Infants and Children The Health Continuum by mikeholy


									Things That Make You Itch
Bobi A. Crump, RN, MSN, CPNP
Pediatric Nurse Practitioner
Alta California Regional Center
  An intensely pruritic (itchy)
  Highly Contagious
  Skin Infestation by the mite:
     Sarcoptes scabiei hominis
Cause and Effect
 Adult Female Mite
     Burrows in the skin to lay eggs
     Leaves a trail of feces (poop) and eggs
     Lives for 30 days
     Lays up to 90 eggs
 Eggs and Larvae
     Eggs hatch in 3 to 4 days
     Mature in 2 weeks
 You are infected with 10 to 15 adult
 females at any given time.
Cause and Effect
 Pruritus (itch)
     Caused by a hypersensitivity of the skin
     Reacting to the eggs and feces
 Lesions appear 3 to 10 days after
 Fingers, wrists, arms, underarms, trunk
 Intense itch occurs after lesion eruption
 Especially intense itching at night
Presents typically on the hands and
             finger webs
Lesions on the palm of the hand
Small scab-like lesions on the upper
          arms and torso

  Intense itching leads to skin breakdown
  and secondary bacterial infections

  Difficult to diagnose in infants, they
  have less of a reaction
Scabies Treatment
  Scabicides applied, directions followed

  Permethrin 5% (Elimite, Nix)
     Applied to every inch from neck down
     Leave on for 8 to 12 hours
     May increase symptoms of itching,
      redness, and swelling, temporarily
Other Scabies Treatment
Also Used:
  Precipitated sulfur 6% in petrolatum
     Used for Pregnant or Nursing mothers
  Lindane 1% (gamma benzene
  hexachloride, Kwell)
  Crotamiton 10% (Eurax)
Other Scabies Treatment
  Antibacterial topical
     Neosporin, Bactroban
  Anti-inflammatory topical
     Hydrocortisone (Cortaid, Westcort)
  Anti-histamines (Oral)
     Benadryl, Atarax, Periactin

Other Scabies Treatment
  Itching –
     Rash may last up to 3 weeks, psychogenic
  Contagiousness - very
  Family Contacts
     All Family members and close contacts
      need treatment, even without symptoms
     Older than 2 months and not pregnant
Other Scabies Treatment
  House Cleaning
     All bed linen and clothing should be
      washed in order to remove eggs and mites
     Scabies can persist for 2-3 days without a
     Articles that cannot be washed should be
      kept in sealable plastic bags for 3-5 days

  Wash Your Hands !!!
Scabies Treatment Follow up
  Reexamine at 2 weeks and one month
  Continued itching may be present
  without the mite, due to the reaction
  Continued lesions at one month, may
  be re-infestation

Lice (pediculosis)
  An intensely pruritic (itchy)
  Highly Contagious
  Scalp infestation and rash by the
     Pediculus capitis (head louse)
     Pediculus humanus corporis (body louse)
     Pthirus pubis (pubic louse)
Pediculus humanus capitis (head louse)
Pediculus humanus corporis (body louse)
Pediculus humanus capitis (head louse)
Pediculus humanus corporis (body louse)
Pthirus pubis (pubic louse)
Lice (pediculosis)
  Nits (eggs) firmly attached to hairs
  Lice (bugs) 1/16 inch, move quickly
  Human host, direct contact spread
  Spread by direct contact
  Clothing and bedding spread
Lice Treatment
  Permethrin 5% (Elimite, Nix)
     Wash hair with a Non-Medicated shampoo
      and towel dry
     Apply permethrin, leave on for 20 min,
      then rinse hair thoroughly
     Nit removal
     Repeat in 7 to 10 days
Lice Treatment
Also Used:
     A200 Pyrinate, Rid Mousse, RID Shampoo,
      End Lice
  Lindane 1%
     Kwell
  Vaseline Ointment
     For eyelash nit removal
     Twice daily for 8 days
Lice Treatment
  Launder towels, pillow cases, sheets, hats,
  and children's stuffed animals in hot water
  and machine dry
  Soak combs and brushes for at least 5
  minutes in very hot water (>131°F or 55°C)
  Dry cleaning may be an effective alternative
  Seal items in plastic bags for 12-14 days
  Vacuum carpets and furniture, change the
  Chemical insecticide sprays are not effective
  in the control of head lice.
Lice Treatment
  Simultaneously treat family members
  Must retreat in 7 to 10 days
  If treating pubic lice, screen for other
  sexually transmitted disease
  Children should not have pubic lice,
  screen for child sexual abuse

  Questions ???
Ringworm (Tinea)
     Tinea   capitis - scalp
     Tinea   Versicolor – scalp and face
     Tinea   corporis – body
     Tinea   pedis - feet
  Fungal infection of the skin
     Ring shaped pink patch
     Scaly, raised border
     Central clearing and patch enlarges
     Mildly itchy
Tinea Versicolor
Ringworm Treatment
     Oral antifungal medication
     Antifungal shampoo
        Selsun Blue
        Nizoral
     Selsun Blue
     Antifungal creams
        Tinactin, Micatin or Lotrimin
        Apply twice a day, up to 3 weeks
The End
Question and scratching time

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