Skin Diseases In Children


1. Dscoid eczema
This is another type of eczema that is common in children and young adults. They present as round, red patches of eczema or skin inflammation located mainly on the arms and legs. The lesions are coin-like, hence the term discoid eczema.

Clinical Features
There are 2 forms of discoid eczema :

A) Wet form: with oozing and crusting lesions.
B) Dry form: with redness and scaly lesions.
Both forms are persistent, lasting for months if untreated.

2. Diaper Dermatitis
This is a childhood skin disorder. It affects young children under the age of 2 years. It is an inflammation of the skin resulting from skin irritation of chemicals in urine and faeces.

There are 4 presentations :
The most common presentation is “chafing dermatitis”. This is most frequently observed at 7 to 12 months of age, when the baby’s urine volume exceeds the absorbing capacity of the diaper. There is involvement of the convex surface of the thighs, buttocks and waist area.

The second is “perianal dermatitis” where the dermatitis is limited to the area around the anus. This is seen in newborns who have experienced diarrhoea.

The third presentation is characterized by shallow ulcers scattered throughout the diaper area.

The fourth presentation consists of confluent redness with satellite lesions involving the inguinal areas and the genitalia. This is due to a secondary yeast (a fungal) infection.

Causes of diaper dermatitis
Diaper dermatitis is the result of prolonged skin contact with urine and faeces. Tight occlusion of faeces and urine by diaper covers increase the penetration of these alkaline substances through the skin.

Avoid self-medication. Consult your doctor for advice.

The basis for treatment in diaper dermatitis is to remove the urine and faeces from the skin surface and prevent skin maceration by keeping the diaper area dry.

Lubrication of diapered skin with a greasy ointment decreases the severity of diaper dermatitis and protects the skin from urine and faeces.

Very frequent diaper changes followed by application of ointment limits maceration and prevent recurrences.

Diaper change a few hours after the baby goes to sleep and reducing fluids just before bedtime may help.

Avoid plastic and rubber pants.

Yeast infection in the diaper area requires antifungal creams. Your doctor will prescribe the appropriate medication.

3. White Patches In Children
The common causes of white patches on the skin of children are :
1) Pityriasis alba
2) Vitiligo

Pityriasis alba
Pityriasis alba is a mild dermatitis (skin inflammation). This is characterized by multiple oval, mildly scaly, flat hypo pigmented (white) patches on the face, arms and upper trunk. The patches are not itchy. The condition tends to become more prominent by sun exposure

Vitiligo is a patchy loss of skin pigment. The patches are flat, completely white and have distinct borders. Hair within the patches of vitiligo is often white as well.

Two types of vitiligo are recognized

In type A, the vitiligo present as multiple white patches which are generalized and symmetrical. The limbs, face and neck are the areas most commonly involved.

In type B, the vitiligo presents as localized patches in a segmental distribution. This type is common in children.

Type A vitiligo tends to continue to spread with new lesions appearing over years whereas Type B vitiligo tends to spread rapidly then stops after about one year. The cause of vitiligo is not entirely known. Some people with vitiligo have a higher incidence of associated diabetes mellitus and thyroid disease.

4. Alopecia Areata
Alopecia areata is a common skin disorder seen in children and young adults. It is characterized by hair loss in localized round areas on the scalp and occasionally on the eyebrows. A positive family history for alopecia areata is found in 10% to 20% of patients.

Chance of hair regrowing
The prognosis for most children is excellent. Complete regrowth of the hair occurs within a year in 95% of children with alopecia areata. About 30% will have a future episode of alopecia areata. Rarely, the entire scalp hair or all the scalp and body hair are lost in the disease.

Cause of alopecia areata
The cause of alopecia areata remains unknown. An immune mechanism is postulated in which auto- antibodies are produced against the hair follicles and this results in premature shedding of the hair.

5. Atopic Dermatitis
Atopic dermatitis or eczema is an itchy, dry, inflammation of the skin. It is the commonest type of skin disease in children. It is not an infectious disease. The child with atopic dermatitis has sensitive skin, which is irritated.

Causes of atopic eczema
Atopic eczema is a genetic disorder associated with a sensitive skin. The condition is often associated with a family history of eczema, asthma or hay fever. There are many external factors, which may aggravate the eczema.

Clinical features of atopic eczema
Most patients present with eczema (redness, scaling and swelling) on the face limbs and trunk. The flexures may be more severely affected. The condition is very itchy.

Aggravating factors of eczema
Aggravating factors include :
Sudden changes of room temperature, strenuous exercise and hot, humid weather.
Synthetic or woolens clothings. Children should be dressed in cotton.
Emotional upsets.
Frequent use of soaps, bubble bath, hot water. Use mild soaps or soap substitutes like emulsifying ointment. The temperature of the bath water should be cool.
Cigarette smoke. In an enclosed room, smokes and fumes will irritate the skin. It is best to ban smoking within the house.
Dogs and cats danders. All furry pets will aggravate eczema. Avoid keeping cats and dogs in the house.
Irritant foods and saliva. Acidic juice in citrus fruits eg. oranges and vegetables eg. tomatoes can cause eczema around the mouth. This is often made worse by lip licking and dribbling.

6. Eczema & Allergy
No, eczema is usually not caused by any specific allergy. Children with atopic eczema have a hypersensitive skin, which reacts to many materials, which come in contact with the skin surface. Although many people believe that allergy causes atopic eczema, they are simply beliefs and have not been verified by scientific studies.

Allergy Test
Children with atopic eczema usually demonstrate multiple positive reactions on skin tests, which are of little relevance in treatment. Blood allergy tests are generally not helpful in the management of atopic eczema.

Swimming for a child with eczema
There is no contraindication to swimming in the sea in patients with atopic eczema. In swimming pools, the chlorinated pool water may irritate the skin.