Transcript Skin Problems

Skin Problems
Paediatric Palliative Care
For Home Based Carers
Funded by
British High Commission, Pretoria
Small Grant Scheme
Skin Problems
 Common in children with HIV
 Often conditions common in all children but more severe
 Often first sign of HIV infection / HIV disease progressing
 Include:
Rashes
Itchy skin
Painful sores
Dry skin
Slow Healing
Boils or abscesses
Drug reactions
Issues for a Child

Hygiene dependent on carer

‘Pick up’ infections
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Distressing symptoms

Secondary infections
(scratching, picking)

May infect others
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Increased risk of skin infections
as HIV disease progresses
Preventing Skin Problems
 Daily washing with soap and water
 Dry skin well
 Moisturise skin
 Wash nappies and clothes regularly
 Keep Nails short and clean
 Expose skin to sun and air when
possible
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Thrush
 Extremely common in children with
HIV
 Caused by Candida infection
 Commonly found in nappy area or
skin folds
 May be painful for a child
 May lead to secondary infection
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Managing Thrush
 Expose skin to sun and air
 Clean area with water
 Gentian Violet or Nystatin
 Pain relief (Paracetamol)
 Wash nappies and clothes
well
 Refer for medication if no
improvement
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Seborrhoeic dermatitis
 Infection/ Inflammation of the skin
 Highly suggestive of HIV infection
 Thick, yellow scales on scalp, face,
nappy area, behind ears
 May be itchy and sore
 May become secondarily infected
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Managing Seborrhoeic
Dermatitis
 Ensure child has clean, short
nails
 Wash skin using aqueous cream
 Moisturise skin
 Pain relief (Paracetamol)
 Refer for Chlorpheniramine
maleate
 Refer as antibiotics or steroids
may be required
Fungal Infections
 Tinea Infections (e.g. Ringworm)
 Flat, round, scaly, dry patches
 Commonly found on face, trunk,
extremities and head (with loss of
hair)
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 May become severe, large, pusfilled patches
 Common and highly infectious
CDC Dr Georg
Management of Ring Worm
 Wash infected area with soap and water
 Ensure thorough hand washing
 Apply Whitfield’s Ointment
 Refer for oral Griseofulvin treatment
(1-3 months!)
Dry Skin and Itching
 Extremely common in children with HIV
 May be very distressing to child
 May lead to skin infections
 Avoid use of soaps
 Bath child in bath oils
 Moisturise skin with emulsifying ointments in stead
 South Coast Hospice’s ‘Itch cream’
 Keep child’s nails clean and short
Chicken Pox
 Caused by Varicella Zoster virus
 Rash, developing to crusts
 Found all over body, particularly on trunk
 Commonly itchy and painful
 Highly contagious (spread by contact with
sores and secretions)
CDC/J.D. Millar
 Much more severe than usual chicken pox
Managing Chickenpox
 Pain relief
 Thorough hand washing
 Keep child away from young, sick, or
elderly people
 Acyclovir treatment
 Symptom relief with Calamine,
Chlorpheniramine maleate
 Wash clothes well
 Antibiotic treatment if infected
Complications of Chicken pox
Complications may occur
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Secondary bacterial infections
Haemorrhagic chickenpox
Pneumonia
Encephalitis
Refer to Clinic/Hospital depending
on presence of danger signs
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Shingles (Herpes Zoster)
 Child has had chicken pox before
 If immune system weakens, the
chicken pox virus returns as shingles
 Extremely painful blisters, in cluster
or line along the line of a nerve
©TALC
 Usually down leg, arm, neck, chest,
face, may involve eye
 Suggestive of HIV in a child
©TALC
Management of Shingles
 Analgesia (Paracetamol, Codeine)
 Oral/IV acyclovir
 Isolate child from sick, young, elderly
 Hand washing
 For itch: Calamine, Chlorpheniramine maleate
 If infected: Antibiotic treatment (Amoxycillin / Flucloxacillin)
Scabies
 Common in all children
 Very itchy bumps all over body
 Caused by tiny mites which tunnel
under the skin
 Commonly between fingers and
toes, in wrist-folds, around waist,
on genitals, palms & soles of feet
 Scratching causes infection,
producing sores with pus
 Symptom relief with
Calamine/Chlorpheniramine
maleate
Abscesses
 Children with HIV commonly get abscesses
 Any child with an abscess must be referred
for investigation and treatment
©TALC
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Molluscum
 Flesh-coloured, dome-shaped
growths
 Vary in size from 3mm – 1cm
 Often indicate advanced HIV
disease
 Commonly occur on the face and
can be extremely disfiguring
 Refer child
Drug Reactions
Children with HIV take lots of drugs
A child may react to these drugs:
 Exfoliating skin rash
 Fever
 Severe pain
 Risk of dehydration and malnutrition
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More common in infected children:
 Taking Co-trimoxazole
 Taking anti-TB therapy
 Starting ARVs (e.g. Nevirapine, Abacavir)
Refer immediately
Skin Breakdown
Children with HIV are are more
likely to get skin breakdown
Due to:
 Malnutrition
 Immobility
 Skin infections
Picture of Skin Breakdown
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This can be prevented through:
 Good nutrition
 Regular turning and good
skin care for immobile, bed
ridden children
 Treatment of skin infections
Kaposi’s Sarcoma
 Most common type of cancer
affecting people with HIV
 Less common in children than
adults but still seen
 Pink, red, purple or
brown/black, painless, lesions
 May start on face, mouth,
gums, palate or penis
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Kaposi’s sarcoma
May lead to skin infections and painful ulcers
May spread to:
 GI tract ( assess for blood in stool or abdominal pain)
 Lungs (assess for dry, productive cough)
Care is usually palliative
ARVs may be of benefit
Management of Skin Problems
 Good Hygiene
 Symptom Relief (Paracetamol, Calamine,
Chlorpheniramine maleate)
 Antibiotic and Antifungal treatment
 Prevent secondary infections (short
nails, Gentian Violet)
 Treatment for secondary infections
Summary
 Children with HIV commonly get a wide range of skin problems
 These can cause intense itching, pain and distress
 Preventing skin problems through good hygiene and care is
extremely important
 Delaying treatment for skin problems makes treatment more
difficult and complications may occur