GuidelinesIMCI
Itchy Skin
IMCI - Skin problems
Papular Urticaria or Papular Pruritic Eruptions
Papular Urticaria or Papular Pruritic Eruptions
Look
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Signs
- Itchy papules at different stages of evolution
- Found on the arms and legs
- Healed lesions are often dark/ hyperpigmented
- The itch is difficult to manage
- May flare after starting ART, but generally improves as the CD4 count increases
- Essential to exclude scabies
Treat
- Trim finger nails and avoid scratching
- Apply 1% hydrocortisone to new, inflamed lesions for five days
- Give oral antihistamine to relieve itch:
- Short term use: Chlorphenamine, oral, 0.1mg/kg/ dose 6-8 hourly
- Long term use for children 2-6 years: Cetirizine, oral, 5mg once daily
- Caution: Do not give antihistamines to children < 2 years of age - Refer if no improvement after 2 weeks or if underlying malignancy or systemic disease is suspected
Features in HIV Infection
- Is a clinical stage 2 defining case
- Consider HIV infection in all cases
Ringworm (Tinea)
Look
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Signs
- An itchy circular lesion with a raised edge and fine scaly area
- Scalp lesions may result in loss of hair
Treat
- Avoid sharing clothes, towels and toiletries (e.g. brushes and combs) to prevent spreading the infection to others
- Wash and dry skin well before applying treatment
- Apply an imidazole (e.g. clotrimazole 1% cream) three times daily until two weeks after lesions have cleared
- For scalp infections (tinea capitis) give oral fluconazole 6mg/kg once daily for 28 days
Features in HIV Infection
- Extensive: there is a high incidence of coexisting nail infection which has to be treated adequately to prevent recurrence of tinea infections of skin
- Fungal nail infection is a clinical stage 2 defining disease
Scabies
Look
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Signs
- Intense itching, more severe at night
- Small burrows between fingers, tows,elbow areas and buttocks
- Secondary infection may occur
- Small babies may have vesicles and pustules on the palms and soles and face
- The infestation spreads easily, usually affecting more than one person in the household
Treat
- All close contacts should be treated simultaneously (even if not itchy)
- Wash all bed linen and underwear in hot water
- Expose all bedding to direct sunlight
- Put on clean clothes after treatment
In children 6 yrs and older
- Apply benzyl benzoate 25% from the neck to the toes.Allow the lotion to remain on the body for 24 hours , then wash off using soap and water
If benzyl benzoate is unsuccessful or in children > 6 yrs
- Apply permethrin 5% lotion. Leave on overnight and wash off in the morning (may be repeated after one week)
- Treatment may need to be repeated after one week
- Treat secondary bacterial infection if present
Features in HIV Infection
- HIV-positive children, may present with crusted scabies - extensive areas of crusting mainly on the scalp, face, back and feet
- Patients may not complain of itching
Integrated Management of Childhood Illness 2022; Skin problems; Itchy Skin
Last checked for updates: June 2023