Steer et al reported an Integrated Management of Childhood Illness (ICMI) algorithm for managing common skin disorders in children of Fiji. This can help local health workers to decide on appropriate triage of the patient. The authors are from the University of Melbourne, Colonial War Memorial Hospital (Fiji), WHO, Charles Darwin University, and Royal Darwin Hospital in Australia.
Patient selection: pediatric patient from 2 months to 5 years of age with a skin problem
The patient is evaluated for:
(1) skin itchiness
(2) pain
(3) general danger sign of serious illness
(4) extent of any warmth, redness and/or swelling (localized vs extensive)
(5) swelling or redness around the eyes
(6) discretes sores or lesions with pus or crusting
(7) papules on hands, elbows, trunk, knees, feet
(8) round or oval flat scaly patches
(9) other types of skin lesions
Common Skin Lesions in Fijian Children
Clinical Findings
Action
very severe skin infection
extensive warm redness and swelling, general signs of serious illness
start antibiotics and refer urgently to hospital
periorbital or orbital cellulitis
swelling, redness around eyes
start antibiotics and refer urgently to hospital
abscess or cellulitis
localized swelling, warm and tender, redness
start antibiotic, refer to hospital
impetigo
discrete lesions with pus or crusts
oral antibiotics for 7 days, schedule followup in 5 days
scabies, infected
itchy papules AND lesions with pus or crusts
oral antibiotics for 7 days, anti-scabies topical skin cream for patient and whole family, followup in 5 and 14 days
scabies, non-infected
itchy papules
anti-scabies topical skin cream for patient and whole family, followup in 14 days
dermatophyte fungal infection
round to oval flat scaly patches with or without itchiness
topical antifungal agent for 14 days, followup in 2 weeks
other skin condition
any skin lesion not meeting above criteria
refer to skin clinic
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