NP619 Module 5&6 Flashcards
seborrhea
self-limiting occurs in infancy and again in puberty yeast Malassezia may be the cause greasy scales sebaceous gland activity is overactive
Seborrhea treatment
baby shampoo to remove scales
sebulex shampoo/t-gel shampoo
corticosteroids topically if inflamed
Antibiotics (topical) if secondary infection
Hemangioma
appear in 1st two weeks
appear in 1-3% of children
small harmless birthmarks that grow for 8-18 monthsand slow and regress over the next 5-8 years
can be nodular masses or telangiectatic macules
they are benighn neoplasms resulting from rapid proliferation of endothelial cells. After proliferating, they undergo comlete regression with fibrosis
Hermangioma-strawberry marks
1/3rd go away by 3 50% by 5 70% by 7 and 90% by 9 Typically no intervention If needed -burrows solution intralesion steroid laser petroleum gauze refer to derm or plastics if needed
Milia
No clinical significance
tiny pearly white cysts 1-2mm
form because oil gland is still forming
Primary are located in infants on normal, healthy skin
secondary form on skin affected for another reason
EPSTEIN PEARLS are on the roof of the infants mouth and are perfectly normal.
Milia Rubra
typical heat rash
No treatment
reassurance
blockage of sweat gland
Usually on overdressed infants in the winter
clear-fluid filled blisters surrounded by red areas or tiny red bumps
erhtymas toxicum
harmless red rash on the skin of newborns. Goes away on its own and has no symptoms
looks like flea bites
Will go away in 5-7 days
1-3mm firm, yellow, or white raised bumps filled with pus on top of a red area of skin. Not on palms or soles. starts on face and spreads. First 3-4 days of life and may not present till day 10.
thrush
white plaque on mucosa
unable to remove with scrape of a tongue blade
from bottles, nipples, inhalers in children and adults
Treat:
nystatin, oral diflucan, oral hygiene
Tinea Corporis
lesions are rough edges, and scaly elevated edges
They have central clearing.
Ringworm
Treat with a topical cream or oitment such as nystatin but must use for several weeks
Use a topical antifungal: Naftin, Nizoral, Oxistat
Tinea capitus
Must use oral anti-fungal caused by Trichophyton tonsurans Griseofulvin 4-12 weeks You can not treat topically. Think prevention. Its a fungus on the head
Impetigo-vesicles in the diaper area
these can enlarge to 3-5 cm bullae that easily rupture, leaving thick, honey-colored crusts.
staph and strep topical ointment of Bactroban if able (right age, small area) Or give Keflex, or Amox easily gets out of control think MRSA Bactrim over 2 mos.
Atopic Dermatitis-
Chronic, pruritic, eczematous dx that nearly always begins in childhood
follows up and down course
It is a result of a complex relationship of environmental, immunologic, genetic and pharmacologic factors
Made worse by infections, psychological stress, climate changes, irritants and allergens
Most clients have a lifelong sensitivity
Atopic Dermatitis
theories- elevated IgE and inflammatory response eosinophilia disordered cell-mediated immunity aeroallergens: patch testing finds house dust 70% mites 70% mold mix 70% grass 43%. Avoidance of these rarely improves
Criteria for AD
3 or more
pruritus
typical morphology
flexural lichenification in adults
facial and extensor involvement in infants and children
dermatitis-chronically or relapsing all the time
personal or family hx of atopy-asthma, allergic rhinitis, atopic dermatitis
AD
Minor (Must also have 3 of these) cataracts chelitis eczema food intolerance conjunctivitis skin infection itching and sweating nipple dermatitis orgital darkening palmar hyperlineraity wool intolerance white dermographism
Prognosis
50% of children with AD will have asthma and allergies by age 13
dermatitis waxes and wanes
50% improvement see by 18 montsh and in other cases dx progresses to childhood with improvement in adolescence
MAJOR MISCONCEPTIONS:
that it is an emotional disorder
that it is precipitated by an allergic reaction
Infant phase AD
starts in 3rd month
most common is presentation in winter months, dry, red scaling areas on cheeks, chin, paranasal, perioral, lip lickers, proceeding to hand, extensor of forearm
childhood phase AD
2-12 years
inflammation in flexeral areas
perspiring stimulates burning and itch scratch cycle
normal duration of sleep is not maintained and patients are miserable
Adult phase 12 and up AD
Begins around puberty
resurgance not understood
flexural areas involved
hands, around eyes, lichenification of anogenital area
Treatment of AD
Triggers temperature change decreased humidity excessive washing contact with irritating subtances contact allergy aeroallergans microbic agents (staph) the predominant one in AD. Tx systemically or topically drmatically improves emotional stress certain foods can provoke
Treatment of AD
Eliminate inflammation and infection
Most can achieve in 3 weeks
takes diligence
Emollients: petroleum jelly and the 3 minute rule: bath in warm water, no soap, pat dry, within 3 minutes apply emollient
Steroid topical: see chart shortest period of time (use group V Cultivate 0.05% can be used at 3 months for severe eczema)
Treatment for AD
emollients-the 3 minute rule
For pruritis-avoid topical antihistamines and can take 1st generation oral at bedtime
Hydroxyzne-atarax(motion sickness and hives)
non-steroidal anti-inflammatory agents like eidel or protopic:not recommended under 2 yrs of age. Refer
Antibiotics: topicals do not work well
If you see crusting or pustulation then tx fo staph
First Cephalexin. You can culture for MRSA-No bactrim under 2 mos. Can try Bactroban if on a leg or arm and small patches
AD cycle
Emollient
control the triggers
steroid cream
MRSA
1 incision and drainage
Treat with clindamycin C&S
Not macrolides, fluorquinolones
VANCO for severe
Fifths disease-slapped cheek look
Parvovirus
mild illness-runny nose, HA, fever
Goes away no treatment
lacy rash
skin warm and dry, macular rash on face centered on cheeks and same on abdomen
can return to daycare. rash shows up
Cafe au lait spots
light oval macules on the body
presented at birth
>6 that are 1.5 cm evidence of neurofibromatosis
Neurofibromatosis 1
genetic disorder with causes tumors to grow along types of nerves
Refer to neurology
slate blue marks
Used to be called Monogolian spots
Don’t confuse with child abuse
fade over time
