Chapter 22: Dermatological Diseases in Children

Welcome to Last Minute Lecture!

This free chapter overview is designed to help students review and understand key concepts.

These summaries supplement not replaced the original textbook and may not be redistributed or resold.

For complete coverage, always consult the official text.

Hello everyone and welcome back to the Deep Dive.

Hey everyone.

We are doing something a little specialized today.

It's something we like to call our Last Minute Lecture Series.

Right.

So if you are a nursing student and you're currently cramming for an exam or you know maybe you're a clinician just looking to brush up on your pediatric specifics, you have definitely come to the right place.

Absolutely.

Today our mission is crystal clear.

We are tackling Chapter 22 from the Davis Advantage for Pediatric Nursing.

That's right.

We are diving deep into dermatological diseases.

Skin.

I mean it sounds simple.

It really does.

It's right there on the surface.

Yeah.

You can see it without an x -ray.

No blood test needed.

But when you actually dig into the textbook specifically regarding pediatrics, it is a massive complex topic.

Oh, totally.

It's not just about rashes.

It's about systemic health.

Right.

Yeah.

I mean it is the largest organ of the body after all.

It handles temperature, protection, sensation.

And in pediatrics, the skin tells us a story about the immune system, hydration status, and even their nutritional health.

It is literally the barrier between the child and the world.

Exactly.

And for this deep dive, we are treating this material like a high -yield review.

A survival guide basically.

Yes.

A survival guide for your exams and more importantly for your clinical practice.

We're going to cover everything from the basic anatomy like why a baby skin isn't just a small adult skin to the really gnarly stuff.

Infections, infestations.

Yeah.

And significant trauma.

It is a really comprehensive roadmap today.

We'll start with anatomy, assessment, and the unique risks of the hospitalized child.

Right.

Then we'll move into those acquired disorders, you know, diaper rash and eczema.

We'll handle the infections, bacterial, viral, and fungal.

We'll look at the things that crawl like licensed scabies.

Always fun.

Always.

And we will finish up with injuries, animal bites, and burns.

So settle in.

We have a lot of ground to cover.

Let's just start at the very beginning.

Anatomy and physiology.

Okay.

Give us the baseline here.

Why can't we just treat a newborn skin like we treat in adults?

So the source material makes a really critical distinction right away and it frames everything else we will talk about.

Newborn and infant skin is significantly thinner and weaker than adult skin.

Thinner and weaker.

Yeah.

Specifically, the stratum corneum, that tough outer layer of the skin is barely developed in a newborn.

Okay.

Let's unpack that.

What does that mean practically for a nurse at the bedside?

It has huge implications.

First, because the skin is thinner,

the connection between the epidermis and the dermis isn't as tight.

The two main layers.

Right.

So this puts infants at a much greater risk for skin tears and blistering from friction, things that wouldn't even bother an adult.

Wow.

But more importantly, it means the skin is not as effective of a barrier against bacteria.

So the infection risk is higher right out of the gate.

Significantly higher.

But it also puts them at risk for fluid loss.

Yeah.

Adult skin is great at keeping water inside the body.

Infant skin.

It's much more permeable.

Water basically evaporates right through it.

Oh, wow.

We call this transepidermal water loss.

So a baby with a skin issue or honestly, even a healthy baby in a very dry environment can become dehydrated surprisingly fast.

Right.

Because the skin is supposed to hold the water in.

Exactly.

And there was another factor with thin skin that the text emphasizes.

Absorption.

Yes.

This is the safety alert that every single student needs to memorize.

Okay.

Pay attention to this one.

Whatever you put on a baby's skin absorbs much faster and much deeper than it would on an adult.

Because it's so thin?

Because it's thin and it has a higher water content.

So topical medications can become systemic medications very, very quickly.

That is a scary thought.

Yeah.

Means if I like apply a high potency steroid cream to a baby's diaper rash.

I might actually be dosing their entire bloodstream with steroids.

Exactly.

You aren't just treating the skin at that point.

You could be affecting their adrenal glands.

So we have to be incredibly judicious with what we apply and how much we apply.

So as the child ages, I assume this changes.

It does.

The skin toughens up.

Those layers bind tighter together and the overall texture thickens.

And then as they hit adolescence, the sweat and sebaceous glands, the oil glands become much more active.

Which perfectly foreshadows our discussion on acne later, I'm sure.

Precisely.

The anatomy dictates the disease process.

You don't see acne in toddlers because those glands are totally dormant.

That makes total sense.

Yeah.

Okay.

So that's the structure.

Now let's talk assessment.

If I'm a nurse and I'm walking into a room to see a child with a quote rash,

what am I asking?

What am I looking for?

History is key here.

You aren't just looking at a rash.

You're investigating it.

You need to ask the parents about the onset.

When exactly did it start?

Is there pruritus?

Pruritus, that's the medical term for itching, right?

Correct.

Does it itch?

Is the kid scratching?

Is it keeping them awake at night?

You also need to ask about allergies, recent immunizations, and medication use.

Why medications?

Because a rash could easily be a reaction to a new antibiotic they started, say, three days ago.

Ah, gotcha.

And when we actually look at the skin, inspection must be really systematic.

You look at the distribution first is the rash on the flexural surfaces.

Those are the creases, right?

Like the inside of the elbows behind the knees, the neck folds.

Yes.

The warm moist areas versus the extensor surfaces, which are the outer parts, outer elbows and knees.

Exactly.

That location tells you a massive amount about what the disease might be.

For example, psoriasis really likes the extensors while childhood eczema loves the flexors.

Oh, that's a great tip.

You also look at the pattern.

Is it clustered together?

Is it linear, like in a straight line?

Linear usually suggests an external cause, doesn't it?

Like a scratch or brushing against a plant or something.

Exactly right.

Or is it dermatomal, meaning it's following a specific nerve path?

Which would suggest something like shingles.

And then we have to differentiate the types of lesions.

The text mentions primary versus secondary lesions.

This seems like a distinction that really trips nursing students up.

It definitely does.

So primary lesions are the ones that arise from the skin itself as part of the initial disease process.

Okay.

These are your macules, which are flat spots,

papules, which are bumps,

and vesicles, which are your fluid -filled blisters.

And the secondary ones.

Secondary lesions happen later.

They essentially grow out of the primary lesion often because the has been scratching or picking at it.

These are your crusts, scars, ulcers, or excoriations.

So if I only look at the crusts, I might totally miss the original cause.

Yeah.

I really need to find a fresh lesion to see what the primary issue actually is.

Ideally, yes.

That gives you the best diagnostic clue.

Okay.

I want to pause on one specific assessment, finding that the text flags as an ominous sign.

And we know the word ominous is never good in medicine.

No, it is not.

Whenever a textbook says ominous, pay attention, we are talking about purpura.

Pupura.

Break that down for us.

What exactly are we looking at?

Visually, these are purple or blue lesions on the skin.

But the key test, the thing the nurse absolutely must do physically is check for blanching.

Meaning when you press down on them, do they turn white?

Correct.

Normal redness like a sunburn or just a standard viral rash creates erythema that blanches.

You press it, the blood moves away, so it turns pale.

You let go, it turns red again.

Right.

Pupura does not blanch.

You press down on it, and it just stays purple.

Why is that?

Because the blood isn't actually inside the vessel anymore.

It has leaked out into the surrounding tissue.

It suggests bleeding under the skin.

Oh, wow.

Yeah.

And in children, this can be associated with critical life -threatening conditions like bacterial meningitis,

specifically meningocatemia.

Or it could be thrombocytopenia, which is a low platelet count.

So if a nurse sees Pupura, this isn't a let's monitor and document type of situation.

Absolutely not.

The text is explicit here.

Notify the provider immediately.

It is a medical emergency until proven otherwise.

Got it.

Okay.

Moving to a very important aspect of assessment, cultural competence.

The textbook has a specific safe and effective nursing care box about assessing dark skin.

Yes.

This is crucial because standard textbook descriptions often rely on how things look on white skin.

This is vital for patient safety.

Signs like pallor paleness or cyanosis turning blue or even jaundice turning yellow can be completely missed if you rely on skin tone alone in patients with darker complexions.

If you are looking for blueness on the cheek of a black child to check for oxygen deprivation, you might not see it until this situation is catastrophic.

So where should we be looking?

Where are the reliable spots?

You need to look at the mucous membranes.

Look at the palpebral conjunctivae.

That's the pink part inside the lower eyelids.

Yes.

Gently pull down the lower lid.

Also check the oral mucosa, the lining of the inside of the mouth and the sclera, the white part of the eyes.

That is where you will see those color changes reliably, regardless of the patient's natural skin pigmentation.

That is such a crucial takeaway for practice.

Okay.

Let's shift gears slightly to the hospitalized child.

We usually think of kids as running around, but when they are bed in a hospital, skin integrity becomes a huge issue.

It really does.

The text highlights a critical component regarding pressure injuries.

And surprisingly in pediatrics, it's not just the mattress causing the problem.

Medical equipment is a major culprit here.

Really?

Like what kind of equipment?

Anything that touches the patient.

Avi boards, oxygen tubing,

pulse oximeter probes,

feeding tubes.

Oh, wow.

Yeah.

If a pulse ox probe is left on a toe too long or if it's taped too tightly, it can break down that fragile skin we talked about earlier.

So the very device we use to monitor their safety is actually hurting them.

If we aren't careful, yes.

What's the intervention then?

Vigilance and rotation.

You need to rotate that pulse ox probe every two to six hours, switch feet, switch toes.

Okay.

And be very careful with tape.

Removing tape aggressively can strip the epithelium, that top layer of skin right off a neonate.

Ouch.

And for positioning in the bed.

Turn the patient every two hours, just like you would with adults.

But here is a specific pediatric detail.

Elevate the head of the bed no more than 30 degrees, if possible.

Why 30 degrees?

Or do sheer.

Sheer being that force when the skin stays put on the sheets, but the heavy skeleton slides down due to gravity.

Exactly.

That tearing force destroys the blood vessels deep in the tissue.

Now, to assess this risk,

the text mentions a specific tool.

We all know the Brayden scale for adults, but for kids.

We use the Brayden Q scale.

This is validated specifically for children older than one year.

And how is it different from the adult version?

It looks at seven factors.

Mobility, activity, sensory perception, moisture, friction, and sheer, and nutrition.

Those are pretty standard.

Right.

But the seventh one is unique to the scale.

Tissue perfusion and oxygenation.

That last one, tissue perfusion, seems very physiological compared to the others.

It is.

Unlike the adult scale, the Brayden Q specifically asks you to look at the patient's oxygen saturation and their hemoglobin levels.

It acknowledges that if the blood isn't carrying enough oxygen, or if the heart isn't pumping well, the skin will literally starve and break down faster.

That's a really comprehensive way to look at it.

Okay.

Let's move into section two of our roadmap.

Acquired disorders, specifically dermatitis.

And let's start with the absolute bane of every parent's existence.

Diaper dermatitis.

Diaper rash.

It is usually caused by simple irritation.

Urine and feces have enzymes that chemically break down the skin.

Visually, what are we seeing when we assess this?

Classic diapodermatitis is erythema redness on the convex surfaces.

Convex meaning the hills of the bum, right?

The parts that are actually touching the diaper.

Right.

But you have to distinguish that from candidiasis, which is a yeast infection.

This is a super common board question and a vital distinction.

Okay.

How do we tell them apart?

Candida looks different.

The text describes it as beefy red.

It's a very intense red.

And the hallmark sign is satellite lesions.

Satellite lesions.

I love that term because it paints a perfect picture.

It really does.

Imagine the main red rash and then little red dots spreading out away from it, just like satellites orbiting a planet.

Okay.

Also, Candida loves the skin folds.

Regular diaper rash usually spares the folds because the diaper doesn't rub deep in there.

But Candida dives right into those warm, dark crevices.

That's a great visual distinction.

So how do we treat these?

For regular diaper rash, barrier creams.

Zinc oxide is the absolute gold standard here.

It's that thick white paste.

And there is a specific nursing tip here about cleaning, isn't there?

Yes.

This is a really common mistake parents and even some nurses make.

You do not need to scrub the zinc oxide off down to the skin with every single diaper change.

Why not?

Because if you scrub it, you damage the healing skin underneath.

Just remove the soiled layer of the poop and apply more cream right on top of the old cream.

Icing the cake, essentially.

Essentially, yes.

Just ice the cake and avoid baby powder or cornstarch.

Wait, why?

I thought powder was specifically to keep things dry.

The powder is actually an inhalation risk for the baby's tiny lungs.

They can breathe it in and cornstarch can actually clump up and cause a Candida infection.

Oh, I hadn't thought of that.

Instead, the recommendation is air time.

Let the baby go diaper free for 15 minutes, four times a day.

A brave strategy for the parents, but very good for the skin.

What about the scalp?

Cradle cap?

That is seborrheic dermatitis.

It looks scaly, greasy, and crusty on the baby's head.

It looks incredibly uncomfortable to us.

But the key difference between this and eczema is that seborrheic dermatitis is usually non -poritic.

Meaning it doesn't itch.

Exactly.

It doesn't itch.

So the baby isn't miserable.

They just look a bit crusty.

How do we get rid of it?

Daily mild shampoo.

And for the stubborn crusts, you apply warm olive oil or baby oil to the scalp, wait about 15 minutes to soften them up, and then gently brush them away.

Gentle being the key word.

Okay.

Moving on to contact dermatitis.

This is your reaction to external irritants.

Right.

Nickel, certain soaps, and of course, plants.

Poison ivy, poison oak, and poison sumac.

Okay.

I feel like there are a lot of myths about poison ivy.

Let's bust one right now.

The blisters.

Oh, yes.

The blisters from poison ivy contain fluid,

but, and this is a huge, but that fluid is not contagious.

Wait, really?

If the blister pops, it doesn't spread the rash.

It does not.

The reaction is caused purely by the plant oil, which is called urushiol.

Once that oil is washed off the skin, the rash cannot spread to someone else, and the fluid inside the blisters is just the body's natural inflammatory reaction.

It's not the oil itself.

So why does it always seem to spread?

Why does it show up on the arm one day and then the leg the very next day?

Usually because the oil is still lingering on clothes or on a pet's fur or trapped under the child's fingernails, or because different parts of the skin react at different speeds.

The thin skin on the wrist might react in 12 hours, but the thicker skin on the leg might take three full days to show the rash.

That makes total sense.

So immediate care is washing.

You have about 15 minutes.

Wash with soap and water to get that oil off.

If you get it off in time, you might prevent the rash entirely.

Good to know.

And a quick note on latex allergies here too, right?

Yes.

If the child has a latex allergy, which is a form of contact dermatitis, make sure you are using vinyl or nitrile gloves, never latex.

Okay.

Let's go deeper into the itchy stuff.

Section three,

atopic dermatitis, commonly known as eczema.

This is a major, major topic in pediatrics.

It's chronic, it's relaxing, and it is intensely pruritic.

It itches wildly.

In fact, we often call it the itch that rashes because it's the scratching that causes the visible skin damage.

And it's connected to other conditions, isn't it?

Yes.

The atopic triad.

If a child has eczema, there's a very strong chance they or their family members also have asthma and allergies.

It's all part of the same hyperreactive immune system profile.

Now the location of the eczema actually changes as the kid grows up.

I found this part fascinating.

It is very distinct.

In infants, you see it on the extensor surfaces, the outer arms and legs, the face, and the scalp.

Basically, the parts of their body they rub against the crib bedding.

But as they become children and start walking, it moves to the flexural surfaces, the inner elbows, behind the knees, the neck.

Okay.

So how do we manage it?

The text has a specific phrase.

Soak and seal.

This is the cornerstone of eczema care.

Eczema's skin loses water very easily.

Hydration is everything.

So you bathe the child in warm water.

Not hot, because hot water strips oils and dries them out further.

Okay, warm water.

And then immediately, while the skin is still damp, you apply a thick moisturizer.

You seal the water in.

Exactly.

But you have to do it within three minutes of getting out of the bath.

Three minutes.

That's fast.

It has to be fast.

If you wait until they are totally dry, the moisturizer just sits on top of dry skin.

You need to trap that bath moisture inside the skin.

What about medications for bad flare ups?

Topical steroids are common for flares to reduce the inflammation, but you must use a very thin layer and be exceptionally careful using them on the face or the diaper area.

Because of the absorption risk we talked about.

Yes.

And because those can literally thin the skin over time, causing atrophy.

And for older kids,

are there other options?

There are immunomodulators like Tacrolimus for children over two years old, but there is a massive safety alert here.

What is it?

Never use occlusive dressings like plastic wrap or tight, non -breathable bandages over these immunomodulators.

It increases the absorption way too much and can become systemically toxic.

Wow.

Okay, definitely noted.

Also, there is some evidence -based practice in this chapter regarding diet and eczema, specifically regarding peanuts.

Yes, the LEP study.

For a very long time, parents were told to completely avoid peanuts in infants to prevent allergies.

Right.

That was the standard advice.

But the evidence now suggests the exact opposite.

Early introduction of peanut products, usually between 4 to 11 months of age and high risk infants, can actually reduce the risk of developing a peanut allergy later.

That is a fact.

Exposing the immune system early helps it learn to tolerate the protein rather than attack it.

Science evolves.

Yeah.

All right.

Let's move to the teenage years, section four, acne and melanoma.

Acne.

It's almost a rite of passage, unfortunately.

The pathophysiology involves P.

acnes bacteria, excess oil production from those newly active sebaceous glands, and plugged follicles, which we call comedones.

And we have open and closed comedones?

Right.

Open comedones are blackheads.

And a fun fact, the black color isn't dirt.

It's oxidized melanin.

Oh, I didn't know that.

Yeah.

Closed comedones are whiteheads.

And for treatment, we have a few heavy hitters mentioned in the text.

Let's start with benzoyl peroxide.

Very effective.

But here is a practical nursing tip.

It bleaches linens.

Oh, no.

Yeah.

Tell the teen to use white towels or old pillow cases because their parents will not be happy when all the nice bathroom towels turn orange.

Very practical advice.

What about retinoids like tretinoin?

Those work really well by increasing cell turnover, but they make the skin incredibly sun sensitive.

The patient absolutely must wear daily sunscreen.

What about antibiotics?

Sometimes oral antibiotics are needed like doxycycline or minocycline for severe inflammatory acne.

And let's bust another myth.

Does eating greasy pizza or chocolate cause acne?

The text is clear here.

Dietary changes are not proven to affect acne.

It's mostly driven by hormones and bacteria.

Speaking of hormones, for females, is there another option?

Yes.

Evidence -based practice shows that oral contraceptives, specifically those with estrogen and progestin, can significantly reduce acne lesions in females by regulating those hormone swings.

Great.

Now, a very serious topic within this section, melanoma.

We typically think of skin cancer as an old person disease.

We do, but it can absolutely occur in children, and it presents differently.

How so?

Well, we all learn the ABCDE rule for adults.

Asymmetry, border irregularity, color changes, diameter evolving.

Right.

But in kids, melanoma might not look like a dark irregular mole.

It might just look pink or red or nodular.

It might look like a simple wart that just won't go away.

That makes it incredibly tricky to spot.

It does.

It requires a high index of suspicion from the provider.

And prevention is the absolute key here.

Severe blistering sunburns in childhood are directly linked to melanoma later in life.

So sunscreen is non -negotiable.

SPF 30 or higher.

Protective clothing.

And strictly avoiding tanning beds.

Absolutely.

Okay, section five, bacterial infections.

Let's talk about the crusty stuff.

Empedigo.

Empedigo is very common in toddlers and preschoolers.

The absolute hallmark sign you are looking for is honey -colored crusts.

Usually around the nose and mouth, right?

Exactly.

It sounds kind of delicious, but it looks terrible.

And it is highly contagious.

It's usually caused by staph or strep bacteria.

How long are they contagious?

They remain contagious until the child has been on antibiotics, usually a topical ointment like neupurosin or an oral antibiotic for a full 24 hours.

So no school or daycare until that 24 hour mark.

Correct.

What about home care for the parents?

Wash all linens and towels daily in hot water, and keep the child's fingernails cut short so they don't scratch and spread the infection to other parts of their own body or to other people.

Next up we have MRSA, methicillin -resistant Staphylococcus aureus.

This one often starts as a red bump that looks suspiciously like an insect bite.

Parents will very often come in and say, I think a spider bit him.

But it's not a spider.

Usually not.

If you don't have a confirmed spider sighting, it's very likely MRSA.

It rapidly progresses to a painful abscess or a boil.

How do we treat that?

Often it requires incision and drainage and IND.

You have to physically get the purulence out.

And antibiotics, I assume.

Yes.

Clindamycin is common, but here is a very specific warning to give parents.

It tastes foul.

Foul.

Terrible.

Getting a kid to voluntarily take liquid clindamycin is a massive battle.

You might need to tell parents to ask the pharmacy to flavor it or mix it with a strong flavored syrup or chocolate home just to mask the taste.

For severe cases, they might even need IV vancomycin.

Good tip on the flavoring.

M prevention for MRSA.

Do not share towels or razors.

Disinfect athletic equipment regularly.

MRSA absolutely loves wrestling mats in locker rooms.

And finally, in the bacterial section, cellulitis.

This is a deeper infection of the soft tissue.

You are looking for redness, warmth, swelling, and fever.

And specifically, you must assess for lymphangitis.

Which is what?

Red streaking.

If you see a distinct red line trekking up the arm or the leg, moving away from the wound and towards the heart, that is the infection traveling through the lymphatic system.

Oh, that sounds bad.

It's a huge red flag.

That's a sign to get medical help immediately, because the next stop for that bacteria is the bloodstream, which means sepsis.

Okay, let's switch gears from bacteria to section 6.

Viral and fungal infections.

First up, warts.

Caused by the human papillomavirus or HPV.

They are very common on hands, which is HPV2 or feet, which are plantar warts HPV1.

The main nursing intervention here is teaching patients.

Patients.

Yes, many warts will actually heal spontaneously on their own, but it takes two to three years.

Kids hate waiting that long.

They do.

But you must advise them not to pick at them, because picking spreads the virus to other fingers.

Makes sense.

And herpes simplex 1.

Cold sores.

You'll see vesicles on the lips or gums.

It is contagious.

It's often triggered by stress or another illness.

And this is the crucial part where we tell people do not kiss babies.

Especially if you have an active cold sore.

Correct.

Neonatal herpes is not just the cold sore.

It can be a fatal systemic infection for a newborn.

Wow.

Okay, now fungal infections.

The tinius.

Ringworm.

We have tinea corporis on the body.

That's the classic circular lesion with central clearing and a raised red border.

Okay.

Then tinea patis, which is athlete's foot.

Keep feet dry.

Air them out in sandals.

And tinea capitis, which is ringworm on the scalp, causing patches of hair loss.

The scalp one is tricky to treat, right?

Because creams don't penetrate the hair shaft very well.

Exactly.

For tinea capitis, you often need oral medication, specifically a drug called grizzofulvin.

And there's a very specific dietary instruction for this drug that I found fascinating in the text.

There is.

Grizzofulvin is best absorbed when taken with high -fat foods.

So the nurse should literally tell the parents to give the medication with a scoop of ice cream, whole milk, or a spoonful of peanut butter.

Doctor's orders.

Eat ice cream.

That's a prescription any kid will gladly follow.

Indeed.

But you do have to monitor their liver and renal function if they're on it for a long duration as it can be tough on the organs.

Right.

And how do we actually diagnose a fungal infection?

Usually a KOH prep where they scrape the skin and look under a microscope for hyphae.

Or they use a wood's lamp.

What's that?

It's a UV light.

Some fungi actually fluoresce bright green under a wood's lamp.

Like a glowing crime scene?

Basically.

Okay.

Section seven.

This is the one that makes my head itch just talking about it.

Insects and infestations.

Let's start with lice.

Peticulosis capitis.

How do we tell the difference between lice, eggs, the nits, and just plain old dandruff?

You do the flick test.

The flick test.

Yes.

Dandruff is loose skin.

It flakes off easily when you flick the hair.

Nits are literally cemented to the hair shaft by the louse.

You have to physically use your fingernails to pull them all the way down the hair strand to get them off.

You'll usually find them near the ears and the nape of the neck where the scalp is warmest.

And the treatment.

A pediculocyte, like permethrin, often known over the counter as NICS.

But check the child's allergies first specifically.

A ragweed allergy can be a contraindication for NICS.

And what about the home environment?

You have to wash all bedding and recent clothing in hot water.

For things you can't wash,

like big stuffed animals or pillows,

bag them up tightly in plastic garbage bags for two full weeks.

The lice will starve without a human host.

Okay.

From lice to scabies.

Scabies are microscopic mites.

They literally burrow under the skin to lay their eggs.

You might actually see linear burrow lines.

They look like tiny grayish threads under the skin.

You'll also see papules.

And the itch.

Intense.

And classically, it is much worse at night.

The nocturnal pruritus is a major diagnostic clue.

Where do they usually hang out on the body?

In older kids, the webs of the fingers, the groin, and the waistline.

But in babies under two years old, the distribution is different.

You might see it on their head, palms, and soles of their feet.

How do we treat scabies?

Permethrin again, but a stronger 5 % cream.

And the application is different.

It goes neck to toe.

Cover every single inch of the body.

Wow.

And you leave it on for 8 to 14 hours, usually overnight, before washing it off.

And here is the critical nursing instruction.

You must treat all household contacts.

Everyone.

Everyone.

Even if Dad isn't itching yet, he gets the cream.

Otherwise, they just pass it back and Got it.

Now let's talk about ticks.

Lime disease.

Carried by the deer tick.

We look for the classic rash, erythema migrans, better known as the bullseye rash.

What's the treatment?

Antibiotics.

But it depends on age.

Doxycycline is the drug of choice for kids over 8 years old.

Amoxicillin is used for kids under 8.

Why the specific age cut off for doxycycline?

Because doxycycline can permanently stain the developing teeth of young children.

Right.

Good to remember.

And tick removal if a parent finds one.

Use fine tipped tweezers.

Grasp it close to the skin and pull straight up with steady pressure.

No twisting.

No twisting.

And definitely no burning it with a match or using Vaseline to try and smother it.

Those old wives' tales can actually agitate the tick and make it regurgitate bacteria into the wound.

Just pull it straight out.

Excellent advice.

Lastly, in this section, insect stings and anaphylaxis.

This is truly life -saving info.

If a child is stung and has an anaphylactic reaction trouble breathing, swelling of the lips or tongue, you use the EpiPen.

Remind us of the classic saying for administering it.

Blue to the sky, orange to the thigh.

Meaning the blue safety cap points up and the orange end goes into the outer thigh.

Do you just jab it and pull it out?

No.

You have to hold it in place, usually for 10 to 15 seconds for older pens or specific package instructions.

And then, crucially, seek medical help immediately.

Because the epinephrine wears off.

Exactly.

Epinephrine just buys you time.

It doesn't cure the reaction permanently.

It wears off and the severe reaction can come right back.

Section 8.

Disorders related to injury.

Let's talk about bites.

Animal bites, specifically.

We see a lot of these in the ER.

Cat bites versus dog bites.

Which is worse.

From an infection standpoint.

Cat bites.

Really, I would have guessed dogs because they're bigger.

The tissue damage from a dog is worse, yes.

Dogs cause crushing and tearing injuries.

But cats have thin needle -like teeth.

They create deep puncture wounds that quickly seal over at the top.

Trapping the bacteria inside.

Exactly.

They trap bacteria, specifically pastorella, deep inside the tissue.

They are very hard to clean and have a very high infection rate.

Dog bites look messier, but because they are open, they are actually easier to irrigate and clean out.

So how do we manage them medically?

Copious irrigation.

Wash it out thoroughly.

And here is a major rule.

Do not suture a puncture wound or any bite that is more than 8 hours old.

Because if you stitch it closed, you'd just be sewing the bacteria inside.

Exactly.

You leave it open to heal by secondary intention, meaning letting it fill in with new tissue from the bottom up so it can drain naturally.

And what about rabies?

If the animal's vaccination status is unknown, like a stray dog or a wild raccoon, you cannot take chances.

It requires the rabies vaccine series plus the rabies immunoglobulin.

Okay, finally, let's discuss the most traumatic skin injury.

Burns.

Section 9.

Burns are categorized by their cause.

Thermal burns, primarily scalds from hot water or spilled coffee, are the most common in children.

But electrical burns are incredibly deceptive.

The text called it the iceberg injury.

Right.

Because what you see on the surface is just the tip.

You might see a tiny burn on the child's finger where they touch the outlet, but the electricity traveled all the way through the body.

It damages nerves, blood vessels, and most importantly, the heart muscle.

So what's the intervention?

These kids require continuous cardiac monitoring for dysrhythmias for up to 72 hours.

Wow.

Now, for assessing the total burn area, we use the rule of nines.

But the textbook notes it's modified for pediatrics.

Yes.

The proportions are different.

Kids have giant heads relative to their bodies.

In a small child, the head accounts for 18 % of the total body surface area, whereas in an adult it's only 9%.

And the legs?

The legs are smaller in kids, at 13 .5 % each.

You have to use the specific pediatric chart to calculate this accurately because it dictates their fluid needs.

And how do we assess the depth of the burn?

Superficial burns involve only the epidermis.

They are red and painful, like a standard sunburn.

Partial thickness burns go deeper into the dermis.

You'll see blisters and weeping fluid.

And full thickness.

Full thickness destroys both layers.

The skin looks white, charred, or leathery.

And surprisingly, there is often no pain in that specific area because the nerve endings have been completely destroyed.

Emergency care for severe burns.

What is the absolute priority when they roll through the door?

Stop the burning process, obviously.

Get the hot or chemical soaked clothes off.

But medically, the priority is the airway.

What are the signs of an inhalation injury?

You assess for singed nasal hairs, soot around or inside the mouth, and hoarseness in their voice.

If you see those, the airway could swell shut very quickly.

Prophylactic intubation might be needed immediately.

And then fluid resuscitation.

Absolutely vital.

You have to prevent hypovolemic shock.

Because the skin barrier is gone, they lose massive, massive amounts of fluid.

We use the Parkland formula to calculate exactly how much IV fluid to give over the first 24 hours.

What about pain?

Burn pain is excruciating.

You must premedicate the child before any dressing changes or debridement.

Of course.

Now, prevention is obviously the best medicine here.

What do we teach caregivers?

Set home water heaters to 120 degrees Fahrenheit maximum.

Always turn pot handles inward on the stove so togglers can't reach up and pull boiling water onto themselves.

Make sure smoke detectors are working.

And for sunburn prevention,

no direct sun exposure for infants under six months old.

We have covered a massive amount of material today.

From the microscopic anatomy of a newborn stratum corneum to the critical care of a severe burn victim.

We really have.

And it really highlights how the skin isn't just a wrapper.

It is the vital barrier to the world.

Whether it is protecting the body from UV rays, holding off a fungal invasion, or keeping necessary fluids inside.

Nursing care is all about maintaining and protecting that barrier.

So when you synthesize all of this, what does this mean for the nursing student heading into practice?

It means vigilant assessment.

Spotting that non -blanching purpura before a child goes into shock.

Checking the diaper area properly without destroying the healing tissue.

Educating parents on sun safety, tick removal, and safe water temperatures.

It is infection prevention, pain management, and family education all rolled into one specialty.

And I think we should leave the listeners with one final thought.

We spent this whole time talking about the physical side of dermatological diseases.

Yes, but consider the psychological impact as well.

Skin disorders are visible to everyone.

A child with severe weeping eczema, or a teenager with cystic acne, or a kid with visible burn scarring.

They carry that with them socially.

It profoundly affects their self -image.

It does.

As pediatric nurses, we have to remember to treat the emotional skin as well as the physical one.

Provide support, listen to their frustrations, and help them navigate the social challenges.

That is a beautiful way to put it and a perfect place to wrap up.

Thank you, expert.

And thank you to everyone listening.

This has been a deep dive special for the Last Minute Lecture Team.

You've got this.

Good luck on your exams.

See you next time.