Advances in research on acute skin failure (ASF) in children

Acute skin failure (ASF) in children is a serious condition caused by hemodynamic instability or hypoperfusion, resulting in unavoidable damage to the skin and subcutaneous tissues. As a rapidly progressing and potentially life-threatening condition, recent research on ASF in children has yielded a series of new advancements, warranting attention from parents and caregivers.

Pathological mechanisms of acute skin failure in children

The core pathophysiological changes in acute skin failure in children mainly include hypoperfusion, hypoxia, inflammatory response, increased vascular permeability, and edema. When a child's cardiac output decreases or the blood's oxygen-carrying capacity declines, skin tissue becomes underperfused, causing cells to switch from aerobic to anaerobic metabolism. Insufficient ATP synthesis leads to cellular edema. Simultaneously, the inflammatory response impairs the dermal barrier and subcutaneous tissue function, increases vascular permeability, and allows plasma proteins and water to leak from blood vessels, further exacerbating tissue damage.

Unique clinical presentation of pediatric ASF :

Unlike adults, where ASF commonly occurs in the buttocks and heels, it is particularly common in the head of children. At the neonatal stage, the brain's volume is already 25% of its adult size, but its weight is only 5%, making the occipital region the most prominent bone structure during childhood development, bearing more pressure per unit area. The sacrococcygeal region is also a common site for ASF in children, which is related to the fact that the sacrum in children is composed of five unclosed sacral vertebrae, resulting in fewer vascular branches.

In children, ASF lesions often present as sudden, deep red, pear-shaped, butterfly-shaped, horseshoe-shaped, or irregular ulcers, which can be red, yellow, or black. These lesions are mostly full-thickness skin defects and often appear within 2 hours to 2 weeks before the child's death, and deteriorate rapidly within hours.

Identification methods :

Multiple organ dysfunction syndrome (MODS) is an independent risk factor for acute septic exacerbation syndrome (ASF) in critically ill children. Studies have shown that nearly 95% of children with ASF developed MODS one week prior to onset, with at least two systems experiencing dysfunction. Immunosuppression is also a significant associated factor for ASF; all children who died from ASF had an immunosuppressed state.

Key indicators for identifying ASF include an increased skin mottling score (2-5 points), prolonged capillary refill time (more than 2 seconds), decreased percutaneous oxygen saturation at the fingertips (more than 5% decrease within 2 hours), and decreased skin sensation. When a child presents with these signs and characteristic skin lesions, a diagnosis of ASF should be considered.

Advances in Prevention and Nursing

The key to preventing ASF in children lies in improving tissue perfusion and promptly correcting hypotension and hypoxemia. For critically ill children, close monitoring of the skin is essential, especially of common sites such as the head and sacrococcygeal region. Nursing care should include regularly adjusting the child's position to reduce continuous pressure on affected areas and keeping the skin clean and dry.

Nutritional support is also very important in the management of ASF. Ensuring adequate protein and calorie intake and maintaining electrolyte balance helps improve the overall condition of the child.

Research on childhood aspirin-deficiency syndrome (ASF) is still in its early stages, with most studies being large-scale clinical observational studies. More prospective studies are needed in the future to identify the specific risk factors for childhood ASF and to determine targeted prevention and intervention measures.

Improving healthcare professionals' awareness and ability to identify childhood abscess (ASF) is crucial. This helps in the early detection of high-risk children and timely intervention, reducing the incidence and severity of ASF. For parents, understanding the basics of ASF, especially when their child has a serious condition, is essential for closely observing skin changes and promptly reporting them to healthcare professionals, thus protecting their child's skin health.

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Editor: kiki Jia