Common Skin Conditions in Children

Liz Moore and Emma KingDermatology Nurse Consultants

Diagnosis?

Nummular DermatitisDisc pattern rash (discoid eczema)Clearly demarcated edgesOccurs at any ageCan be associated with atopic eczemaItchySurrounding skin not as dry at atopic eczemaProne to secondary bacterial infectionOften thought to be ringworm

Treatment

General eczema managementMore resistant to treatmentMay require more intensive wet dressing application and admissionPotent topical steroidsTar preparationsPhototherapy (UV radiation)Intralesional steroid injections – nodular prurigo

Diagnosis?

Eczema Herpeticum

Herpes simplex virus 1Affinity for the skin and nervous systemFluid filled blisters – vesiclesMultiple crusted erosionsGrouped, punched outPainful, increased itchViral swabMaybe unwell – fever and malaiseSecondary bacterial infection

Treatment

NO TOPICAL STEROIDSRemove crusts – soaks or compresses+/- oral/IV AcylovirMost often oral KeflexAdmission prn – severe extensive diseaseOphthalmology review if involves the eyes

Diagnosis?

Molluscum Contagiosum

Caused by a harmless virus (MCV)PoxvirusVery common in childrenTransmitted by swimming pools, sharing baths, towels and direct contactIn adults most often a sexually acquired infectionPearly papuleCentral dimple and core

Treatment

Self limiting, but may take up to 2 yearsComplicated by atopic eczemaTreatment involves irritating the lesions –Burow’s solution diluted 1:10, Benzac gel, occlusive tape, Aldara, CantharoneSqueeze, curette, cryotherapy - ? scaringShower rather than bathAtrophic scarring with or without treatment

Diagnosis?

Psoriasis

Inflammatory disease of the skinErythema and scaleFamilialIncreased epidermal proliferation Increased rate of cell turnover thickens the epidermis and produces scalingTriggers – infections, trauma, stress, drugs Peaks of onset – 16 to 22 years, 57 to 60 yearsPlaque, Guttate, Flexural, Erythrodermic, Palmoplantar, Scalp, Nail, Genital

Treatment

Emollients, topical steroids, keratolytics, tar, dithranol, calcipotriol, antibiotics (if infected), Immunosuppressants e.g. methotrexate, cyclosporinAcitretinPhototherapyBiologicsPsychological effect – suicidal ideationStress management, exercise, weight reduction

Diagnosis?

WartsProliferation of the skin > benign tumors Human papillomavirus (HPV) Types

Common warts, plantar wartsPlane wartsGenital wartsSubungual warts

Transmission is from person to personIn children most spontaneously resolve within 2 yearsPersistent in immunosupressed individuals

TreatmentTreatment is designed to be cytodestructive (destroy all epidermal cells within the tumor)Common warts and plantar warts

Topical keratolytics – occlusion and paringCryotherapyImmunotherapy - DCPImiquimod

Plane wartsCryotherapyKeratolyticsTretinoin

Genital wartsCryotherapyImiquimod

Subungual wartsKeratolyticsCryotherapy

Recurrence rate is high therefore many treatments may be necessary

Diagnosis?

Scabies

Caused by a mite – Sarcoptes scabieiDirect skin-to-skin contact, close physical contactNot from animalsBurrows a tunnel and releases toxic secretionsIncubation – 3 weeksItching develops after 4-6 weeks due to sensitisation, allergic reaction to the presence of the miteEczematous changesItch exacerbates at nightScaly burrows on fingers and wrists

Treatment

Lyclear (Permethrin) – wash off after 8-24hrsRepeat treatment one week laterTreat the whole familyWash linen and clothes day after treatmentRemove soft toysMites survive for a max. of 36 hrs away from hostEczema treatmentsReturn to school after 2 treatments completedItching may take 3 weeks to resolve

Diagnosis?

TineaDematophytes (fungi) invade and proliferate in the outer layer of the epidermisCan also affect nails or hairAnnular rashScaly and itchy, definite edge, central clearingCommonPrevalence increases with age, humid climates, crowded living conditionsChildren - commonly acquired from animalsCulture skin scrapings, nail clippings, or plucked hairTypes - corporis, pedis, capitisRepeat culture at end of treatment

TreatmentCapitis

Oral griseofulvin or Lamisil (give with fatty food)

Identify sources if possible

No sharing of hair combs/brushes or head wear

Hair growth is slow

Antifungal shampoo – reducing shedding of spores

Corporis

Topical antifungals – ketoconazole, miconazole

Pedis

Oral griseofulvin or Lamisil

How To Contact Us!Services Monday to Friday, business hoursPhone: 9345 5510 Page: 9345 5522Email: Liz - liz.moore@rch.org.au

Emma - emma.king@rch.org.au