- Acne Vulgaris
TX: - Goal is to prevent scarring and promote positive self image
Topical treatments – benzoyl peroxide (OTC) Retin A (RX)
Oral antibiotics (Tetracycline, PCN, Erythromycin)
Unresponsive to treatment – Accutane (risk teratogenic effect – oral conceptives for some females
- Acne Vulgaris
- Disorder of sebaceous hair follicles.
- Bacterial Pharyngitis
- Abrupt onset (may be gradual in children < 2)
Sore throat usually severe
Erythema and inflammation of pharynx and tonsils
Fever (usually high 103-104) begins early in illness and lasts 1-4 days
Abd. Pain vomiting, headache
Cervical lymph nodes enlarged
Usually last 3-4 days
If strep treated with penicillin for 10 days or erythromycin if allergic to pen
Noninfectious after 24 hours of penicillin treatment
Acetaminophen, warm salt water gargles - Cellulitis
S/S - Area is usually red, hot, swollen and painful. May see red streaking of surrounding area from lymphangitis
Child usually has fever, malaise and headache
- Cellulitis
TX - Antibiotics (IV or IM)
Warm compresses
Hospitalization for I&D may be indicated in some cases
- Cellulitis
- Bacterial infection of the sub q tissues and dermis usually from a break in the skin
Causative agent: usually staph or strep
- Conjunctivitis (Pink Eye)
Treatment - Prevent spread (viral and bacterial very contagious), good handwashing (don’t share towels)
Antibiotic eyedrops/ointment – polymyxin, erythromycin (can go back to school after 24-48 hours on eye drops) also have antiviral eyedrops
Antihistamines if allergic cause (zyrtec)
Supportive – cool compresses - Conjunctivitis (Pink Eye)
- Inflammation of the conjunctiva
May be viral, bacterial or allergic
- Dermatitis
- Contact - Diaper Dermatitis
Atopic – eczema
Seborrheic – cradle cap
After treatment with steroid, good skin care
- Diaper candidiasis
Treatment - Lotrimin, nystatin cream – good hygiene
- Diaper candidiasis
- Diffuse erythema to diaper area, including in skin folds
- Erythema Infectiosum (Fifth Disease)
Causative agent: - Parvovirus 19
- Erythema Infectiosum (Fifth Disease)
Complications - Caution for pregnant mom – risk for intrauterine infection (may cause fetal death during first trimester)
- Erythema Infectiosum (Fifth Disease)
Incubation: - 4-21 days
- Erythema Infectiosum (Fifth Disease)
Infectious period - unknown (may extend from febrile stage to time rash first appears
- Erythema Infectiosum (Fifth Disease)
S/S - May first have nonspecific symptoms of headache, runny nose, malaise, fever
Fiery red, edematous rash on cheeks (appearance that child has been slapped)
1-4 days after facial rash, lacy red rash appears on trunk and extremities (the rash fades and reappears) may last 2-29 days aggravated by exercise, warm bath, rubbing of skin and stress
- Erythema Infectiosum (Fifth Disease)
Transmission: - airborne, blood, and transplacental
- Exanthem Subitum (Roseola)
Causative agent: - Human herpevirus 6 (HHV-6)
- Exanthem Subitum (Roseola)
Infections period: - unknown thought to extend from febrile stage to time rash 1st appears
- Exanthem Subitum (Roseola)
S/S - Sudden high fever, malaise, irritability, headache, vomiting, diarrhea
In 3-5 days fever subsides and within hours or days a rash appears (classic) on neck/trunk and persists for 24-48 hrs. then fades
- Exanthem Subitum (Roseola)
Treatment: - No treatment as its viral, symptomatic treatment
- Fungal
Candidiasis
Thrush
Treatment - nystatin oral suspension also boil pacifiers, nipples and breastfeeding mothers may also need to be treated
- Fungal
Candidiasis
Thrush - White plaques on tongue, gums and buccal mucosa
- Impetigo (bacterial)
Causative agent: - aures and/or group A strep
- Impetigo (bacterial)
S/S - Serous filled lesions that become pustular, later rupture leaving shiny, honey-crusted lesions with a scaly boarder. The lesion erodes and bleeds easily. Mildly puritic.
- Impetigo (bacterial)
Transmission: - Extremely contagious and spreads easily to other parts of the body and to other people
- Impetigo (bacterial)
Treatment - Topical (Bactroban, Neosporin) and oral antibiotics
Wash with warm soapy water TID
Good hand washing and careful hygiene
May return to school after 24 hours of antiobiotics
- Impetigo (bacterial)
- Most common bacterial skin infection inchildren, usually secondary from another skin lesion (insect bite, scratch)
- Otitis Media (general info)
- One of the most common childhood illnesses
Refers to infection or blockage of the middle ear
Generally described as Acute OM (sudden onset with short duration) or OM with effusion (presence of fluid – effusion – behind the tympanic membrane
Etiology: bacterial - Streptococcus pneumoniae, H-influenzae
Viruses (RSV and influenza) and allergies often predispose them to infection
Peak incidence 6-12 months (onset within first year increases risk of recurrent disease - Otitis Media (risks)
- Day care
Use of pacifier after 6 months
Environmental smoke exposure
Bottle-feeding (putting child to bed with bottle, also causes tooth decay
Allergies/URI’s - Otitis Media TX
- Antibiotics prescribed for children 6mos. or younger
Wait 72 hours for spontaneous resolution in otherwise healthy infant or child
6 mos.- 2 years antibiotics for those with severe symptoms (fever and severe ear pain
Antibiotics – Amoxcillin (Augmentin) 10-14 days
If recurrent placed on prophylactic antibiotic tx. up to 6 months
Tubes (myringotomy)
- Pediculosis (Lice)
S/S - Intense pruritus
Visible nits or lice (lice can live only 48 hours off human host and nits are capable of hatching for 10 days)
- Pediculosis (Lice)
Treatment: - Killing the active lice – OTC preparation (RID or NIX) – initial tx and repeat 1-2 weeks For resistant strain may use Elimite (left on overnight with a shower cap)
Removing nits – using find tooth nit comb
Preventing spread or recurrence – treat and /or wash all linens, has, combs and brushes
Cleaning of carpet, furniture
- Pediculosis (Lice)
- Infestation of small, blood-sucking insects. Live only on humans, transmitted by direct contact with infected persons or objects (brushes, hats)
Capitis – found on the scalp
Corporis – found on the body
Pubis – found in pubic hair (also called crab lice) seen in adolescents (maculae cerlae (blue spots) may be found on thighs and trunk in cases of heavy infestation. Dark brown spots on underwear and sheets are insect waste materials.
- Pharyngitis
- Inflammation of the pharynx and surrounding lymphoid tissue
Viral or bacterial (Group A beta hemolytic streptococci (GABHS)–serious complications including rheumatic fever and glomerular nephritis) - S/S
Acute OM - Bulging, opaque, red, non-mobile TM
Drainage (usually yellowish green, purulent, and foul smelling, indicates perforation of TM)
Fever, irritability, fussy, rub or hold affected ear, rolls head side to side, loss of appetite
OM with effusion
- S/S
OM with effusion - Dull gray or yellow; retracted TM with decreased mobility; air bubbles may be visible through tympanic membrane
Tinnitus – popping sounds
Hearing loss, difficulty communicating - Scabies
S/S - Intense puritus – worse at night, visible burrows, papules, vesicles, nodules more common on the wrist, finger webs, elbows, umbilicus, axillae, groin, and buttocks
May develop secondary infection
- Scabies
Tx - Topical Elimite or Kwell (because risk of neurotoxicity do not use Kwell with children
- Scabies
- Scabies or “itch mite” highly contagious
Transmitted by close personal contact with infected persons (scabies mite cannot survive more that 3 days away from human skin)
Major complication is impetigo from continued scratching
- Scarlet Fever (Scarlatina)
Causative agent: - Toxin from Group A strep infection
- Scarlet Fever (Scarlatina)
Complications - due to extension of strep infection (rheumatic fever and glomerluar nephritis)
- Scarlet Fever (Scarlatina)
Infectious period: - acute state until 36 hours after antibiotics
- Scarlet Fever (Scarlatina)
S/S - Onset: abrupt fever, vomiting headache, abdominal pain, pharyngitis, and chills
Within 5-6 days fever subsides and fine, red rash appears in axilla, groin, and neck
Desquamation by end of the first week (starts on face and moves down trunk)
White strawberry tongue (initially presents with white furry coat with red projecting papillae) by 4th day, white sloughs off leaving red swollen tongue (strawberry tongue)
- Scarlet Fever (Scarlatina)
Transmission: - airborne or direct contact
- Scarlet Fever (Scarlatina)
TX - Pencillin (erythromycin if allergic to pen) to treat the strep
- Tinea (Ringworm)
(Fungal) - Skin infection caused by a group of fungi called dermatophytes
Transmitted by person to person, by animals, or objects (combs, hats, shoes, etc.)
- Tinea (Ringworm)
Treatment - Capitis – Oral griseofulvin for 6-8 weeks and selenium sulfide shampoo (Selsum Blue) Ketoconazole or Lamisil alterative choice for those who do not tolerate Griseofulvin
Corporis – antifungal creams such a Lotrimin or Monostat (Miconazole) TI D x 1 week or until lesion improves
Cruis – antifungal creams Lotrimin or Lamisil BID – loose clothing
Pedis – antifungal crams BID until lesions improve – Lotrimin, Miconazole (Monostat or Micatin If no response or resistant – oral Griseofulvin x 1 month
- Tinea (Ringworm)
- Erythema, round lesion, may look scaly, raised boarder, may or may not be pruritic
Capitis – lesion on the scalp
Corporis – lesion on the face, trunk, extremities
Cruris – lesion involving groin region “jock itch” causes intense inflammatory reaction
Pedis – lesion involving the feet “athelete’s feet (may become chronic)
Unguium – infection involving nails or nail beds
- Tonsilitis Dx evaluation
- Throat culture (takes 1-2 days for results)
Rapid Strep test(20% incidence of false negative)
- Tonsilitis Tx
- Antibiotics if bacterial, may return to school after 24 hrs. of antibiotics
Tonsillectomy - Tonsillitis (general info)
- Inflammation and infection of the two palatine tonsils
May be viral or bacterial
Rare before 3
- Tonsillitis S/S
- Similar to pharyngitis
Tonsils may appear bright red or cover with white exduate or cryptic plugs
Difficulty swallowing
Mouth breathing and mouth odor - Treatment
- Symptomatic and supportive
Contact isolation in hospital setting
Antiviral med (acyclovir) for immunocompromised child who presents with varicella or zoster infections
Varicella zoster immune globulin (VZIG) for children at high risk administered within 96 hrs of exposure
- Varicella (Chicken pox)
Complications - Secondary bacterial infection of lesions – staph & group A strep from scratching can result in impetigo
CNS complications –encephalitis, convulsions, coma
Reye’s syndrome
Corneal involvement if lesions involved in the eye
- Varicella (Chicken pox)
Incubation period: - 10-21 days
- Varicella (Chicken pox)
Infectious period - 1-2 days before onset of rash until all lesions are dried (5-7) days
- Varicella (Chicken pox)
S/S - Fever, malaise, anorexic 24-48 hours prior to rash
Macular rash – usually starts on trunk, scalp and then extremities (develops in crops over 3-4 days, goes from rash, to teardrop vesicles, pustular then dry and develop crust
Zoster (shingles) - found in primary infection of varicella where the varicella-zoster virus enters the sensory nerve and dorsal root ganglia and establishes an infection. Presents with pain and tenderness along involved nerve and surrounding skin for 2 weeks prior to rash - Varicella (Chicken pox)
Transmission: - primary secretions of respiratory tract or skins lesions
- Varicella (Chicken pox)
Treatment - Symptomatic and supportive
Contact isolation in hospital setting
Antiviral med (acyclovir) for immunocompromised child who presents with varicella or zoster infections
Varicella zoster immune globulin (VZIG) for children at high risk administered within 96 hrs of exposure
- Viral Pharyngitis
- Gradual onset
Sore throat – reaches peak on the 2nd or 3rd day)
Erythema and inflammation of pharynx and tonsils
Fever (usually low grade)
Hoarseness, cough, rhinitis, conjunctivitis, malaise, anorexia (early)
Cervical lymph nodes enlarged and tender
Usually lasts 3-4 days
