INTEGUMENTARY ASSESSMENT
● Elevation ● Firmness to palpation and ● Progressive Growing over several weeks Table 2. ABCDE–EFG Method
The skin is the largest organ system and works to keep the body in homeostasis despite daily assaults from the environment. It retains body fluids while protecting underlying tissues from microorganisms, harmful substances, and radiation. It modulates body temperature and synthesizes vitamin D (Bickley, 2021). Certain disease processes and systemic conditions first present with skin disruptions. The integument system contains three layers: The epidermis, the dermis, and the subcutaneous tissues. It is important to use specific terminology to describe skin lesions and rashes. This becomes especially important when discussing them with other healthcare providers and evaluating treatment responses. Appropriate descriptions include each of the following elements: Number, size, color, shape, texture, primary lesion, location, and configuration. A lesion is any single area of altered skin. It may be solitary or multiple. Look for lesions suggesting melanoma, basal cell carcinoma (BCC), or squamous cell carcinoma (SCC) throughout the skin examination, regardless of the patient’s skin color (Bickley, 2021). Detecting skin cancer at an early stage can increase the likelihood of successful treatment. Ask the patient if they have noticed any changes in the lesion. When screening moles for melanomas, clinicians often describe them using the ABCDE–EFG method (see Table 2). A lesion is described as it relates to its (Bickley, 2021): ● Asymmetry of one side of the mole compared to the other ● Border irregularity, especially if ragged, notched, or blurred ● Color variations (more than two colors, especially blue-black, white, or red) ● Diameter >6 mm ● Evolving or changing rapidly in size, symptoms, or morphology
Description of Lesions: ABCDE–EFG
Asymmetry
A B C
Border
Color
Diameter Evolving Elevation Firmness Growing
D
E E F
G
(Bickley, 2021)
Self-Assessment Quiz Question #1 What does the “A” in the ABCDE–EFG method stand for when screening moles for melanomas?
a. Appearance of the mole. b. Asymmetry of the mole. c. Amplitude of the mole. d. Area of the mole.
COMMON PEDIATRIC RASHES
Impetigo Impetigo (also called pyoderma) is a superficial bacterial skin infection that is highly contagious. Streptococcus pyogenes and Staphylococcus aureus can cause impetigo. Streptococcal impetigo, or nonbullous impetigo, begins as papules. The papules evolve into pustules and then break down to form thick, adherent crusty lesions. The crusts are typically golden or honey-colored. These lesions usually appear on exposed areas of the body, most commonly the face and extremities, but can occur anywhere on the body. Multiple lesions typically develop. In cases of nonbullous impetigo, physical examination cannot differentiate streptococcal from staphylococcal infection (Centers for Disease Control and Prevention [CDC], 2022b). Figure 1: Impetigo
Impetigo can occur in people of all ages, but it is most common among children between the ages of 2 and 5 years. Scabies infections and activities that result in cutaneous cuts or abrasions increase the risk of impetigo. Poor personal hygiene, including a lack of proper hand, face, or body hygiene, can increase the risk of impetigo (CDC, 2022b). Impetigo can occur in any climate and time of year but is more common in temperate climates and tropical or subtropical locations during the summer. Streptococcal impetigo is most commonly spread through direct contact with other people with impetigo, including through contact with drainage from impetigo lesions. Lesions can be spread (by fingers and clothing) to other parts of the body. People with impetigo are much more likely to transmit the bacteria than asymptomatic carriers are. Increased risk of disease spread from person to person is found in crowded situations, such as in schools and daycare centers (CDC, 2022b). Antibiotic treatment, whether oral or topical, should be aimed at group A strep and S. aureus. Topical antibiotics, mupirocin or retapamulin, may be used when there are only a few lesions, while oral antibiotics are used for multiple lesions (CDC, 2022b). The spread of impetigo can be prevented by covering lesions; treating them with antibiotics; and practicing good face, body, and hand hygiene. An infected person’s clothing, linens, and towels should be washed daily and not shared with others in the household. If lesions are covered, people with impetigo can return to school or work after initiating antibiotic treatment. The spread of all types of group A strep infection can be reduced by good hand hygiene, especially after coughing and sneezing and before preparing foods or eating, and respiratory etiquette (e.g., covering your cough or sneeze).
From Heilman, J. (2000). Impetigo. https://upload.wikimedia. org/wikipedia/commons/thumb/a/a4/Impetigo2020.jpg/800px- Impetigo2020.jpg. CC BY-SA 4.0
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