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Alterations of the Integument in Children
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Acne Vulgaris
Most common skin disease Affects 85% of the population between
ages 12 and 25 years Develops at sebaceous follicles located
primarily on the face and upper parts of the chest and back
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Acne Vulgaris (cont’d)
Noninflammatory acne Blackheads Whiteheads
Inflammatory acne Caused by follicular wall rupture in closed
comedones Cystic nodules develop when inflammation is
deeper
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Acne Vulgaris (cont’d)
Physiologic factors: Follicular hyperkeratinization Excessive sebum production Colonization of Propionibacterium acnes Inflammation secondary to the action of
inflammatory products produced by P. acnes The excessive production of sebum is related
to androgenic hormones
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Acne Vulgaris (cont’d)
Clinical management: Topical treatments Systemic therapies Surgery Scarring treated with dermabrasion, lasers,
and resurfacing techniques
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Cystic Acne
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Acne Vulgaris
Acne conglobata Highly inflammatory form of severe acne Characterized by the formation of
communication cysts and abscesses beneath the skin
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Atopic Dermatitis
Most common form of eczema in children The cause is unknown, but 80% of
individuals demonstrate a personal or family history of asthma or allergic rhinitis
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Atopic Dermatitis (cont’d)
Manifestations: Increased IgE levels Elevated interleukin-4 Positive allergen skin tests Eosinophilia
Clinical manifestations: Severe pruritus, eczematoid appearance and
age-dependent distribution of skin lesions• Young: rash to face, scalp, trunk, arms and legs• Older: rash to neck, antecubital and popliteal fossae,
hands and feet
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Atopic Dermatitis (cont’d)
Clinical management: Accurate diagnosis and identification Elimination of exacerbating factors Reduction of emotional stresses Hydration of skin Anti-inflammatory agents Immunomodulator and systemic therapies
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Atopic Dermatitis (cont’d)
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Diaper Dermatitis
Group of inflammatory disorders affecting the lower abdomen, genitalia, buttocks, and upper thigh
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Diaper Dermatitis (cont’d)
Diaper dermatitis is an irritant contact dermatitis Inflammation encouraged by prolonged
exposure to irritation by urine and feces, maceration by wet diapers, airtight plastic diaper covers, and possible association with intercurrent illness and early introduction of cereals
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Diaper Dermatitis (cont’d)
Clinical manifestations: Vary from mild erythema to erythematous
papular lesions Treatment:
Frequent diaper changes to keep area clean and dry
Frequent exposure of perineal area to air Topical antifungal medications Short-term topical steroids Barrier creams or pastes
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Diaper Dermatitis (cont’d)
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Infections of the Skin
Bacterial infections: Impetigo contagiosum
• Superficial skin infection usually caused by Staphylococcus or group A streptococci
• High incidence in hot, humid climates Bullous impetigo Vesicular impetigo
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Impetigo
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Infections of the Skin
Bacterial infections Staphylococcal scalded-skin syndrome (SSSS)
• Serious skin infection caused by exfoliative toxin producing group II staphylococci
• The exfoliative toxin causes separation of the skin just below the granular layer of the epidermis
• Manifestations: Fever, malaise, rhinorrhea, and generalized erythema
and skin tenderness, skin sloughing, and secondary infections
• Treatment with oral and intravenous antibiotics, and aseptic technique to prevent infection
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Infections of the Skin (cont’d)
Fungal infections: Tinea capitis (scalp)
• Most common fungal infection of childhood• Causative organisms found on cats, dogs, and
rodents• Lesions circular and manifested by broken hairs at
site, scaling and raised borders Tinea corporis (ringworm)
• Kittens and puppies common source• Lesions erythematous, round scaling patches that
spread peripherally with clearing in the center Treatment with antifungals
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Tinea Capitis
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Infections of the Skin
Fungal infections Thrush
• The presence of Candida in the mucous membranes of the mouths of infants, and less commonly in adults
• Characteristics: White plaques or spots in the mouth that lead to
shallow ulcers Tongue appears to have white covering
• Thrush can spread to the groin, buttocks, and other parts of the body
• Treatment with oral antifungal suspension
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Infections of the Skin (cont’d)
Viral infections Molluscum contagiosum
• Highly contagious viral infection of the skin• Transmission is skin to skin and contact with
contaminated items• The virus encourages epidermal cell proliferation• Lesions slightly umbilicated dome-shaped papules
primarily on the face, trunk, and extremities• No specific treatment but self-limiting and clears in 6
to 9 months
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Molluscum Contagiosum
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Infections of the Skin
Viral infections Rubella (German measles or 3-day measles)
• RNA virus• The disease is mild in most children• Manifestations:
Enlarged cervical and postauricular lymph nodes, low-grade fever, headache, sore throat, runny nose, cough
Faint pink to red maculopapular rash caused by virus dissemination to the skin
• Vaccination for rubella combined with mumps and rubeola (measles) (MMR)
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Rubella
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Infections of the Skin
Viral infections Rubeola
• RNA paramyxovirus• High fever, malaise, enlarged lymph nodes, runny
nose, conjunctivitis, barking cough• Koplik spots over buccal mucosa
Roseola• Characterized by fever and an erythematous
macular rash that lasts about 24 hours
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Infections of the Skin (cont’d)
Viral infections (cont’d) Chickenpox (varicella)
• Highly contagious DNA virus• Spread by close person-to-person contact and
airborne droplets• First signs of illness include fever, itching, and
appearance of vesicles on face, trunk, and scalp• Uncomplicated infection requires no therapy• Vaccine available
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Chickenpox
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Infections of the Skin
Viral infections Herpes zoster (shingles)
• Occurs mainly in adults• Varicella virus persists for life in sensory nerve
ganglia and reactivates • Lesions consist of groups of vesicles situated on an
inflammatory base and follow the course of a sensory nerve
• Therapy similar to that for chickenpox
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Infections of the Skin (cont’d)
Viral infections (cont’d) Smallpox
• Highly contagious and deadly• Caused by poxvirus variolae• Eradicated in 1977 and vaccines discontinued in
1972• Concern that bioterrorists have virus led to
implementation of vaccination and isolation criteria by the CDC
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Insect Bites and Parasites
Scabies Contagious disease caused by the itch mite
Sarcoptes scabiei Transmitted by personal contact and infected
clothing and bedding Female mite tunnels millimeters to 1 cm into
the stratum corneum, deposits eggs, and over a 3-week period the eggs mature into adult mites
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Insect Bites and Parasites (cont’d)
Scabies (cont’d) The primary lesions are burrows, papules, and
vesicular lesions with severe itching Patient is at risk for secondary infections from
scratching Treated with application of scabicide and linen
cleaning
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Scabies
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Insect Bites and Parasites
Pediculosis Pediculus capitis (head), pediculus corporis
(body), and Phthirus pubis (crab or pubic) Highly contagious parasite that survives by
sucking blood• Acquired through personal contact and shared
clothing, combs, or brushes Treated with pediculicides; all clothes, towels,
bedding, and brushes should be washed in hot water
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Insect Bites and Parasites (cont’d)
Flea bites Cat, dog, and human fleas Bites occur in clusters along the arms and legs The characteristic lesion is an urticarial wheal
with a central hemorrhagic puncture Treatment includes:
• Spraying home• Treating infected animals• Washing clothing and bedding in hot water
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Insect Bites and Parasites (cont’d)
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Insect Bites and Parasites (cont’d)
Lyme disease Multisystem inflammatory disease Spirochete, Borrelia burgdorferi causative
agent transmitted by tick bite Occurs in stages:
• Localized infection• Disseminated infection 9 months after bite• Late persistent infection continuing for years
Treatment with antibiotics
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Insect Bites and Parasites (cont’d)
Bedbugs Cimex lectularius Live in the crevices and cracks of floors, walls,
and furniture and in bedding or furniture stuffing
3 to 5 mm long and reddish brown Bedbugs feed in the darkness
• Attach to the skin, suck blood, and leave Lesions are red macules that develop into
nodules
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Hemangiomas
Strawberry hemangiomas Raised vascular lesions that usually emerge 3
to 5 weeks after birth The lesions proliferate, become bright red, and
elevate with small capillary projections Cavernous hemangiomas
Present at birth Cavernous hemangiomas involve larger and
more mature vessels than strawberry hemangiomas
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Strawberry and Cavernous Hemangiomas
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Vascular Malformations
Port-wine stains Congenital malformation of dermal capillaries Flat, pink, to dark reddish purple lesions
Salmon patches Macular, pink lesions resulting from distended
dermal capillaries• Usually fade by 1 year of age
Common on the nape of the neck, forehead, upper eyelids, or nasolabial folds
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Port-Wine Hemangioma
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Miliaria
Vesicular eruption after prolonged exposure to perspiration, with subsequent obstruction of eccrine ducts Miliaria crystallina
• Ductal rupture within the stratum corneum• Clear vesicles without erythema
Miliaria rubra (prickly heat)• Erythematous papules and papulovesicles
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Miliaria Rubra
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Other Skin Disorders
Erythema toxicum neonatorum Benign, erythematous accumulation of
macules, papules, or pustules Cause is unknown No treatment is required