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Chapter 47 Alterations of Integument in Children
Terms in this set (29)
Pustular disorder of pilosebaceous unit (hair follicle, sebaceous gland, and arrector pili muscle) that results in formation of discrete papular or pustular lesions and may lead to scarring.
Begins around puberty - may begin earlier and persist longer for females; however, overall incidence and severity greater in males.
Affects >85% of teenagers.
Can cause psychological issues.
Lesions typically located on face and neck and, to lesser extent, on back, chest, and shoulders.
(whiteheads and blackheads):
1) Whiteheads - pale, slightly elevated papules w/ no visible orifice.
2) Blackheads - plugs of material that accumulate in sebaceous glands that open to skin surface; color results from melanin that has moved into sebaceous glands from adjoining epidermal cells.
Caused by follicular wall rupture in closed comedones.
Consists of papules, pustules, nodules and, in severe cases, cysts.
Cystic nodules develop when inflammation is deeper.
TX: focuses on clearing up existing lesions, preventing new lesions, and limiting scar formation:
1) Topical antibiotic.
2) Oral antibiotic.
3) Topical retinoids.
4) Isotretinoin (Accutane).
5) Soaps are NOT effective except for cleaning oil - use mild soap.
Comedones or cysts have multiple openings, large abscesses, and interconnecting sinuses.
Inflammatory nodules not uncommon.
Healing often leaves deep keloidal lesions.
Affected persons have anemia w/ elevated WBCs, ESR (erythrocyte sedimentation rate), and neutrophil counts.
TX: systemic corticosteroid therapy, oral retinoids, and systemic antibiotics.
Aka "atopic eczema" - most common form of eczema in children.
Cause is unknown, but 80% of individuals demonstrate personal/family hx of asthma or allergic rhinitis.
Highly pruritic chronic inflammatory skin disease.
Begins early in life.
70% of children have spontaneous remission before adolescence.
: chronic, relapsing form of
; disturbance in epidermal barrier fxn that leads to increased
transepidermal water loss and dry skin
; and IgE-mediated
sensitization to food and environmental antigens.
1) Increased IgE levels.
2) Elevated interleukin-4.
3) Positive allergen skin tests.
5) Infancy: lesions appear on cheeks and scalp; skin of cheeks may be paler, w/ extra creases under eyes (Dennie-Morgan folds).
6) Adolescents and adults: dry, red patches affecting face, neck, upper trunk; also bends of elbows and knees.
7) Seconary infections common.
1) Accurate DX and identification.
2) Elimination of exacerbating factors.
3) Reduction of emotional stresses.
4) Hydration of skin.
5) Anti-inflammatory agents.
6) Immunomodulator and systemic therapies.
1) Treat symptoms (dryness, pruritus, infection, inflammation).
2) Emollients and skin hydration.
3) Avoiding exposure to irritants.
4) Topical corticosteroids for acute flare-ups (but can cause local and systemic side effects).
5) Systemic therapy reserved for severe acute exacerbations.
6) Short-term corticosteroids for flare-ups in adults.
8) Antibiotics for secondary infections.
9) Phototherapy - as adjunct for severely affected person over age 12.
Highly contagious viral infection of skin.
Transmission is skin-to-skin and contact w/ contaminated items.
Virus encourages epidermal cell proliferation.
Lesions slightly umbilicated dome-shaped papules primarily on face, trunk, and extremities.
No specific TX but self-limiting and clears in 6-9 months.
SSSS (staphylococcal scalded skin syndrome)
is a staphylococcal skin infection that occurs more commonly in young children with low titers of antistaphylococcal antibody. Painful blisters and bullae form over large areas of the skin, requiring systemic antibiotics for treatment.
Viral infection of skin.
German measles or 3-day measles.
Mild disease in most children.
Manifestations: enlarged cervical and postauricular lymph nodes, low-grade fever, H/A, sore throat, runny nose, cough; faint pink to red maculopapular rash caused by virus dissemination to skin.
High fever, malaise, enlarged lymph nodes, runny nose, conjunctivitis, barking cough.
Koplik spots over buccal mucosa -small, white spots (often on reddened background) that occur near Stensen's duct in early course of measles.
a benign disease of infants with a sudden onset of fever that lasts 3 to 5 days, followed by a rash that lasts 24 hours.
Viral infection of skin.
Highly contagious DNA virus.
Spread by close person-to-person contact and airborne droplets.
1st signs of illness inc. fever, itching, and appearance of vesicles on face, trunk, and scalp.
Uncomplicated infection requires no therapy.
Viral infection of skin.
Highly contagious and deadly.
Caused by poxvirus variolae.
Eradicated in 1977 and vaccines D/C'd in 1972.
Concern that bioterrorists have virus led to implementation of vaccination and isolation criteria by CDC.
Contagious disease caused by itch mite Sarcoptes scabiei.
Transmitted by personal contact and infected clothing and bedding.
Female mite tunnels mm-1 cm into stratum corneum, deposits eggs, and over 3-week period, eggs mature into adult mites.
Primary lesions: burrows, papules, and vesicular lesions w/ severe itching.
Pt at risk for secondary infections from scratching.
Treated w/ application of scabicide and linen cleaning.
Pediculus capitis (head), pediculus corporis (body), Phthirus pubis (crab or pubic).
Highly contagious parasite that survives by sucking blood.
Acquired thru personal contact and sharing clothing, combs, brushes.
Treated w/ pediculicides; all clothes, towels, bedding, and brushes should be washed in hot water.
Cat, dog, human.
Bites occur in clusters along arms and legs.
Characteristic lesion: urticarial wheal w/ central hemorrhagic puncture.
1) Spraying home.
2) Treating infected animals.
3) Washing clothing and bedding in hot water.
Multisystem inflammatory disease.
Spirochete, Borrelia burgdorferi, causative agent transmitted by tick bite.
Occurs in stages:
1) Localized infection.
2) Disseminated (dispersed) infection 9 months after bite.
3) Late persistent infection continuing for year.
TX w/ antibiotics.
Cimex lectularius - live in crevices and cracks of floors, walls, and furniture and in bedding/furniture stuffing; 3-5 mm long and reddish brown.
Feed in darkness - attack to skin, suck blood, and leave.
Lesions: red macules that develop into nodules.
Raised vascular lesions that usually emerge 3-5 weeks after birth.
Lesions proliferate, become bright red, and elevate w/ small capillary projections.
Present at birth.
Involve larger and more mature vessels than strawberry hemangiomas.
Congenital vascular malformation of dermal capillaries.
Flat, pink to dark reddish-purple lesions.
Macular, pink lesions resulting from distended dermal capillaries.
Usually fade by 1 year of age.
Common on nape of neck, forehead, upper eyelids, or nasolabial folds.
Vesicular eruption after prolonged exposure to perspiration, w/ subsequent obstruction of eccrine ducts.
Ductal rupture w/in stratum corneum.
Clear vesicles w/out erythema.
Erythematous papules and papulovesicles.
Erythema toxicum neonatorum
Toxic erythema of newborn.
Benign, erythematous accumualtion of macules, papules, pustules.
Appears 3-4 days after birth.
Self-limiting and resolves spontaneously w/in few weeks of birth.
No TX required.
SJS (Steven Johnson Syndrome) and TEN (toxic epidermal necrolysis) (the severe form of SJS)
severe, immune, blistering skin reactions to drugs
The onset of skin eruptions is preceded by malaise, anorexia, fever, and mild inflammation of the eyelids, conjunctiva, mouth, or genitalia. Erythema with tenderness is first described in the trunk, face, and palms, extending to the groin and mucous membranes. Blisters and bullae form and large areas of necrotic epidermis may be shed, leaving open, weeping, painful areas of underlying skin.
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