Integumentary Integumentary systemsystem

Dr: SAHAR Anwar rizk Dr: SAHAR Anwar rizk

• Anatomy and physiology :

1. Dermis: consists largely of fibroblasts

2. Sebaceous gland: are active at birth due to influence of maternal hormone

3. Apocrine glands: become functional around 8-10 years

Skin disease in children may be due to any of the following:

• Bacterial infection: as impetigo contagiosa or cellulitis

• fungus: as Candida

• Skin Parasites: in scabies or pediculoses

A-Bacterial infection: 1- (impetigo contagiosa)

• It is a highly contagious superficial skin bacterial disease (staphylococcus aureus, bacteria hemolytic streptococci)

• IT characterized by localized inflammation and infection in epidermis

• There is two major disease cause impetigo 1-characterized by crusted lesion2-characterized by fragile bulla( brown shriner)

Incidence and EtiologyIncidence and Etiology• It is more prevalent during mid to

late summer& humid climate• Peak incidence among children 2-6

years, • Causes :• poor sanitation • It most commonly spread by direct

contact

Clinical manifestationsClinical manifestations• Lesion that begin as small red macules and

progress to small, thin vesicles or pustules that rupture easily and exposed weeping .The crusts fall &no traces.

• Systemic symptoms such as : weakness, fever & diarrhea

• It appear in the face, around the mouth

• Pruritus is associated with child scratches

Treatment and Nursing Treatment and Nursing Management Management

• Eliminating the causative organism: 1- By topical antibiotic therapy in case of

few lesions2-If lesion wide spread or don’t respond,

administer oral systematic antibiotics. 3-Nursing Assessment : Observe for presence of high temp,

respiratory rate, heart rate, dermatitis, lymphadenopathy .

• Teach the care giver to :

1. Prevent the spread of infection & complication& isolate the child

2. Careful hand washing before and after contact with the child

3. Ask the child to don’t touch the lesion when awake

4. Use comfort measure : -such as genital soaking & remove the

crust with warm soapy water. -Keep the child nail cut short

2-Cellulitis2-Cellulitis• Cellulites : is a bacterial infection involving the

dermis and subcutaneous gland

• Incidence and Etiology:-occur at any age -1-2 days following trauma that disrupt the skin-Streptococcus pyogenes &staphylococcus-children with cellulites of head have incident of

traumaPath physiology :bacteria inter the skin , after minor trauma infection in connective tissue

Clinical manifestation Clinical manifestation • Erythema, swelling, warmth, and pain • Lymphangitis , lymphadenopathy,• Systemic symptoms as: fever, chills,

malaise • Child with facial erythema due to

influenza type B are at risk for meningitis

Treatment& Nursing Treatment& Nursing management management

• Systemic antibiotic• Hospitalization in case of febrile &

acutely ill & use IV antibiotic

• COMFORT Measure:1. Warm compresses to increase circulation2. Cold compresses used to relive pain

• Immobilization is recommended for comfort and decrease edema

B-Fungal infectionB-Fungal infection• The body has several defense

mechanisms:1. Nutritional status2. General health3. Skin properties: as PH, Rate of

epithelial turn over inhibit fungal infection

1-Candidiases 1-Candidiases • Candidiases & moniliases are the most

common type of infection

• Candida albicance a commensally fungal of the mouth & gastroenteritis

• It exist in 2 form yeast and spore

• Incidence and Etiology:• Incidence of thrush in infant 2-4%

candidiasiscandidiasis

Candidia diaperCandidia diaper

• Etiology :A-Causes related to child :Alteration in immune

system & from vaginal canal& bottle nipple• Use of antibiotic therapy &endocrine disease &

immunosuppressive therapy• Child with anemia &asthma (corticosteroid)

B-Causes related to diaper:• have macerated mucous membrane • Improper use of diaper • Wear of nylon

Clinical manifestationClinical manifestation1. Thrush:2. Creamy whit plaque on mucus membrane and

lateral border of the tongue3. Lesion cover the oral cavity &cause mild

discomfort

Candidal diaper :1. Acute onset of erythema begin in perineal

area• erythematous skin occur in apposed surface

as axillae

Treatment& Nursing Treatment& Nursing managementmanagement

Candidal diaper:• change diaper as soon as soiled• Avoid over washing the skin • Apply ointment as Zink oxide nystatine cream

& or 1%hydrocortisone • keep the area dry and exposed to air

Thrush:1. Oral nystatin 4-6 hrs interval &continue 48hrs

after resolution of the symptom2. nystatin cream to nipple with Candida

2-2- tineatinea• Definition: It is a superficial fungus infection of

the skin. It is highly contagious

• Classification: according to part affected

1. worm of Ring scalp (Tinea Capital)2. worm of Ring of skin (Tinea corporis)3. worm of Ring of feet (Tinea pedis)

Tinea CapitalTinea Capital• It is the most common dermal infection children &

occur frequently at school age• It transmitted more often from contact with fomites

than direct contact

• Clinical manifestation: 1. Lesion inform of circular patch about 2inch in

diameter with or without alopecia2. Alopecia are demarcated with or without erythema3. Skin become scaly & black dotes result from broken

hair 4. crusting, pustules ,and lymphadenopathy 5. Kerions ,are moist, boggy, scalp nodule

Tinea capitalTinea capital

Treatment& Nursing Treatment& Nursing managementmanagement

• Oral administration of grisefofulvin +the use of shampoos containing 1%selenium sulfide help to limit the spread of spores.

• Terbinafine & fluconazole help in short treatment

• Head should covered with skull cap that must be washed daily

• All object that have come into contact with the infected child must clean thoroughly.

InfestationInfestation

A-scabies : -caused by scabies mite -it transmitted from person to person - Incubation period 2-6 week during this

period the infection can transmitted -Parasite burrows itself in the skin for

depositing egg

Clinical ManifestationClinical Manifestation• Parts that involved are moist, wet skin i.e,

axilla, between fingers, toes, around umbilicus, genitalia.

• Lesions appear as dark blue lines indicating the path used by the itch mite to burrow itself& color due to fecal deposition

• Sever itching• in second infection ,papules, vesicles,

pustules occur

Treatment& Nursing Treatment& Nursing managementmanagement

• Permethrin or preparation contain DDT as benzyle

• The child should bathe in tepid water the skin dry, the scabicide applied

• Attention should given to folded area • Then child put in clean clothes • All child clothes and bedding should

be washed in hot water and dried in a hot dryer

• Cut the nail &prevent the scratch.

pediculosispediculosis• It is infestation of child with pediculi• There are three types:1. Pediculosis Capital2. Pediculosis pubic : pubic in old, in

eyelashes in young children3. Pediculosis corporis (body) Each type caused by different louse

PediculosisPediculosis capitiscapitis

• Incidence and Etiology :

1. It is a head lice, it is common in children 3-10 years.

2. The risk increase in girls ,at school age.

3. It transmitted through head to head contact.

4. The classroom considered as a primary source of infestation.

Path physiologyPath physiology• Head lice can crawl quickly on dry

hair. The female lives on scalp and lay 4-10 egg, it attached to end of hair (nit), water insoluble substance holds the nits to hair

Treatment& Nursing Treatment& Nursing managementmanagement

• Use of pediculocides to remove the nit • A solution of 1% permethrin for killing

pediculosis • Combing hair with fine toothcomb dipped

in hot • Antibiotics if pustules appear in neck • Clothes and head cover should cleaned

boiled and dried

Clinical ManifestationClinical Manifestation• Persistent itching , pruritus in the

occipital area.• Persistent scratching result in excoriation

& secondary infection. • Enlargement of posterior cervical gland

Intestinal parasiteIntestinal parasite• 1-Ascariases:

• Etiology: Ascariases lumbricoides

• Clinical manifestation :1. Abdominal pain, distention2. Enlarged abdomen, anorexia, fever

• Diagnoses: egg can be detected by stool analysis

complicationcomplication• Intestinal obstruction, pneumonia,

cough with blood stain, peritonitis.

• Transmission:1. Contact with contaminated stool2. Food can be contaminated when

feces used as fertilizer.

incidenceincidence• Most common in warm climate • Poor sanitary area, in children 1-4 year

• Incubation: 4-8 week

• Control: -sanitary disposal of feces -treatment of feces before using as a fertilizer -vegetables must thoroughly cooked or soaked in diluted iodine• Treatment: mebedazole

2-pinworm(enterobius)2-pinworm(enterobius)• It is a nocturnal and itching sleeplessness.

Diagnoses :direct visualization of worm

Complication: move of worm to appendix, female genital tract, peritoneal cavity

Transmission: fecal- oral, ingestion or inhalation of egg egg contaminated any thing as toys.

Incidence: most common in preschool and school child ,in crowded place

Incubation:1-2 months

controlcontrol• Good hand washing:1. After contact with infected child2. Bed linen, clothes, after toilet • Keep the child nail short

Treatment: mebedazole