Skin Disorders in Young Children

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Atopic Dermatitis

1. What is Atopic Dermatitis?

• Atopic dermatitis or eczema is an itchy, dry, inflammation of the skin.
• It is the commonest type of skin disease in children.
• It is not an infectious disease.
• The child with atopic dermatitis has sensitive skin which is irritated easily.

2. Why does my child have atopic eczema?

• Atopic eczema is a genetic disorder associated with a sensitive skin due to deficiency of a surface protein called fillagrin.
• The condition is often associated with a family history of eczema, asthma or hay fever.
• There are many external factors which may aggravate the eczema.

3. What are the clinical presentations of atopic eczema?

• Most patients present with eczema (redness, scaling and swelling) on the face, limbs  and trunk.
• The flexures may be more severely affected.
• The condition is very itchy.
• Crusting may be present when the eczema becomes infected .

4. What are the aggravating factors in eczema? How to avoid them?

• Aggravating factors include:

1. Sudden changes of room temperature, strenuous exercise and hot, humid weather.
2. Synthetic or woollen clothings. Children should be dressed in cotton.
3. Emotional upsets
4. Frequent use of soaps, bubble bath, hot water. Use mild soaps or soap substitutes like emulsifying ointment. The temperature of the bath water should be cool.
5. Cigarette smoke. In an enclosed room, smokes and fumes will irritate the skin. It is best to ban smoking within the house.
6. Dogs and cats danders. All furry pets will aggravate eczema. Avoid keeping cats and dogs in the house.
7. Irritant foods and saliva. Acidic juice in citrus fruits eg. oranges and vegetables eg. tomatoes can cause eczema around the mouth. This is often made worse by lip licking and dribbling.

5. Will my child ‘grow out’ of eczema?

• The tendency for sensitive skin will remain with your child even into teenage years.
• However, your child’s eczema will gradually improve as they get older and only a few continue to have troublesome eczema in adult life.

6. Is eczema due to an allergy?

• No, eczema is usually not caused by any specific allergy.
• Children with atopic eczema have a hypersensitive skin which reacts to many materials which come in contact with the skin surface.
• Although many people believe that allergy causes atopic eczema, they are simply beliefs and have not been verified by scientific studies.

7. Will allergy tests help my child’s eczema?

• No. Children with atopic eczema usually demonstrate multiple positive reactions on skin tests, which are of little relevance in treatment.
• Blood allergy tests are generally not helpful in the management of atopic eczema.

8. Is swimming contraindicated in a child with eczema?

• There is no contraindication to swimming in the sea in patients with atopic eczema.
• In swimming pools, the chlorinated pool water may irritate the skin.

9. Treatment of your child’s atopic eczema

There is no single medication which will cure eczema. It is possible to control eczema effectively by using a simple treatment plan:

• 1) Emollients

These are products which moisturize and soften the skin. They help to reduce the itching and scratching, are safe and should be used frequently.

• 2) Topical steroid cream

The use of an appropriate topical steroid is safe and an essential part of treatment. Your doctor will advise you on the appropriate cream to use.

• 3) Anti-itch (antihistamine) medication

Given an hour before bed, this will help the child settle and have a comfortable night’s sleep.

• 4) Antibiotics

Skin with eczema seems to attract certain bacteria to the skin. Antibiotics remove these bacteria and may improve the eczema. Your doctor will advise you on whether antibiotics are needed.

• In addition to the above, nails should be kept short to prevent excoriation.

Discoid eczema (Nummular eczema)

1. What is discoid eczema?

• This is another type of eczema that is common in children and young adults.
• They present as round, red patches of eczema or skin inflammation located mainly on the arms and legs. The lesions are coin-like, hence the term discoid eczema .

2. Clinical Features

There are 2 forms of discoid eczema:

• a) Wet form: with oozing and crusting lesions.
• b) Dry form: with redness and scaly lesions.

Both forms are persistent, lasting for months if untreated.

3. Why is it important to recognize discoid eczema?

• Discoid eczema is frequently mistaken for ringworm.
• It does not respond to antifungal creams.

4. Treatment:

• Treatment is with moderate strength steroid creams.
• Lesions are slow to resolve and treatment takes considerable time before improvement is seen.

Nummular or discoid eczema

Diaper Dermatitis

1. What is Diaper Dermatitis?

• This is a childhood skin disorder.
• It affects young children under the age of 2 years.
• It is an inflammation of the skin resulting from skin irritation of chemicals in urine and faeces.
• There are 4 presentations:

1. The most common presentation is “chafing dermatitis”. This is most frequently observed at 7 to 12 months of age, when the baby’s urine volume exceeds the absorbing capacity of the diaper. There is involvement of the convex surface of the thighs, buttocks and waist area.
2. The second is “perianal dermatitis” where the dermatitis is limited to the area around the anus. This is seen in newborns who have experienced diarrhoea .
3. The third presentation is characterized by shallow ulcers scattered throughout the diaper area .
4. The fourth presentation consists of confluent redness with satellite lesions involving the inguinal areas and the genitalia. This is due to a secondary yeast (a fungal) infection

2. What is the cause of diaper dermatitis?

• Diaper dermatitis is the result of prolonged skin contact with urine and faeces.
• Tight occlusion of faeces and urine by diaper covers increase the penetration of these alkaline substances through the skin.

3. What is the treatment?

• Consult your doctor for advice. Avoid self-medication.
• The basis for treatment in diaper dermatitis is to remove the urine and faeces from the skin surface and prevent skin maceration by keeping the diaper area dry.

1. Lubrication of diapered skin with a greasy ointment decreases the severity of diaper dermatitis and protects the skin from urine and faeces.
2. Very frequent diaper changes followed by application of ointment limits maceration and prevent recurrences.
3. Diaper change a few hours after the baby goes to sleep and reducing fluids just before bedtime may help.
4. Avoid plastic and rubber pants.
5. Yeast infection in the diaper area requires antifungal creams. Your doctor will prescribe the appropriate medication.
6. In severe dermatitis, your doctor may prescribe hydrocortisone 1 % cream twice daily to help decrease the infant’s discomfort.

Contributors

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

National Skin Centre. Singapore

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