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flat, not palpable, circumscribed, <1cm diameter, brown, red, purple, white, tan.
raised, firm, circumscribed, <1cm diameter, brown, red, pink, tan, or bluish red (warts)
elevated, circumscribed, fluid-filled (clear), <1cm (varicela, blister)
vesicle, >1cm in diameter (blister)
elevated, circumscribed, encapsulated, filled with liquid or semi-solid material (sebaceous cyst)
elevated, superficial, filled with purulent fluid (impetigo,acne), filled with pus.
elevated, firm, circumscribed, palpable, 1-2cm (lipomas)
reddened area caused by increased amounts of oxygenated blood in the dermal vasculature
localized red or purple discolourations caused by blood into dermis and subcutaneous tissues.
pinpoint spots in the epidermis
local or generalized (specific areas such as truncal or perineal)
size, shape (clustered, diffuse <spread out, discrete < all by itself)
a bacterial infection caused by staph aureus and group-a b-hemolytic streptococcus, it is readily recognizable skin rash
bacterial infection of the skin caused by staph aureus and group a b-hemolytic streptococcus, infection of the hair follicle that results from occlusion of the hair follicle, may result from poor hygiene, prolonged contact with contaminated water, maceration, moist environment, or use of occlusive emollient product
bacterial infection of the skin caused by staph aureus and group a b-hemolytic streptococcus, a localized infection and inflammation of the skin and subcutaneous tissues and is usually preceded by skin trauma of some sort.
bacterial infection of the skin caused by staph aureus and group a b-hemolytic streptococcus, results from infection with s. aureus that produces a toxin, which then causes exfoliation; it has an abrupt onset and results in diffuse eythema and skin tenderness, most common in infancy and rare beyond 5 yrs. of age.
scalded skin syndrome
most commonly occurred as a skin or soft tissue infection, such as cellulitis or an abcess, caused by methicillin-resistant s. aureus.
infection with group a strep bacteria, strawberry tongue
caused by rubella virus, transmitted by direct or indirect contact with droplets, primarily by nasopharyngeal secretions, but also in blood, stool, and urine; also transmitted from mother to fetus
rubella (German measles)
caused by measles virus, transmitted by direct or indirect contact with droplets, primarily by nasopharyngeal secretions, but also blood and urine; highly contagious.
caused by varicella zoster virus, human herpes virus 3; highly contagious, transmitted by direct contact with infected person's nasopharyngeal secretions or via air-borne spread, to a lesser degree by contact with unscabbed lesions; also transmitted from mother to fetus.
varicella zoster (chickenpox)
caused by human herpes virus 6, less frequently human herpes virus 7; transmission mode: little is known but suspected to be from saliva of infected person and enters the host through the oral, nasal, or conjuctival mucosa
exanthem subitum (roseola infantum or sixth disease)
caused by human parvovirus B19, transmitted by large droplet spread from nasopharyngeal viral shedding or percutaneous exposure to blood and blood products, also transmitted from mother to fetus
erythema infectiosum (fifth disease)
caused by viruses belonging to enterovirus genus, transmitted by direct contact with infected fecal, oral secretions; spread mostly through saliva
hydration is primary concern
coxsackie virus (hand, foot, and mouth disease or herpangina)
fungal disease of the skin occurring on any part of the body
"ringworm" of the body can be found on the face, trunk, and extremities; one or more circular lesions, often with scaling borders and a clear center may be present; lesions may be red and inflamed in the area of scaling; they may also present as a round patch of itchy skin without central clearing
Tx: topical antifungal cream is required for at least 4 weeks
ringworm of the scalp presents as areas of hair loss, and/or areas of scaly, flaking skin; hairs may break off close to the scalp leaving a black dot appearance; areas of the scalp may be inflammed and swollen; this is called a kerion
Tx: oral Griseofulvin for 4-6 wks taken with liquid/food with fat on it; no school or daycare for 1 wk after treatment initiated
tan or hypopigmented oval scaly lesions, especially on upper back and chest and proximal arms; more noticeable in the summer with tanning of unaffected areas.
Tx: selenium sulfide shampoo apply all over body allow to stay on skin overight, may cause skin irritation; topical antifungals
"athlete's foot" often presents initially with itching, blisters, and reddened areas on a white, damp-appearing surface; it is often found between the toes and on the soles of the feet; without treatment the rash causes thickened, discolored, crusty skin in the infected areas.
Tx: topical antifungal cream, powder, or spray; appropriate foot hygiene
erythema, scaling, maceration in the inguinal creases and inner thighs (penis/scrotum spared)
Tx: topical antifungal
fiery, red lesions, scaling in the skin folds, and satellite lesions
Tx: nystatin cream/ointments
- metals (nickel)
- wool, feathers, furs
- dyes, cosmetics, perfumes
poison ivy, oak, sumac
- caused by the plant's oil (urushiol) - very potent as it penetrates through the epidermis and bonds with the dermal layer (initiates immune response.
- even smoke from burning brush piles can produce a reaction.
- animal not affected but are carriers (fur/saliva)
- shoes, yard tools, toys, golf balls
- lesions are blisters.
- healing and end of itching - 10 to 14 days
treatment of contact dermatitis
poison ivy, oak, sumac
- immediately wash with soap and warm water.
- avoid harsh soap and scrubbing.
- thoroughly launder all contact clothing - hot water.
- prevent scratching - risk for secondary infection.
- prevention - teach to recognize plants.
- meds - benadryl orally, topical corticosteroids (limit use of calamine and caladryl in childre)
prolonged exposure to irritants in the diaper area (urine, feces, soaps, baby wipes)
inadequately rinsed cloth diapers, chemical in disposable wipes, diarrheal stools, monitor/change diaper as soon as it becomes wet.
s/s: flat, red rash in the convex skin creases, red and shiny, may or may not have papules.
tx: prevention is best management, topical cream/ointments with vit. a,d,e, zinc oxide, petrolatum helpful to provide barrier to the skin.
change diapers frequently, avoid rubber pants, gently wash diaper area with soft cloth, avoid harsh soap, avoid wipes that contain fragrance or preservatives
infantile: 2-6mos, remission by age 3.
pre-teen/teenage: onset 12 yrs, may continue lifelong.
majority - family history (genetic predisposition)
symptoms improved with humidity and worsen during winter - dry heat.
nursing goals: less itching, no secondary infection, skin hydration
atopic dermatitis (eczema)
factors that may trigger or exacerbate atopic dermatitis
- irritants (soaps, detergents, disinfectants/cleaning products, contact with liquids such as citrus juice, perfumed products, fabric w/ sharp fibers such as wool or man-made fabrics, dust and dirt)
- contact/airborne irritants (dust mites, pet dander, hair, or saliva, human dander dandruff, molds, seasonal pollens)
- microorganisms (staph aureus, viral infections such as URIs, mycologic such as fungi and dermatophytes)
- other factors (temp and climate, lack of humidity increases dryness of skin, sweating, foods, psychological stressors, hormones
therapeutic management of atopic dermatitis
- use of topical corticosteroids
- emollients are used for both prevention and during therapy for active AD.
- oral antihistamines are sometimes recommended for a limited period of time.
- clothing, bed linens, bath towels and clothes made of either 100% cotton or cotton blend containing at least 80% cotton is often more comfortable to individuals with AD.
- some fabric cleaning or softening products may act as irritant, suggest products that is hypoallergenic.
- skin care ( wash off sweat and exposure to irritants, colloidal oatmeal to water is soothing, after meds application smooth thin layer of emollient over skin, nails kept short and clean, children encourage to try not to scratch because it intensifies itch and can cause outbreaks of skin.
inflammatory reaction to the fungus Pityrosporum ovale and is worsened by peak sebaceous gland activity in infancy and adolescent (hormonal influence)
s/s of seborrheic dermatitis: scalp lesions are yellow, greasy appearing plagues
prevention of cradle cap in seborrheic dermatitis
- adequate scalp hygiene:
- mild shampoo to soften crusts, then rinse and comb to remove.
- antidandruff shampoos containing selenium sulfide, or ketoconazole
neonatal acne ( birth through 4wks of age)
infantile acne (1-12 mos of age): usually resolves in 1-3 mos and is believed to be caused by stimulation of sebaceous glands by maternal adrogens.
mid-childhood acne (more than or equal to 1-6 yrs of age): rare in 1-6yrs; may be caused by increased in adrenal androgen production around 7 yrs old.
preadolescent/prepubertal acne (7-11 yrs old): appear as a first sign of impending pubertal maturation.
adolescent acne (more than or equal to 12 yrs old): most common skin condition involving hair follicle, sebaceous glands over face, neck, chest, and upper back; peak: females 16-17, males 17-18
causes of acne vulgaris
- no association with dietary intake
- psychological factors (emotional stress)
therapeutic management of adolescent acne
- adequate rest
- moderate exercise
- well-balanced diet
- reduction of stress
- gentle clean with mild cleanser twice daily.
- antibacterial soap ineffective, may be too dry when used in combination with topical acne meds.
- hygiene of hair and brushing hair away from forehead may improve acne in the forehead
caused by mite - burrows into epidermis
s/s of scabies
appears as papules, burrows, vesicles with intense itching.
therapeutic management of scabies
elimite cream: (teach) cream should remain on skin 8-12 hrs then removed by bathing, will kill mite immediately but rash and itch persist 2-3 weeks.
female parasite lays her eggs (nits) at the base of the hair shaft where it is warm.
nits hatch 7-10 days
stress to parents anyone can get it
transmission through shared personal items (combs, scarves, caps, PJ parties, coats)
psychologic effect: stressful for children.
avoid radically cutting hair/shave head - teased by peers, it can infest short hair readily as long hair
pediculosis capitis (head lice)
s/s of head lice
itching, appearance of nits
therapeutic management for head lice
- over the counter products (Rid, Nix, LiceMD)
- home remedies (mayonnaise, olive oil)
- prescription (Ovide lotion, Natroba, Ulesfia lotion)
mites, ticks, spiders, scorpions
life threatening bites are from scorpion, black widow and brown recluse spiders.
disease vary from benign to fatal.
most common tick-borne (deer) in Northeast US
stages 1-3 with 2 being most serious - involve cardiac, musculoskeletal, neurologic.
early diagnosis in stage 1 - recognize characteristic rash (erythema migrans) and begin immediate implementation of Amoxicillin (10-14 day course)
prevention for lyme disease
teach parents to protect children from exposure to ticks:
- light-colored clothing
- tuck pant legs into socks
- long-sleeved shirt in wooded areas
- walk in the center of trails
- American Lyme Disease Foundation