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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

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Skin Problems

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  1. Skin Problems Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme

  2. 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 Slow Healing Itchy skin Boils or abscesses Painful sores Drug reactions Dry skin

  3. Issues for a Child • Hygiene dependent on carer • ‘Pick up’ infections • Distressing symptoms • Secondary infections (scratching, picking) • May infect others • Increased risk of skin infections as HIV disease progresses

  4. 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 ©TALC

  5. 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 ©TALC

  6. 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 ©TALC

  7. 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 ©TALC

  8. 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

  9. Fungal Infections • Tinea Infections (e.g. Ringworm) • Flat, round, scaly, dry patches • Commonly found on face, trunk, extremities and head (with loss of hair) • May become severe, large, pus-filled patches • Common and highly infectious ©TALC CDC Dr Georg

  10. 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!)

  11. 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

  12. 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) • Much more severe than usual chicken pox CDC/J.D. Millar

  13. 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

  14. Complications of Chicken pox Complications may occur • Secondary bacterial infections • Haemorrhagic chickenpox • Pneumonia • Encephalitis Refer to Clinic/Hospital depending on presence of danger signs ©TALC

  15. 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 • Usually down leg, arm, neck, chest, face, may involve eye • Suggestive of HIV in a child ©TALC ©TALC

  16. 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)

  17. 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

  18. Abscesses • Children with HIV commonly get abscesses • Any child with an abscess must be referred for investigation and treatment ©TALC ©TALC

  19. 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

  20. 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 More common in infected children: • Taking Co-trimoxazole • Taking anti-TB therapy • Starting ARVs (e.g. Nevirapine, Abacavir)    Refer immediately ©TALC

  21. Skin Breakdown Children with HIV are are more likely to get skin breakdown Due to: • Malnutrition • Immobility • Skin infections This can be prevented through: • Good nutrition • Regular turning and good skin care for immobile, bed ridden children • Treatment of skin infections Picture of Skin Breakdown ©TALC

  22. 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 ©TALC

  23. 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

  24. 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

  25. 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

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