Nearly all children will have a skin problem at some point of their lives. Consultation regarding a skin problem is one of the common causes of OPD visit to a paediatrician’s clinic. Most skin lesions are due to either allergies or viral in paediatric age group. Here, the commonly observed lesions are listed and discussed.
Molluscum contagiosum is a common, benign, self-limiting viral infection of the skin. It generally affects children and is caused by a human specific poxvirus. Infection is rare in children under one year of age; it typically occurs in the two to five year age group. Infection follows autoinoculation or contact with affected people. The incubation period is from two weeks to six months. The condition is more common in young children and in children who swim, who bathe together, and who are immunosuppressed.
Molluscum appears as multiple dome-shaped pearly or flesh colored papules with a central depression (umbilication), which usually appear on the trunk and flexural areas. They vary in size from one mm to 10 mm, with growth occurring over several weeks.
Treatment: In people with normal immune systems, the disorder usually goes away on its own, over a period of some months to years. Persons with a compromised immune system (such as AIDS) may have a rapidly worsening case of molluscum contagiosum.
Individual lesions may be removed surgically, by scraping, de-coring, freezing, or through needle electro surgery. Surgical removal of individual lesions may result in scarring. Medications, such as those used to remove warts, may be helpful in removal of lesions, but can cause blistering that leads to temporary skin discolouration. Cantharidin, commonly called ‘beetle juice,’ is the most common solution used to treat the lesions.
Atopic dermatitis is due to a hypersensitivity reaction (similar to an allergy) in the skin, which leads to long- term swelling and redness (inflammation) of the skin. People with atopic dermatitis may lack certain proteins in the skin, which leads to greater sensitivity.
Atopic dermatitis is most common in infants. It may start as early as age two to six months. Many people outgrow it by early adulthood. Children with atopic dermatitis often have asthma or seasonal allergies and test positive to allergy skin tests. There is often a family history of allergic conditions such as asthma, hay fever, or eczema.
However, atopic dermatitis is not caused by allergies. The condition tends to get worse when the person is exposed to certain triggers. The following can make atopic dermatitis symptoms worse:
- Allergies to pollen, mould, dust mites, or animals
- Cold and dry air in winter
- Colds or the flu
- Contact with irritants and chemicals
- Contact with rough materials, such as wool
- Dry skin
- Emotions and stress
- Exposure to too much water, such as taking too many baths or showers and swimming too often
- Feeling too hot or too cold, as well as sudden temperature changes
- Fragrances or dyes added to skin lotions or soaps
The type of rash and where it appears depends on the age of the patient:
- In children younger than age two, skin lesions begin on the face, scalp, hands, and feet. They are often crusting, bubbling, or oozing rashes that itch.
- In older children and adults, the rash is more commonly seen on the inside of the knees and elbows, as well as the neck, hands, and feet.
- During a severe outbreak, rashes may occur anywhere on the body.
Itching, which is sometimes intense, almost always occurs. Itching may start even before the rash appears. Atopic dermatitis is often called the ‘itch that rashes’ because itching starts, and then the skin rash appears from scratching.
Treatment: Taking care of your skin at home may reduce the need for medications.
- Avoid scratching the rash or skin.
- Relieve the itch by using a moisturiser, topical steroid cream, or other prescribed cream and taking antihistamines to reduce severe itching.
- Keep you child’s fingernails cut short. Consider light gloves if night time scratching is a problem.
- Keep the skin moist (called lubricating or moisturising the skin). Use ointments (such as petroleum jelly), creams or lotions two to three times a day. Moisturisers should be free of alcohol, scents, dyes, fragrances, or other chemicals.
- A humidifier in the home will also help
Medications: These include antihistaminics to avoid the itchiness, which helps the skin to heal. Also topical corticosteroid ointments are prescribed when the symptoms are too much.
Urticaria (also called hives) is a condition in which red patches and wheals occur on the skin. The release of chemicals such as histamine from mast cells in the skin causes small blood vessels to leak fluid. This results in tissue swellings called ‘wheals’. The wheals can be a few millimetres or several centimetres in size, coloured, white or red, often surrounded by a red flare, and frequently itchy. Wheals may form rings, a map-like pattern or large patches. Each wheal may last a few minutes or several hours, and may change shape.
Hives lasting less than six weeks are called ‘acute urticaria.’ With this type of hives, the cause can often be found. Certain foods, medications, viruses and other illness and even things in your home (cats, dogs, dust) can cause hives. Insect bites and internal diseases may also be responsible.
Sometimes, hives will occur in individuals repeatedly without an obvious cause. This is called ‘chronic urticaria.’ While mainly a nuisance and not associated with other serious internal disease, the exact mechanism for this condition is not known, and the hives usually disappear on their own, though it may take months to years. Frustration is common, since efforts at attempting to identify an underlying cause are usually not successful.
Treatment remains a continuous dose of antihistaminic agent. Only in extreme cases an oral steroid is prescribed.
Infectious skin lesions are a major cause of skin lesions in childhood. Bacterial causes such as impetigo is one of the most common skin infections among kids, and usually produces blisters or sores on the face, neck, hands, and diaper area.
This contagious superficial skin infection is generally caused by one of two bacteria: Staphylococcus aureus or Streptococcus pyogenes (also called group A streptococcus, which also causes strep throat). Methicillin-resistant Staphylococcus aureus (MRSA) is also becoming an important cause of impetigo.
Impetigo usually affects preschool and school age children. A child may be more likely to develop impetigo if the skin has already been irritated by other skin problems, such as eczema, poison ivy, insect bites, and cuts or scrapes due to minor trauma.
Good hygiene can help prevent impetigo, which often develops when there is a sore or a rash that has been scratched repeatedly.
Treatment includes either an antibiotic ointment or oral antibiotics depending on the severity of the lesions.
Viral fevers like chicken pox, measles, German measles, hand-foot-mouth disease are other common causes of skin problems in childhood.
Ringworm is a common skin disorder, otherwise known as tinea, that can affect the skin on the body (tinea corporis), scalp (tinea capitis), feet (tinea pedis, or athlete’s foot), or groin (tinea cruris, or ‘jock itch’). Ringworm is not, as the name suggests, caused by a worm. It is caused by a fungal infection of the skin, and the fungi responsible for the infection are known as dermatophytes.
The fungi that cause ringworm tend to grow in warm, moist areas of the body, such as areas of frequent sweating. Most commonly, ringworm results in itchy, scaly, and reddened skin and bald patches if the scalp or beard areas are involved. The infection is highly contagious and is passed from person to person through direct skin contact or via contact with contaminated items such as toilet articles, clothing, and even by contaminated shower or pool surfaces.
Treatment includes topical anti-fungal ointments. Oral anti-fungal drugs are also used for severe widespread lesions for two to three months.