CHILDHOOD ECZEMA (atopic dermatitis)

Atopic dermatitis, often called eczema, or atopic eczema, is very common skin disease. It affects around 10% of all infants and children. The exact cause is not known, but atopic dermatitis results from a combination of family heredity and a variety of conditions in everyday life that trigger the red, itchy rash.

How do we know if it is atopic dermatitis?

• Time of onset. This type of eczema usually begins during the first year of life and almost always within the first five years. It’s seldom present at birth, but it often comes on after six weeks. Other rashes also can start at that time, so it may be confusing at first but most rashes disappear within a few days to weeks. Atopic dermatitis tends to persist. It may wax and wane, but it keeps coming back.

• Itching. Atopic dermatitis also is a very itchy rash. Much of the skin damage comes from scratching and rubbing that the child cannot control.

• Location. The location of the rash also helps us recognize atopic dermatitis. In babies, the rash usually starts on the face or over elbows or knees, places that are easy to scratch and rub. It may spread to involve all areas of the body, although the moist diaper region is often protected. Later in childhood the rash is typically in the elbows and knee folds. Sometimes, it only affects the hand, and at least 70% of people with atopic dermatitis have had eczema at some time in their life. Rashes on the feet, scalp, or behind the ears are other clues that might point to atopic dermatitis.

• Appearance. The appearance of the rash is probably the least helpful clue because it may be very different from one person to another.

• Heredity. If other family members or relatives have atopic dermatitis, asthma, or hay fever, the diagnosis of atopic dermatitis is more likely.

What causes atopic dermatitis?

Atopic dermatitis is not contagious. People with atopic dermatitis cannot “give” it to someone else. Atopic dermatitis inflammation results from too many reactive inflammatory cells in the skin. Research is seeking the reason why these cells over-react. Patients with atopic dermatitis (or asthma or hay fever) are born with these over-reactive cells. When something triggers them, they don’t turn off as they should. We try to control atopic dermatitis by preventing the trigger factors that turn on the inflamed skin, or by “damping the flames” with anti-inflammatory therapies.

What triggers atopic dermatitis?

Trigger factors may be different for different people. Most children are worse when they have a cold or other infection. Most have worse problems in the winter; but others simply can’t stand the sweating during hot, humid summer weather. Let’s look at the trigger factors that seem to affect every child with atopic dermatitis.

• Dry skin
• Irritants
• Stress
• Heat and sweating
• Infections
• Allergens

How can you avoid triggers?

1. Keep the skin barrier intact. MOISTURIZE
2. Wear soft clothes that “breathe.” Avoid fabrics of wool, nylon, or stiff material.
3. If sweating causes itch, find ways to keep cooler. Such as:
4. Reduce exertion, especially during times of flare.
5. Layer clothing and adjust temperature settings.
6. Don’t overheat rooms, especially the bedroom.
7. Use light bedclothes.
8. When itching from sweating, dust, pollen, or other exposures, take a cooling shower or tub bath.
9. Learn to recognize signs of infection and treat early.

If you suspect food allergy, be systematic. Likely offenders are eggs, milk, peanuts, soy, wheat, and seafood, but any food can do it. Can you exclude the most likely offender for a week? Substitute hydrolysate for cow formula. Keep a food diary. When the skin clears up, try the food. Watch for signs if itching or redness over the next two hours. Do not try a suspect food if it causes hives or face swelling. Don’t exclude multiple food groups at the same time. It is rare to have more than one or two food allergies, and your child can get malnourished with prolonged avoidance of many foods.

With allergy-prone kids, furry animals are a risk. If you must have pets, keep    them outside or at least off beds, rugs, and furniture where the child plays. Dust mites collect in bedroom carpets and bedding. Simple control measures include covering pillows and mattresses, removing bedroom carpets and frequent washing of bedclothes in hot water.

Think about stress-causing events and ways to cope with them. Review problems with your doctor. Try to make atopic dermatitis treatments part of a daily, family routine. Encourage children with atopic dermatitis to do what they can on their own.

Treatment

• Moisturizers. Ointments such as petroleum jelly (such a Vasoline) are best unless they are too thick and cause discomfort. Creams may be fine for moderately dry skin or in hot, humid weather. Apply them to wet skin, immediately after bathing. Lotions and oils are not rich enough and often have a net drying effect on atopic dermatitis on skin.

• Corticosteroids. Often called topical (applied to the skin) steroids, these are cortisone-like-medications used in creams or ointments which your doctor may prescribe (Hydrocortisone, Desonide, Triamcinolone). They are not the same as the dangerous “steroids” some athletes misuse. Cortiscosteroid medicines are very helpful. Often they are the only treatment that can calm the inflamed skin.

Use of steroid ointments and creams requires good judgement and careful supervision. They come in strengths from mild to super-potent. Hydrocortisone is quite safe. The more potent ones can cause thinned skin, stretch marks, and other problems if used too many days in the same areas of the body. Parents should monitor the child’s use. Ask the doctor about potency and side effects of prescribed corticosteroid medicines.

• Antibiotics. Oral or topical antibiotics reduce the surface bacterial infections that may accompany flares of atopic dermatitis.

• Antihistamines. Often prescribed to reduce itching, these medicines may cause drowsiness but seem to help some children.

• Tar preparations. Tar creams or bath emulsions can be helpful for mild inflammation.

When will my child outgrow atopic dermatitis?

IMPETIGO

Impetigo is a skin infection caused by bacteria, usually staph or strep. Impetigo is contagious. The condition starts as a tiny, barely perceptible blister on the skin usually at the site of a skin abrasion, scratch, or insect bite. Over the next few days, red and itchy sores begin to ooze, leaving behind a sticky golden crust spots that grow larger day by day. The hands and face are the favorite locations for impetigo, but it often appears on other parts of the body.

Parents should keep a watchful eye

Parents should not let impetigo run its course, as it may continue indefinitely without treatment. In rare cases, impetigo can lead to a form of kidney disease known as acute glomerulonephritis.

Cuts and scrapes on a very young child will likely be noticed as the parent bathes the child. Unfortunately, after children reach a certain age and bathe alone, they tend to demand privacy for their bodies. It is important that parents teach their children to report any unusual rashes, bumps, or irritations to them so that care may be taken to avoid infection.

and is contagious.

How does one get impetigo?

While the germs causing impetigo may have been caught from someone else with impetigo it usually begins out of the blue without an apparent source of infection.

Contagion

Impetigo is contagious when there is crusting or oozing. While it’s contagious, take the following precautions:

• Patients should avoid close contact with other people.

• Children should be kept home from school for 1-2 days.

• Use separate towels for the patient. His towels, pillowcases, and sheets should be changed after the first day of treatment. The patient’s clothing should be changed and laundered daily for the first two days.

All these measures are only needed during the contagious-crusting or oozing-stage of impetigo. Usually, the contagious period ends within two days after the treatment starts. Then children can return to school and special laundering and other precautions stopped. If the impetigo doesn’t heal in one week, please return for evaluation.

Treatment

Antibiotics taken by mouth usually clear up impetigo in four to five days. It’s most important for the antibiotic to be taken faithfully until the prescribed supply is completely used up. In addition, an antibiotic ointment should be applied thinly four times daily. Bacitracin, Polysporin of Bactroban ointment is advised. Bacitracin and Polysporin can be purchased without a prescription.

Keys to making treatment successful include:

• Crusts should be removed before ointment is applied.

• Soak a soft, clean cloth in a mixture of ½ cup of white vinegar and a quart of luke warm water.

• Press this cloth on the crusts for 10-15 minutes three to four times a day as long as you see crusting or oozing.

• Then gently wipe off the crusts and smear on a little antibiotic ointment.

• You can stop soaking the impetigo when crusts no longer form.

• When the skin has healed, stop the antibiotic ointment.

KERATOSIS PILARIS

Keratosis pilaris is a common skin disorder which may affect the sides of the upper arms, the anterior thighs and the face. It usually appears between the ages of two and three, but may only become noticeable later, usually in the wintertime. In fact, most people with keratosis pilaris notice that it improves in the summer and worsens in the winter.

Generally, the typical changes in the skin are rough-surfaced, slightly red bumps, each of which is at the opening of a hair follicle. This is probably an inherited trait just as some people inherit curly hair or blue eyes. It is really harmless, but may be somewhat unsightly and may occasionally itch slightly.

Treatment

Fortunately, the keratosis pilaris on the face almost always disappears within a year or two after the onset of puberty. The other areas may remain a problem for many years. Treatment is never rapidly effective, but is usually beneficial. Several different medications may need to be tried before the one that works best for you is found. Besides prescription medicines, you can help yourself by regularly using a good moisturizing cream or lotion on the affected areas.

MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a virus-caused growth which appears as a small bump on the skin, often with a small, central, dimple-like depression. It may occur on any part of the body and there may be a single growth or as many as 50 or more.

As the name suggests, these growths are contagious and are spread from place to place on the body and to other people by physical contact. Sometimes they are spread by sexual contact and if this is the case, sexual partners should be examined for presence of lesions.

Treatment

Treatment consists of physically removing these superficial growths from the skin. This may be done by curettement (scraping them off with a special surgical instrument), application of various medicines to the growths or by freezing them with liquid nitrogen. Molluscum contagiosum lesions may also become infected with bacteria and may sometimes require antibiotic therapy. Since molluscum contagiosum lesions sometimes go away by themselves, treatment by cautery or surgery requiring stitches is avoided because of the scarring that results from these methods.

Sometimes new lesions keep appearing after treatment. This is probably because some growths were in an early stage at the time of the treatment and could not be seen with naked eye. Eventually, after all visible and incubating lesions have been destroyed the appearance of new molluscum contagiosum lesions will stop.

SCABIES

Scabies is a highly contagious, but curable, skin disease that affects nearly one third of a billion people worldwide. It is caused by a tiny mite, just barely visible to the naked eye, that spends nearly its entire life in or on the human skin.

Although more common in warm climates, scabies can occur anywhere and within all social and income levels. It affects men, women, and children of all ages.

Prevention Transmission

Scabies is highly contagious and easily transmitted from person to person through close physical contact, such as between family members, sexual partners, or children playing at school. An unproven, but possible method of transmission is via infested clothing, bedding and towels.  To avoid reinfestation, you doctor may recommend that all affected household members be treated at the same time with the same 24 hour period.

Although scabies mites can’t live long without a human host, there have been a few cases of apparent transmission through infested clothing and bedding. Even so, heroic cleaning efforts are generally unnecessary. Normal hot water laundering of towels, linens, and all clothing used within the previous 48 hours is typically sufficient to prevent reinfestation. Clean clothes or heavy winter jackets and sweaters need not be cleaned.

Treatment

Please see a physician or dermatologist for treatment options.