia
edition, page no: - 383-393
 Intensive Care Nursery House Staff Manual,
UCSF medical centre

Child with skin disorder

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