Pediatric Care Prototype Lesson: Scroll 1

Introduction to Pediatric Care SKIN DISEASE

INTRODUCTION:

In this program, we will learn about the diagnosis, treatment, and management of children of different ages with skin problems. After completing this program, you will be able to:

1. Use the knowledge of basic pathophysiology of the skin and its related structures to differentiate among a variety of presentations of skin problems and formulate a diagnosis.

2. Develop an immediate treatment plan based on the children’s diagnosis and understanding of the developmental and physiological factors that affect children’s skin conditions.

3. Plan with the child and family a strategy for good skin hygiene and management of children’s acute and chronic skin conditions

Overview

The skin is the largest organ in the body. It is an important barrier between the individual and the environment. It protects the body from the substances, such as environmental pathogens, bacterial infections, and controls water and heat loss across the epidermis. It is also a barrier to ultra violet radiation. Skin is also an important component of the immune response.

In 20-40 weeks of gestation the skin becomes functional and develops a protective barrier. Infant skin still is completing the developmental process during the first year of life. During first year of life the bacteria that colonize the skin in children are different from the bacteria that colonize adult skin.

The skin barrier as a protective element is immature through the first 2 years of life. Infant skin is thinner than adult skin thus, infants are more susceptible to ultraviolet rays of the sun. Sunscreen above SPF 15 can only be used when infants are 6 months of age or older than 6 months. Before 6 months infants have to be carefully protected from the sun.



The skin is composed of the epidermis, dermis and the subcutaneous layer.

Epidermis

The epidermis is the most important layer of the skin and performs the role of barrier. It is very thin (0.12mm), but it can also thicken and form calluses. It sloughs off about every 30 days. The role of skin barrier includes: protecting from harmful bacteria, environmental substances and other pathogens as well as protecting from sun’s ultraviolet rays.

The Stratum Corneum (SC) is part of the top layer of the epidermis, the outer skin barrier. Skin barrier functions are the responsibility of the (SC). The SC contains cells called keratinocytes and melanocytes.

Keratinocytes form the tough superficial layer covering the body. Keratin is the main component of skin, hair and nails. The melanocytes, which are located near the base of the epidermis, synthesize the pigment called melanin. This provides protection from ultraviolet radiation and determines skin color. It also serves to protect the skin’s DNA from ultra violet light radiation. Dermis The dermis varies from 1-4mm. in thickness. It contains macrophages, fibroblasts, fat cells, and mast cells. Macrophages are phagocytic and participate in immune responses. Fibroblasts secrete connective tissue materials. Mast cells participate in hypersensitivity by releasing histamine.

The dermis also contains, lymphatic vessels, blood cells, and nerves. These nerves feel the sensation of pain, itching, pressure heat and cold. This is another way that the skin offers protection to the individual. Dermal appendages Dermal appendages include hair, nails sebaceous glands, and sweat glands.

Eccrine sweat glands are located all over the body, but the greatest number are the palms of the hands and the soles of the feet. Apocrine sweat glands are located in other parts of the body i.e. the axilla, face, and genital area/ Subcutaneous layer and Dermal Appendages.

The subcutaneous layer of the skin connects the overlying dermis to muscle that underlies it. Nails are keratinized plates that are seen at the end of fingers and toes. Nail growth is continuous throughout life. The nails are only partly visible. The part that is hidden is covered and supported by the dermis. Hair follicles come from a bulb located very deep in the dermis. Hair growth begins in the bulb. Hair is fully hardened when it comes out at the surface of the skin. Hair growth is different depending on body surfaces, race, gender and age. Sebaceous glands open up on the surface of the skin through a canal. Sebaceous glands are found on face, chest and back. Growth of sebaceous glands is stimulated by androgens. Let’s review what we learned in the previous two paragraphs about normal skin in infants.

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