Common paediatric skin disease

Common paediatric skin disease
Emma King
Nurse Practitioner
Dermatology Department and Private Suites
The Royal Children’s Hospital
Melbourne, Australia
Diagnosis?
Hand Foot and Mouth Disease
(Coxsackie virus)
•
An abrupt onset of scattered papules that
progress to oval or linear vesicles in an
acral distribution
•
Children are not usually ill and are
normally afebrile
•
Incubation period is 3-5 days
•
Virus enters via the enteric route
•
Contagious from 2 days before to 2 days
after the onset of the eruption
•
But… virus is excreted in faeces for up to
2 weeks
•
NO TREATMENT needed unless flaring
eczema.
Diagnosis?
Pityriasis Rosea
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Absent or minimal prodrome
'Herald patch' in 80%
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Eruption occurs hours to days later
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usually near proximal joint
larger than other patches
symmetrical and proximal
long axis of patch in Christmas tree distribution
free edge of scale internally
Usually lasts 3-6/52

topical steroids and/or UVB for symptoms
Diagnosis?
Pityrosporum Folliculitis/6 week rash
• Otherwise known as ‘milk spots’, infantile
acne
• Is really a yeast folliculitis
• Fades as sebaceous glands settle to
quiescent childhood levels
Treatment
•
•
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Sebizole shampoo 1:5 water
• Apply to affected areas with a cotton ball
• Leave on for a couple of hours then rinse off in the bath
• Wash the face, body and scalp with the sebizole and rinse off
Hydrozole cream to affected areas bd until clear
Usually clears within 3 days
Diagnosis?
Scabies
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•
•
•
•
•
•
•
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Caused by a mite – Sarcoptes
scabiei
Direct skin-to-skin contact, close
physical contact
Not from animals
Burrows a tunnel and releases
toxic secretions
Incubation – 3 weeks
Itching develops after 4-6 weeks
due to sensitisation, allergic
reaction to the presence of the
mite
Eczematous changes
Itch exacerbates at night
Scaly burrows on fingers and
wrists
Scabies treatment
•
Lyclear (Permethrin) – wash off after 8-24hrs
•
Repeat treatment one week later
•
Treat the whole family
•
Wash linen and clothes day after treatment
•
Remove soft toys
•
Mites survive for a max. of 36 hrs away from
host
•
Eczema treatments
•
Return to school after 2 treatments completed
•
Itching may take 3 weeks to resolve
Diagnosis?
Irritant Napkin dermatitis

The skin barrier function is impaired > increased irritation
by urine, faeces, Candida albicans, bacterial overgrowth,
soaps and nappy wipes

Settle inflammation
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Treat any secondary infection; Hydrozole cream bd

Use disposal nappies
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10%Olive oil in zinc paste/Bepanthan ointment
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Frequent nappy changes
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Nappy free time when possible
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Wash with diluted bath oil/olive oil using cotton balls or
Rediwipe towels
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Dab gently rather than wipe vigorously
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Bath oil and no other irritants in bath
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No antiseptics/cleansers/napkin wipes etc
Diagnosis?
Molluscum Contagiosum
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Caused by a harmless virus (MCV)
•
Poxvirus
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Very common in children
•
Transmitted by swimming pools, sharing baths, towels and direct
contact
•
In adults most often a sexually acquired infection
•
Pearly papule
•
Central dimple and core
Treatment
•
Self limiting, but may take up to 2 years
•
Complicated by atopic eczema
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Treatment involves irritating the lesions – Burow’s solution diluted
1:10, Benzac gel, occlusive tape, Aldara, Cantharone
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Squeeze, curette, cryotherapy - ? scaring
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Shower rather than bath
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Infection control measures
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Atrophic scarring with or without treatment
Diagnosis?
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Treatment
•
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Capitis
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Oral griseofulvin or Lamisil (give with fatty food)
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Identify sources if possible
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No sharing of hair combs/brushes or head wear
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Hair growth is slow
•
Antifungal shampoo – reducing shedding of spores
Corporis
•
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Topical antifungals – ketoconazole, miconazole
Pedis
•
Oral griseofulvin or Lamisil
Diagnosis?
Eczema (atopic and discoid)
•
The most common skin disease, especially in early childhood (30%)
•
Onset is most common in the 1st year of life.
•
The hall marks are chronic, pruritic and relapsing skin dryness,
inflammation and erythema
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Improves with time most children grow out of it
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It can be linked with asthma and allergic rhinitis
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An associated immune response to environmental and food allergens
and irritants
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If not managed effectively secondary bacterial skin infections are
common.
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It can affect any part of the skin however it is most common on the face
and flexures.
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A primary disturbance of the epidermal barrier function
• Dry skin (decreased filaggrin and ceramides)
• Staph Aureus
• Signs
• Papules and Vesicles
• Erythema
• Secondary erosions and lichenification
• Skin infection
• Dry skin
• Itch
Assessment
Look for
1.
2.
3.
4.
5.
6.
7.
8.
Extent %
Infection /3
Broken skin /3
Erythema /3
Lichenification /3
Xerosis /3
Sleep pattern /10
Itch /10
(SCORAD http://adserver.sante.univnantes.fr/Scorad.html )
Principles of management
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Manipulation of environment
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Education on removal of heat, dryness, prickle, allergies
Adequate skin care
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Regular application/use of emollients; even on clear skin
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Aggressive use of adequate topical steroids
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•
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Trial hydrocortisone for mild eczema and face otherwise need a prescription for
elocon or advantan
Wet dressings/clothes within 24-48 hours if the eczema is not
controlled with emollients and steroids
Adequate treatment of skin infections
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Removal of crusts ASAP, by bathing and wiping away
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Oral antibiotics if needed
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Bathing with bleach and salt
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Adequate education, demonstration and support
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If not responding to these measures consider other options
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Referral to GP or Hospital
Infected eczema
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Crusted
Weeping
Acute flare
Itchier
Plan;
• Remove crusts ASAP in the
bath with a wet soft towel
• Apply steroids and moisturisers
to open areas once crusts
removed
• +/- oral antibiotcs
• May also need wet dressings
and cool compressing
The role of allergy in eczema
• Allergic contact dermatitis
• Look for patterned eczema
• Environmental allergen
• Older children/adults
• House dust mite, grasses, pollens
• Foods
• Babies rather than older children
• Urticarial eczema
• Flare within 2 hours of ingesting
food
Food intolerance
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Reaction to food through non-allergic means
Perioral eczema
18/12 to 5yo
May have hand involvement
May have napkin dermatitis
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Consider acidic and junk foods
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Consider using SLS free toothpaste
Topical Treatments
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Steroids use aggressively and NOT THINLY when flaring
• Face- hydrocortisone 1%(Sigmacort) or pimecrolimus (Elidel),
bd, prn
• Body- mometasone furoate (Elocon) ointment, cream or
methylprednisolone aceponate (Advantan) fatty ointment,
ointment, lotion, nocte, prn
•
Emollients- use often every day
• QV Kids Balm, QV Cream, Cetaphil cream, Dermeze,
Hydraderm, aqueous cream, Avene cream, good quality
sorbolene CREAM, 10% liquid paraffin, 10% soft white paraffin,
10% glycerine in aqueous cream, Stelatria, Stelatopia, Kenkay
• Bath oils, QV, Hamiltons, Avene, Dermaveen, Kenkay
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Use wet dressings within 48 hours if the eczema has NOT improved
with the above.
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Tar for lichenified or discoid eczema (not to face or groin). e.g.
Hamiltons eczema cream.
Bathing
• Very important, 1-2/day
• Assists by
• Physically removing staph
• Cool temperature assists in reducing
inflammation
• Salt (pool); less stinging, cooling,
antiseptic, anti inflammatory
• 100 grams/10 litres water
• Bleach; antisepetic
• 12 ml/10 litres water
• Every day for 1 month then reduce if possible
• Cool – 29-31 degrees
Why apply wet dressings?
Tubifast OR Chux
• Reduce itch
• Treat Infection
• Moisturise the skin
• Protect the skin
• Promote sleep
Wet clothes can be used to reduce cost and if other
not available
Treatment for moderate and severe facial eczema
1.
Advantan for 3-5 nights
2.
Elidel bd of not improving with
hydrocortisone. Then if not
improving.
3.
QV Kids Balm/ Stelatria/QV
Cream or Cetaphil cream QID
4.
Cool compressing QID
5.
Antibiotics if infected
Treatment for mild facial eczema
• Hydrocortisone bd prn
• QV cream/Cetaphil/Avene/Kenkay, Sorbolene bd-tds
Case four. What is the plan?
ACUTE FLARE
• Advantan ointment to face nocte for 3-5 nights, then
hydrocortisone bd prn or Elidel cream if still moderate
• Cool compressing to the face QID, QV Balm post
• QV Kids Balm/Stelatria to the face QID for 3-5 days
then cream
• Cool bleach, salt and oil bath daily
• Advantan ointment to limbs and trunk nocte prn
• QV/Cetaphil cream to limbs and trunk tds
• Wet Dressings nocte
• Wet singlet bd until clear
• Keflex 7/7
If the above is undertaken there will be 90%
improvement in 3 days.
Thank you
Dermatology nurses; Emma King, Liz Leins, Robyn
Kennedy, Danielle Paea, Leigh Fitzsimons, Claire
Borlase, Lauren Weston
Email;
[email protected]
Phone; 9345 4803
Web; www.rch.org.au
RCH Private Suites; 9345 6438
Outpatient clinics; Mon am, Wed pm, Thurs pm
Eczema Workshops; Tues and Wed am
phone; 9345 4691
Eczema Community clinics; Monday; Collingwood,
Thursday; Broadmeadows