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Chapter 2 Index
A. Evaluation by system:
1. General
2. HEENT
3. Cardiopulmonary
4. GI
5. GU
6. Orthopedics
7. Neurological
8. Skin
--The Evaluation of a
Rash: Is it Allergic?
--Common Viral Rashes of Childhood
--Parvovirus B19
--Diagnosis and Treatment of Diaper Rash
--Common Dermatologic Conditions |
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Summer Problems: Sunburn and Poison Ivy
I. Sunburn
Introduction: Sunburn is difficult to treat. Our approach should be on
prevention. In 1996, about 1 million Americans were diagnosed with skin
cancer accounting for 1200 deaths. Melanoma on increase dramatically- due
to brief exposure of high intensity Ultraviolet rays. (200-400 wavelength).
Children more at risk - they spend 3X amount of time in the sun.
Prevention:
- Wear protective clothing and sunglasses: caps and hats that shield
most of the face and eyes.
- Use a sunscreen: not necessary to use SPF more than 15: 1/15th of sun
rays get to the skin. Sunscreen provides up to 5 hours of protection so it
needs to be reapplied. Even waterproof preparations stay on in the water
for about 80 minutes. Use also if in high altitudes, or near sand, snow,
concrete. Umbrellas offer 50% protection. Apply 30-45 minutes before
going outside.
- Avoid the most intense times of day if possible: 10AM - 3PM
- Increase exposure gradually - about 5-10 minutes more each day.
- Never let a baby less than 6 months in the sun - their skin is much
too sensitive. Also do not use sunscreens in this age group: may absorb
drugs through the skin easily- unable to metabolize.
Treatment: Treatment can only provide symptomatic relief -
pain and heat lasts about 48 hours.
- Tylenol or Motrin in usual doses
- 1% hydrocortisone cream TID
- Cool baths with 2 ounces of baking soda or cool compresses
- Increase liquid intake
DO NOT apply petrolatum or other ointments, or butter: these prevent heat
and sweat from escaping and are painful to remove. Do not use benzocaine:
causes an allergic rash.
II. Poison Ivy, Oak, and Sumac: Like sunburn, prevention is
much more effective than treatment.
Sources of Poison Ivy: actual plant, burning of leaves or wood wrapped
with plant, on the coats of pets. Poison oak is same plant as poison ivy -
just at an earlier stage of development.
Prevention: Allergy shots are ineffective.
- Teach children what the leaves of poison ivy look like: have picture
of plant to show family.
- Have children wear long sleeves in areas you know have poison ivy
- Make sure parents know that children should wash with an irritative
soap (e.g. octagon) after coming in at night - this can remove the oil
responsible for causing poison ivy (oleoresin).
Clinical Characteristics of Poison Ivy:
The rash is typically linear, often involves the face, genitals, and
fingers, and is terribly pruritic. It tends to come out over a number of
days - not because of spreading, but because of antigen retained on skin,
under fingernails and on clothing. Can take 10 to 14 days to go away.
Treatment:
- Topical: steroids, calamine lotion: cooling with a drying effect;
compresses with wet dressing: most but not dripping. Do not use Caladryl
(topical antihistamine is sensitizing)
- Systemic treatment: antihistamines: Benadryl, Atarax; severe cases: 5
day oral steroid pack
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