Question

A 6 month-old male with a past medical history of eczema presents to the clinic today with a chief complaint of a reddened area over the inner left thigh. The area is warm, mildly swollen and tender with a central lump. He started having tactile fevers, irritability, and poor feeding today which prompted the mother to bring him for evaluation. VS: T 38.5, P 110, R 26 He is fussy but distractible with a pacifier. He has a left upper inner thigh erythematous lesion measuring 3 x 4 cm. The skin over the area is mildly indurated, warm, brightly erythematous, and tender. Near the center of the lesion, a 1x2 cm raised and fluctuant pustule filled with purulent material is noted. There is no joint involvement. What other assessments do you want to make or history questions do you want to ask? What are your primary concern for this child/family? What medical care do you anticipate from the provider? What education will you give the family before discharge?

Answer 1

What other assessments do you want to make or history questions do you want to ask?

• Assessment of the type of skin.
• Assess for diaper rash and allergens such as home dust, environmental hazards, bathing additives.
• Assess the severity of eczema.
• Collect the history of
• Frequency of bathing or showering.
• Use of moisturizer
• adverse reactions to any topical agents
• Family history of any allergens.
• Cultural practices and beliefs.

What is your primary concern for this child/family?

• Make the child calm by placing in a comfortable position.
• Provide psychological support to the mother and make her support the baby.
• Plan for skin care and for adequate feeding.
• Talk with the mother about the care needed and treatment therapy.

What medical care do you anticipate from the provider?

• The first line of treatment is the use of ointments and gentle moisturizer.
• Topical steroids for the treatment of a fluctuant pustule filled with purulent material.
• The dietician should be included to ensure the adequate nutrition needed for the child.
• Oral steroids if necessary based on the severity of the inflammation.

What education will you give the family before discharge?

• Observe the child is an allergen to any dairy or food.
• Use of cotton clothes and avoid synthetic materials.
• Provide soft, wrinkled free bedding for sleeping.
• Keep the child's nails short to prevent itching.
• Use of moisturizer every day after bath to avoid dryness of the skin.
• Apply plenty of ointments or creams over the lesion.