Skin problems in children: Frequently asked questions

 What are some common skin problems in children?

Probably the most common skin problems in children are things that most of us recognize, like bug bites, scrapes, and bruises. Diaper rash is incredibly common in babies. Eczema is also quite common as are problems with the sun and skin infections due to bacteria, viruses, and fungi.

Are they often treatable by over-the-counter medications?

Many skin conditions in children are treatable by over-the-counter medications, but some do require prescriptions. It is important to know exactly what you are treating so the appropriate therapy can be started.

Are skin problems often triggered by allergies, etc.?

There certainly are a number of skin problems that are triggered by allergies, such as poison ivy rashes which are very, very common in the spring and summer. Atopic dermatitis most commonly occurs in people who have allergies or asthma or a family history of allergies.

What is serosis? How is psoriasis treated?

There are a couple of different diseases that sound somewhat like the word in your question. One is psoriasis, which is a skin condition where one sees reddish/orange areas on the skin that have thick white scale. Psoriasis lesions are more frequent on the elbows, knees, and scalp. Psoriasis also frequently causes nail changes. Another skin condition that sounds very similar is xerosis. Xerosis is the medical term for dry skin. The guest that asked that question might want to follow-up on a question as to which of those conditions they were referring to.

Are children more apt to be allergic to bug bites?

Children are more likely to get bigger reactions to bug bites. Typically you may see much bigger bumps at the site of a bite on a child than one on an adult. Also, because children, as a group, spend more time playing outdoors than do adults, they are more likely to be bitten.

What about children with acne? What over-the-counter remedies do you suggest?

For children with non-scarring acne, over-the-counter benzyl peroxide-based medications can be very effective. If the child has large, deep, acne lesions, or lesions that are causing scarring, or that don't respond to over-the-counter benzyl peroxide preparations, I would suggest they see a dermatologist, because there are a number of prescription treatments available that are extremely effective for acne. It is also important for parents to realize that acne is caused by hereditary factors--normal hormones--and that a teenager can have the cleanest face in the world and still have very severe acne. So, just cleansing will not treat acne. Over cleansing can actually cause irritation.

My newborn has really dry skin--what causes this and what can I do?

Dry skin has a number of causes. In the immediate newborn period, it can be seen in post-mature babies. It is important to distinguish dry skin from eczema, and severe cases of dry skin should be evaluated by a physician. For mild dry skin, it is important to limit exposure to soaps and to frequently apply bland thick moisturizers such as Vaseline, Eucerin, Vanicreme, or Aquaphilic.

Can benzyl peroxide help reduce scarring?

Benzyl peroxide can help prevent acne lesions, which, in turn, reduces scarring. Some of the lesions on the face that people believe to be scars are actually post-inflammatory pigment changes. These will eventually fade away. True scars do not completely go away on their own. Benzyl peroxide will not make an existing scar go away. To treat scars requires cosmetic surgical techniques, which is why it is very important to treat bad acne so scars aren't made. Preventing scarring is much easier than treating once it has occurred.

Are there any bubble baths out there that you suggest for my 2 year old who always seems to get an itchy rash from the bubble bath?

All bubble baths dry skin, as they contain soap. Certainly, children with problems with bubble bath should avoid them. My suggestion would be to substitute fun bath toys for bubbles, and if a child gets rashes after bubble baths to avoid bubble baths completely.

Are things like psoriasis hereditary?

Psoriasis is a hereditary condition. It has a definite tendency to run in families. However, not everyone who develops psoriasis has someone else in his or her family with it. A minority of children of patients with psoriasis actually develop the disease themselves.

Psoriasis, how is it treated? Can diet affect it?

Mild psoriasis is treated with topical corticosteroids, topical Vitamin-D related compounds such as Dovonex and topical Vitamin-A related compounds such as Tazorac. Ultraviolet light is also quite effective for psoriasis, but it carries with it, as all sun exposure does, an increased risk for later skin cancers and photoaging. Severe cases of psoriasis that don't respond to topical treatments or light therapy sometimes have to be treated with oral or injectable medications, although one certainly tries to avoid doing so in children. Diet does not play a major role in the treatment of psoriasis.

What does eczema look like? Same for kids and adults?

Eczema looks the same in children and adults. It can actually vary quite widely in its appearance, from a red weepy crusty appearance to thickened dry skin with skin markings depending on the underlying cause of the eczema and how long it has been present. Eczema can, however, be mimicked by other conditions such as fungal infections of the skin, bacterial infections of the skin, and even, on occasion, herpes simplex. If a child has any sort of unusual rash that is worsening or doesn't resolve in a few days, I would suggest seeing a physician and getting an accurate diagnosis.

What warning signs should parents be aware of for potentially dangerous skin conditions?

Certainly any rash in a child who appears ill should be evaluated immediately by a physician. As I mentioned earlier, any rash that steadily is worsening and spreading should be evaluated. Parents also should realize that it is possible to become allergic, or irritated, by over-the-counter treatments. It is not a good idea to go from over-the-counter therapy to over-the-counter therapy without an idea of what you are treating.

What about sunburn? What are the best treatments? What is the best sunblock to use for kids?

For most people, 80 percent of their total lifetime sun exposure occurs in childhood. To prevent skin cancer and to reduce photoaging, one can make the most impact by limiting sun exposure in childhood. It is also known that melanoma, a potentially fatal skin cancer, is associated with blistering sunburns in childhood. To avoid excess sun exposure, one can limit outdoor activities in the middle part of the day between 10:00 and 2:00, to use clothing and hats, and to apply a sunscreen of SPF 15 or higher. If one is going to be sweating or swimming or otherwise exposed to water, it is very important that the sunscreen be waterproof. Even waterproof sunscreens should be reapplied every two hours while one is out in the sun. There are sunscreens and sunblocks. Sunblocks block all form of light, and zinc oxide is a good example of a sunblock. It is a very effective way to prevent sun although people don't like to wear plain zinc oxide. When one looks for a sunblock/sunscreen, make sure the SPF is 15 or higher and that it says broad-spectrum sun protection.

My daughter has small, ring-like dry patches on her body. They don't itch but they look terrible. What could they be?

There are a number of possibilities for dry, ring-like patches on the body. Probably the most common one is a form of eczema. Sometimes fungus infections (ringworm) can present ring-like patches. To make the distinction, I would suggest you see your dermatologist. Certainly a good moisturizer applied a couple of times a day, especially right after bathing, is effective for mild forms of eczema and would not harm a fungal infection. I would suggest starting that immediately while waiting for an evaluation.

I have only one question doctor, and I'm sorry it's not about skin. I am 17 years old, and I have been getting bumps on my tongue and I get one every night. They are pretty big and hurt!! Do you know what they are and what I can do to stop the pain and spreading? PLEASE HELP ME.

You need to be evaluated by a physician: a dermatologist would be a good place to start.

My kid is diabetic...any skin issues I should be aware of, now or later in life?

People with diabetes are more prone to skin infections. I would be very aware of your child's skin and make sure to get any skin problems evaluated promptly. Later in life, people with diabetes remain prone to skin infections and, because they can develop problems with sensation in their extremities, may have problems with ulcerations of their feet. It is important to do a good job controlling diabetes and make sure your child is followed closely by a physician.

What should adults who work in the sun do for protection?

The recommendations for adults are essentially the same as for children. It is important to realize that clothing and hats can provide a significant amount of sun protection. For people who are in the sun a lot and can't avoid the sun, there are a number of lines of clothing that are loose and light and provide an SPF of over 30. One such line is made by Solumbra. Rit Dye makes a product called SunGuard that raises the SPF of clothing. It is also very important to wear sunglasses and to apply an SPF 15 or higher sunscreen every couple of hours. Adults who have had a lot of sun exposure should be aware of any changes, new bumps or lumps on their skin, and get evaluated for any new skin lesions. There are a number of websites such as the American Academy of Dermatology website that can provide more information on things to look for. The American Cancer Society also offers useful information in that regard.

I would like to thank all of the guests for their questions and remind people that skin conditions can often be effectively treated. I would encourage parents of children with skin problems to have them evaluated by a dermatologist. For all parents, please protect your children's skin from the sun. That is something you can do that will help them keep from developing skin problems as they age.

Mary Stone, MD
Division of Dermatology
University of Iowa Health Care