Inflammatory Skin Conditions

Question 1

What are the acute inflammatory skin conditions?

Answer 1

Acute hypersensitivity reactions may cause diaper dermatitis, contact dermatitis, erythema multiforme, and urticaria.

Question 2

What are the chronic inflammatory skin conditions?

Answer 2

• atopic dermatitis (hypersensitivity)
• seborrhea
• psoriasis

Question 3

Diaper Dermatitis

Answer 3

Definition: an inflammatory reaction of the skin. Diaper dermatitis refers to an inflammatory reaction of the skin in the area covered by a diaper; Prolonged exposure to urine and feces may lead to skin breakdown. Diaper wearing increases the skin’s pH, activating fecal enzymes that further contribute to skin maceration.

Teaching Guidelines:
- Change diapers frequently. Change stool-soiled diapers as soon as possible.
- Avoid rubber pants.
- Gently wash the diaper area with a soft cloth, avoiding harsh soaps.
- Use baby wipes in most children but avoid wipes that contain fragrance or preservatives.
- Once a rash has occurred, follow all the prevention tips above and add the following:
- Allow the infant or child to go diaperless for a period of time each day to allow the rash to heal.
- Blow-dry the diaper area/rash area with the dryer set on the warm (not hot) setting for 3 to 5 minutes.
- Discourage parents from using any type of baby powder to avoid the risk of aspiration; inhalation of talcum-containing powders may result in pneumonitis

Tx:
- Topical products such as ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum are helpful to provide a barrier to the skin

Question 4

Atopic Dermatitis (eczema)

Answer 4

Notes:
- often associated with food allergies, allergic rhinitis, and asthma, though not all children with AD will develop one of those other disorders
- Complications: Bacterial superinfection

Patho:
1. Child encounters a trigger antigen
2. Antigen presenting cells stimulates interleukins to begin inflammatory process
3. Skin starts to itch and child starts to scratch
4. Scratching causes rash to appear
5. Sweating and humid or dry environment worsens eczema

Question 5

Contact Dermatitis

Question 6

Erythema Multiforme

Answer 6

Definition: an acute, self-limiting hypersensitivity reaction. It may occur in response to viral infections, such as adenovirus or Epstein–Barr virus; Mycoplasma pneumoniae infection; or a drug (especially sulfa drugs, penicillins, or immunizations) or food reaction.

Most common forms: Stevens–Johnson syndrome and toxic epidermal necrolysis

S/s:
- fever
- malaise
- achiness (myalgia)
- rash
- burning
- lesions over the hands and feet and extensor surfaces of the extremities, with spread to the trunk
- Lesions progress from erythematous macules (flat reddened areas) to papules, plaques, vesicles, and target lesions over a period of days

Tx:
- oral hydration
- Administer analgesics and antihistamines as needed to promote comfort.
- If oral lesions are present, encourage soothing mouthwashes or use of topic oral anesthetics in the older child or teen.
- Oral lesions may be debrided with hydrogen peroxide.

Question 7

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

Answer 7

• High fever and flu-like symptoms for 1 to 3 days prior to rash appearing.
• Rash is characteristic of erythema multiforme with the addition of inflammatory bullae on at least two types of mucosa (lips, oral mucosa, bulbar conjunctivae, or anogenital region).
• Stevens–Johnson syndrome results in skin detachment of 10% or less, while toxic epidermal necrolysis involves 30% skin detachment.
• Mortality rate of 10% (High, 2019).
• Treatment: hospitalization, isolation, fluid and electrolyte support, treatment of secondary infection of the lesions
• Ophthalmologic consult to determine if corneal ulceration, keratitis, uveitis, or panophthalmitis is present.