Common paediatric skin disease

Transcription

1 Common paediatric skin disease Emma King Nurse Practitioner Dermatology Department and Private Suites The Royal Children s Hospital Melbourne, Australia

2 Diagnosis?

3 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.

4 Diagnosis?

5 Pityriasis Rosea Absent or minimal prodrome 'Herald patch' in 80% usually near proximal joint larger than other patches Eruption occurs hours to days later 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

6 Diagnosis?

7 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

8 Treatment 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

9 Diagnosis?

10 Scabies 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

11 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

12 Diagnosis?

13 Irritant Napkin dermatitis The skin barrier function is impaired > increased irritation by urine, faeces, Candida albicans, bacterial overgrowth, soaps and nappy wipes Settle inflammation Treat any secondary infection; Hydrozole cream bd Use disposal nappies 10%Olive oil in zinc paste/bepanthan ointment Frequent nappy changes Nappy free time when possible Wash with diluted bath oil/olive oil using cotton balls or Rediwipe towels Dab gently rather than wipe vigorously Bath oil and no other irritants in bath No antiseptics/cleansers/napkin wipes etc

14 Diagnosis?

15 Molluscum Contagiosum Caused by a harmless virus (MCV) Poxvirus 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

16 Treatment Self limiting, but may take up to 2 years Complicated by atopic eczema Treatment involves irritating the lesions Burow s solution diluted 1:10, Benzac gel, occlusive tape, Aldara, Cantharone Squeeze, curette, cryotherapy -? scaring Shower rather than bath Infection control measures Atrophic scarring with or without treatment

17 Diagnosis?

18 Treatment Capitis Oral griseofulvin or Lamisil (give with fatty food) Identify sources if possible No sharing of hair combs/brushes or head wear Hair growth is slow Antifungal shampoo reducing shedding of spores Corporis Topical antifungals ketoconazole, miconazole Pedis Oral griseofulvin or Lamisil

19 Diagnosis?

20 Eczema (atopic and discoid) The most common skin disease, especially in early childhood (30%) Onset is most common in the 1 st year of life. The hall marks are chronic, pruritic and relapsing skin dryness, inflammation and erythema Improves with time most children grow out of it It can be linked with asthma and allergic rhinitis An associated immune response to environmental and food allergens and irritants If not managed effectively secondary bacterial skin infections are common. It can affect any part of the skin however it is most common on the face and flexures.

21 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

22 Assessment Look for 1. Extent % 2. Infection /3 3. Broken skin /3 4. Erythema /3 5. Lichenification /3 6. Xerosis /3 7. Sleep pattern /10 8. Itch /10 (SCORAD )

23 Principles of management Manipulation of environment Education on removal of heat, dryness, prickle, allergies Adequate skin care Regular application/use of emollients; even on clear skin Aggressive use of adequate topical steroids Trial hydrocortisone for mild eczema and face otherwise need a prescription for elocon or advantan Wet dressings/clothes within hours if the eczema is not controlled with emollients and steroids Adequate treatment of skin infections Removal of crusts ASAP, by bathing and wiping away Oral antibiotics if needed Bathing with bleach and salt Adequate education, demonstration and support If not responding to these measures consider other options Referral to GP or Hospital

24 Infected eczema 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

25 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

26 Food intolerance Reaction to food through non-allergic means Perioral eczema 18/12 to 5yo May have hand involvement May have napkin dermatitis Consider acidic and junk foods Consider using SLS free toothpaste

27 Topical Treatments 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 Use wet dressings within 48 hours if the eczema has NOT improved with the above. Tar for lichenified or discoid eczema (not to face or groin). e.g. Hamiltons eczema cream.

28 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 degrees

29 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

30 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

31 Treatment for mild facial eczema Hydrocortisone bd prn QV cream/cetaphil/avene/kenkay, Sorbolene bd-tds

32 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.

33 Thank you Dermatology nurses; Emma King, Liz Leins, Robyn Kennedy, Danielle Paea, Leigh Fitzsimons, Claire Borlase, Lauren Weston ; Phone; Web; RCH Private Suites; Outpatient clinics; Mon am, Wed pm, Thurs pm Eczema Workshops; Tues and Wed am phone; Eczema Community clinics; Monday; Collingwood, Thursday; Broadmeadows