MN 581
Unit 8 Discussion
Shelly Dillon
I have been fortunate to be able to see a large amount of skin and dermatologic concerns in the pediatric population. During my clinical rotation, my preceptor is very relaxed about it and helped me feel better prepared to take on the challenging area of skin issues. Much like the literature, she admits, you can’t know everything. Focus on whether skin issues are bacterial, infectious, altering, or chronic. The literature supports that primary care providers often seek more education on skin concerns (Chandry & Kaimel, 2020). Pediatric skin diseases can often be challenging for primary care providers. Skin is seen easily as our largest organ and an error in diagnosis or treatment is easily noticed. The vast range of skin disorders is daunting. Chandry & Kaimel, 2020 also found in their study that people expect the primary care provider to be knowledgeable and accurate in diagnosing and treating “common or normal� skin issues with referral to a specialist but expect early referral when deemed necessary to dermatology.
A few of the skin disorders I have observed and participated in care are molluscum contagiosum, atopic dermatitis, eczema, hidradenitis suppurative, and pityriasis rosea. Depending on the setting they are seen in, the area of the body it affects, and the severity of the symptoms drive the aggressive nature of treatment (Vivar & Kruse, 2018). The following were seen in my clinical rotation and classic symptoms were present which made it easier to recognize.
Molluscum contagiosum: I have seen this 3 times. Small skin-colored pearls are often umbilicated. Spread in skin-to-skin contact. Often resolve spontaneously. Treatment if bothersome can include cryotherapy. If large area, dermatology referral is necessary for keloidal treatment. (epocrates, 2019)
Eczema and atopic dermatitis: Seen numerous times. Severity ranges from mild to severely pruritic. Emollient and itch relief is key factors to comfort. May have an allergy component and benefit from antihistamines. One of the most common skin conditions seen (epocrates, 2019).
Hidradenitis suppurative: I have seen this in various age groups. Not usually diagnosed until adolescence and young adulthood. Requires multidisciplinary approach to be well controlled. I saw a chronic case, not a flared presentation. And we did not treat it as it was not the chief complaint.
Pityriasis rosea: Inflammatory skin condition with unclear etiology but often seen after an infection. Presents in school-age children more often than young children. Begins with a larger herald patch and erupts in smaller oval lesions. Normally resolves spontaneously over a few weeks, but can persist longer. (epocrates, 2019).
Skin diseases and disorders can affect children’s self-esteem to the detriment of developmental stages (Vivar & Kruse, 2018). Infant skin disorders can affect the infant and caregiver bonding, school-age children with any variety of birthmarks or skin condition report increased bullying, and Adolescents with hidradenitis or acne face depression and higher suicidal rates (Vivar & Kruse, 2018). Patient populations count on primary care to diagnose and accurately treat these issues with confidence (Chandry & Kaimel, 2020). The delicate balance of being knowledgeable but confident in handing off the torch to a specialist is the key to patient satisfaction with skin disorder treatment.
I am getting more comfortable in skin disorders although it is a very large area of knowledge. I look forward to your experiences this week.
Shelly
Reference:
Chandy, N. P., & Kaimal, R. S. (2020). Pediatric skin diseases in primary care: Diagnostic dilemmas a primary physician may face. Journal of family medicine and primary care, 9(9), 5066–5069. https://doi.org/10.4103/jfmpc.jfmpc_761_20
Epocrates. (2019). Epocrates medical references (Version 22.9.1) [Mobile app]. Google Play Store. https://play.google.com/store/apps/details?id=com.epocrates&hl=en_US
K.L. Vivar, L. Kruse (2018) The impact of pediatric skin disease on self-esteem. International Journal of Women’s Dermatology. 4(1): 27-31. https://doi.org/10.1016/j.ijwd.2017.11.002.