Skin Conditions of Childhood Flashcards
What are two dermatological conditions that pharmacists should be more aggressive in regarding therapy?
Eczema and Acne
In acne, what should be the starting point for acne treatment as of now?
Almost a defacto starting point for combination therapy
- BP combomination with a retinoid
- Retinoid with an antibiotic
When would mono-therapy for acne be appropriate for acne?
Only time to use a single agent would be in the mildest case of acne possible
What is a major difference in the treatment of acne between the USa and Canada?
Differin - Adapalene
- OTC in the USA; not CAnada
Should be used by more children; need to be more aggressive with therapy here
Describe the available strengtbs of benzyl peroxide and if they are OTC or not
OTC –> 2.5-5%
Rx –> 10%
Indication of Benzyl peroxide
Solo for mild acne (rare)
Combination for moderate acne
Describe the mechanism of action of benzyl peroxide?
Anti-bacterial action - Delievers a blast of oxygen and decreases P. acnes
Exfoiliant Action = Mild surface peeling - Closed comedos open up and have less build up
How long should benzyl peroxide be trialled before a benefit may be seen?
3 months of a try to ramp up
What is the most common formulation of benzyl peroxide? Issue on this front?
Gels and lotions are the most common
BP Lotion - 6-8 hours of contact time
BP Washed - 15 hours of contact; washes may be more valuable than once thought
Do not need soap/wash and lotion/gel –> Only one BP product required
BP Washes - Benzac Wash (4 or 5%) - Not enough contact time; new reports coming out that may be more effective than once thought
–> Can go to BID-TID
Old Thinking –> More redness; OD to start and then BID-TID after a month
What are some common adverse effects of Benzoyl peroxide?
Redness, peeling, dryness, burning, bleaches clothes
Describe the role of spot treatment in acne?
Acne Patches:
- People report that they love them and say they “work”
- Astringent in there
- 4 or 5 versions; can be useful
Emergency Skin Patch - Okay
Emergency benzoyl peroxide should not be used
–> SPOT TREATMENT is still not effective
In acne, what is a cornerstone of therapy for everyone?
Normal skin care should be included in therapy
Skin Cleansing BID
Describe the indication of retinoids in acne?
Very effective topical agents
First-line agent or added to others
Describe the mechanism of action of retinoids?
Decrease the cohesiveness of the follicular wall
Increases the penetration of other agents
Vitamin A derivatives - reduce follicular stickness by retinoid receptors
Describe the avilable retinoids and there main adverse effects
Adapelene - least irritating
Tretinoin - Most photosensitizing
Taxarotene - Most potent
How can retinoids be dosed in acne?
Choose a formulation (examples: tretinoin 0.01% or 0.025% cream or 0.025% gel and 0.05% gel)
Start low and then assess in 2 months
Dose HS (photosensitive agents)
Skin needs to be dry prior to application
Pea-sized amount - disappear on skin in 1 min
Critical Counselling Point with Retinoids
Initial worsening of acne
Bring out everything clogging the pores that are hiding underneath
How can one apply benzoyl peroxide and retinoid in acne? Exceptions?
Apply retinoid at night
Apply BP during the day
–> Tretinoin and BP at same time –> D.I. and phosotosensitivity issue
BP can degrade (oxidize) tretinoin if used simulataneously, but this does not occur wjen using micronized tretinoin gel
–> patient could use both at HS
Adapalene and BP Combo Product - Tactupump - AVoids drug inetraction
What type of condition is diaper rash?
Irrirant contact dermatitis
Self-limiting - Episodes last approximately 2-3 days
Where does diaper rash commonly affect?
Only affects areas where diarhhea splashes
Skin folds are typically spared
What are some causes of diaper rash?
Fecal/urine contact –> Viral gastroenteritis ( stomach flu) leads to harsh diarhhea and harsh GI enzymes in the feces
Chemical residue (laundry detergent, wipes)
Chaffing
Antibiotic - Diarhhea as s/e
Formula more problematic than breast milk
What are some differentials f diaper rash?
Eczema - Typpically on face; not diaper area
Impetigo - Different presnetation, splotches
How can diaper rash be prevented?
Change diapers as quickly as possible
Keep the area clean
Barrier products - Tx and rotection - Vaseline
Describe the treatment of diaper rash
Keep the area clean
USe a barrier product at every diaper change
Allow air time
Steroid cream can be used
Describe the duration of treatment and agents for diaper rash
If just a diaper rash –> TX < 3 days
If yeast infected, >3 days and:
a) Fiery Red
b) vesicles/Sqatellites
c) Skin fold involvement
Describe the treatment agents for yeast-infected diaper rash
Keep the area clean
Anti-fungal
Steroid Cream
Barrier Cream
What is one way a pharmacist can conclude that diaper rash is yeast infected without seeing the rash?
Infant Oral Thrush - Yeast infection of the mouth
If have oral thrush with a diaper rah, automatically fungal
What anti-fungals and other agents can be used in the treatment of diaper rash? Duration?
Antifingals:
1) Clotrimazole 1%
2) Miconazole 2%
Applied BID for approximately 1 week and 1 week after clearing
If no improvement - suspect bacterial - MD referral
Steroids (0.5-1% HC - Can go up to Spectro Eczema - legal aspects here tho) for 2 days –> 1 FTU
Describe the application of the agents for diaper rash in infected and non-infected states? Can the agents be mixed together?
Antifungla –> HC –> Barrier
- Wait 2-3 mins between each application
- Ensure barrier is completly removed before the next application
Uninfected:
1) HC 0.5-1 % BID for 1-2 days
2) BArrier Creamk 4-5x day everyday
Infected:
1) ANti-fungal cream BID for 14 days
2) HC 0.5-1% BID for 1-2 days
3) Barrier Cream 4-5x per day everyday
** Do not mix corticosteroids and antifungals prior to applying
When should a child be refrred to an MD for diaper rash?
Refer to doctor if the rash does not improve in 7 days or resolve within 14 days
What is the difference between lice and nits?
Lice are alive
Nits are the eggs of lice and are laid close to the scalp for warmth - Glued to the hair shaft and do not wash out (need a special comb)
Symptoms –> None to itching
What are the two main OTC agents used for lice? Drug of choice?
Nix and Kwellada-P –> Permethrin 1% - pediculocides
Physical Agents –> Resultz (ispropyl myristate), ZAP (coconut and anise oil), NYDA (dimethicone)
Drug of Choice –. NYDA
Describe how NIX can be used for the treatment of lice?
Permethrin 1%
- Synthetic Pyrethroid (incraesed potency)
- High amount of safety in children
Application:
1) Wash hair with regular shampoo
2) Add creme rinse for 10 minutes
3) Rinse out
Manufacturer states that repeats are not needed as has residual activity and enough will hang around to kill the nits
–> Cut the losses and repeat to be sure
Will need to remove the nits and resistance is possible
What is Resultz? How to use?
Isopropyl Myristate
- Not an insecticide; dissolves lice exoskeleton
10 Mins of Application
Repeat in 7 days
What is NIx Ultra?
Resistant Lice - Resistant to insecticides
Anise Seed Oil 15% added
–> Aromatic compounds are somewhat deadly to lice
–> Very hard to see what is in the ultra version on website
–> Aromatic, some of the aromatic compounds have anti-lice properties whether agricultural or on people
Permethrins - Use it twice - Some resistance developping to NIX
What is the drug of choice for lice? What is the agent? Describe its mechanism of action?
Dimethicone
- Penetrates deeply and suffocates the lice and egg’s breathing system
- Physical and contact reaction with the lice
What is ZAP in the treatment of Lice? Efficacy?
Coconut/Anise OIl
–> 15 minutes of contact
- Nit pick
–> Repeat in 9 days
- Still a decent choice
- Aromatic oils have some value; do not know the concentration of effective dosages of the oils
Describe how NYDA should be used?
1) Dry hair
2) Apply NYDA (10-34 mL)
3) After 30 minutes of contact, then start nit-combing with product in the hair and product will dry
4) Leave the product in the hair for 8 hours (if overnight can use shower cap)
5) Wash out with regular shampoo in the next morning
6) Re-check the hair in 8-10 days
7) Repeat in 9 days (range 7-10 days)
What may occur after any treatment of lice?
Scalp can be itchy for a few days after lice treatment
–> Lice will put anti-coagulants in the scalp
Describe the rates of lice resistance to treatments
Lice can develop resistance to insecticides
Lice will not develop resistance to NYDA
Used to be worried about repeats to reduce resistance - NYDA can be repeated safely
What can be done if their is treatment failure of lice?
Suspect resistance if treatment resistance
Use a different agent (a different drug)
No resistant lice to NYDA so can use it again; most likely missed some of the lice
What strength of steroid can be used for diaper rash?
Can use spectro eczema on diaper rash area
- Spectro eczema for 1 dose for 2 days
- Spectro eczema is used in the UK for diaper rash
- Not indicated on label
HC 1% is low level; HC 2.5% can be prescribed as an RX; and is better agent
Zincofax - Use the CS once a day; covering it up, more absorption but not too concerned for one day use
How can a diaper rash be diagnosed as fungal? Is this diagnostic criteria?
Rash in the folds - Not a complete disganostic yes or no for for a fungal infection
3 day rule - Dial more into fungal infection
Spots above or below the diaper area - Thinking infection
What anti-fungals can be used for diaper rash?
Can use Canesten (vaginally or for the feet) - clotrimazole
–> off the shelve
MD may prescribve ketoconazole for insurnace coverage reasons
Ketoconazole is similar to Canesten
1 vs 2% Canesten - Go with 1% - Nothing compels us to go with xtra strength
What are warts? Transmission? Sx?
Human Papilloma Virus
Transmission - Touch to touch (self-innoculation can occur)
25% “spontaneously” regress –> Fail to mention spontaneous is one year
Cosmetic nuisance up to being painful
What is a solution agent that can be used for the treatment of warts?
Salicyclic Acid Preps
Duofilm Liquid (Salicylic acid and lactic acid)
Compound W for 8 weeks
How can duofilm be used for a wart?
Soak the wart first
Rub off dead skin
Vaseline at the base
Apply the drops
Cover the wart
Continue OD for 8-12 weeks
Describe the duration fo treatment with solution therapies for hand warts?
Duofilm Liquid - 8-12 weeks
Compound W - 8 weeks
Describe how to use OTC Cryotherapy for warts 9Compound W freeze off)
1) Lightly press the tip
2) Attach the tip to the applicator
3) Press down the tip into the canister and hold for 2 to 3 seconds - will hear a hiss sound
4) Apply the cold tip precisely on the wart
- Soak the wart first
20 Seconds on the Hand
40 Seconds on the Foot (20 seconds, reload, another 20 seconds)
Describe the duration of use and repeats of cryotherapy for warts
Apply every 2-3 weeks for about 4 repeats
Is there a difference in efficacy between salicylic acid and cryotherapy for warts?
Equally effective so let the parent decide based on what they think the child can handle
When should a pharmacist refer for warts?
On the Face –> Refer
Multiple Lesions - Likely refer
What severity of acne can pharmacists prescribe for?
Mild acne –> Comedonal
< 20 comedones (whitehead/blackhead)
Or
< 15 inflammatory papules, or a lesiob count < 30
What is a concern regarding plantar warts?
Core is a concern
Need to remove the core to remove the wart
What is a solution agent that can be sued for plantar warts? Duration?
School Wart Remover (40% Salicylic Acid)
12 weeks for a wart
Dual Action and Non-Dual Action for Plantar Warts Therapy
Dual Action: Freeze area then apply salicylic acid OD for 14 days - repeat for 4 cycles
Non-Dual Action: Freeze area Q2-3 weeks
Salicylic Acid on Plantar Wart Duration
OD to Q2days for 12 weeks
How can one distinguish a rash from teething from one of eczema on a child?
Saliva is contact dermatitis from teething
If not sure, just refer
Eczema and teething are common at this age
If parent is whiping saliva off the cheek, then more clues to a rash from teething
Teething around 6 months; eczema also common the face at this age
What is fifth disease?
Starts with cold symptoms and then a rash develops
AKA - Slapped Cheek
What causes fifth disease?
Human Parvovirus
What is the difference between fifth and sixth disease in relation to when it occurs?
6th Disease - 2-3 years of age
5th Disease - 5-6 years of age and up to early adolescence
5th Disease commonly develops after 6th disease
If fifth disease contagious? What is the treatment of fifth disease?
Fifth disease is contagious although it is a mild disease
No treatment for fifth disease
- Rash is not itchy
- Low grade fever can be present and Advil or Tylenol is unlikely required
Describe rashes and URTi. How can one know if fifth disease has occured?
Rashes and utricaria (hives) are common with URTi
–> Hives will tend to be itchy and move
–> Rash with fifth disease is unlikely to be itchy
No one will know its fifth disease as it will intially present just as cold type symptoms
A low grade fever (not flu symptoms) may be present
Will know its fifth disease when a rash hits and develops
Fifth –> Virus with a little bit of cold symptoms and a rash
Describe what commonly occurs with fifth disease and Tylenol/Advil?
The rash is due to the virus
If Tylenol or Advil is given prior to the rash, the drug will commonly be blamed for the rash (drug-induced rash)
Describe the symptoms of fifth disease
Fifth disease begins with a low fever, headache, and mild cold-like symptoms
A rash appears a few days later
A distinctive red rash on the face that makes the child appear to have a “slapped cheek”
A few days later the rash spreads down to the trunk, arms and legs and usually lasts 1-3 weeks
After a few days, the rash, which may be itchy (unlikely), takes on a lacy-net like look
In the time it takes for the rash to completly clear, it may seem to get worse before it finally fades away
What is the Roseola also known as?
AKA Sixth Disease
Describe sixth disease
URTi initially; presents like a cold however a fever is present
The rash develops later
Contagious
What is a common issue in sixth disease compared to fifth disease regarding medication usage?
High fever in sixth disease compared to fifth disease so therefore antipyretic medication usage is more common
Tylenol and Advil are more likely to be blamed for the rash rather than sixth disease
Describe the treatment of sixth disease? How does the rash present?
No treatment for the rash; treatment of fever does not help with the rash
The rash is not blistering and no puss present
A splotchy rash that develops on the face and trunk and then spreads to the legs and arms
Rash should go away in 2-3 days
No treatment here
Describe the difference in rash duration between fifth and sixth disease? Rash presnetation?
In sixth disease, rash should disappear in 2-3 days
- Rash is maculopapular (flat lesions, pimple like)
In fifth disease, the rash lasts longer (approx. 2 weeks)
- Erythema rash (just redness)
Describe the symptoms of sixth disease?
Starts with a high fever that lasts for 3 to 5 days
CHild may be cranky or irritable
When the fever ends, a rash of small pinkish-red spots develop on the childs face and body
The spots will turn white when you touch them and they may have a lighter ring around them
The rash usually spreads to the neck, face, arms and legs
The rash can last from a couple of hours up to 2 days
The rash is not commonly itchy
What is a maculopapular rash?
A maculopapular rash is made of both flat and raised lesions
A marker for many diseases, allergic reacytions, and infections
Most of the time, the cause is a viral infection
What is hand/foot/mouth disease? How does it appear?
GI Virus - Gets past the gut
Starts with a cold
Appears as 2 days of fever, 2 days of mouth sores and 2 days of a rash
Cold symptoms initially, then get mouth ulcers (spots in the mouth that burst open)
If involves the hands and feet, easily diagnositic
Is the diagnosis of hand/foot/mouth disease easy?
Somewhat easier to diagnosis than other childhood derm conditions when limited to the hands, feet and mouth
Sometimes may not present in the mouth and may only presnet around the mouth
What age group is hand/foot/mouth disease common in?
Ages under 5 years old
Treatment of hand/foot and mouth disease?
Nothing for treatment here
Maybe some eczema cream - Not as itchy as chicken pox
Tough it out situation
Is hand/foot/mouth disease a serious or mild disease?
Hand, foot and mouth is usually not a severe dillness
What are some of the main symptoms of hand, foot and mouth disease?
Small, painful ulcers in the mouth
A skin rash that looks like red spots, often with small blisters on top that appears on the hands (palms) and feet (soles), buttocks and sometimes other places
How can hand/foot/mouth disease spread?
Disease is spread via contact with an infected person’s saliva or stool
Not spread for animals
Are antibiotics necessary for hand/foot/mouth disease? Duration of disease?
Antibiotics are not required for hand/foot/mouth disease (viral) and will not help it go away any faster
It can last for 7-10 days
How is mollsuscum spread? How many lesions?
A viral infection that is transmitted via skin to skin contact
- 10-20 lesions on average
Describe the difference between molluscum and warts?
Similar to the wart virus
Warts are dense (vasculature and core udnerneath)
Molluscum lesions are soft and malleable
–> Dome shaped with indentations on the top
Describe the treatment of molluscum?
Self-limiting: Will disappear in 6-9 months with the immune system
MD is required for treatment
- No OTC therapies effective here
First Line –> Frozen off by cryotherapy
Second Line –> curretage (cutting) of lesions - lidocaine injection underneath
Cantharine (beetle juice) is not likely to be effective here
What age group is commonly effected by molluscum?
Any age can be effected by molluscum
In adults - Differential –> STD
Traditionally affects children 10 years and younger
Describe the lesions of molluscum? Symptoms?
Firm, dome shaped, flesh-colored bumps
Relatively painless, but they can be very itchy
Molluscum is generally asymptomatic and is often not accompanied by a fever or malaise
May have only one lesion but often presents as a group of papules spread throughout the body
What is a concern with mollusucm?
The disease can spread throughout the body via self-contamination
What is milia?
Used to be called childhood acne
- Cosmetic front here; low level stuff
Self-limiting and will go away on its own in a couple of weeks
Little white bumps that commonly occur along the nose line
Describe the treatment of milia
No pharmacological therapy here
A face cloth can be used to help get rid of the little bumps
Is milia common in pediatrics? When does it appear?
About to 40-50% of newborn babies will have milia; most often on the cheek, nose and chin
Typically appears a day or two after birth
What is angular chelitis? WHat is impetigo? How can one distinguish between both disease states?
Angular Chelitis - Bust open the sides of the mouth and get irritation
Impetigo - Vesicles and lesions around the mouth (commonly) that have golden and yellow exudate
Simply describe a pharmacists role in impetigo?
Pharmacists have prescribing authority for impetigo
- Does the individual have access to care?
While we have prescribing authority here, impetigo can have various presentations so it is okay to refer
Describe the prevalence of impetigo
Most common bacterial skin infection in children aged 2-5 years old
Describe the symptoms of impetigo
Contagious skin infection that mainly affects children and infants
Appears as red sores on the face, especially around a child’s nose and mouth
The sores burst open and develop honey coloured crusts
–> Sores that do not blister aare common (non-bolous) - No blistering other than oozing (70%)
Red sores that quickly rupture, ooze for a few days, and then form a yellowish-brown crust
Itching and soreness are generally mild
What time of the year is impetigo more common?
Impetigo is more common in the summer
Describe the age demographic impetigo affects
All age groups, but is usually seen in young children
Describe impetigo: Age, causuative organism; sx, and duration
All age groups, but is usually seen in young children
Streptococcus pyogenes or Staphylococcus Aureus
Involves the face
Has regional lympadenopathy
Self-limited to 2 to 3 weeks
Vesicles may progress to pustules –> easily rupture –> honey-coloured crusts
Does impetigo have one or multiple condition presentations?
A less common form of impetigo, called bullous impetigo, may feature large blisters that occur on the trunk of infants
A more serious form of impetigo, called ecthyma, penetrates deeper into the skin - causing painful fluid-or pus-filled sores that turn into deep ulcers –> RAre
What age does impetigo commonly affect?
Commonly occurs in children aged 2-5 years old
How can impetigo be spread?
Crowded Conditions - Spreads easily in schools and child care setting
More common in the summer
Transmitted through skin to skin contact
What is the differential of impetigo?
Eczema - Will be itchier, less crusts
Contact Dermatitis - Will have contact with something
Herpes SImplex - Painful and tingling
Impetigo is not painful or itchy; golden crusts can hue us into impetigo
Impetigo can affect other areas other than around the mouth –> e.g. butt
How can a pharmacist differentiate between impetigo and a cold sore?
Cold Sores –> More cases of impetigo than herpes simplex; however symptoms are close enough that they can through us off
Cold Sore - Typically around the age of 10
Impetigo - Typically around 2-5 years of age
Cold Sores –> HAve a little vesicle inside
When its off the lip margin –> Impetigo
If on the lip margin –> Cold Sores - Older kids, more painful and little vesicles
What are the main differences between cold sores and impetigo?
1) Cold sores involve red lesions. Impetigo may involve red lesions but these rupture quickly and then form golden-brown crusts.
2) Impetigo spreads more quickly than cold sores.
3) Impetigo never occurs inside the mouth and can form anywhere on the body. Largely not the case with HSV-1.
4) Impetigo is usually painless and only visual. Cold sores can cause pain and early stages can present with tingling.
5) HSV-1 is transmitted through infected bodily fluid, particularly saliva – lips, nose, eyes, mouth, cheeks, genital region
Impetigo is caused by a bacteria that preys on manipulated skin and can occur anywhere
Does impetigo require treatment?
Impetigo is self-limiting and often improves within a week of treatment or within a few weeks without treatment
Can polysporin be used for impetigo? What agents in the polysporin are we wanting the agent to include?
Polysporin can be used; however, prescribed agents are more effective
Do not select polysporin unless there is no acess to Fucidin or mupirocin
Polysporin - Not concerned about gram negtaive here (polymyxin); use of this agent is for gram positive coverage (bacitran and gramcidin)
What are some prescription agents that can be used for impetigo? Application?
Mipirocin and Fucidin
If crusts are thick, use warm water compress to soften the crusts first and then remove for better antibiotic contact
Effect of Topical Antibiotics in Impetigo
Self-limiting condition
- Should have a couple of days less when treated
Describe how the prescription agents should be used for impetigo
Impetigo usually requires 5-7 days of therapy - Often go for 5 days here
Mupirocin 2% cream or ointment
Apply to affected areas three times daily for up to 10 days. Rub in gently.
Fusidic ACid 2% Cream or Oitment
Apply to affected areas three to four times daily for 7-14 days. RUb in gently. (Just choose TID or QID)
Describe the duration of topical antibiotics in impetigo
Impetigo requires 5-7 days of therapy –> Just go for 5 days
Once its clear, stop –> No need to continue for 1 week after like antifungals
If trajectory is not better in 5 days, cosnider misdiagnosis
What is a new treatment for impetigo? How is it used?
Ozanex (ozenoxacin) - Quinolone cream for impetigo
- Continue to recommend mupirocin or fusidic acid
- Apply a thin layer to the affected areas 2 times a day for 5 days
What are some conditions in children that are unlikely to be seen in a pharmacy? Why?
Measles
Mumps
Rubella (German Measles)
Chicken Pox
MMRV (MEasles, Mumps, Rubella, varicella) Vaccinations
What do childhood vaccine protect an child from?
Chicken Pox
Measles
Meningitis
Mumps
Polio
Whooping Cough
When do children recieve the MMRV vaccine?
12 Months old
18 Months old
Grade 6 –> Varicella (Chicken Pox) vaccine
What are some main points regarding Measles, chicken pox, mumps?
All conditions are viral
Measles harder on children than German measles
Chicken pox is itchier than measles
Chicken pox are small vesicles that crust over
Mumps mainly hits the jaw glands
Not a lot of therapy for any of them
Describe measles
Starts with a fever (39-40 C), runny nose, red watery eyes, and a cough (dry raspy) that can last after the rash clears
Red bumps with tiny white dots appear a few days later on the inside of the cheeks
Rash appears on face and progresses down the back and trunk to arms and hands and finally legs and feet
Classic MAculaopapular Rash - Flat, red lesions but eventuallyd evelops bumps that may be itchy
Rash lasts about 5 days; total illness lasts 7-14 days
Quite sick for 3-5 days
What is german measles also known as?
Rubella
Describe german measles (rubella)
Generally a mild disease in children
Occurs most often in children aged 5 to 9 years of age
Starts with 1-2 days of a mild fever (37 C), swollen and tender lymph nodes
Rash then begins on face and spreads downward
Standard MAculopapular rash - Rash can itch and last for up to 3 days
MLess tough on a child than measles
- MIld skin reaction, low fever, low cold-like symptoms
About a week and then done
No treatment here
Many individuals with rubella have few or no symptoms
Is mumps a deadly disease?
Not leading to death - However can be painful
Describe mumps
Parotid Glands well and patient develops a “hamster-like” face - Painful and swollen salivary galnds
The symptoms of mumps normally appear 2-3 weeks after the patient has been infected; however, almost 20% of people with the virus do not suffer any sigbs or symptoms at all
Describe when the symptoms of a rash occur after vaccination? Which vaccines are the worst for rashes?
Most reactions at the injection site occur within 2 weeks and most general reactions or fever within 7 days
- Chicken pox and measles are the worst for rashes –> More than just local reactions
- Measles Vaccine Rash - Call MD if rash onset at day 7-10 and persists for > 3 days
What are some common symptoms that can develop after vaccination? Which is less common?
Fevers are still common for most vaccinations as moutning an immune response
Rashes are quite rare –> No more than 5%
Most rashes are not caused by the vaccine - Large rashes have a low potential to develop
Feverish and local site reactions are common after vaccination
Describe symptoms that may occur after the DTAP vaccine
Pain, tenderness, swelling or redness at the injection site lasts for 24 to 48 hours (51% of children)
fever lasts 24-48 hours
Describe symptoms that develop after Measles vaccine
Can result in a fever (10%) and rash (5%) about 7 to 10 days following injection
fever lasts 2 or 3 days
The mild pink rash is mainly on the trunk and last 2 or 3 days. No treatment is necessary and child is not contagious
Describe symptoms that may occur after Chicken Pox Vaccination
Pain or swelling at the injection site for up to 1-2 days (19% of children)
Fever lasting 1 to 3 days begins 17 to 28 days after vaccine (14%) - Can give acet or ibu
Chicken Pox-like vaccine rash (usually 2 lesions) at the injection site (3%)
Chicken Pox like vaccine rash (usually 5 lesions) scattered over the body (4%)
The mild rash begins 5 to 26 days after the vaccine and usually lasts a few days
Children with these vaccine rashes can go to day care or school
–> Vaccine rashes are not contagious, avoid school if widespread and weeping lesions (likely chickenpox)
Describe the symptoms that may occur after the pneumonoccocus vaccine
Pain, tenderness, swelling OR redness at the injection site in 15-30%
Mild fever in 15% for 1-2 days
No serious reactions
Describe the rash that may occur after the MMRV vaccine
A rash that looks like measles, rubella. or chicken poc may occur about 1-2 weeks after the vaccine
Describe the symptoms of chicken pox
Incubation period of chickenpox ranges from 11-21 days
Prodromal Sx –> Low grade fever, headache and malaise
On the following day, charcteristic rash begins
–> Lesions evolve from erythemous macules to form small papules
Quickly, a clear vesicle arises on the erythemous base
–> Vesicles turn into lesions
Described as “de-drop on a rose petal”
Describe the progression of the rash in chicken pox
1) Chickenpox rash starts with red spots that can occur anywhere on the body
2) The spots fill with fluid. The blisters may burst. They may spread or stay in a small area.
3) The spots scab over. More blisters might appear while others scab over.
Scabs 4 or 5 days later - Could be mistaken as molluscum
What are some therapies that a patient may use for chicken pox? Describe if the agnets are effective?
1) Polysporin - Chicken pox is a virus so not effective
2) Calamine/Witch Hazel –> Astringents - Can use to help relieve itchiness and dry skin out
3) Benadryl –> Not effective
4) Cool Compress - Can be effective to help reduce swelling
5) Tylenol (yes), Advil (No)
What are some non-pharamcological stratgeies that can be sued for symptom management in chicken pox?
Take a cool oatmeal bath
Calamine Lotion
Cool, wet wash cloth for itchy areas
ASA in a child following vaccinatio
–> never give ASA to a child within 6 weeks of recieving vaccine - Reye’s Syndrome
Describe the use of Tylenol and ADvil in Chicken Pox
Tylenol - Can help relieve pain with sores that develop on skin ir in the mouth
Ibuoprofen and NSAID’s - NOOO - CAn make you very ill
Describe the use of NSAID’s in Chicken Pox
NSAID’s - Risk of necrotizing soft tissue infections
-Necortizinfg Fascitis/Cellulitis - Cannot use ASA for this reason; Ibuprofen now on the radar
Chicken pox is not that painful but can have a mild fever
- Ibuprofen can likely be used; however, LEGAL - Do not recommend
Ibuprofen should not be recommended for chickenpox management
–. Sufficient evidence to contraindicate ibuprofen for the management of chickenpoix symptoms due to elevated risk of NSTI
What is the firts line anti-pytretic io children with chicken pox?
ACETAMINOPHEN
