‘Itch-Scratch-Itch’… What a dilemma!

‘Itch-scratch-itch’….is a typical chief complaint for many children who present to the pediatric primary care office. The infant is irritable and the mother wants the infant to stop being irritable; the child, or adolescent wants to stop ‘feeling itchy’; and their parents want medications that will immediately return the skin to normal. What a dilemma!

As nurses, our undergraduate education provided a solid foundation for nursing interventions to maintain skin integrity during hospitalizations. Today, nurses in both in-patient and outpatient settings perform skin assessments regularly and provide nursing interventions for skin care to provide comfort measures and to keep the skin intact, well hydrated, and free from preventable skin infections. So robust is this nursing educational foundation and practice that many pediatric nurse practitioners (PNPs) build on this foundation in advanced practice and develop expertise in the assessment and diagnosis of children presenting with a variety of skin conditions by prescribing medications and skin care strategies and/or making referrals to pediatric dermatologists.

As is always true in clinical practice, individual expertise must constantly be questioned as new research and evidence-based information emerges. In this issue of Contemporary Pediatrics, the article authored by Drs Osier, Matiz, Ghali, and Eichenfield (Staphylococcis aureus infections in atopic dermatitis) provides some new and insightful information on the pathogenesis, treatment, and the clinical course for children with atopic dermatitis and comorbid staphylococcus aureus infections. The authors base part of their article on the results of a National Institutes of Health study on the microbiomes of patients with or without atopic dermatitis. The PNPs reading this article will obtain an in-depth understanding of the skin microbiome of atopic dermatitis and recognize the relationship between the pathogenesis and the accuracy of the diagnosis and reasons for recurrent disease flares as well as current evidence-based treatment strategies. This information is directly applicable to PNP clinical practice and may help PNPs reduce the number of pediatric patients who return with ‘itch-scratch-itch’ as their chief complaint.