SKIN

CONDITIONS

SCABIES

Scabies:
An ITCHY skin condition (Often severe itching which is
worse at night)
Caused by a burrowing mite called Sarcoptes scabiei
Visible thin irregular, burrow tracks made up of tiny
blisters or bumps on the skin in the folds
- In young children, most often seen on soles of feet,
palms of hand, scalp, face and neck
Highly contagious

Treatment of scabies:
Should consider whole families and contact groups
Easily treated with topical creams
Complications can result when vigorous itching breaks
the skin and a secondary bacterial infection occurs
(such as Impetigo). In vulnerable patients (HIV, immune
insufficient) crusted scabies can occur and this is hard
to treat

Infection control
Contact precautions required
Incubation is 4-6weeks
Patient is contagious until 24hours after starting
effective treatment
Skin is infective
Rash may persist for weeks even after treatment
PREVENTION
Clean all clothes and linen using hot soapy water
Starve the mites out of items you can't wash

IMPETIGO

Impetigo:
Infection caused by Stphylococcus or Streptococcus
bacteria
Infects the superficial layers of the skin
Acute
The term Impetiginisation is used for superficial
secondary infection of a wound of other skin condition
Mainly affects exposed areas
Presents with single or multiple irregular crops of
irritable superficial plaques- these extend into lesions as
they heal

Types
Nonbullous impetigo- Starts as a pink macule that
evolves into a vesicle or pustule and then into crusted
erosions. Usually resolves within 2-4weeks
Ecthyma- starts as nonbullous impetigo but develops
into a punched out necrotic ulcer. Leaves a scar
Bullous impetigo- presents with small vesicles that
evolve into flaccid transparent bullae (serous fluid
containing blister). Heals without scarring

Treatment
Cleanse the wound
Use moist soaks to gently remove crusts
Apply antiseptic and antibiotic ointment
Cover the affected areas
Oral antibiotics for extensive impetigo
Complications: The bacteria can become invasive and
cause cellulitis, Steph scalded skin syndrome or toxic
shock syndrome (rare), rheumatic fever

Isolation precautions
Contact precautions required
Contagious when lesions appear and until crusted and
healed or 48 hours after commencing antibiotic
treatment
Skin lesions are the infective material
PREVENTION
Avoid use of shared towels, flannels, sheets or clothes as
these are highly contagious
Child must stay away from school until crusts have dried
out

BOILS

Boils
A tender red lump on the skin caused by an infection of
the hair root or sweat pore (Usually staphylococcus
aureus)
Increasing size and pain of lump
Develop a white or yellow centre in the lump, filled with
pus
A large boil may be called an abscess if it becomes
deeper

Treatment
Warm compress to help the boil open up and drain a few
times a day
If boil opens, use antiseptic solution to wipe it away and
cover area with a dressing which stops it from spreading
and stops the child scratching it
Antibiotics if boil becomes infected or if not resolved
within a week
Incision and drainage may be required
Prevent by bathing child after perspiration and wear
loose fitting clothes

ECZEMA

Eczema
A chronic inflammatory skin condition
Also called atopic dermatitis.
Dry, itchy skin and rashes
Eczema is not contagious.
The cause is not known. It is likely caused by both genetic and
environmental factors (family history, asthma, food allergies,
allergic rhinitis).
Eczema may get better or worse over time, developing in
infancy but it is often a long-lasting disease. People who have
it may also develop hay fever and asthma.
Involves periods of remissions and exacerbations

Classification
Infantile
Generalised, cheeks, scalp, trunk- red, weepy, oozy, crust
Childhood
Antecubital fossa popliteal fossae, neck, wrists, ankles,
feet- clusters,of small erythematous papules, dry.
Preadolescent and adolescent
Face, hands, feet- thick lesions,

Treatment
Application of moisturisers after bathing (immediately to lock in
moisture)
Stop itching plain, tepid bath
Use mild soap or non-soap cleansers
Gently pat skin dry- don't rub
Control eczema triggers and avoid them
Keep fingernails short to prevent secondary infection
Wearing cotton, soft fabrics
Avoid tight and rough clothing
Topical corticosteroids

CELLULITIS

Cellulitis
Inflammation of the cellular and other tissues
underneath the skin (dermis and subcutaneous)
May complicate any infection of the skin- often
associated with cracks in the skin, cuts, bites, blisters
where bacteria can enter skin
Infection spreads along the divisions between the
organs under the skin
Bacterial infection (streptococcal or staphylococcal
organisms)
Most common in younger children
Untreated or severe can result in abscesses, gangrene!

Signs and symptoms and treatment

Pain in the area
Swelling
Redness
Malaise
Fever
Tachycardia
Treat with antibiotics.
Elevation
Observe carefully

HERPES ZOSTER
(Shingles)

Herpes Zoster
Condition caused by the reactivation of the chicken
pox virus (herpes varicella zoster) in someone who had
chicken pox before.
Some of the viruses have stayed alive in the nerve cells
for several years
Usually for no known reason, but may be due to
immunosupression
Acute viral infection of structures along the pathway of
peripheral nerves.

Signs and symptoms

A rash like chicken
pox appears
In an area
supplied by one
nerve
Usually only on
one side of the
body
Stops exactly at
midline
Severe pain before

Treatment
Analgesia (very painful!)
Acyclovir
Antipruritic drugs
Anti inflammatory drugs
Keep area clean with normal saline
Exclude from day care and school until crusted as very
contagious
Child should wear gloves/ cut nails to prevent scratching

HERPES SIMPLEX
Type 1 and Type 2

Herpes simplex
Viral disease
HSV-1 oral type of herpes, HSV-2 anal genital area
After initial infection, HSV stays in the nerve cells,
dormant but alive
Fever, stress, sunlight, mensturation, immunosupression
can reactivation the virus

Signs and symptoms

Type 1- occurs on lips or nose during fevers (above
waist)
Burning, itching, tingling before lesions appear in clusters
of fluid filled vesicles that ulcerate dry and crust within 12 weeks
Type 2- genital herpes (below the waist)
Pain and tenderness, vesicles erupt, rupture then
ulcerate within 1-7days
If child HIV positive, may occur in other places, spread
further and last longer due to immunosupression

Treatment
No cure
Topical therapies may shorten duration of cold sores
Oral antiviral to reduce severity of reinfection
Reduce pain
Encourage fluid (swallowing may be painful so watch
hydration)
Use hot soapy water to wash utensils, toys, towels etc
Don't share items