Mothers & Children

Common skin problems in children

Caring for skin for children aged 5-12 years

Many of the skin problems seen in toddlers are also seen throughout childhood. Click here to read about conditions which affect toddlers.

Chickenpox. Image: Phyllis Buchanan (PhylB) on FlickrChicken pox - caused by infection of the highly contagious varicella zoster virus.The virus spreads through the air or via physical contact and the incubation period is between 10 and 21 days.

The physical symptoms begin with itchy spots, usually on the chest and back; the rash then spreads all over the body in the following three to four days. The spots develop into blisters which can break easily and form scabs. Other symptoms of chicken pox can include; fever, lethargy, headache, cough and rhinorrhea (runny nose).

Most often, children recover completely without treatment. Paracetamol is recommended for fever and pain relief and topical creams, such as calamine lotion can reduce skin itchiness. Lukewarm baths, lightweight clothing, closely cropped nails and mittens may all prevent scratching which can lead to scarring.

Community Acquired Methicillin Resistant Staphylococcus Aureaus (CA-MRSA) - also known as the superbug, CA-MRSA is a type of bacterial infection in the skin and soft tissue characterized by open wounds and cellulitis (soft tissue infection). It is highly contagious and is rapidly transmitted between school and kindergarten children, or within families. To prevent infection, it is recommended that a child’s cuts or grazes be immediately cleaned and dressed. It is also suggested that carers encourage children to wash their hands regularly and avoid contact with other people’s sores or scars. Treatment involves the administration of oral antibiotics such as clindamycin and tetracyclines.

Eczema - refers to a range of conditions which involve skin inflammation, the most common of these being atopic dermatitis. Atopic dermatitis is characterised by an itchy, red rash which most commonly appears on the face and scalp. The condition usually appears in a child’s first year of life and may be dry, scaly, blistered, weeping, bleeding or warm to the touch.

Atopic dermatitis is a complex disease and, although its precise cause is unknown, various genetic and environmental factors are believed to be involved. As a result, children who have a family history of allergy or dermatitis are more prone to developing this type of dermatosis.

The itchiness of atopic dermatitis can be extremely aggravating, to the extent that it may interfere with a child’s sleep or other daily activities. Babies or children will often try to scratch or rub their affected skin against clothing and objects to alleviate this irritation. It is important to discourage children from scratching their skin as this may cause it to become infected. Some parents find that closely cropping fingernails helps to minimise the damage caused by scratching in younger children; babies may also benefit from wearing ‘scratch mitts’ or being tightly swaddled during their sleep.

Most cases of childhood atopic dermatitis are mild and the vast majority of these outgrow the condition. Unfortunately, a small proportion of people have a moderate to severe condition which persists into adulthood.

Atopic dermatitis is a chronic condition which needs to be continually managed and monitored. It is typical for atopic dermatitis to improve or flare up intermittently, sometimes in response to allergens or other environmental triggers. There are, however, some simple measures you can take to relieve some of your child’s discomfort: regularly (twice daily) apply an emollient, these products smooth the skin and may help to ease the itchiness; dress them in soft clothing; keep them cool where possible; avoid exposure to known allergens or triggers; wash their clothes in mild detergents and bathe them with gentle fragrance-free soaps or soap-free cleansers.

It is important to see a qualified physician to accurately diagnose your child’s skin condition, they will be able to give lifestyle advice and prescribe an appropriate treatment plan.

For more information on symptoms, causes and treatment options, refer to the atopic dermatitis article on our Science of Skin website.

Hives (papular urticaria or welts) - itchy, red, raised areas of skin caused by histamines, chemicals produced by the body in immune response to a variety substances. They are commonly caused by pollen, pet allergens, certain foods, insect bites, medications or infections.

Hives usually last for a few hours or days, then disappear on their own. In the meantime, you can make your child more comfortable by giving them a cool bath, applying calamine lotion to the hives and dressing them in loose fitting clothing. When hives cause significant discomfort, a doctor may prescribe an antihistamine to minimise the swelling.

NB: If a child with hives has difficulty breathing call an ambulance immediately as they may be suffering from anaphylactic shock.

Impetigo (school sores) - a contagious skin infection caused by bacteria (either staphylococcus or streptococcus). It appears as patches of tiny, red, itchy blisters, often around the mouth and nose; though it can also occur elsewhere.

These blisters break open, oozing a yellow liquid and then form yellowy-brown scabs. New blisters can form by touching existing sores then transferring the bacteria to other parts of the body. The blisters usually appear one to ten days after infection, depending on the type of bacteria present. Impetigo is highly contagious, being spread through touching someone with infected skin or sharing their personal items (i.e. bedsheets or clothing). It is more likely to develop on skin that has already been broken, through a cut or bite, for example.

Impetigo is usually treated with oral antibiotics, or by washing the sores twice a day and applying a bactericidal cream. The infection can take a week to ten days to cease, in which time the sores should be dressed to prevent its spread. Furthermore, the child’s clothing and linen needs to be washed each day in this period. Encourage the child not to scratch, and wear gloves or regularly wash your hands when treating impetigo.

Mole (naevi). Image: SuperFantastic on FlickrMoles (naevi) - are benign spots or marks on the skin of different shapes and sizes. Moles can jut out or lie flush with the skin and their colour can range from beige or light pink to dark brown and even black. Some children are born with a few moles, though most develop during their lifetime.

Sun exposure can increase the number of moles on a child’s skin, however most of the time they are harmless and no treatment is required. Occasionally melanoma, the most dangerous type of skin cancer, can arise from moles; though this is very rare in childhood. Nonetheless, it is wise to monitor your child’s moles for any changes and speak to your doctor if you notice anything of concern.

Things to look for include moles which are uneven in shape, larger than half a centimetre in size, have a blend of colours, irregular or blurred edges or appear to be growing.

010202 Molluscam_220Molluscum contagiosum - a viral infection of the skin caused by a poxvirus. It is a contagious disease particularly common in young children. After approximately two to three months of the virus incubating, small, round growths begin to emerge. These are light pink or tan colour and can look similar to warts. They can sometimes become red and irritated or have a tiny white spot in the centre.

Though they can develop anywhere, mollusca in children commonly appear on the face, arms, legs or torso. They often arise in clusters in skin folds such as the armpits, behind knees or in the groin. Molluscum contagiosum is spread through touching infected skin or objects and a child can extend them across their own body by touching or scratching the growths.

While molluscum contagiosum usually resolves on its own over many months, treatment is recommended to stop its spread. Treatments include: cryotherapy (freezing - usually with liquid nitrogen); curettage (removing with sharp instrument under local anaesthetic); laser therapy; astringents (substances which destroy the top layers of skin) and applying topical medications to the skin.

Threadworm. Image: Salvadorjo from Wikimedia commonsPinworms (threadworm, seatworm or Enterobius vermicularis) - are tiny white worms about a centimeter long which live inside the intestines. A child can get this common parasite by touching an object (i.e a toy) that has pinworm eggs on it, then putting their hand to their mouth and swallowing the eggs which then hatch in the intestines.

The female worms move to the anus during the night to lay their eggs, this can cause restlessness and make a child’s bottom very itchy. Children often reinfect themselves by scratching their bottoms and returning the eggs to their mouths. You can check for pinworms by looking at your child’s stools for worms or checking their anus with a torch during the night. Alternatively, you can use a piece of clear sticky-tape or a pinworm paddle (a sterile applicator with an adhesive surface, obtained from your healthcare provider) on the anus, to collect the eggs for laboratory examination under the microscope.

It is simple to eliminate pinworms in children older than two years with over-the-counter medications containing the ingredients mebendazole or pyrantel. A repeat dose is given two weeks later to destroy worms which may have hatched in the meantime and all family members should be treated. Putting clothes and linen through a hot wash will kill any worms or eggs left on them and washing hands regularly helps to prevent the spread of pinworm.

010202 Psoriasis_674Psoriasis - a chronic skin condition in which patches of skin becomes red, inflamed and covered by white, flaky skin. These outbreaks occur because skin cells are produced more quickly than normal, causing a build-up which creates the plaques; this is thought to be caused by faulty signals from the immune system.

There are five types of psoriasis, with plaque psoriasis and guttate psoriasis being those which occur most in children. One in ten people with psoriasis develop the condition as a child and early onset is linked with more severe forms.

Depending on the type and severity of the psoriasis, treatment might involve: medicated creams; oils or moisturisers; oral medication or light therapy. For more information on the types, causes, diagnosis and treatment of psoriasis refer to the psoriasis article on our Science of Skin website.

010202 ringworm_220Ringworm - is an itchy fungal infection of the skin which presents as scaly rings a couple of centimeters wide. Ringworm is contagious and is passed between contact with infected people, pets and personal items (i.e. towels, hairbrushes and clothing).

A topical antifungal usually needs to be applied to the affected areas for three or four weeks, continuing after the rash has disappeared. Occasionally ringworm does not respond and a stronger, prescription, topical or oral medication will be required from your doctor.

The following steps can be taken to prevent reinfection: dry your child thoroughly and keep them cool; don’t let your child share personal items; wash the child’s linen and clothing; have pets with ringworm treated and have children wear thongs in communal swimming or bathing areas.

Warts - warts are benign growths or tumours, usually on the feet (plantar warts) or hands, caused by infection of the human papilloma virus. Warts will occasionally resolve without treatment, however, this can take months and in the interim the virus within existing warts can proliferate and generate fresh ones. Thus, prompt professional treatment with salicylic acid, canthardin or liquid nitrogen is recommended.

References

American Academy of Dermatology, For Kids, Accessed 03 November 2016, <https://www.aad.org/public/kids>.

American Academy of Dermatology n.d., ‘Eczema’, retrieved 11 July 2011, <https://www.aad.org/public/diseases/eczema>.

The Children’s Hospital at Westmead 2010, ‘Chickenpox, retrieved 4 August 2010, <http://www.chw.edu.au/parents/factsheets/chicpoxj.htm>.

CLINUVEL Pharmaceuticals n.d., ‘Atopic Dermatitis’, retrieved 11 July 2011, <http://www.clinuvel.com/science-of-skin/skin-conditions/common-skin-conditions/atopic-dermatitis>.

DermNet NZ 2011, ‘Molluscum contagiosum’, retrieved 4 July 2011, <http://dermnetnz.org/viral/molluscum-contagiosum.html>.

DermNet NZ 2011, ‘Moles’, retrieved 11 July 2011, <http://dermnetnz.org/lesions/moles.html>.

MedicineNet n.d., ‘Pinworms’, retrieved 4 July 2011, <http://www.medicinenet.com/pinworm_infection/article.htm>.

The Royal Children’s Hospital Melbourne 2010, ‘Hives’, retrieved 4 July 2011, <http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=3740>.

State Government of Victoria, Department of Health 2008, ‘Impetigo (school sores) information sheet’, retrieved 11 July 2011, <https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-advice/impetigo-school-sores>.

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