Skin Problems in Children

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Children's skin problems span nearly two decades from birth through adolescence. Several common pediatric skin conditions will be discussed including: diaper dermatitis, atopic dermatitis, warts and acne.

What is diaper dermatitis?

Diaper dermatitis, or diaper rash as it is more commonly known, is not a diagnosis but rather a category of skin conditions affecting the diaper area. There are four types of diaper dermatitis, including:

  • Irritant contact dermatitis
  • Overgrowth of yeast (Candida albicans)
  • Allergic contact dermatitis
  • Inflammatory skin conditions such as seborrheic dermatitis

The most common type of diaper dermatitis is irritant contact dermatitis, associated with skin exposure to either urine or feces (or both) for a long period of time. Irritant contact dermatitis usually appears as bright red, sometimes slightly swollen, or even blister-like patches in the diaper area. Prolonged irritant contact dermatitis can increase the risk of infection in the affected area.

The primary treatment and prevention of irritant contact dermatitis includes barrier creams and ointments, most commonly containing zinc oxide. A mild topical steroid ointment or cream can also be very helpful in more quickly reducing the inflammation.

The next most common type of diaper dermatitis is the overgrowth of yeast, most commonly Candida albicans. The warm, moist, and often irritated environment of the diaper makes the skin more prone to an overgrowth of yeast. This condition generally develops on top of irritant contact dermatitis.

Usually, it appears as bright red bumps, patches, and sometimes pus-bumps that are found on the skin and in its folds. The condition can be treated with an over-the-counter topical antifungal cream such as clotrimazole (Mycelex), mycostatin (Nystatin), or with a prescription medication. A barrier cream, often containing zinc oxide, is also recommended to treat and prevent this skin condition. If irritant contact dermatitis is also present, sometimes an additional mild topical steroid is prescribed. If this condition is only treated with topical steroids, the yeast will spread.

Rarely, allergic contact dermatitis will occur. This condition is usually associated with a component of the diaper itself. Symptoms include redness and swelling with itchiness that continues to recur in the same area such as the near the diaper’s adhesive tape, or around the leg where there is elastic in the diaper.

Treatment of allergic contact dermatitis is very similar to the treatment of irritant contact dermatitis: barrier creams and ointments, most commonly containing zinc oxide, or mild topical steroid ointment if necessary.

To prevent allergic contact dermatitis, you need to identify the material that is causing the problem and avoid it.

Seborrheic dermatitis, commonly known as cradle cap in infants and dandruff in older children and adults, can also be the cause of diaper dermatitis. This condition also affects other areas of the body such as the scalp, eyebrows, around the nose, and sometimes the chest area. Treatment includes the careful use of mild topical steroid and antifungal creams.

Topical steroids require very careful use, especially in the diaper area to prevent potential side effects such as thinning of the skin and stretch marks. These effects can be prevented by using low potency topical steroids, such as hydrocortisone 1 to 2 percent, and applying topical steroids sparingly to the affected areas only twice daily as needed for no longer than two weeks at a time.

What is atopic dermatitis?

Atopic dermatitis, or eczema, is a skin condition that can occur at any time in life. It often starts early in childhood and may not diminish until early adulthood. Over half of the infants with atopic dermatitis grow out of the condition by age 2, though flare-ups can occur throughout life.

Atopic dermatitis is a chronic condition, which means that it cannot be cured but it can be treated and controlled with proper guidance from a physician.

The condition is most common among families who have a history of allergies. Although food allergies may cause flare-ups, removing suspected foods (such as eggs, milk, fish, wheat and peanuts) from your child’s diet is not likely to cure the problem. If you suspect that a food is worsening the rash, discuss this with your health care provider.

Atopic dermatitis can also get worse when the skin comes into contact with irritating substances such as harsh soaps and scratchy, tight fitting clothing. Scratching can also promote infections that require treatment.

What are the symptoms of atopic dermatitis?

In infants:

  • Red, very itchy dry patches of skin
  • Rash on the cheeks that often begins at 2 to 6 months of age
  • Rash oozes when scratched

Symptoms can become worse if the child scratches the rash.

In adolescence and early adulthood:

  • Red scaly rash on creases of hands, elbows, wrists and knees and sometimes on the feet, ankles and neck
  • Thickened skin markings
  • Skin rash may bleed and crust after scratching

How is atopic dermatitis treated?

Treatment is aimed at reducing extreme itching and dry skin symptoms. It includes topical steroid creams and oral antihistamines. Treatment will depend on the age of the child and the severity of the symptoms. Follow your health care provider’s instructions for using the medications.

To help your child, you can also:

  • Avoid long, hot baths, which can dry the skin. Instead use lukewarm water and give your child sponge baths.
  • Apply moisturizing cream or lotion right after bathing or showering. This step will help trap moisture in the skin.
  • Keep the room temperature as regular as possible. Changes in room temperature and humidity can dry the skin.
  • Keep your child dressed in cotton. Wool, silk and man-made fabrics such as polyester can irritate the skin.
  • Use mild laundry soap and make sure that clothes are well rinsed.
  • Watch for skin infections, which are more likely with eczema. Contact your health care provider if you notice an infection.
  • Avoid rubbing or scratching the rash.
  • Use moisturizers often.

If atopic dermatitis is severe, systemic medications may need to be used. If open wounds result from excessive itching, a topical antibiotic (Bactroban) may be used. Occasionally, a systemic antibiotic is necessary to treat infection. If these treatment methods are not effective, alternative therapy such as phototherapy (light therapy) may be recommended for older children.

Warts

Warts result from an infection with a virus, and are common in children of all ages.

Warts commonly present as hard bumps on fingers, hands and feet.

Molluscum contagiosum is similar type of infection caused by a different virus. It looks like skin colored or white bumps that can appear anywhere on the body.

What causes warts?

Common and flat warts are caused by the human papilloma virus (HPV), while molluscum contagiosum warts are caused by a pox virus. Warts usually spread through direct contact. It is also possible to pick up the virus in moist environments such as showers and locker rooms.

How are warts treated?

Unfortunately there are no antiviral treatments that actually target the virus itself. Instead, the treatment available is targeted against the skin in which the virus is living.

Over-the-counter treatments include liquid and film medications containing salicylic acid, which softens the abnormal skin cells and dissolves them. The film types of wart medications tend to work better because they have a higher percentage of salicylic acid (40 percent).

Over-the-counter wart treatments should be used as directed. First, soak the wart in warm water to help the medication penetrate the skin. Then gently rub off dead skin with a washcloth or pumice stone. Apply the medicine and cover with a bandage (replace the bandage if it gets wet). The medication stays on for 48 to 72 hours.

Repeat the treatment as necessary to remove the wart. This may take many weeks.

In the dermatologist's office, wart treatment will depend on the age of the child, the number and location of the warts, and the patient's and parent's decision. Wart treatment options by the doctor include:

  • Freezing the wart with liquid nitrogen (cryotherapy)
  • Destroying the wart with chemicals (trichloroacetic acid or cantharidin preparations)
  • Burning the wart off with electricity or a laser (such as a flash lamp or CO2 lasers)
  • Injecting the wart with yeast preparations
  • Oral cimetidine (Tagamet®) may be prescribed along with one of the methods above. It has been shown to boost the immune system to better mount an immune response to the wart virus infection. Cimetidine is usually used for a trial two to three months.
  • Imiquimod (Aldara®) is a cream that may be prescribed to help your body’s immune system fight warts.

Molluscum contagiosum treatment methods by the doctor include:

  • Topical tretinoin (Retin-A®)
  • Destroying the wart with chemicals (trichloroacetic acid or cantharidin preparations)
  • Freezing the wart with liquid nitrogen (cryotherapy)
  • Scraping the wart off (curettage)

It is important to mention that these wart treatments often need to be repeated every three to four weeks until the wart is gone. Individual molluscum lesions can usually be cured in fewer treatments.

All of these treatment methods may cause scarring and/or blisters so it is important to practice good wound care throughout the healing process.

How can warts be prevented?

Certain precautions can be taken to reduce the chance of getting warts, including:

  • Wearing rubber sandals or shoes in public shower areas or swimming pools
  • Avoiding direct physical contact with those who have visible warts
  • Practicing good hygiene

What is acne?

Acne is one of the most common skin problems. Acne is most common in adolescence and is associated with a hormonal surge. Adolescent acne usually benefits from treatment. Acne also affects 20 percent of adults.

What causes acne?

Poor hygiene, poor diet and stress can aggravate acne but do not cause it.

Acne starts when tiny hair follicles or pores become plugged with oily secretions (sebum) from the skin’s sebaceous glands as well as keratin (a skin protein). This blockage is known as a black head or a white head. These plugged follicles can develop into swollen, red, tender pus bumps, or larger cysts or nodules that can cause temporary or permanent scarring.

What products should be avoided to reduce acne?

If the acne is predominantly around the hairline, it may be associated with hair products such as conditioner, hair gels, hair mousse, oils, and grease. This type of acne can be improved by limiting hair products and pulling the hair away from the face.

Comedogenic (pore-blocking) moisturizer or cosmetics should be avoided. Try switching to a water based non-comedogenic moisturizer and/or cosmetics.

Although diet has not been shown to influence acne, if you think certain foods cause your acne to flare up, then avoid them.

How can acne be treated?

Acne treatment can start with over-the-counter cleansers containing either benzoyl peroxide or a low percentage of salicylic acid. If the use of these products does not improve the acne within 6 to 8 weeks, it may be necessary to see a dermatologist. It is important not to wait too long before seeking treatment to avoid any unnecessary scarring.

Prescribed acne treatments will depend on the age of the patient, skin type, and most importantly, the severity of the acne. The topical regimen almost always includes an acne wash, either an over-the-counter or prescription benzoyl peroxide wash. This can be replaced or alternated with non-soap cleansers if the other prescribed acne treatments are causing excessive dryness or mild irritation. The topical medication retinoid (Retin-A, Differin) is a mainstay of treatment.

Depending upon the patient's age and the type of acne, an oral antibiotic (tetracycline, minocycline, doxycycline or erythromycin) may be beneficial. A topical antibiotic ((erythromycin or clindamycin), instead of an oral antibiotic, can be very helpful.

It is important for the patient to follow the prescribed treatment for at least 6 to 8 weeks before considering changing therapy. During a follow-up visit with the dermatologist, a re-evaluation can determine whether or not the treatment plan needs to be modified.

Other medications that have been helpful are oral birth control pills for females, especially when they report acne flare-ups around the menstrual period. If an individual has severe scarring acne, or if aggressive standard therapy does not improve their acne, an oral retinoid (Accutane®) may be necessary. If this is dosed and monitored appropriately it can be a safe option, only if necessary.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/3/2013...#6951