Recognize the skin conditions commonly seen in the pediatric population, including a variety of transient cutaneous conditions in newborns, miliaria, oral candidiasis, ichthyosis, and hemangiomas.
Describe the factors that may precipitate or contribute to these pediatric skin disorders.
Discuss the therapeutic interventions frequently used in these pediatric dermatology conditions.
Identify the important patient teaching issues for these pediatric skin disorders.
Many skin conditions in newborns are transient, selflimiting problems that do not require intervention other than to provide reassurance to parents.
Genetic skin disorders may present lifelong problems for affected individuals.
Transient, self-limiting problems that generally do not require intervention other than to provide reassurance to parents include acne neonatorum, acropustulosis of infancy, erythema toxicum neonatorum, harlequin color change, cutis marmorata, sebaceous gland hyperplasia, subcutaneous fat necrosis (if small affected area), sucking blisters, and transient pustular melanosis.
Miliaria crystallina (self-limited), miliaria rubra (common prickly heat), and miliaria profunda (found in patients who have had several bouts of miliaria rubra) are all sweat-retention diseases related to heat exposure. Miliaria crystallina and rubra are the most common forms seen in the neonatal period.
Oral candidiasis, also known as oral thrush, is an infection of the oropharyngeal cavity with Candida albicans, a yeast commonly seen in the infant period.
Ichthyosis, which means “fish scale,” is a broad category of dermatologic conditions involving varying presentations of excessive scaling of the skin. Major hereditary types, which have been described, include two autosomal recessive congenital ichthyoses (epidermal ichthyosis and lamellar ichthyosis types), ichthyosis vulgaris, and X-linked ichthyosis. Several other, rarer forms exist but are not covered in this chapter.
Hemangiomas of infancy are common, benign, vascular tumors comprised of endothelial cells. They may be isolated, small, and uncomplicated or may lead to significant cosmetic and/or medical complications and require intervention.
Also potentially related to an inflammatory reaction to Pityrosporum (Malassezia) species
FIGURE 13-1. Neonatal acne (benign cephalic pustulosis) with multiple uniform red papules. (From Lugo-Somolinos, A., et al. (2011). VisualDx: Essential dermatology in pigmented skin. Philadelphia, PA: Wolters Kluwer.)
FIGURE 13-2. Scattered papules and pustules on the dorsum of the foot in acropustulosis of infancy. (From Lugo-Somolinos, A., et al. (2011). VisualDx: Essential dermatology in pigmented skin. Philadelphia, PA: Wolters Kluwer.)
FIGURE 13-4. Milia. (From Jensen, S. (2010). Nursing health assessment. Philadelphia, PA: Wolters Kluwer.)
FIGURE 13-5. Cutis marmorata in a 2-month-old baby. (From Salimpour, R. R., Salimpour, P., & Salimpour, P. (2013). Photographic atlas of pediatric disorders and diagnosis. Philadelphia, PA: Wolters Kluwer.)
FIGURE 13-7. Sucking blister. The lesion on the left hand of this newborn is the result of sucking that occurred in utero. (Courtesy of Denise A. Salerno, MD, FAAP.)
TABLE 13-1 Nursing Care of Children with Skin Disorders
Reassure parents regarding the benign nature of these conditions.
Assure that the child is kept adequately warm, but avoid overdressing or occlusive clothing.
FIGURE 13-11. Prickly heat in a 6-week-old infant. (From Hall, J. C. (2000). Sauer’s manual of skin diseases (8th ed., p. 407). Philadelphia, PA: Lippincott Williams & Wilkins.)
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