Chapter 30: Pediatric Integumentary Problems

Eczema represents a superficial inflammatory condition of the epidermis frequently linked to familial atopic disease patterns, presenting with pruritus, erythema, scaling, and exudation typically in flexural areas. Management focuses on symptom relief through tepid baths with colloidal oatmeal, immediate moisturization with occlusive agents, and judicious use of topical corticosteroids, while vigilant monitoring for honey-colored crusted lesions indicating secondary bacterial infection guides escalation of care. Impetigo constitutes a highly contagious bacterial infection predominantly caused by beta-hemolytic streptococci or methicillin-resistant staphylococcal species, manifesting as vesicular lesions that rupture into characteristic golden crusts requiring immediate contact precautions, warm compresses to facilitate crust removal, and rigorous antibiotic adherence to prevent sequelae such as post-streptococcal glomerulonephritis. Pediculosis capitis involves infestation of the scalp and hair shaft by lice transmitted through direct or fomite contact, necessitating treatment with pediculicidal agents alongside manual nit removal and environmental decontamination protocols, with specific age-based contraindications such as lindane neurotoxicity in infants. Scabies, caused by the parasitic mite Sarcoptes scabiei burrowing within the epidermis, presents with intense pruritus and characteristic linear burrows requiring simultaneous treatment of the patient and all household contacts using scabicides applied to cool skin while avoiding facial and cranial regions. The chapter concludes with burn injury management in children, acknowledging their physiological vulnerability due to thinner dermal layers, immature immune responses, and altered fluid-to-mass ratios; assessment relies on age-adjusted body surface area calculations rather than adult-based rules, while resuscitation for burns exceeding ten percent of total body surface area is guided by urine output, heart rate response, and capillary refill adequacy.