Mothers & Children

Common skin problems in toddlers

Caring for skin from 18 months - 4 years

Many of the skin problems seen as babies or during childhood are also seen in toddlers. Click on the links to read about conditions which affect children or newborn babies.

Chickenpox. Image: Johann Dreo (nojhan) on FlickrChickenpox - 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.

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.Fifth disease. Image: Andrew Kerr from Wikimedia commons

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.

Fifth disease (erythema infectiosum or slapped cheeks disease) - is an infection caused by human parvovirus B19. Initially, a child may have a fever and cold-like symtoms, followed approximately one week later by the appearance of a rash, typified by bright red cheeks. By the time the rash becomes apparent the child is no longer infectious and usually feels well. The rash persists for seven to ten days, fading in a lacy pattern; it can reappear in the following weeks if the child gets hot. In a healthy child, the infection is generally mild, with some children having no symptoms whatsoever.

If your child is uncomfortable with fever paracetamol or ibuprofen may help (make sure you read the packaging for the appropriate dose), otherwise, treatment simply involves rest and keeping up fluids. The virus is spread through saliva (i.e. kissing or sharing cutlery) and nasal secretions (i.e. coughing or sneezing), so the risk of infection can be reduced by children regularly washing their hands.

Hand Foot Mouth Disease. Image: MidgleyDJ from Wikimedia commonsHand, foot, and mouth disease (HFMD) - an infection caused by several different viruses, often the coxsackie virus. HFMD symptoms can include a slight fever, lethargy, sore throat, loss of appetite and a red, spotty rash on the hands and feet.

After 1-2 days sores erupt on inside of mouth, making it difficult to eat, drink and swallow. HFMD is contagious, being spread through saliva, nasal secretions and fluid within the blisters of the rash.

Generally, children recuperate fully within ten days. In the meantime, you can relieve pain and discomfort with an appropriate dose of paracetamol or ibuprofen (be sure to read the instructions on the packaging). Your child’s doctor may also prescribe a medicated solution to coat the sores and ease pain. Watch your child’s temperature and ensure they don’t become dehydrated, since the mouth is sometimes too painful to drink. Softer foods will be easier for the child to eat and cold drinks or icy poles may be soothing; avoid spicy, salty and sour foods.

Molluscam contagiosum. Image: Salvadorjo from Wikimedia commonsMolluscum contagiosum - is 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.

010202 Threadworm_220Pinworms (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.

Psoriasis - 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 the Science of Skin website.

Ringworm. Image: Fluteflute from Wikimedia commonsRingworm - 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.

References

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

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

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

NSW Government 2008, ‘Hand, Foot and Mouth disease’, retrieved 4 July 2011, <http://www.health.nsw.gov.au/factsheets/infectious/handfootmouth.html>.

The Royal Children’s Hospital Melbourne 2010, ‘Slapped cheek or Fifth syndrome’, retrieved 4 July 2011, <http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=10751>.

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

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