Indian J Pediatr DOI 10.1007/s12098-013-1271-9
PEDIATRICS IN GENERAL PRACTICE
Guest Editor: Bhim S. Pandhi
Common Skin Problems in Children Gomathy Sethuraman & Neetu Bhari
Received: 3 June 2013 / Accepted: 7 October 2013 # Dr. K C Chaudhuri Foundation 2013
Abstract Childhood dermatological problems contribute about one-third of all consultations in the setting of both pediatrics and dermatology outpatient services. Skin disorders in children may cause anxiety to parents. General Practitioners should be familiar with the common prevalent skin problems as immediate pediatric dermatology consultation may not be possible. Infections, infestations and dermatitis are the most prevalent diseases among Indian children. The scope of this review is to briefly highlight these common and other important dermatological problems in children. Keywords Children . Skin diseases . Pyoderma . Scabies . Viral infections . Dermatitis
Introduction The prevalence of skin diseases in children varies considerably in different parts of the world. Atopic dermatitis is the most prevalent dermatoses in the Middle East and Western countries [1–3]. In India, infections and infestations are the most common skin problems, seen in nearly half of the cases followed by dermatitis (25 %) [4–6]. Of these, bacterial infections contribute to 27.29 % and scabies in 10.16 % of the cases. Fungal and viral infections are observed in 4.65 % and 3.68 % of the cases respectively [4–6]. Allergic reactions like urticaria, papular urticaria, and drug reactions are reported in 6.5 % of the children [4]. Disorders of hair and nails are seen in 5.2 % of the children [5]. This review mainly focusses on these common and important skin problems and their management. G. Sethuraman (*) : N. Bhari Department of Dermatology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India e-mail: [email protected]
Bacterial Infections Pyodermas Pyoderma is a superficial bacterial infection of the skin, which includes impetigo, folliculitis, furuncle, ecthyma and several others. Impetigo Impetigo is the most frequently encountered bacterial skin infection, which is caused by Staphylococcus aureus and Streptococcus pyogenes [7, 8]. It occurs in two clinical forms, the non-bullous impetigo or impetigo contagiosa and bullous impetigo. Although impetigo contagiosa occurs on any body surface, the exposed parts, especially face and the extremities are frequently affected. It evolves from small papulovesicles or pustules that rapidly rupture to form the typical honey colored crusted plaques with surrounding erythema (Fig. 1a). Impetigo may also develop on pre-existing atopic eczema or scabies lesions (secondary impetiginization). Bullous Impetigo occurs on the face and moist intertriginous areas. Clinically, it presents as thin walled, flaccid, subcorneal blister that ruptures rapidly leaving behind an erythematous and moist erosion, surrounded by a pathognomonic peripheral remnant of blister roof (Fig. 1b) [8]. Folliculitis and Furuncle Folliculitis is a superficial staphylococcal infection of the follicular ostia, which involves scalp, buttocks and perineum. It presents as asymptomatic, superficial erythematous papules and pustules with perilesional erythema centered on the hair follicles (Fig. 2). Unlike in folliculitis, furuncle is a deep seated infection involving the hair follicle and its surrounding soft tissue, forming a tender
Indian J Pediatr Fig. 1 a Impetigo. Honey colored crusted plaque on the chin. b Bullous Impetigo. Moist erythematous erosion with a peripheral remnant of blister roof
nodule or abscess (Fig. 2). Children with folliculitis and furuncle have no constitutional features [7, 9]. Treatment of pyodermas For localized superficial infections, topical mupirocin or fusidic acid is used, two to three times a day, until healing of lesions. For multiple lesions and deeper infections, systemic antibiotics are recommended for a period of 7–10 d: cloxacillin/dicloxacillin 50–100 mg/kg/d 4 times a day; cephalexin 25–50 mg/kg/d 3–4 times a day; amoxycillin/ clavulinic acid (40 mg of amoxicillin/kg/d) 2–3 times a day. Failure to respond to antibiotic treatment may suggest methicillin resistant organisms, which are treated with clindamycin, vancomycin, or trimethoprim/sulfamethoxazole [7, 9].
Infestations Scabies Scabies is a common infestation caused by the mite Sarcoptes scabiei variety hominis. It is transmitted by close direct contact and rarely by fomites. The clinical manifestations usually develop 3 wk after the primary infestation. The earliest symptom of scabies is nocturnal pruritus, which may manifest as extreme irritability in infants. Face, palms and soles are particularly affected in younger children, while waists, wrists, ankles, interdigital spaces, penis and areola are commonly affected in older children (Fig. 3a). A variety of primary and secondary lesions such as papules, nodules, burrows and
Fig. 2 Folliculitis and furuncles. Multiple erythematous follicular pustules and abscesses on the fore head
vesiculopustules occur in scabies. Of these, burrows and nodules are the specific lesions. Burrows are located just beneath the stratum corneum and consist of linear or serpiginous whitish lesions with a black dot at the end, which represents the location of female mites. Nodular scabies is characterized by severely pruritic reddish brown nodules commonly seen on the trunk, axillae and genitalia (Fig. 3b). It may persist for several months even after resolution of scabies [9–11]. Diagnosis is usually clinical, based on the typical lesions. Similar involvement in other family members often support the diagnosis. The treatment of choice is 5 % permethrin cream, applied all over the body except around the eyes and mouth. A repeat application is recommended after 1 wk. Permethrin is not recommended in infants below 2 mo of age in whom sulfur 6 % ointment is safe, which should be applied from neck down for 3 consecutive days and rinse 24 h after last application [11]. Oral Ivermectin 200 μg/kg, given 2 doses at 1–2 wk interval is also a good option [12]. Ivermectin is not indicated in children
PEDIATRICS IN GENERAL PRACTICE
Guest Editor: Bhim S. Pandhi
Common Skin Problems in Children Gomathy Sethuraman & Neetu Bhari
Received: 3 June 2013 / Accepted: 7 October 2013 # Dr. K C Chaudhuri Foundation 2013
Abstract Childhood dermatological problems contribute about one-third of all consultations in the setting of both pediatrics and dermatology outpatient services. Skin disorders in children may cause anxiety to parents. General Practitioners should be familiar with the common prevalent skin problems as immediate pediatric dermatology consultation may not be possible. Infections, infestations and dermatitis are the most prevalent diseases among Indian children. The scope of this review is to briefly highlight these common and other important dermatological problems in children. Keywords Children . Skin diseases . Pyoderma . Scabies . Viral infections . Dermatitis
Introduction The prevalence of skin diseases in children varies considerably in different parts of the world. Atopic dermatitis is the most prevalent dermatoses in the Middle East and Western countries [1–3]. In India, infections and infestations are the most common skin problems, seen in nearly half of the cases followed by dermatitis (25 %) [4–6]. Of these, bacterial infections contribute to 27.29 % and scabies in 10.16 % of the cases. Fungal and viral infections are observed in 4.65 % and 3.68 % of the cases respectively [4–6]. Allergic reactions like urticaria, papular urticaria, and drug reactions are reported in 6.5 % of the children [4]. Disorders of hair and nails are seen in 5.2 % of the children [5]. This review mainly focusses on these common and important skin problems and their management. G. Sethuraman (*) : N. Bhari Department of Dermatology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India e-mail: [email protected]
Bacterial Infections Pyodermas Pyoderma is a superficial bacterial infection of the skin, which includes impetigo, folliculitis, furuncle, ecthyma and several others. Impetigo Impetigo is the most frequently encountered bacterial skin infection, which is caused by Staphylococcus aureus and Streptococcus pyogenes [7, 8]. It occurs in two clinical forms, the non-bullous impetigo or impetigo contagiosa and bullous impetigo. Although impetigo contagiosa occurs on any body surface, the exposed parts, especially face and the extremities are frequently affected. It evolves from small papulovesicles or pustules that rapidly rupture to form the typical honey colored crusted plaques with surrounding erythema (Fig. 1a). Impetigo may also develop on pre-existing atopic eczema or scabies lesions (secondary impetiginization). Bullous Impetigo occurs on the face and moist intertriginous areas. Clinically, it presents as thin walled, flaccid, subcorneal blister that ruptures rapidly leaving behind an erythematous and moist erosion, surrounded by a pathognomonic peripheral remnant of blister roof (Fig. 1b) [8]. Folliculitis and Furuncle Folliculitis is a superficial staphylococcal infection of the follicular ostia, which involves scalp, buttocks and perineum. It presents as asymptomatic, superficial erythematous papules and pustules with perilesional erythema centered on the hair follicles (Fig. 2). Unlike in folliculitis, furuncle is a deep seated infection involving the hair follicle and its surrounding soft tissue, forming a tender
Indian J Pediatr Fig. 1 a Impetigo. Honey colored crusted plaque on the chin. b Bullous Impetigo. Moist erythematous erosion with a peripheral remnant of blister roof
nodule or abscess (Fig. 2). Children with folliculitis and furuncle have no constitutional features [7, 9]. Treatment of pyodermas For localized superficial infections, topical mupirocin or fusidic acid is used, two to three times a day, until healing of lesions. For multiple lesions and deeper infections, systemic antibiotics are recommended for a period of 7–10 d: cloxacillin/dicloxacillin 50–100 mg/kg/d 4 times a day; cephalexin 25–50 mg/kg/d 3–4 times a day; amoxycillin/ clavulinic acid (40 mg of amoxicillin/kg/d) 2–3 times a day. Failure to respond to antibiotic treatment may suggest methicillin resistant organisms, which are treated with clindamycin, vancomycin, or trimethoprim/sulfamethoxazole [7, 9].
Infestations Scabies Scabies is a common infestation caused by the mite Sarcoptes scabiei variety hominis. It is transmitted by close direct contact and rarely by fomites. The clinical manifestations usually develop 3 wk after the primary infestation. The earliest symptom of scabies is nocturnal pruritus, which may manifest as extreme irritability in infants. Face, palms and soles are particularly affected in younger children, while waists, wrists, ankles, interdigital spaces, penis and areola are commonly affected in older children (Fig. 3a). A variety of primary and secondary lesions such as papules, nodules, burrows and
Fig. 2 Folliculitis and furuncles. Multiple erythematous follicular pustules and abscesses on the fore head
vesiculopustules occur in scabies. Of these, burrows and nodules are the specific lesions. Burrows are located just beneath the stratum corneum and consist of linear or serpiginous whitish lesions with a black dot at the end, which represents the location of female mites. Nodular scabies is characterized by severely pruritic reddish brown nodules commonly seen on the trunk, axillae and genitalia (Fig. 3b). It may persist for several months even after resolution of scabies [9–11]. Diagnosis is usually clinical, based on the typical lesions. Similar involvement in other family members often support the diagnosis. The treatment of choice is 5 % permethrin cream, applied all over the body except around the eyes and mouth. A repeat application is recommended after 1 wk. Permethrin is not recommended in infants below 2 mo of age in whom sulfur 6 % ointment is safe, which should be applied from neck down for 3 consecutive days and rinse 24 h after last application [11]. Oral Ivermectin 200 μg/kg, given 2 doses at 1–2 wk interval is also a good option [12]. Ivermectin is not indicated in children
