Nursing topic

1. PAEDIATRIC
SKIN LESIONS
Richie Chacko
Paediatric & Nonatal Nursing

2. Skin Lesions
Definition
A skin lesion is a superficial growth or
patch of the skin that does not resemble
the area surrounding it

3. Primary skin lesions
• Primary skin lesions are variations in color or
texture that may be present at birth, such as
moles or birthmarks, or that may be acquired
during a person's lifetime,such as those
associated with infectious diseases (e.g. warts,
acne, or psoriasis), allergic reactions (
e.g. Hives or contact
dermatitis), or environmental agents (e.g. sun
burn, pressure, or temperature extremes).

4. Secondary skin lesions
• Secondary skinlesions :are those changes in
the skin that result from primary skin lesions,
either as a natural progression or as a result
of a person manipulating (e.g. scratching or
picking at) a primary lesion.

5. Primary skin lesions
• Macule
A macule is an area of color change less than 1.5 cm diameter. The
surface is smooth.
• Patch
A patch refers to a large area of color change, with smooth surface.
• Papule
Papules are small palpable lesions. The usual definition is that they
are less than 0.5 cm diameter, although some authors allow up to
1.5 cm. They are usually visibly raised above the skin surface, and
may be solitary or multiple.
• Papules may be sessile, pedunculated, filiform, or verrucous

6. • Plaque
A plaque is a palpable flat lesion greater than 0.5 cm diameter.
Most plaques are elevated, but a plaque can also be a thickened
area without being visibly raised above the skin surface.
• Nodule
A nodule is an enlargement of a papule in three dimensions (height,
width, length).
• Vesicle
Vesicles are small blisters less than 0.5cm diameter. They are fluid-
filled papules, and may be single or multiple.
• Pustule
A pustule is a purulent vesicle. It is filled with neutrophils, and may
be white, or yellow. Not all pustules are infected.

7. • Bulla
A bulla is a large fluid-filled blister. It may be a single
compartment or multiloculated.
• Wheal
A wheal is an edematous papule or plaque caused by swelling
in the dermis. Whealing often indicates urticaria.
• Purpura
Purpura is bleeding into the skin. This may be as petechiae
(small red or brown spots), or as ecchymoses (bruises).
• Telangiectasia
Telangiectasia is the name given to prominent cutaneous
blood vessels.

8. Secondary skin lesions
• Scaling
Scaling is an increase in the dead cells on the surface of the skin
(stratum corneum). The scale can be psoriatic-type (large white or
silver flakes), pityriasis-type (branny powdery scale), or lichenoid
(tightly adherent to skin surface).
• Lichenification
Lichenification is caused by chronic rubbing which results in
palpably thickened skin with increased skin markings and lichenoid
scale. It occurs in chronic eczema eg. atopic dermatitis or lichen
simplex.
• Exfoliation
Exfoliation is the stratum corneum peeling off, usually occurring
after acute inflammation.

9. • Crusting
Crust occurs when plasma exudes through an eroded
epidermis. It is rough on the surface and is yellow or
brown in color. Bloody crust appears red, purple or
black.
• Excoriation
An excoriation is a scratch mark. It may be a linear
erosion or a picked scratch. Excoriations may occur in
the absence of a primary dermatosis.
• Erosion
An erosion is caused by loss of the surface of a skin
lesion, it is a shallow moist or crusted lesion.

10. • Fissure
A fissure is a thin crack within epidermis or
epithelium, and is due to excessive dryness.
• Ulcer
An ulcer is full thickness loss of epidermis or
epithelium. It may be covered with a dark-colured
crust called an eschar.
• Erythroderma
Erythroderma is a term used to indicate red skin
over the entire body.

11. Etiology
• Affects
– >80% of adolescents
– >40% of adults over than 25
• Genetics plays a role
• Associated with
– Disfigurement
– Pain
– Loss of confidence
– Depression
• Effects on quality of life are comparable to those
suffering from chronic diseases like asthma, seizures
and diabetes

12. Risk Factors
• Friction and manipulation
• Occlusive products
• Close fitting sports equipment
• Medications:
– Steroids
– Antiepileptics
– Progestin only contraceptives

13. • Controversial link between diet and acne
although many patients believe that their
acne is influenced by certain foods
• Western diet may be associated with acne
• Skim milk is associated with acne in teenage
girls
• Stress: acne among university students was
associated with exam stress

14. PATHOPHYSIOLOGY
follicular hyperkeratinization
proliferation +
decreased desquamation of keratinocytes
hyperkeratotic plug
(microcomedone)

15. Sebaceous glands enlarge
Sebum production increases
Growth medium for P. Acnes
plugs provide anaerobic
Lipid-rich environment

16. Bacteria thrive
Inflammation results
Chemotactic factors attract neutrophils
Depending on conditions
Non-inflammatory
open/closed comedones
Inflammatory papule/
pustule/nodule

17. CLINICAL FEATURES
Mild acne
• Comedomes:
– Closed (whiteheads) are closed flesh colored papules 1-
3mm in size
– Open (blackheads) are open and the contents of the
comedome oxidizes upon expose to the light (tyrosine is
oxidized to melanin)
Moderate acne
• Comedomes/Papules/Pustules
Severe acne
• Papules/Pustules/Nodulocystic lesions

18. ICE PICK SCAR

19. THUMBPRINT SCARS

20. ATROPHIC SCARS

21. HYPERTROPHIC SCARS

22. KELOIDS

23. SEVERE ACNE
• Acne fulminans
– Severe acne in young males in association with
fever, arthritis
• Acne conglobata
– Comedomes, pustules, foul smelling cysts, sinus
tracts, atrophic and keloid scarring
• Treat with high dose steroids

24. ACNE FULMINANS

25. ACNE CONGLOBATA

26. DIAGNOSIS
• patient history, physical examination
• characteristics of the lesion,
• where and how it appears on the patient's body
• scrapings or swab samples from lesions for
examination under a microscope
• immunofluorescence test
• bacterial, fungal, or viral cultures
• contrast lighting and subdued lighting test

27. MEDICAL TREATMENT
• Basic skin care
– No washing, scrubbing or picking
– Cleanse with a gentle soap, may contain salicylic acid,
glycolic acid or benzoyl peroxide
– If moisturize use noncomedogenic agent
• Based on skin type, choose appropriate vehicle for
topical treatments
– Oily (solutions, gels, pledgets)
– Combination (lotions)
– Dry (cream, ointment)

28. TOPICAL RETINOIDS
• Tretinoin (Retin A), Adapalene (Differin),
Tazarotene (Tazorac)
TOPICAL ANTIBIOTICS
• Erythromycin, Clindamycin
BENZOYL PEROXIDE
AZELAIC ACID
SYSTEMIC ANTIBIOTICS
• Tetracyclin, Doxycyclin, Minocyclin
HORMONAL CONTROL

29. NURSING MANAGEMENT
• Assess the client for the presence of cutaneous lesions
• Assess bony prominences, perineum, and dependent and
pruritic areas for pallor, redness, and breakdown.
• Implement measures to treat existing cutaneous conditions
• Implement measures to prevent additional tissue
breakdown
• If tissue breakdown occurs or existing breakdown
progresses:
1. notify appropriate health care provide
2. perform care of involved areas as ordered or per standard
hospital procedure.

30. WARTS
• Warts are a very common, harmless skin
infection caused by a virus. For reasons that
are not entirely clear, children seem to
develop warts more often than adults. This is
NOT a sign of a problem with the immune
system. the spread can be lessen by
discouraging picking, biting or scratching.

31. Etiology
• Caused by viruses from the human
papillomavirus (HPV)
• contagious and commonly found in school-
aged children
• They rarely occur in children younger than 2
years.

32. Pathophysiology
• The HPV virus infects the epithelium
• systemic dissemination of the virus does not occur.
• Viral replication occurs in differentiated epithelial cells
• viral particles can be found in the basal layer
• They cause thickening of the stratum layers and
large blood vessels.

33. Symptoms
• Small, fleshy, grainy bumps
• Flesh-colored, white, pink or tan
• Rough to the touch
• Sprinkled with black pinpoints, which are
small, clotted blood vessels

34. Tests and diagnosis
• Examining the wart
• Scraping off the top layer of the wart to check
for signs of dark, pinpoint dots — clotted
blood vessels — which are common with
warts
• Removing a small section of the wart (shave
biopsy) and sending it to a laboratory for
identification of HPV and analysis to rule out
other types of skin growths

35. Treatments and drugs
• Stronger peeling medicine (salicylic acid).
• Freezing (cryotherapy)
• Other acids (bichloroacetic or trichloroacetic
acid)
• Laser treatment.

36. Prevention
• To reduce your risk of common warts:
• Avoid direct contact with warts. This includes your own
warts.
• Don't pick at warts. Picking may spread the virus.
• Don't use the same emery board, pumice stone or nail
clipper on your warts as you use on your healthy skin
and nails.
• Don't bite your fingernails. Warts occur more often in
skin that has been broken. Nibbling the skin around
your fingernails opens the door for the virus.
• Groom with care. Use a disposable emery board. And
avoid brushing, clipping or shaving areas that have
warts. If you must shave, use an electric razor.
• Wash your hands carefully after touching your warts or
surfaces such as shared exercise equipment.

37. SCABIES
Human scabies is an intensely pruritic skin
infestation caused by the host-specific
mite Sarcoptes scabiei hominis. Approximately
300 million cases of scabies are reported
worldwide each year.

39. Definition/ Etiology
• Human scabies is an intensely pruritic skin
infestation caused by the host-specific
mite Sarcoptes scabiei var hominis.

40. Pathophysiology
• Transmission of scabies is predominantly
through direct skin-to-skin contact
• The mite does not penetrate deeper than the
superficial layer of the epidermis
• Within 10 weeks the symptoms of primary
infection occurs

41. Signs and symptoms
• Itching, mainly at night: Itching is the most
common symptom.
• Rash: Many people get the scabies rash.
• Sores: Scratching the itchy rash can cause sores.
• Thick crusts on the skin: Crusts form when a
person develops a severe type of scabies called
crusted scabies.
• They appear as serpiginous, grayish, threadlike
elevations in the superficial epidermis, ranging
from 2-10 mm long.

42. Nodular scabies
• Nodules occur in 7-10% of patients with scabies,
particularly young children. In neonates unable to
scratch, pinkish brown nodules ranging in size from 2-
20 mm in diameter may develop.
Crusted scabies
• In crusted scabies, lesions are often hyperkeratotic and
crusted and cover large areas. Marked scaling is
common, and pruritus may be minimal or absent. Nail
dystrophy and scalp lesions may be prominent. The
hands and arms are the usual locations for lesions, but
all sites are vulnerable.
Secondary lesions
• These lesions result from scratching, secondary
infection, and/or the host’s immune response against
the scabies mites and their products.

43. Diagnosis
• History collection and Physical examination.
-pruritic rash and characteristic linear burrows.
• The diagnosis is confirmed by light
microscopic identification of mites, larvae,
ova, or scybala (feces) in skin scrapings.
• In rare cases, mites are identified in biopsy
specimens
• elevated immunoglobulin E (IgE) titers and
eosinophilia

44. Management
• administration of a scabicidal agent (eg, permethrin,
lindane, or ivermectin).
• appropriate antimicrobial agent if a secondary
infection has developed.
• Pruritus may be partially alleviated with an oral
antihistamine, such as hydroxyzine hydrochloride
,diphenhydramine hydrochloride or cyproheptadine
hydrochloride.
• Antihistamine: To control the itch and help you sleep.
• Steroid cream: To ease the redness, swelling, and itch.

45. Nursing Interventions
• Monitor for signs and symptoms of infection
• Monitor susceptibility to infection
• Limit visitors when necessary
• Instruct visitors to wash their hands when
visiting remedy and after leaving the patient
• Maintain aseptic environment during the
installation of equipment

46. • Instruct the patient to wear loose
• Keep the skin clean to keep them clean and dry
• Monitor the skin will be reddish
• Bathe the patient with warm water and soap
• Give skin care in the area epidema
• Inspection of skin and mucous membranes of the
redness, heat
• Inspection of the wound condition
• Provide antibiotic therapy if necessary
• Teach how to avoid infection