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Four very common skin problems

Considering how the skin surrounding our children's bodies is constantly exposed to injury, bacteria and various other irritants, it is amazing that children do not have more skin problems. A number of factors account for this, including the protective keratin layer on the surface, the chemicals in perspiration and the internal defenses present in the bloodstream.

Nonetheless, when skin problems do occur, most are fortunately only a nuisance. Four of the most common skin problems that affect children will be discussed this week and another four next week.

Eczema

Eczema is an inflammatory skin condition that results probably from exposure to allergens and irritants in susceptible individuals. This common skin condition appears usually within the first five years of life and sometimes, but not always, is accompanied by other allergic diseases such as hay fever and asthma.

The rash of eczema is often weepy (one that emits a fluid) and itchy, typically occurring in the creases of joints, neck, face and about the trunk. Scratching may lead to bleeding and infection.

The condition often diminishes in intensity as the child grows older, and more than 40 percent of children will outgrow the problem when they become adults. The rashes of poison ivy and other poisonous plants are similar to eczema but are short-lived and limited to the areas of contact.

Some parents find that mechanical irritation and heat make their child's rash worse. Dietary factors are occasionally important, and many physicians will eliminate certain food allergens (milk, eggs, citrus juices and nuts being the most common).

Treatment of eczema is aimed at reducing dryness, itching and inflammation. Topical agents include wet dressings and steroid ointments and creams that provide relief from scaling and dryness.

Oral anti-itching drugs such as Benadryl and other antihistamines may be helpful. Secondary infections that develop when bacteria invade the irritated skin are treated with the appropriate antibiotic.

Warts

Warts are caused by the papilloma virus and are very common, with as many as 10 percent of all people infected at any one time.

They can take a variety of appearances _ the most common is that ugly little critter that looks like a wrinkled pimple on the fingers and around the nails. Another form is the tiny, round, flesh-colored, flat wart located usually on the back of the hands, neck or face.

The third type is the plantar wart, which resembles a hard pebble like a bump on the soles of the feet. Warts are harmless, but depending on their location they can be painful. They would definitely take last place in a beauty contest of skin diseases.

How warts are actually spread is poorly understood. It is thought to be due to a susceptible child's direct contact with the virus through a break in the outer layer of the skin.

While your children can spread the warts on themselves, they are not very contagious to other people. They are rare in children under the age of 2.

The "success" of folk remedies for warts is due to the fact that warts often disappear by themselves.

"Warts are harmless, so treatment should be conservative," Largo dermatologist Fred Gurtman said, "and they tend to recur even after treatment that seemed successful."

So when should warts be treated?

"They should be removed when the warts appear to be spreading or enlarging, cause the child discomfort because of where they are located, or the child is embarrassed by their appearance," Gurtman said. Sometimes your child's physician will recommend an over-the-counter medication that contains salicylic acid or refer the child to a dermatologist for surgical removal by scraping, cauterizing or freezing.

"Acne' of the newborn

More than 40 percent of newborns develop a rash on their face that resembles the pimples they might get as teenagers. This newborn "acne" begins around 2 to 3 weeks of age and often lasts until 4 to 6 months of age. Boys are affected more often than girls.

The whiteheads, blackheads and pimples appear in crops on the nose, chin, cheeks and occasionally the forehead. No one knows the exact cause, but it is thought to be attributable to maternal hormone stimulation of the baby's sluggish sweat glands before birth.

In most cases, no treatment is necessary, since the rash clears on its own. Wipe spit-up milk from the infant's face as soon as possible with a cotton ball and warm water. Avoid soaps, even "gentle" baby soaps, on the face. They are too drying. Make sure sheets are soft and non-irritating. Other creams, ointments and topical steroids should be avoided unless recommended by the infant's physician.

Molluscum contagiosum

Molluscum contagiosum is a harmless skin infection caused by a virus. The rash is commonly found under the arms and the adjacent chest areas and consists of flesh-tone, waxy-looking pimples. In the center of each pimple is a small dimple, so that the rash resembles small pearls with indented centers.

With gentle pressure from the side, the molluscum discharge a firm, granular white mass. There are usually no symptoms except for occasional itching. Dozens and often hundreds of lesions may be seen.

Despite its name, the contagiousness of molluscum is generally low. Because of the difficulty in treating that many lesions in a child, watchful waiting is usually the best therapy. Furthermore, the molluscum naturally go away within six to 12 months without treatment or scarring.

Some physicians treat the molluscum with the topical application of tretinon (Retin A), salicylic acid or surgical removal when the rash occurs in areas where there's discomfort from the pimples being rubbed.

Next week, a look at moles, impetigo, hives and white patches on the skin.

This column is written to draw attention to the issues discussed. It should not be relied upon as medical advice and is not intended to replace the advice of your child's physician.

Dr. Bruce A. Epstein has practiced pediatrics in St. Petersburg since 1973. He is a member of the American Academy of Pediatrics. He is married and has three grown children.

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