Nursing Care for Common Skin Disorders in Children

Skin disorders are among the most common health concerns in pediatric populations. According to research, over 70% of patients presenting with skin diseases are children aged 0-5 years. From minor irritations like diaper rash to chronic conditions like eczema, nurses play a vital role in identifying, managing, and educating families about these conditions. Understanding the various types of skin disorders, their characteristic features, and appropriate interventions helps nurses provide effective care and improve outcomes for young patients.

Understanding birthmarks (naevi) in children 🔗

Birthmarks are skin anomalies present at birth or appearing shortly after. They are classified into two main categories: vascular and pigmented birthmarks. More than 80% of babies have some type of birthmark, and most are harmless and require no treatment.

Vascular birthmarks 🔗

Vascular birthmarks occur due to abnormal blood vessel formation in the skin. The most common types include:

Salmon patches (naevus simplex): These are the most common vascular birthmarks, occurring in up to 40% of newborns. They appear as flat, pink marks on the eyelids, forehead, or nape of the neck. Often called “angel kisses” or “stork bites,” most fade during infancy, though some on the neck may persist into adulthood.

Port-wine stains (naevus flammeus): These flat, pink to purple marks are present at birth and grow with the child. Unlike salmon patches, port-wine stains are permanent and do not fade over time. They commonly appear on the face and may thicken with age. Laser therapy can lighten these marks, with earlier treatment showing better results.

Hemangiomas (strawberry naevi): These soft, raised vascular swellings typically appear within one to four weeks after birth and grow rapidly during the first year. About 70% of hemangiomas disappear by age 7. Treatment is usually necessary only when they interfere with vision, breathing, or feeding.

Spider naevus: This appears as a central red spot with fine radiating blood vessels resembling spider legs. While usually harmless, multiple spider naevi may indicate liver disease and warrant further evaluation.

Pigmented birthmarks 🔗

Congenital melanocytic naevi: These moles are present at birth and range from light brown to black. Found in about 1% of newborns, they require monitoring as larger lesions carry a small risk of malignancy.

Mongolian spots: These blue-gray birthmarks commonly appear on the lower back or buttocks and resemble bruises. They are completely harmless and typically fade by school age without treatment.

Café-au-lait spots: These flat, light brown patches can appear anywhere on the body. While usually benign, multiple café-au-lait spots may indicate neurofibromatosis and should be evaluated by a physician.

Erythema in children 🔗

Erythema refers to skin redness caused by increased blood flow to the superficial capillaries. In pediatrics, two common presentations are diaper rash and toxic erythema.

Diaper dermatitis 🔗

Diaper rash is the most common skin disorder in infants, with peak incidence occurring between 9 and 12 months of age. It results from prolonged contact between the skin and irritants like urine and feces, combined with moisture and friction.

Clinical features: Skin findings include erythema, papules, scaling, and erosions affecting the buttocks, thighs, and suprapubic area. The skin folds are typically spared in irritant dermatitis. When Candida infection is present, satellite pustules and involvement of skin folds become characteristic features.

Management strategies:

Frequent diaper changes reduce exposure to irritants. Using superabsorbent diapers helps reduce skin overhydration. Barrier creams containing zinc oxide or petrolatum protect the skin. For moderate cases, low-potency topical corticosteroids may be used briefly. Candidal involvement requires antifungal treatment such as nystatin or clotrimazole.

Toxic erythema neonatorum 🔗

This benign, self-limiting condition appears in the first days of life. It presents as red macules, papules, or pustules scattered across the body, sparing the palms and soles. No treatment is required as it resolves spontaneously within one to two weeks.

Eczema and atopic dermatitis 🔗

Eczema, particularly atopic dermatitis, is the most common chronic inflammatory skin condition in children. It affects 20-25% of children and significantly impacts quality of life for patients and families.

Clinical presentation: Symptoms include dry, itchy, red, and scaly skin. In infants, it commonly affects the face, neck, scalp, elbows, and knees. In older children, the flexural areas such as elbow creases and behind the knees are typically involved. The intense itching can lead to sleep disturbances and secondary skin infections from scratching.

Nursing interventions:

Moisturization is fundamental. Apply moisturizers immediately after bathing while the skin is still damp. Use fragrance-free, dye-free products for the entire family. Recommend lukewarm baths with gentle cleansers rather than hot water. Teach parents to identify and avoid triggers such as certain fabrics, environmental allergens, and stress. Topical corticosteroids are prescribed for active flares, with calcineurin inhibitors as steroid-sparing alternatives.

Bacterial skin infections (pyoderma) 🔗

Bacterial skin infections in children are primarily caused by Staphylococcus aureus and Group A Streptococcus. Impetigo accounts for approximately 10% of skin complaints in the pediatric population.

Impetigo 🔗

Non-bullous impetigo: This is the most common form, characterized by small vesicles that rupture and form honey-colored crusts on an erythematous base. It commonly affects the face and extremities.

Bullous impetigo: Caused by toxin-producing S. aureus, this form presents with larger fluid-filled blisters that rupture less readily. Children under two account for 90% of bullous impetigo cases.

Treatment and nursing considerations:

Topical antibiotics like mupirocin are effective for localized cases. Oral antibiotics are indicated for widespread infection or systemic symptoms. Children can return to school 12-24 hours after starting antibiotic treatment. Educate families about hand hygiene, avoiding sharing of personal items, and keeping lesions covered. Monitor for complications including post-streptococcal glomerulonephritis.

Fungal infections 🔗

Fungal infections commonly affecting children include tinea (ringworm) and candidal infections. These conditions thrive in warm, moist environments.

Tinea corporis (ringworm): Presents as circular, scaly patches with raised borders and central clearing. It spreads through direct contact with infected persons, animals, or contaminated objects. Topical antifungal creams are usually effective, though extensive infections may require oral treatment.

Tinea capitis: Affects the scalp and is common in children. It causes scaly patches, hair loss, and sometimes inflammatory masses called kerions. Oral antifungal therapy is necessary since topical treatments cannot penetrate hair follicles adequately.

Candidal infections: In infants, Candida commonly causes diaper dermatitis, presenting with bright red erythema, satellite lesions, and involvement of skin folds. Treatment includes topical antifungals applied with each diaper change and maintaining dry skin.

Parasitic infestations 🔗

Common parasitic skin conditions in children include scabies and pediculosis (lice). These require specific treatment protocols and environmental measures.

Scabies: Caused by the mite Sarcoptes scabiei, it presents with intense itching, especially at night, and linear burrows typically found between fingers, on wrists, and in the genital area. Treatment involves topical permethrin applied from neck to toes and left on for 8-14 hours. All household contacts require simultaneous treatment, and bedding and clothing must be washed in hot water.

Pediculosis: Head lice are common in school-age children. They cause scalp itching, and nits (eggs) are visible attached to hair shafts. Topical pediculicides and manual nit removal are the mainstays of treatment. Environmental measures include washing bedding and vacuuming furniture.

Viral skin infections 🔗

Several viral infections manifest with characteristic skin findings in children.

Molluscum contagiosum: Caused by a poxvirus, it presents as small, dome-shaped papules with central umbilication. Lesions typically form on the torso, buttocks, arms, and legs and can take months to years to resolve. While often left untreated, persistent cases may be treated with cryotherapy or curettage.

Viral warts: Caused by human papillomavirus, warts are common in children. They appear as rough, raised lesions on hands, feet, and other areas. Multiple treatment options exist, including salicylic acid, cryotherapy, and observation.

Herpes simplex: Primary infection causes painful vesicles that evolve into ulcers. In children, herpetic gingivostomatitis causes oral lesions, fever, and difficulty eating. Antiviral therapy is beneficial when started early.

Psoriasis in children 🔗

While less common than eczema, psoriasis does occur in children and can begin at any age. Guttate psoriasis is particularly common in children and often appears following a streptococcal infection.

Clinical features: Psoriasis causes well-defined, thick, red, scaly patches commonly affecting the scalp, face, buttocks, elbows, and knees. Unlike eczema, itching in psoriasis tends to be milder. The condition is chronic and characterized by periods of flares and remission.

Management: Topical treatments include corticosteroids, vitamin D analogues, and calcineurin inhibitors. Phototherapy may be recommended for moderate to severe cases. Treating underlying infections, particularly streptococcal pharyngitis, may help clear guttate psoriasis.

Acne in children and adolescents 🔗

While most common during adolescence due to hormonal changes, acne can occur at various ages. It results from blockage and inflammation of sebaceous follicles.

Clinical presentation: Older children and teenagers may experience comedones, papules, pustules, and in severe cases, nodules and cysts. The face, chest, and back are commonly affected.

Treatment approach: Mild acne responds to topical treatments including benzoyl peroxide and retinoids. Moderate to severe cases may require topical or oral antibiotics. Nurses should educate patients about proper skin care, avoiding picking at lesions, and the importance of treatment adherence. Psychological support is important as acne significantly impacts self-esteem in adolescents.

Nursing assessment and interventions 🔗

Effective nursing care for pediatric skin disorders involves comprehensive assessment and family-centered education.

Assessment priorities: Document lesion characteristics including location, size, shape, color, texture, and distribution. Note associated symptoms such as itching, pain, or fever. Obtain a thorough history including onset, progression, previous treatments, family history, and potential triggers or exposures.

Key nursing interventions:

Maintain skin integrity through appropriate hygiene and moisturization. Implement infection control measures for contagious conditions. Administer prescribed medications and teach proper application techniques. Provide comfort measures to relieve itching and prevent scratching. Support the child’s emotional well-being, as visible skin conditions can affect self-esteem. Educate families about the condition, treatment regimen, trigger avoidance, and when to seek medical attention.

What do you think? How do you approach parent education when managing chronic skin conditions like eczema in young children? What strategies have you found most effective in helping families maintain consistent skincare routines at home?

References

1. https://www.brynmawrdermatology.com/pediatric-dermatology-10-common-skin-conditions-in-children/
2. https://www.nationwidechildrens.org/conditions/birthmark
3. https://www.bad.org.uk/pils/vascular-birthmarks
4. https://www.gillettechildrens.org/conditions-care/birthmarks-and-vascular-anomalies
5. https://www.luriechildrens.org/en/specialties-conditions/nevi/
6. https://www.rchsd.org/programs-services/plasticsurgery/conditions-treated/birthmarks/
7. https://www.ncbi.nlm.nih.gov/books/NBK559067/
8. https://www.mayoclinic.org/diseases-conditions/diaper-rash/diagnosis-treatment/drc-20371641
9. https://publications.aap.org/pediatrics/article/155/6/e2025071812/201952/Atopic-Dermatitis-Update-on-Skin-Directed
10. https://www.childrensnational.org/get-care/health-library/eczema-atopic-dermatitis
11. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/treating-eczema-psoriasis-in-children
12. https://www.ncbi.nlm.nih.gov/books/NBK430974/
13. https://www.ncbi.nlm.nih.gov/books/NBK568809/
14. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/impetigo.html
15. https://www.aad.org/public/diseases/psoriasis/treatment/could-have/child-have
16. https://www.aad.org/public/diseases/eczema/childhood/child-have/difference-psoriasis
17. https://www.skinsurgerycenter.net/conditions/pediatric-dermatology