Wednesday, June 20, 2018
Health

Mayo Clinic Q&A: UTIs in children; treating old acne scars

CHILDREN CAN GET UTIS, TOO

My daughter is 3 and has had two urinary tract infections in the past six months. Is this common in kids? What can we do to prevent a future infection, and does this mean she will always be more susceptible?

Urinary tract infections are usually thought of as an adult problem. Although they aren't particularly common in children, kids can get UTIs, too. There are some steps you can take to help prevent UTIs in your daughter. Most of the time, having one or two UTIs as a child doesn't raise the risk for having more in the future.

A UTI is an infection in any part of the urinary system — the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. (That's the tube that carries urine from your bladder out of your body.) During the first year of life, boys get UTIs more often than girls. Beyond the first year, UTIs are more common in girls.

UTIs typically develop when bacteria get into the urinary tract through the urethra and begin to multiply in the bladder. That can happen as a result of not wiping properly after a child goes to the bathroom. Holding urine for prolonged periods or constipation also can increase the risk of a UTI. In a 3-year-old child, toilet training can make it more likely that these issues will occur.

UTIs in this age group typically present with symptoms that may include a strong, persistent urge to urinate; a burning or painful sensation when urinating; passing frequent, small amounts of urine; or cloudy, red, pink or strong-smelling urine. Young children may not be able to pinpoint or articulate their symptoms, but they usually can tell that it hurts when they go to the bathroom. If a child has been successfully toilet trained, and then starts to have frequent accidents, that could signal the presence of a UTI.

In some cases, a UTI may lead to pelvic pain, especially in the center of the pelvis and around the area of the pubic bone. Some children also may develop a fever with a UTI. Although uncommon, the presence of a fever, back pain or vomiting may signal a more serious infection that is affecting the kidneys and the bladder.

Treatment for UTIs in children usually involves taking an antibiotic. Symptoms often go away within several days of treatment, but to ensure that the infection is completely eliminated, it's important to give your child the full course of antibiotics, as prescribed.

Among children who have a UTI, about one-third will get another infection later in life. Only about 10 percent will get a third infection. When UTIs are severe or when they keep happening, your child's doctor may order an ultrasound or other imaging tests to see if any anatomic abnormalities could be increasing his or her risk of developing UTIs.

To help prevent future UTIs, encourage your daughter to wipe from front to back after using the bathroom. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra. Also, remind her to go to the bathroom regularly — about once every two to three hours — so she is not holding in urine for long periods of time. If she has constipation, treat it aggressively with dietary changes and, if necessary, medication.

Brian Lynch, M.D., Community Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minn.

HOW TO TREAT ACNE SCARRING

What is the best way to treat acne scars that are a few years old? How effective and safe are treatments?

A variety of treatments can be used to help reduce the appearance of acne scars. To be most effective, the inflammatory phase of acne that includes active pimple formation and redness needs to be resolved before treatment for scarring begins.

Moderate to severe cases of acne can result in scars that cause discoloration and indentations in the skin. In most cases, acne scars do improve over time without treatment. That's particularly true of discoloration. Indentations may be more stubborn and less prone to disappearing on their own.

For lasting skin color changes, creams that contain a bleaching agent can help fade discoloration. These products are available without a prescription at many drugstores and pharmacies for you to use at home. It's also important to consistently use sunscreen with an SPF of 30 or higher on your face and any other areas of scarring to protect your skin and minimize contrast in skin color.

For scarring that leaves skin indentations, you have a number of options. Dermatologists are trained in procedures that work to smooth the skin. For example, laser resurfacing can help improve skin tone and appearance. For this procedure, a dermatologist uses a laser to damage the collagen beneath your skin and stimulate the growth of new, healthier collagen. Other energy-based procedures, such as pulsed light sources and radiofrequency devices, also can be used to help make scars less noticeable.

In some cases, soft tissue fillers, such as collagen or fat, can be injected under the skin or into indented scars to fill them out. Injections of botulinum toxin, or Botox, also may be used around acne scars to relax the skin, reduce puckering and improve the skin's overall appearance. Both of these techniques need to be repeated occasionally to maintain their results.

For more severe scarring, your dermatologist may recommend a chemical peel or dermabrasion. These procedures involve removing the top layer of skin to eliminate surface scars and make deeper scars less apparent. Healing and recovery after these techniques can take several weeks or more.

Surgery may be useful in some cases of acne scarring, too. Using a minor surgical procedure called punch excision, a dermatologist cuts out individual acne scars and repairs the wound with stitches or a skin graft. Another technique called subcision involves inserting needles under the skin to loosen fibers below a scar to help improve its appearance.

All of these approaches have been approved for treating acne scars, but each of them comes with the potential for side effects. Before you decide on any treatment, review the possible side effects with your dermatologist. If you have any questions, don't hesitate to ask.

Not all of these treatments work the same way for everyone. Some people may see better results with one approach than others do. In addition, acne scars may require a combination of treatments to reduce or eliminate them. To determine the best plan for you, make an appointment to talk with a dermatologist about the range of treatment options that are available. He or she can review the risks and benefits of each, and help you decide what's appropriate for your situation.

Jennifer Hand, M.D., Dermatology, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to [email protected] For more information, visit mayoclinic.org. © 2016 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency LLC. All rights reserved.

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