Category: Skin

Doctors use the word tinea to describe a group of contagious skin infections caused by a few different types of fungi. They can affect many areas of the skin and depending on their location and fungal type, the infection has different names.

• Tinea capitis is a skin infection or ringworm of the scalp caused by a fungus called dermatophytes (capitis comes from the Latin word for head). It mostly affects children.
• Tinea corporis is ringworm of the body (corporis means body in Latin). In wrestlers this is often called tinea gladiatorum.
• Tinea pedis or athlete’s foot is an infection that occurs on the feet, particularly between the toes (pedis is the Latin word for foot).
• Tinea cruris or jock itch tends to create a rash in the moist, warm areas of the groin (cruris means leg in Latin). It most often occurs in boys when they wear athletic gear.
• Tinea versicolor or pityriasis versicolor is a common skin infection caused by a slow-growing fungus (Pityrosporum orbiculare) that is a type of yeast. It is a mild infection that can occur on many parts of the body.

Although the name ringworm is attached to some of these conditions, worms are not involved in any of them. The infections are caused by fungi.

Signs and Symptoms

In many cases of ringworm and other tinea infections, circular, ring-shaped sores are formed, which is why the term ringworm is used. On the body, these lesions or patches may be slightly red and often have a scaly border. They may grow to about 1 inch in diameter. While some children have just one patch, others may have several of them. They tend to be itchy and uncomfortable.

• In ringworm of the scalp, itching may develop on the head, along with round and raised lesions. Hair loss can occur in patches. Some cases of scalp ringworm do not produce obvious rings and can be confused with dandruff or cradle cap. In a few cases, the child will have a reaction to the fungus and develop a large boggy area called a kerion. This looks like a pus-filled sore (abscess), but it is really an allergic reaction to the fungus. The infected area will heal once the fungus is treated. Steroids are often given to speed healing. Sometimes, bacteria can infect the area later. If this occurs, your pediatrician may advise the use of antibacterials.
• When fungi cause athlete’s foot, the skin can become itchy and red with cracking and flaking between the toes. This is most common in adolescents.

Tinea infections are spread by skin-to-skin contact, most often when a child touches another person who is already infected. The fungi thrive in warm, damp environments and at times can be spread in moist surfaces, such as the floors of locker rooms or public showers. When a child sweats during physical activity, the moisture on the skin can increase the chances of a fungal infection.

The incubation period for these infections is not known.

When To Call Your Pediatrician

Contact your pediatrician if your child has symptoms of a tinea infection.

How Is The Diagnosis Made?

Most tinea infections can be diagnosed by your pediatrician on visual examination of the affected area. The diagnosis can be confirmed by taking skin scrapings at the site of the infection—for example, by gently scraping a damp area of the scalp with a blunt scalpel or toothbrush—and testing the collected cells in the laboratory. Also, when one type of fungal infection is looked at in a dark room using a special blue light called a Wood’s lamp, it will have a fluorescent appearance. Not all of the fungi are fluorescent, so this test can’t be used to rule out the possibility of a fungal skin or scalp infection.

Treatment

Antifungal medications applied directly on the head are ineffective for treating ringworm of the scalp. Instead, your pediatrician may recommend giving your child antifungal medications by mouth, most often a medicine called griseofulvin, that should be taken for an average of 4 to 6 weeks. A variety of other medicines can be used. Washing your child’s hair with selenium sulfide shampoo can decrease shedding that could spread the infection to others.

Over-the-counter antifungal or drying powders and creams are effective for other types of tinea infections, including athlete’s foot and tinea corporis. Your pediatrician may prescribe a cream for treating the rash associated with jock itch. Topical medications including clotrimazole and ketoconazole are used to treat ringworm of the body as well as tinea versicolor.

What Is The Prognosis?

Ringworm infections usually respond well to treatment within a few weeks, although they can sometimes come back.

Prevention

Good hygiene is important for preventing many tinea infections. For example, to avoid ringworm of the scalp, make sure your child shampoos often, and encourage him to avoid sharing hairbrushes, combs, hats, hair ribbons, and hair clips with other children. He should keep his skin and feet clean and dry, especially between the toes. Have your child wear sandals in locker rooms or at public showers or swimming pools. Give your youngster clean socks and underwear every day.

No matter our age or skin tone, we all need to take steps to prevent sunburn when we’re enjoying the outdoors. Children especially need to be protected from the sun’s burning rays, since most sun damage occurs in childhood. Like other burns, sunburn will leave the skin red, warm, and painful. In severe cases it may cause blistering, fever, chills, headache, and a general feeling of illness.

Your child doesn’t actually have to be burned, however, in order to be harmed by the sun. The effects of exposure build over the years, so that even moderate exposure during childhood can contribute to wrinkling, toughening, freckling and even skin cancer later life. Also, some medications can cause a skin reaction to sunlight, and some medical conditions may make people more sensitive to the sun.

How to treat a sunburn

The signs of sunburn usually appear 6 to 12 hours after exposure, with the greatest discomfort during the first 24 hours. If your child’s burn is just red, warm, and painful, you can treat it yourself. Apply cool compresses to the burned areas or bathe the child in cool water. You also can give acetaminophen to help relieve the pain. (Check the package for appropriate dosage for her age and weight.)

If the sunburn causes blisters, fever, chills, headache or a general feeling of illness, call your pediatrician. Severe sunburn must be treated like any other serious burn; if it’s very extensive, hospitalization sometimes is required. In addition, the blisters can become infected, requiring treatment with antibiotics. Sometimes extensive or severe sunburn also can lead to dehydration and, in some cases, fainting (heatstroke). If your child has these symptoms, contact your pediatrician right away or take them to the nearest emergency facility.

Sunburn prevention

Many parents incorrectly assume that the sun is dangerous only when it’s shining brightly. In fact, it’s not the visible light rays but rather the invisible ultraviolet rays that are harmful. Your child actually may be exposed to more ultraviolet rays on foggy or hazy days because they’ll feel cooler and therefore stay outside for a longer time. Exposure is also greater at higher altitudes. Even a big hat or an umbrella is not absolute protection because ultraviolet rays reflect off sand, water, snow and many other surfaces.

Try to keep your child out of the sun when the peak ultraviolet rays occur (between 10 a.m. and 4 p.m.).

In addition, follow these guidelines to protect your child’s skin in the sun:

• Always use a sunscreen to block the damaging ultraviolet rays. Choose a sunscreen made for children with a sun protection factor (SPF) of at least 30 or higher. (Check the label.) Apply the protection half an hour before going out. Keep in mind that no sunscreens are truly waterproof; thus they need to be reapplied every 1 -and-a-half to 2 hours, particularly if your child spends a lot of time in the water. Choose a product that is labeled “water resistant,” and check the instructions on the bottle.
• Dress your child in lightweight cotton clothing with long sleeves and long pants. SPF-rated clothing and hats are also a good idea to protect your child’s skin when they’re outdoors.
• Use a beach umbrella or similar object to keep your child in the shade as much as possible.
• Have them wear a hat with a wide brim.
• Babies under 6 months of age should be kept out of direct sunlight. If adequate clothing and shade are not available, sunscreen may be used on small areas of the body, such as the face and the backs of the hands.

Definition

• A foreign body (FB) (eg, splinter, fishhook, sliver of glass) is embedded in the skin.

Symptoms of a Foreign Body in the Skin

• Pain: Most tiny slivers (eg, cactus spine) in the superficial skin do not cause much pain. Deeper or perpendicular FBs are usually painful to pressure. FBs in the foot are very painful with weight bearing.
• FB Sensation: Older children may report the sensation of something being in the skin (“I feel something there”).

Types of Foreign Bodies

• Wood/Organic FBs: Splinters, cactus spines, thorns, toothpicks.
• Metallic FBs: Bullets, BBs, nails, sewing needles, pins, tacks.
• Fiberglass spicules.
• Fishhooks: May have a barbed point that makes removal difficult.
• Glass.
• Pencil lead (graphite).
• Plastic FBs.

When to Call Your Doctor

Call Your Doctor Now (Night or Day) If

• Deeply embedded FB (eg, needle or toothpick in foot)
• FB has a barb (eg, fishhook)
• FB is a BB
• FB is causing severe pain
• You are reluctant to take out FB
• You can’t remove FB
• Site of sliver removal looks infected (redness, red streaks, swollen, pus)
• Fever occurs

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If

• You think your child needs to be seen
• Deep puncture wound and last tetanus shot was more than 5 years ago

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Parent Care at Home If

• Tiny, superficial, pain-free slivers that don’t need removal
• Tiny plant stickers, cactus spines, or fiberglass spicules that need removal
• Minor sliver, splinter, or thorn that needs removal and you think you can remove it

Home Care Advice for Minor Slivers

1. Tiny, Pain-Free Slivers: If superficial slivers are numerous, tiny, and pain free, they can be left in. Eventually they will work their way out with normal shedding of the skin, or the body will reject them by forming a little pimple that will drain on its own.
2. Tiny Painful Plant Stickers: Plant stickers (eg, stinging nettle), cactus spines, or fiberglass spicules are difficult to remove because they are fragile. Usually they break when pressure is applied with tweezers.
   • Tape: First try to remove the small spines or spicules by touching the area lightly with packaging tape, duct tape, or another very sticky tape. If that doesn’t work, try wax hair remover.
   • Wax Hair Remover: If tape doesn’t work, apply a layer of wax hair remover. Let it air-dry for 5 minutes or accelerate the process with a hair dryer. Then peel it off with the spicules. Most will be removed. The others will usually work themselves out with normal shedding of the skin.
3. Needle and Tweezers: For large slivers or thorns, remove with a needle and tweezers.
   • Check the tweezers beforehand to be certain the ends (pickups) meet exactly (if they do not, bend them). Sterilize the tools with rubbing alcohol.
   • Cleanse the skin surrounding the sliver briefly with rubbing alcohol before trying to remove it. If you don’t have any, use soap and water but don’t soak the area if FB is wood (Reason: can cause swelling of the splinter).
   • Use the needle to completely expose the large end of the sliver. Use good lighting. A magnifying glass may help.
   • Then grasp the end firmly with the tweezers and pull it out at the same angle that it went in. Getting a good grip the first time is especially important with slivers that go in perpendicular to the skin or those trapped under the fingernail.
   • For slivers under a fingernail, sometimes a wedge of the nail must be cut away with fine scissors to expose the end of the sliver.
   • Superficial horizontal slivers (where you can see all of it) usually can be removed by pulling on the end. If the end breaks off, open the skin with a sterile needle along the length of the sliver and flick it out.
4. Antibiotic Ointment: Wash the area with soap and water before and after removal. To reduce the risk of infection, apply an antibiotic ointment such as Polysporin (no prescription needed) once after removal.
5. Call Your Doctor If
   • You can’t get it all out.
   • Removed but pain becomes worse.
   • Starts to look infected.
   • Your child becomes worse.

And remember, contact your doctor if your child develops any of the “Call Your Doctor” symptoms.

When your child has a strep throat, there’s a chance that they’ll get a rash known as scarlet fever.

The symptoms of scarlet fever begin with a sore throat, a fever of 101 to 104 degrees Fahrenheit (38.2–40 degrees Celsius), and headache. This is followed within 24 hours by a red rash covering the trunk, arms and legs.

Scarlet fever rash

The rash is slightly raised, which makes the skin feel like fine sandpaper. Your child’s face may turn red, too, with a pale area around their mouth. This redness will disappear in 3 to 5 days, leaving peeling skin in the areas where the rash was most intense (neck, underarms, groin, fingers and toes). They may also have a white coated, then reddened, tongue and mild abdominal pain.

Treatment for scarlet fever

Call your pediatrician whenever your child complains of a sore throat, especially if they also have a rash or fever. The doctor will examine them and swab his throat to check for strep bacteria. If strep throat is found, an antibiotic (usually penicillin or amoxicillin) will be given. If your child takes the antibiotic by mouth rather than an injection, it’s extremely important to complete the entire course; shorter treatment sometimes results in a return of the disease.

Most children with strep infections respond very quickly to antibiotics. The fever, sore throat, and headache usually are gone within 24 hours. The rash, however, will remain for about 3 to 5 days.

If your child’s condition does not seem to improve with treatment, notify your pediatrician. If other family members develop a fever or sore throat at this time—with or without a rash—they, too, should be examined and tested for strep throat.

Complications of scarlet fever in children

If not treated, scarlet fever (like strep throat) can lead to ear and sinus infections, swollen neck glands and pus around the tonsils. The most serious complication of untreated strep throat is rheumatic fever, which results in joint pain and swelling and sometimes heart damage. Very rarely, the strep bacteria in the throat can lead to glomerulonephritis, or inflammation of the kidneys, causing blood to appear in the urine and sometimes high blood pressure.

Scabies is caused by a microscopic mite that burrows under the top layers of skin and deposits its eggs. The rash that results from scabies is actually a reaction to the mite’s body, eggs, and excretions. Once the mite gets into the skin, it takes two to four weeks for the rash to appear.

In an older child, this rash appears as numerous itchy, fluid-filled bumps that may be located under the skin next to a reddish burrow track. In an infant, the bumps may be more scattered and isolated and often are found on the palms and soles. Because of scratch marks, crusting, or a secondary infection, this annoying rash often is difficult to identify.

According to legend, when Napoleon’s troops had scabies, one could hear the sound of scratching at night from over a mile away. A bit of exaggeration perhaps, but it illustrates two key points to remember if you think your child has scabies: It’s very itchy and contagious. Scabies is spread only by person-to-person contact, and this happens extremely easily. If one person in your family has the rash, the others may get it, too.

Scabies can be located almost anywhere on the body, including the area between the fingers. Older children and adults usually don’t get the rash on their palms, soles, scalp, or face, but babies may.

Treatment

If you notice that your child (and possibly others in the family) is scratching constantly, suspect scabies and call the pediatrician, who will examine the rash. The doctor may gently scrape a skin sample from the affected area, and look under the microscope for evidence of the mite or its eggs. If scabies turns out to be the diagnosis, the doctor will prescribe one of several antiscabies medications. Most are lotions that are applied over the entire body—from the scalp to the soles of the feet—and are washed off after several hours. You may need to repeat the application one week later.

Most experts feel the whole family must be treated—even those members who don’t have a rash. Others feel that although the entire family should be examined, only those with a rash should be treated with antiscabies medications. Any live-in help, overnight visitors, or frequent baby sitters also should receive care.

To prevent infection caused by scratching, cut your child’s fingernails. If the itching is very severe, your pediatrician may prescribe an antihistamine or other anti-itch medication. If your child shows signs of bacterial infection in the scratched scabies, notify the pediatrician. She may want to prescribe an antibiotic or another form of treatment.

Following treatment, the itching could continue for two to four weeks, because this is an allergic rash. If it persists past four weeks, call your doctor, because the scabies may have returned and need retreatment.

Incidentally, there is some controversy over the possible spread of scabies from clothing or linen. Evidence indicates that this occurs very rarely. Thus, there’s no need for extensive washing or decontamination of the child’s room or the rest of the house, since the mite usually lives only in people’s skin.

Scabies is a very itchy, contagious skin infection caused by microscopic mites that burrow into the skin’s upper layers and cause a rash. It is an infection that occurs not only in children, but in people of all ages.

Symptoms

Scabies causes a rash that appears 2 to 4 weeks after the mites enter the skin. The rash is actually the body’s reaction to the proteins, eggs, and excretions of the mites. It can be extremely itchy and become worse at night. Along with a rash, the burrowing mites can form threadlike gray or white lines on the skin that resemble irregular pencil marks.

In children younger than 2 years, the rash appears most commonly on the palms, soles of the feet, head, and neck. In older children, the rash is found between the fingers or in the folds and creases of the wrist and elbows, as well as at the waistline, thighs, buttocks, and genitals.

The incubation period for scabies is usually 4 to 6 weeks. If your child has had a previous scabies infection, symptoms can occur 1 to 4 days after being exposed again to the mites.

What you can do

If your child develops scabies, she will probably scratch the scabies rash, which will increase the likelihood of the skin developing a secondary bacterial infection. To lower this risk, keep your child’s fingernails trimmed during a scabies infection.

When to call the doctor

If you notice that your child has an itchy rash, contact your pediatrician. The doctor will look at the rash, make the diagnosis, and recommend a treatment.

Diagnosis

Pediatricians can often diagnose a scabies infection by examining the rash and asking relevant questions (eg, the intensity of the rash’s itchiness). Because children tend to scratch the rash repeatedly, the scratch marks and crusting of the rash sometimes make this infection hard to identify.

Your pediatrician may decide to confirm the diagnosis of scabies by gently taking a scraping from the rash or a burrow and having it examined under a microscope to identify the mite or its eggs.

Treatment

Children with a scabies rash should be cared for with one of several lotions or creams used for treating this infection. Most often, pediatricians choose a permethrin 5% cream. It should be applied over the entire body from the neck to the toes. In infants and young children, it should also be placed on the head, scalp, and neck because the rash can affect these parts of the body in this age group. About 8 to 14 hours after applying permethrin, bathe your child to remove the cream.

Other lotions and creams can also be used, such as crotamiton 10%. Ask your pediatrician whether the cream or lotion should be reapplied (often about a week after the first use).

Even after scabies has been treated effectively, the itching associated with it can continue for several weeks and even months. This persistent itching does not mean that your child is still infested with scabies. To soothe the itching, ask your pediatrician about giving your child an oral antihistamine or topical corticosteroid.

Prognosis

Despite the itchiness and discomfort of a scabies infection, it is a mild and highly treatable condition. You can send your child back to child care or school after completing the treatment for scabies.

Prevention

A scabies infestation is easily spread from person to person through close contact, particularly skin to skin. If someone in your family has scabies, ask your doctor whether others in the household such as family members or live-in help should be tested or treated for scabies.

Your ten-month-old doesn’t look or act very ill, but she suddenly develops a fever between 102 degrees Fahrenheit (38.9 degrees Celsius) and 105 degrees Fahrenheit (40.5 degrees Celsius). The fever lasts for three to seven days, during which time your child may have less appetite, mild diarrhea, a slight cough, and a runny nose, and seems mildly irritable and a little sleepier than usual. Her upper eyelids may appear slightly swollen or droopy. Finally, after her temperature returns to normal, she gets a slightly raised, spotty pink rash on her trunk, which spreads only to her upper arms and neck and fades after just twenty-four hours. What’s the diagnosis? Most likely it’s a disease called roseola— a contagious viral illness that’s most common in children under age two. Its incubation period is seven to fourteen days. The key to this diagnosis is that the rash appears after the fever is gone. We now know that a specific virus causes this condition.

Treatment

Whenever your infant or young child has a fever of 102 degrees Fahrenheit (38.9 degrees Celsius) or higher for twenty-four hours, call your pediatrician, even if there are no other symptoms. If the doctor suspects the fever is caused by roseola, he may suggest ways to control the temperature and advise you to call again if your child becomes worse or the fever lasts for more than three or four days. For a child who has other symptoms or appears more seriously ill, the doctor may order a blood count, urinalysis, or other tests.

Since illnesses that cause fever can be contagious, it’s wise to keep your child away from other children, at least until you’ve conferred with your pediatrician. Once she is diagnosed as having roseola, don’t let her play with other children until her fever subsides. Once her fever is gone for twenty-four hours, even if the rash has appeared, your child can return to child care or preschool, and resume normal contact with other children.

While your child has a fever, dress her in lightweight clothing. If she is very uncomfortable because of the fever, you can give her acetaminophen in the appropriate dose for her age and weight. Don’t worry if her appetite is decreased, and encourage her to drink extra fluids.

Although this disease rarely is serious, be aware that early in the illness, when fever climbs very quickly, there’s a chance of convulsions. There may be a seizure regardless of how well you treat the fever, so it’s important to know how to manage convulsions even though they’re usually quite mild and occur only briefly, if at all, with roseola.

If your child has a scaly round patch on the side of his scalp or elsewhere on his skin, and he seems to be losing hair in the same area of the scalp, the problem may be a contagious infection known as ringworm or tinea.

This disorder is caused not by worms but by a fungus. It’s called ringworm because the infections tend to form round or oval spots that, as they grow, become smooth in the center but keep an active red scaly border.

Scalp ringworm often is spread from person to person, sometimes when sharing infected hats, combs, brushes, and barrettes. If ringworm appears elsewhere on your child’s body, he may have the type spread by infected dogs or cats.

The first signs of infection on the body are red, scaly patches. They may not look like rings until they’ve grown to half an inch in diameter, and they generally stop growing at about 1 inch. Your child may have just one patch or several. These lesions may be mildly itchy and uncomfortable.

Scalp ringworm starts the same way the body variety does, but as the rings grow, your child may lose some hair in the infected area. Certain types of scalp ringworm produce less obvious rings and are easily confused with dandruff or cradle cap. Cradle cap, however, occurs only during infancy. If your child’s scalp is continually scaly and he’s over a year old, you should suspect ringworm and notify your pediatrician.

Treatment

A single ringworm patch on the body can be treated with an over-the-counter cream recommended by your pediatrician. The most frequently used ones are tolnaftate, miconazole, and clotrimazole. A small amount is applied two or three times a day for at least a week, during which time some clearing should begin. If there are any patches on the scalp or more than one on the body, or if the rash is getting worse while being treated, check with your pediatrician again. She will prescribe a stronger medication and, in the case of scalp ringworm, will use an oral antifungal preparation. Your child will have to take medicine for several weeks to clear the infection.

You also may need to wash your child’s scalp with a special shampoo when he has scalp ringworm. If there’s any possibility that others in the family have caught the infection, they also should use this shampoo and be examined for possible signs of infection. Do not allow your child to share combs, brushes, hair clips, barrettes, or hats.

Prevention

You can help prevent ringworm by identifying and treating any pets with the problem. Look for scaling, itchy, hairless areas on your dogs and cats, and have them treated right away. Any family members, playmates, or schoolmates who show symptoms also should be treated.

A school-aged child may develop an itchy rash that spreads and joins up to form irregular patches, most often on the elbows, knees, and scalp, or around the navel. Eventually, the patches become covered with thick white scales.

These patches are typical of psoriasis. Unlike eczema, psoriasis is not an allergic condition. Frequently, there is a family history of psoriasis, and the child may have had unusually extensive cradle cap in infancy or dandruff in the toddler and preschool years. The condition occurs in both sexes but is more common in girls.

Attacks of psoriasis are often linked to periods of emotional stress, such as examination time at school. In some children, psoriasis may follow strep throat.

Do not try to remove the scales or treat the condition with over-the-counter remedies. If your pediatrician diagnoses psoriasis, your child may be referred to a dermatologist.

Poison ivy, poison oak, and poison sumac commonly cause skin rashes in children during the spring, summer, and fall seasons. An allergic reaction to the oil in these plants produces the rash. The rash occurs from several hours to three days after contact with the plant and begins in the form of blisters, accompanied by severe itching.

Contrary to popular belief, it is not the fluid in the blisters that causes the rash to spread. This spreading occurs when small amounts of oil remain under the child’s fingernails, on her clothing, or on a pet’s hair that then comes in contact with other parts of her body. The rash will not be spread to another person unless the oil that remains also comes in contact with that person’s skin.

Poison ivy grows as a three- leafed green weed with a red stem at the center. It grows in vinelike form in all parts of the country except the Southwest. Poison sumac is a shrub, not a vine, and has seven to thirteen leaves arranged in pairs along a central stem. Not nearly as abundant as poison ivy, it grows primarily in the swampy areas of the Mississippi River region. Poison oak grows as a shrub, and it is seen primarily on the West Coast. All three plants produce similar skin reactions. These skin reactions are forms of contact dermatitis.

Treatment

Treating reactions to poison ivy—the most frequent of these forms of contact dermatitis—is a straightforward matter.

• Prevention is the best approach. Know what the plant looks like and teach your children to avoid it.
• If there is contact, wash all clothes and shoes in soap and water. Also, wash the area of the skin that was exposed with soap and water for at least ten minutes after the plant or the oil has been touched.
• If the eruption is mild, apply calamine lotion three or four times a day to cut down on the itching. Avoid those preparations containing anesthetics or antihistamines, as often they can cause allergic eruptions themselves.
• Apply topical 1 percent hydrocortisone cream to decrease the inflammation.
• If the rash is severe, on the face, or on extensive parts of the body, the pediatrician may need to place your child on oral steroids. These will need to be given for about six to ten days, often with the dose tapering in a specific schedule determined by your pediatrician. This treatment should be reserved for the most severe cases.

Call the pediatrician if you notice any of the following:

• Severe eruption not responsive to the previously described home methods
• Any evidence of infection, such as blisters, redness, or oozing
• Any new eruption or rash
• Severe poison ivy on the face
• Fever