Integumentary Dx|Pediatric Dermatology and Skin Integrity Assessment:
Epidermis, Dermis, Subcutaneous Tissue, Barrier Function, Permeability,
Thermoregulation, Excretion, Sensation, Birthmarks, Port Wine Stains,
Hemangiomas, Mongolian Spots, Salmon Patches, Contact Dermatitis, Atopic
Dermatitis, Eczema, Seborrheic Dermatitis, Diaper Dermatitis, Pruritus,
Impetigo, Cellulitis, Candidiasis, Thrush, Tinea Capitis, Tinea Corporis, Tinea
Cruris, Tinea Pedis, Pediculosis Capitis, Scabies, Acne, Lyme Disease, Nursing
Interventions, Topical and Systemic Treatments Exam Questions Verified and
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•Functions of the Skin
•Protect the deeper tissues from injury
•Regulation of temperature
•Excretion of water
•Aid in the production of vitamin D
•Sensations of touch, pain, heat, and cold
Skin Composition
•Outer epidermis
•Inner supportive dermis
•Blood vessels
•Nerves
•Sweat glands
•Subcutaneous layer
•Primary adipose tissue
•Attaches dermis to underlying structures
,Pediatric Differences in the Skin
•Skin is thinner and more susceptible to irritants and infection.
•Ratio of skin surface area to body volume is greater, allowing greater absorption.
•Skin is more susceptible to bacterial invasion.
•Skin has less ability to regulate temperature.
Pediatric Considerations
•Infant: skin is not mature at birth
•Adolescence: sebaceous glands become enlarged and active
•Infants and < 2 years old should not use topical medications without an order from a HCP due to the
greater absorption through the skin and their larger skin to body mass ratio.
•IgA does not reach adult levels until about age 2 to 5. Infants are less resistant to organisms.
Skin Assessment
•Assess history
•Assess exposure
•Assess character
•Assess sensation
Common Birthmarks
•Port wine stain- result of a capillary malformation; present at birth and will become darker as the child
grows; the stain is permanent
•Hemangiomas- result from the proliferation of dilated capillaries and endothelial cells of the capillary
linings; are not usually visible at birth but will appear during the first few weeks of life and grow during
the first year; generally, they disappear after age 1 and are gone by age 5 or 6.
•Salmon patch- caused by distended dermal capillaries that are believed to result from persistent fetal
circulation; can appear darker when the child cries; usually fade during the first year of life
, •Stork bites
•Angel kisses
•Mongolian spots- are not vascular but the result of collections of pigment deep in the dermis; present
at birth, can look like bruises, typically fade by age 4 or 5.
Dermatitis
Inflammation of the skin that occurs in response to contact with an allergen or irritant.
•Common Irritants
•Urine and stool, fabric softeners, soap, lotions, diaper wipes
•Common Allergens
•Poison ivy, Poison oak
•Lanolin
•Latex, rubber
•Nickel
•Fragrances
Dermatitis Signs and Symptoms
•Dry, inflamed skin
•Erythema
•Pruritus
•Blistering
•Weeping lesions
•Diaper dermatitis can progress to macules and papules