Many issues confront camp nurses in our practice specialty. Every nurse worries about massive injuries, disease outbreak, or severe allergic reaction. However, one of the most persistent and annoying issues that I found in my camp practice was the abundance of dermatological complaints that I was asked to evaluate and address. This was a topic that my previous training and background left me feeling unprepared for, so I thought I would give a little information on some of the more common skin issues I come across and how to go about addressing them.
I am not a dermatologist, all advice offered is sourced to the best of my abilities, but should not be viewed as authoritative or take the place of your physician's evaluation or instructions.
Contact Dermatitis is a localized irritation of the skin, a generally flat itchy rash, but sometimes can present a blisters or hives, that is caused by contact with an irritating substance. The substance can be just about anything; but soaps, detergents, cleaning products, latex, kerosene, ethylene oxide, certain foods, and drinks are often the main offenders. The rash can occur instantly, but more often takes hours, and sometimes up to three days to appear after exposure Trying to isolate the source of a contact dermatitis in the camp setting is often an exercise in frustration. After many instances of trying to play medical detective, I personally only spend time and energy trying to isolate an irritating substance if the reaction is severe or persistent. If the reaction is severe or distressing it may be outside the scope of camp practice, it may require evaluation and testing by an allergist.
Treatment of contact dermatitis is generally focused on relieving the itch and irritation. A cool compress and a topical hydrocortisone is generally all that is required. If the reaction is large or particularly annoying. A systemic H1 antagonist such as diphenhydramine (Benadryl), Loratadine (Claritin), or Fexofenadine (Allegra) may be needed. An H1 inverse agonist, such as Cetirizine (Zyrtec) can be used in addition to or in place of an H1 antagonist. If needed an H3 antihistamine, such as Ranitidine (Zantac) may be added. (1). Occasionally perception corticosteroids may be needed.
Impetigo is a common camp malady, that most often affects younger campers. Appears as a weeping blister or sore that has a yellow honey crust. The sores are a dermal infection of generally staphylococcus aureus, but Streptococcus is also a causative organism. The infection is spread by direct contact and is transmitted very easily by scratching.
Treatment of mild impetigo is often done with a topical antibiotic ointment such as mupirocin. In more severe cases a systemic antibiotic is needed. Due to the extremely contiguous nature of impetigo, my camp’s physician usually writes for both systemic antibiotics and a mupirocin applied after gentle cleansing twice a day. Laundering of personal linens and aggressive cleaning of common surfaces is required to control the spread of infection. (2)
Tinea corporis may have a variety of appearances; most easily identifiable are the enlarging raised red rings with a central area of clearing. Other presentations may be a patchy or consolidated rash that has a raised edge with a scaly texture. The rashes are generally found on areas of the body prone to be especially moist. Tinea corporis is commonly called ringworm, but different sites of fungal infection have different common names such as athlete's foot or jock itch.. Tinea corporis is caused by a tiny fungus known as dermatophyte. These organisms normally live on the superficial skin surface, and when the conditions are favorable, they can induce a rash or infection. The disease can also be acquired by person-to-person transfer usually via direct skin contact with an infected individual. Be mindful that a fungal presentation on one part of the body may be spread to other sites. A common saying is “apply socks before jocks” to prevent a case of athlete's foot from becoming jock itch.
Treatment with topical antifungals, such as tolnaftate, is generally applied to the area twice a day for at least 3 weeks. The lesion usually resolves within 2 weeks, but therapy should be continued for another week to ensure the fungus is completely eradicated. Severe cases may require treatment with oral medication, and should be referred to the physician for evaluation. (3)
A solid dermatological reference may be handy to have around camp. Obviously severe skin issues would be referred to the doctor, but a good reference guide such as Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology can be helpful in identifying and initiating treatment of common skin issues. (4) Please feel free to use the comment section to share any common skin issues and their treatments that come up in your camp practice.