What is acne and why do I have pimples?
The medical term for “pimples” is acne. Most people get at least some acne, especially during their teenage years. Why you get acne is complicated. One common belief is that acne comes from being dirty. This is not true; rather, acne is the result of changes that occur during puberty.
Your skin is made of layers. To keep the skin from getting dry, the skin makes oil in little wells called “sebaceous glands” that are found in the deeper layers of the skin. “Whiteheads” or “blackheads” are clogged sebaceous glands. “Blackheads” are not caused by dirt blocking the pores, but rather by oxidation (a chemical reaction that occurs when the oil reacts with oxygen in the air). People with acne have glands that make more oil and are more easily plugged, causing the glands to swell. Hormones, bacteria (called P. acnes) and your family’s likelihood to have acne (genetic susceptibility) also play a role.
Skin Hygiene
Washing your face is part of taking good care of your skin. Good skin care habits are important and support the medications your doctor prescribes for your acne.
» Avoid over-washing/over-scrubbing your face as this will not improve the acne and may lead to dryness and irritation, which can interfere with your medications.
» In general, milder soaps and cleansers are better for acne prone skin. The soaps labeled “for sensitive skin” are milder than those labeled “deodorant soap.”
» “Acne washes” may contain salicylic acid. Salicylic acid fights oil and bacteria but can be drying and can add to irritation, so hold off using it unless recommended by Dr. Douglas. Scrubbing with a washcloth or loofah is also not advised as this can irritate and inflame your acne.
» If you use makeup or sunscreen make sure that these products are labeled “won’t clog pores” or “won’t cause acne” or “non-comedogenic,” which means it will not cause or worsen acne.
» If you play sports, try to wash right away when you are done. Also, pay attention to how your sports equipment (shoulder pads, helmet strap, etc.) might rub against your skin and be making your acne worse!
What can I do to help the acne go away?
Some lifestyle changes can be beneficial in helping acne as well. Stress is known to aggravate acne, so try to get enough sleep and daily exercise. It is also important to eat a balanced diet. Some people feel that certain foods (like pizza, soda or chocolate) worsen their acne. While there aren’t many studies available on this question, strict dietary changes are unlikely to be helpful and may be harmful to your health. If you find that a certain food seems to aggravate your acne, you may consider avoiding that food.
Tips for using your acne medications correctly
» Apply your medication to clean, dry skin.
» Apply the medicine to the entire area of your face that gets acne. The medications work by preventing new breakouts. Spot treatment of individual pimples does not do much.
» Sometimes it is the combination of medicines that helps make the acne go away, not any single medication. Just because one medication may not have worked before does not mean it won’t work when used in combination with another.
» The medications are not vanishing creams (they are not magic!) – they take weeks to months to work. Be patient and use your medicine on a daily basis or as directed for six weeks before you ask whether your skin looks better. Try not to miss more than one or two days each week.
» Don’t stop putting on the medicine just because the acne is better. Remember that the acne is better because of the medication, and prevention is the key.
» When applying topical medications to the face, use the “5-dot” method. Take a small pea-sized amount
and place dots in each of 5 locations of your face: mid-forehead, each cheek, nose, and chin. Then rub in. You should not see a “film” of the medication on your skin; if you do, you’re probably using too much.
» Topical medications may lead to dryness where you use them. This almost always improves as your skin
gets used to the medication (about 2-3 weeks). Some tips to get you through this time include waiting 15-20 minutes after washing before applying the topical medication and starting out with use every 2-3 days, gradually working up to “every day” use.
» Taking oral medications with food often helps with symptoms of upset stomach.
What is alopecia areata?
Alopecia means hair loss, and there are several types. Alopecia areata is one of the most common hair loss disorders characterized by loss of hair in round patches, usually on the scalp.
What causes alopecia areata?
The exact cause of alopecia areata is unknown, but it seems to be caused by the immune system attacking the hair follicles by mistake. The hair follicle is the pocket at the base of the skin that grows and holds the hair. When the follicle is attacked, this causes the hair to fall out just below the surface of the skin. The scalp itself is usually perfectly normal. Occasionally, the scalp itches slightly, but usually there are no associated symptoms.
Treatment of alopecia areata
Dr. Douglas may decide not to give your child any treatment for alopecia areata at first. Sometimes the hair can grow back on its own. A “wait and see” approach may be the best option in some children. Other times, Dr. Douglas might decide to treat. Some treatments for alopecia areata include:
» topical steroid creams or ointments
» steroid injections into the bald patches
» contact sensitizers, such as squaric acid or DPCP
» other topical medications, like anthralin or minoxidil
These treatments are helpful in some patients, but not all children respond to therapy. Even with a good response to treatment, the hair may fall out again in the future. Treatment may help treat the bald patches that already exist, but these treatments do not prevent new ones from forming.
How can I help support my child with alopecia areata?
» Educate your child about alopecia areata. Be open and honest and support your child.
» Discuss the diagnosis with your child’s teacher and principal. If they know what your child has, they will be better able to support your child in the school setting as well. Give your child the option of informing classmates.
» Help your child learn what to say if someone asks about the hair loss. This can be a simple answer such as “I have alopecia” or anything they are comfortable responding. Having a prepared response helps some children to handle questions more easily.
» Provide your child with positive messages and praise. Your outlook has a great impact on how your child feels about themselves. Self-esteem is crucial.
» Model good problem solving and ways to cope. This means that it is alright to show and share your feelings. If you or your child have a hard time coping and it affects your everyday life, you may want to consider speaking with a counselor.
» Give your child the choice to interact with other children who have alopecia. This allows them to share their experiences and know they are not alone.
Additional resources for families with alopecia:
»National Alopecia Areata Foundation
Website: www.naaf.org
E-mail: info@naaf.org
»The Childrens Alopecia project
childrensalopeciaproject.org
»National Alopecia Areata Registry
The National Alopecia Areata Registry collects patient information in an effort to identify the cause(s) of alopecia areata. Toll-free number: (866) 837-1050
Allergic Contact Dermatitis
Contact dermatitis is an itchy rash that is caused by something touching(contacting) your skin. The rash is usually red, bumpy, and itchy. Sometimes there are blisters filled with fluid.
There are two types of contact dermatitis:
1. Some things that contact skin are very irritating and will cause a rash in most people. This rash is called irritant contact dermatitis. Examples are acids, soaps, cold weather, and friction.
2. Some things that touch your skin give you a rash because you are allergic to them. This rash is called allergic contact dermatitis. These are items that do not bother everyone’s skin. They only cause a rash in people who are allergic to those items.
Why do some people get allergic contact dermatitis?
People often ask a question like: “Why am I getting a rash from my favorite earrings now? I have been wearing them for a year with no problem!” This can be very confusing. The answer is that you are not born with allergies. Allergies start after your body has become familiar with something. This can take days, months, or even years to happen. Thus, allergies appear during childhood and adulthood.
Patch Testing
If a rash seems like it may be allergic contact dermatitis (it does not go away or it keeps coming back in the same place) but the exact cause is not clear, a patch test may help figure out what is causing the rash.
A patch test is a special allergy test to find out if something touching the skin is causing an allergic rash. Tiny amounts of many items are taped to the skin on the back. The back is used because it is a large area. Two days later, the tape is removed and the skin is checked to see if there is a small rash in any of those spots. Sometimes reactions are delayed so the skin is checked again after two or three more days. If the test shows you are allergic to something, that may be what caused your rash. You will be given information on those items including where they are found and how they can be avoided.
How is allergic contact dermatitis treated?
Treatment depends on how bad the rash is. If the rash is only on small areas of skin, steroid ointments are usually prescribed. If the rash has spread or is severe, oral steroids are sometimes used. Oral antihistamines can help with itching. Many antihistamines are sold over the counter such as diphenhydramine and cetirizine. Others require a prescription.
To prevent the rash from coming back, you must avoid contact with whatever caused the rash. This can be hard but is extremely important. Once you are allergic to something, you will always be allergic to it. The rash can get worse each time it comes back. You can even get a rash all over the body including areas that have not been in contact with what you are allergic to. This is called “autosensitization dermatitis” or “id reaction.”
What is atopic dermatitis?
Atopic dermatitis, also called eczema, is a common and chronic skin condition in which the skin appears inflamed, red, itchy and dry. It most commonly affects children.
Atopic dermatitis is most likely caused by a combination of genetic and environmental factors. Genetic causes include differences in the proteins that form the skin barrier. When this barrier is broken down, the skin loses moisture more easily, becoming more dry, easily irritated, and hypersensitive. The skin is also more prone to infection (with bacteria, viruses, or fungi). The immune system in the skin may be different and overreact to environmental triggers such as pet dander and dust mites.
Allergies and asthma may be present more frequently in individuals with atopic dermatitis, but they are not the cause of eczema. Infrequently, when a specific food allergy is identified, eating that food may make atopic dermatitis worse, but it usually is not the cause of the eczema.
In infants, atopic dermatitis often starts as a dry red rash on the cheeks and around the mouth, often made worse by drooling. As children grow older, the rash may be on the arms, legs, or in other areas where they are able to scratch. In teenagers, eczema is often on the inside of the elbows and knees, on the hands and feet, and around the eyes. There is no cure, but there are recommendations to help manage this skin problem.
Skin Care to Prevent Dryness
» Bathe daily or every-other-day in order to wash off dirt and other potential irritants (the optimal frequency of bathing is not yet clear).
» Water should be warm (not hot), and bath time should be limited to 5-10 minutes.
» Pat-dry the skin with a towel and immediately apply moisturizer while the skin is still slightly damp. The moisturizer provides a seal to hold the water in the skin.
» Finding a cream or ointment that the child likes or can tolerate is important, as resistance from the child may make the daily regimen difficult to keep up.
» The thicker the moisturizer, the better the barrier it generally provides.
» Ointments are more effective than creams, and creams more so than lotions. Creams are a reasonable option during the summer when thick greasy ointments are uncomfortable.
Treating the Rash
The most commonly used medications are topical corticosteroids (“steroids”). There are many different types of topical corticosteroids that come in different strengths and formulations (for example, ointments, creams, lotions, solutions, gels, oils). Therefore, finding the right combination for the individual is important to treat and to minimize the risk of unwanted side effects from the corticosteroid, such as skin thinning. In general, these topical corticosteroids should be applied as a thin layer and no more than twice daily. It is very unusual to see any side effects when a topical corticosteroid is used as prescribed.
Treating the Itch
Your child may be very itchy. Sometimes the itch will affect your child’s ability to sleep through the night. Oral anti-itch medicines (antihistamines) can be helpful for inducing sleep, but usually do not reduce the itch and scratching.
Avoiding Triggers
Some children have specific things that trigger episodes of itchiness and rashes, while others may have none that can be identified. Triggers may even change over time. Common triggers include: excessive bathing without moisturization, low humidity, cigarette or wood smoke exposure, emotional stress, sweat, friction and overheating of skin, and exposure to certain products such as wool, harsh soaps, fragrance, bubble baths, and laundry detergents.
Recognizing Infections as a Trigger
Because the skin barrier is compromised, individuals with atopic dermatitis can also develop infections on the skin from bacteria, viruses, or fungi. The most common infection is from Staphylococcus aureus bacteria, which should be suspected when the skin develops honey-colored crusts, or appears raw and weepy. Infected skin may result in a worsening of the atopic dermatitis and may not respond to standard therapy. Diluted bleach baths can be helpful to reduce infection by S. aureus and thereby help better control atopic dermatitis. Some patients require oral and/or topical antibiotics or antiviral medications for these types of flares
The Role of Foods in Atopic Dermatitis
Children with atopic dermatitis have an increased incidence of food allergies. It is common for parents to look to food as the possible cause for their child’s eczema. However, studies have shown that food allergy often exist side-by-side with atopic dermatitis, but it is not causing the atopic dermatitis.
What is tinea?
Tinea is a fungal infection of the skin, hair or nails. These fungal infections are named for where they occur on the body. Some examples are:
» Tinea capitis (scalp)
» Tinea corporis (body)
» Tinea cruris (groin) – “jock itch”
» Tinea faciei (face)
» Tinea pedis (feet) – “athlete’s foot”
» Tinea unguium or onychomycosis (nail)
Is tinea contagious?
People usually get tinea by touching a person who has it. Family members and close contacts may pass the fungus back and forth. Wrestlers are particularly at risk because of skin contact during the sport. The fungus that causes tinea can also live on sheets, brushes, hats, damp floors, gym mats, in the soil, and on pets. People can get tinea from touching these things too.
Some tips to prevent spreading tinea to others or back to yourself:
» Avoid sharing combs, hair brushes, hats, pillowcases and towels.
» Keep combs and hair brushes clean.
» Towel dry well after baths or showers. Pay special attention to body folds and feet, including the skin between toes.
» Wear sandals or flip flops in locker rooms, public showers and around the pool.
» Change your socks at least once daily.
Why is tinea sometimes called ``ringworm``? Is it caused by a worm?
On much of the body and face, tinea can look like a red, scaly ring. Because of the ringed shape, it is sometimes called “ringworm” even though it is not caused by a worm.
What does tinea look like?
The appearance of tinea, as well as the symptoms, may be different on different parts of the body.
Tinea capitis (scalp):
The scalp may show flakes of skin resembling dandruff. There may also be pus bumps or patches of hair loss or broken hairs. In some people, the fungus causes more inflammation with redness, crusting and weeping on the scalp, and there may be enlarged lymph nodes in the neck (“swollen glands”). When hair loss occurs, it is usually temporary, and the hair will grow back. However, if the fungus has caused too much inflammation or scarring, the hair may not grow back completely.
Tinea corporis, faciei, and cruris (body, face and groin):
These are typically the areas where the name “ringworm” is used, as the fungal infection looks like a red, scaly ring with clearing in the center. Sometimes there are multiple rings or partial rings or rings that have come together to become irregular shapes, still with the edge being red and scaly and notably clear areas in the center.
Tinea pedis (“athlete’s foot”):
The skin is usually moist and flaky between the toes. There are sometimes also the red, scaly rings on top of the toes and feet, as well as flaky skin on the bottoms or sides of the feet. Sometimes, blisters may be present.
Onychomycosis (nail fungus):
This type of fungus is more common in adults than in children. Children with onychomycosis frequently have a household member who also has nail fungus. In this type of tinea, the nails get thick and yellow, and there is a buildup of loose skin and fungus under the affected nails, especially at the outer edge of the nails.
How is tinea treated?
There are a variety of over-the-counter and prescription medications to treat tinea infections. The type and length of treatment that is recommended or prescribed will differ depending on the type of tinea.
Tinea on the face, body, groin and feet is usually treated with medications that you apply directly to the skin (topical medications). These include creams, lotions and gels. Examples are terbinafine, ketoconazole, ciclopirox and oxiconazole. These medications generally need to be used for several weeks. If the infection is extensive, oral antifungal medications may be needed.
Tinea capitis (scalp) and onychomycosis (nail fungus) usually need to be treated with prescription medications taken by mouth. These medications need to be taken for several weeks to months. Examples include griseofulvin, terbinafine, fluconazole and itraconazole. A medicated shampoo is also recommended for tinea capitis both for the person with the infection and people who live in the same house. The shampoo will not clear the infection but can prevent spread to other people.
What are infantile hemangiomas?
Infantile hemangiomas are benign (non-cancerous) collections of blood vessels in the skin. They typically undergo a period of rapid growth for several months before they eventually begin to slowly improve.
When do infantile hemangiomas need to be treated?
Most hemangiomas do not require any treatment; however, a small number do require treatment because of complications potentially caused by the hemangioma. Sometimes treatment is needed if the hemangioma is growing too large or if there is a risk of permanent scarring or disfigurement (damage to the appearance). Treatment may also be necessary if the hemangioma is affecting a vital function, such as vision, eating or breathing, or to help with healing when the skin overlying the hemangioma starts to break down; this is called ulceration. Propranolol has become the most widely used medication for the treatment of serious complications from hemangiomas.
What is propranolol and how does it work?
Propranolol is a “beta-receptor blocker”. Beta-receptors are present on many tissues in the body including the heart, lungs, eyes and blood vessels. Propranolol has been used for many years in the treatment of high blood pressure and irregular heartbeats as well as migraine headaches. While the exact way in which it works on hemangiomas has not been identified, it is known that propranolol can constrict blood vessels (make them narrower), decreasing the amount of blood flowing through them. This can make the hemangioma softer and less red. Propranolol also seems to limit the growth of hemangioma cells, so that the size of the hemangioma is reduced over time. The effects of Propranolol can be quite rapid, with most patients showing improvement within the first few days to weeks on the medication. Propranolol has been approved by the Food and Drug Administration (FDA), specifically for the treatment of hemangiomas.
Are any tests needed before starting propranolol?
Occasionally, Dr. Douglas will order tests to be sure your child can safely take the medication. These may include an electrocardiogram (EKG), or occasionally other laboratory tests, depending upon your child’s history and physical examination, and the family history. If there are several hemangiomas on your child’s skin, an ultrasound of the abdomen may be ordered to check for hemangiomas in the liver or spleen. Dr. Douglas will discuss with you about what specific testing, if any, may be needed for your child.
What are hives?
Hives typically appear as pink or red puffy spots (“welts”) on the skin. They can be different sizes, from very small to quite large. They are usually itchy. Hives can appear anywhere on the body. If you draw a circle around a single hive on the skin, it will usually have moved, changed shape, or disappeared completely within 24 hours, though new hives may have popped up in other locations. In young children, hives can look like big circles or rings on the skin. The rings may have normal skin in the middle, or look purplish like a bruise. Sometimes this purple patch will last longer than the hive itself.
It is common for young children with hives to also get swelling of the hands and feet. This can be uncomfortable, and may cause the child to avoid walking. When hives occur after scratching or rubbing the skin, it is called dermatographism, which literally means “skin writing.” These marks usually go away in less than an hour. Dermatographism is a normal finding that happens in over 5% of healthy people and may also become more noticeable during breakouts of hives.
What causes hives?
Hives are a skin reaction to many different causes. Infections are the most common cause of hives in young children. Often the child seems well and has no or very few other symptoms of an infection before the hives begin. Other common causes of hives include medicines and foods. Less common causes include additives to foods such as preservatives and color dyes, exercise, stress, sunlight, and contact with cold substances like ice. In most cases, hives occur in perfectly healthy people, but occasionally hives may be a sign of a more serious condition like an autoimmune disease. Often, a specific cause for hives cannot be found.
How long do hives last?
In over 80% of children, outbreaks of hives will end within 2 weeks. Occasionally hives will continue to break out for longer. The term “chronic urticaria” is used when the breakouts continue for longer than 6 weeks.
When should I be worried about hives?
Call 9-1-1 or go to the nearest emergency room if your child has swelling or tingling of the mouth, tongue or throat, trouble breathing, trouble swallowing, and/or vomiting with the hives. These are signs of anaphylaxis, which is an emergency.
How are hives treated?
Hives related to infections will go away on their own. If there is another known cause for the hives, it should be avoided. Antihistamines are the main treatment for hives. Your healthcare provider may recommend over-the-counter cetirizine (Zyrtec), loratadine (Claritin) or fexofenadine (Allegra) during the daytime because they do not cause sleepiness. Over-the-counter diphenhydramine (Benadryl) or prescription hydroxyzine may be recommended at night. These medications work best when taken on a regular schedule each day so that hives are suppressed, rather than taking the medicine once the hives appear. Dr. Douglas may prescribe other treatments for hives that don’t respond to antihistamines.
Molluscum Contagiosum
Molluscum contagiosum is a viral skin infection seen most commonly in young to school-age children. It typically causes small bumps on the skin, which can occur anywhere on the body. The virus is contagious and spread by direct contact with the skin of an infected person or sharing damp towels, clothing, personal items and gym mats (e.g., wrestlers, gymnasts, etc.) with someone who has molluscum. Siblings bathing together and swimming together (especially when sharing kickboards and towels) also seem to be risk factors to develop the bumps, but this is not a reason to limit swimming.
What are molluscum?
Molluscum are usually small, flesh-colored to pink bumps with a shiny appearance and slightly depressed center. They can develop on the face, eyelids, trunk, extremities, and genitalia but usually do not involve the palms or soles. Molluscum bumps can only affect the skin and mucous membranes (fleshy lining of the eyes and genitals) – the virus never affects the internal organs. Molluscum bumps are painless, but may be itchy and can last for several months to sometimes years. Molluscum virus is extremely common in children.
After contact with the virus that causes them, molluscum may incubate for 2-8 weeks before appearing in the skin. Scratching or picking the bumps is one way the virus can be spread. Areas of the body where rubbing/friction of skin surfaces occurs (for example, the inner arm and sides of the belly) are common locations for molluscum infection.
In some patients, the bumps will become red and form pus bumps resembling pimples. This change in appearance is usually good and signifies that the patient’s immune system is recognizing the virus and is starting to clear the viral infection. If there is no pain or fever, the molluscum bump is unlikely to be “infected”.
Prevention
As the virus is contagious through direct contact, it is best to take measures to avoid the spread of the virus.
» Try to prevent your child from scratching or picking at the bumps. If eczema/rash is forming around the bumps, topical steroid preparations can be helpful to reduce the inflammation and the urge to scratch.
» Do not have children with molluscum bumps share towels or clothing; you may want to consider having siblings bathe separately.
» Avoid direct contact with a known infection.
» Molluscum is not dangerous. In general, it is not a reason a child should be held out of daycare or school activities.
What is a nevus sebaceus?
A nevus sebaceus (also known as “nevus of Jadassohn”) is an uncommon type of birthmark seen in about 0.3% of newborns. This type of birthmark is a small area of skin that has too many oil glands that grow larger than normal. Most of the time a nevus sebaceus is noticed right at birth, but sometimes it might be subtle and not noticed until later in childhood.
Why does a nevus sebaceus appear?
We now know that a nevus sebaceus is the result of a localized genetic change in the skin. This means that the genetic material in the area of the nevus sebaceus is different than the rest of the body. This is not passed from generation to generation and appears by chance in a person. No risk factors have been identified.
Are there any complications of a nevus sebaceus?
Most individuals with a nevus sebaceus do not have any complications from their birthmark. Occasionally, growths might develop within them. The vast majority of growths associated are not dangerous (i.e., benign), but very rarely the growths can be cancerous (i.e., malignant). It is extremely unlikely that these changes would happen in childhood; they are more likely seen after adolescence. Very large, extensive nevus sebaceus may be associated with changes in the eyes, brain and skeleton. This is referred to as nevus sebaceus syndrome, and it is exceedingly rare.
What is perioral dermatitis?
Perioral (or periorificial) dermatitis is a common acne or rosacea-like rash that develops around the mouth, nose and eyes of children and young adults.
What causes perioral dermatitis?
We don’t know the exact cause of perioral dermatitis. Sometimes perioral dermatitis is triggered by steroid medicines that are taken by mouth, applied to the skin or inhaled. One possible cause is an overgrowth of normal skin mites and yeast.
Perioral dermatitis facts:
» Perioral dermatitis looks like many tiny pink or skin-colored bumps that usually come close to the lips, but don’t go onto the lips.
» Perioral dermatitis may appear at any age in childhood and adolescence. Girls and boys both get it.
» The rash of perioral dermatitis is usually not very bothersome, although it can cause mild itching or burning.
» Many people with perioral dermatitis have a history of eczema or asthma. This may be because patients with eczema and asthma need to use steroid medications (and may have skin barrier problems).
» Topical steroids may at first seem like they help perioral dermatitis, but the rash often comes back and may even get worse as soon as topical steroids are stopped. Because of this, many people want to start the topical steroids again, but it is important to try to break this cycle.
How is perioral dermatitis treated?
There are many ways to treat perioral dermatitis, and sometimes you need to try several different medications before finding the one that works best for you. The rash needs to be treated for at least 3-6 weeks to fully improve. Dr. Douglas will decide which medications to start with based on how severe the rash is and which treatments have helped before. The following treatments have all been used to successfully clear perioral dermatitis:
» Remove triggers
» Topical antibiotics
» Topical non-steroid anti-inflammatory creams
» Anti-mite therapies
» Oral antibiotics
What should be expected after treatment?
Even after the rash clears with the right treatment, there is still a chance the perioral dermatitis may eventually come back. Scars from the rash are unlikely but have been seen in a few patients. Follow up with PDKC regularly and let us know if the rash comes back.
What is a pilomatricoma?
Pilomatricoma or pilomatrixoma is a benign (non-cancerous) bump under the skin. It usually forms on the head or neck of school-aged children, but can grow anywhere on the body. Typically, only one pilomatricoma forms at a time. Some people are prone to getting them and may get several at one time or over their lifetime.
What causes a pilomatricoma?
Pilomatricomas grow from cells in the hair follicle (where the hair forms). The exact cause of pilomatricomas is not known. Some people have an injury or irritation at the site before the pilomatricoma forms.
How is a pilomatricoma diagnosed?
Dr. Douglas can diagnose a pilomatricoma with a physical examination. A biopsy can be done to confirm the diagnosis, but is often not needed.
What does a pilomatricoma look like?
Pilomatricomas are often more easily felt than seen because they are under the skin. They feel like a small, hard lump (like a pebble) under the skin. The skin over the lump looks normal or can be a purple or blueish color. If the pilomatricoma becomes irritated, it can appear red or swollen. Pilomatricomas can be tender to touch, but usually do not cause a lot of pain or other problems.
What is the treatment?
Pilomatricomas do not usually go away on their own. They can slowly grow over time. If needed, pilomatricomas can be removed with a minor surgery. The surgery leaves a small scar.
What is a port-wine stain?
A port-wine stain is a type of birthmark made of dilated small blood vessels in the skin. It is also called a capillary malformation. This type of birthmark is usually present at birth. It can appear as light red or darker red to purple discolorations on any part of the body but is most common on the forehead, nose, cheek and chin. Port-wine stains usually grow in proportion to the growth of the child. Unlike hemangiomas, a more common type of vascular birthmark in children, port-wine stains are flat, do not grow quickly, and do not go away on their own.
For most children with this type of birthmark, there are no other associated health problems. In a small group of children, port-wine stains can be associated with brain and eye problems. This occurs in a condition called Sturge-Weber syndrome.
Port-wine stains can occur on other parts of the body including arms and legs and can be associated with overgrowth of the soft tissues and bones underlying the stain.
Over time, port-wine stains become darker red or purple in color and the involved skin may get thicker. The teeth, gums, and jaw underneath a port-wine stain may slowly enlarge over time, which often requires surgery.
What causes port-wine stains?
In the past few years, an important discovery was made about the cause of port-wine stains. In most children, a small genetic change occurs in the birthmark in a gene called GNAQ. Port-wine stains occur spontaneously, and are not inherited from parents.
How are port-wine stains treated?
Laser therapy with a pulsed dye laser (PDL) can help lighten the color of the port-wine stain and may prevent darkening and thickening of the stain with time. The laser works by targeting a part of red blood cells called hemoglobin. When the laser hits the skin, the energy from the laser is absorbed by the red blood cell, which causes it to become hot and, in turn, destroys the red blood cell and the surrounding abnormal dilated blood vessels. Complete clearance of the port-wine stain is difficult, however, even with laser treatment.
Generally 4 to 8 laser treatment sessions are performed on the skin, about 6-8 weeks apart. Some experts believe that starting treatment before 1 year of life can yield better results because the skin of a young infant is thinner, allowing the laser to penetrate more effectively. Stains on the extremities do not respond to the pulsed dye laser as well as stains on the face or neck.
Some patients describe the pulse of the laser as similar to a rubber band snapping against the skin. Depending upon the size and location of the stain, laser therapy may be performed without anesthesia, with topical anesthesia, or under general anesthesia. This is an important point to discuss with your doctor.
Immediately after the laser treatment, the port-wine birthmark will look bruised and may feel sore. Redness, swelling and itching may also occur immediately after the procedure and last for a few days. An ice pack may be applied to reduce discomfort. The bruising may last for 2-3 weeks. Although rare, blistering of the skin may occur. Protection of the treated area from the sun is important to avoid brownish discoloration of the skin after the bruising has resolved. It is also necessary to minimize tanning, which can decrease the usefulness of laser treatments. The risk of scarring from the pulsed dye laser is very small. With time, the remaining stain can begin to darken again and retreatment may be necessary.
What is psoriasis?
Psoriasis is a common, chronic condition in which red plaques with thick scales form on the skin. Psoriasis is a fairly common skin condition that affects 1-2% of all people. It is chronic, meaning the symptoms can come and go at any time throughout a person’s life. Psoriasis can develop at any age – from infancy to adulthood. In fact, one-third of psoriasis patients develop the condition before the age of 20. Psoriasis varies from person to person, both in severity and how it responds to treatment. There is no cure for psoriasis, but many treatment options are available depending on where it is located on the body and the severity of the disease.
What causes psoriasis?
We do not yet know what causes psoriasis, but we do know that the immune system and genetics play major roles in its development. In patients with psoriasis, the immune system is mistakenly activated, resulting in a faster growth cycle of skin cells. Normally, the skin goes through constant renewal by shedding the outer, dead layer of skin cells while new skin cells are made underneath. Normal skin cells mature and fall off the skin in three to four weeks. Psoriasis skin cells only take three to four days to go through this cycle. Instead of falling off, the cells pile up and form thick, red, scaly patches.
Psoriasis tends to run in families. If one parent has the condition, there is a 25% chance that each child will have it. Certain triggers can bring out psoriasis or make it worse. In children, injury to the skin and infections are common triggers. Up to half of children with psoriasis will have a flareup of psoriasis 2-6 weeks after illnesses such as ear infections, strep throat, or a common cold. Psoriasis itself, however, is not contagious.
Emotional Considerations in Children
For many children, the main problem with psoriasis is its visibility and the effect it may have on the child’s self-esteem and confidence. Children with psoriasis are at risk of depression and anxiety. Though psoriasis is not contagious, and the patches do not leave permanent scars on the skin, it can leave emotional scars. Caregivers are encouraged to keep a close eye on their child’s emotions and maintain open communication about their mood.
Other concerns for children with psoriasis:
Children with psoriasis are at risk of suffering from obesity, diabetes (high blood sugar), high cholesterol, and heart disease later in life. It is important to maintain a healthy weight by eating a good, balanced diet and staying active. The whole family should be part of this healthy lifestyle.
What is a pyogenic granuloma?
A pyogenic granuloma (PG) is a benign (not cancerous) red bump made of newly formed small blood vessels. Another medical name for pyogenic granuloma is a “lobular capillary hemangioma.” PGs can happen anywhere on the skin, and they can appear at any age. PGs often grow quickly, and they may get a scab over the top. With time, PGs might bleed, especially if they are bumped or scratched.
What causes a pyogenic granuloma?
PGs often appear after an injury. Sometimes it is hard to remember the injury as it may have been minor, for example, an insect bite or scratch. More rarely, PGs may appear with the use of certain medications, such as isotretinoin, or in birthmarks, such as port-wine stains. Sometimes a specific cause is not found.
What do I do if my child's pyogenic granuloma is bleeding?
When a PG is bleeding, it may seem like a lot of blood and may be frightening. However, PGs do not bleed enough to cause problems from blood loss.
To stop the bleeding, put some ointment (like petroleum jelly) on a cold washcloth and apply firm pressure to the PG for at least ten minutes. Watch the clock and try not to peek, because ten minutes feels like a long time. To make a cold washcloth, you can dampen the washcloth with cold water or put an ice pack in the washcloth. In most cases, just applying pressure will make the bleeding stop. If the bleeding cannot be stopped, call your healthcare provider.
What is scabies?
Scabies is a common skin problem caused by the human itch mite. People of any age, race and social group can get scabies, regardless of personal hygiene.
The mite is transmitted by close skin-to-skin contact. The mite burrows into the skin, where it feeds and lays eggs. The mite only lives in the upper layers of the skin; it does not go into the bloodstream or other body organs. After a few weeks, the patient develops an allergic reaction causing the very itchy scabies rash.
What does scabies look like?
The rash can look like hives, pimples, blisters or scaly and crusted bumps. Any body area can be affected, but it is common to see the rash on the hands, feet, underarms, belly button and genitals. In children less than 2 years old, the rash can be all over the body. The rash tends to be worse in the elderly or in people with a weakened immune system.
The rash and itching can be very mild or very severe; it depends on how the immune system responds to the mite. Not everyone reacts in the same way. This is why some people may have the mite but do not yet have a rash. It is common to see that only one or two people in the house have the rash, even though everyone has been exposed to the mite. It is important to treat all close contacts, not only those who have the rash.
How is scabies diagnosed?
Dr. Douglas can diagnose scabies by doing a careful head-to-toe skin exam. Special tests are not always needed to make the diagnosis. Dr. Douglas may perform a skin scraping to look for the mite or other clues under the microscope.
How is scabies treated?
There are different medications that can be used to treat scabies. 5% permethrin cream is the most commonly used and is the first line treatment for most patients. This cream needs to be applied on the entire skin surface, from neck to toes, making sure it covers all body folds and the space between fingers and toes. The face is usually not affected in children and adults and doesn’t usually need the cream unless specified by your doctor. However, in children less than 2 years old, permethrin cream should be applied to the whole body, from head to toe, as the head and neck areas can also be affected in this age group. Permethrin cream is left on the skin overnight for 8-14 hours before it is rinsed off the next day. The treatment needs to be repeated in one week.
There are other creams and oral medicines that can be used in special situations. These include specially made sulfur cream or ointment, other topical creams and oral ivermectin. Not all medications can be used in young infants and pregnant women. You and Dr. Douglas will determine which medication is safe for you and your family.
Dr. Douglas may also prescribe other creams and oral medicines to help calm the itch and irritation from the rash. The itch and rash may persist for several weeks after treating scabies. If you are getting new bumps after one month, you should be evaluated again.
In addition to the person with the rash, treatment is required for all household members and close contacts, such as grandparents or babysitters. Everyone should be treated at the same time to prevent re-infestation, even if contacts don’t have a rash.
The mite lives in the skin, but it can also survive outside of the body in clothes and bed linens. Therefore, careful cleaning of bed linens, clothing, towels, strollers, car seats, etc. following the skin treatment is very important to help eradicate the infestation.
Steps for successful treatment
» Follow the medication instructions carefully.
» Repeat the treatment when instructed by your doctor (usually in 7 days).
» Treat all close contacts and household members.
» Treat everyone at the same time.
» Wash clothing, bed linens and towels using hot water and dry using the hot cycle the day after skin treatment.
» Items that cannot be washed can be decontaminated by dry-cleaning or placing in a sealed plastic bag for at least 72 hours.
» Vacuum furniture, carpets, car seats and strollers.
» Fumigation of living areas is not necessary.
» Pets do not need to be treated.
What is a Spitz nevus?
Nevus (Nee vis) is a medical name for a mole. A Spitz nevus is a type of mole named after Dr. Sophie Spitz who first described it. In the past, Spitz nevi were called “benign juvenile melanoma.” This name is no longer used since melanoma is a type of skin cancer and Spitz nevi are benign moles.
A Spitz nevus often looks like a pink, raised bump. It can also be a blue, brown, or black flat mark or raised bump. When a Spitz nevus first appears, it will typically grow for a few months. After that time, the Spitz nevus should stop growing and stay the same size, shape, and color. After a few years, Spitz nevi sometimes get smaller, flatter, or even disappear.
How is a Spitz nevus diagnosed?
Some Spitz nevi can be diagnosed by Dr. Douglas examining them. Sometimes they need to be biopsied (a skin test where the mole is removed and evaluated) to be diagnosed.
What is the treatment?
Not all Spitz nevi need treatment. Most of the time, they are watched over time for changes. Measuring the mole’s size and taking photographs of it will help the doctor monitor for changes in size, color, and shape. Spitz nevi can be removed surgically. Surgical removal is recommended for Spitz nevi with concerning features or changes. Spitz nevi should not be removed or treated by burning, scraping, freezing, or laser. Dr. Douglas will help you decide the best treatment for your child’s moles.
How can I protect my child's skin?
When your child is outdoors, protect the skin with hats and clothing. Wear long sleeves and pants when possible. Look for sun-protective clothing like rash guards (swim shirts), and clothes with a high UV Protection Factor (UPF). When possible, avoid mid-day sun and seek shade. Use sunscreen on exposed skin, and reapply often to prevent sunburns and skin damage. Protecting from the sun helps prevent changes in your child’s nevi.
What is vitiligo?
Vitiligo (vit-ih-LIE-go) is a condition where individuals develop patches of white or lighter-colored skin. This results from destruction or reduction of melanocytes, the cells that produce pigment in our skin, so that they cannot properly function. The cause of vitiligo is not clearly understood, but it appears in most cases to be an autoimmune condition limited to the skin. In other words, the body’s own immune system attacks the normal pigment-making cells in the skin. As an autoimmune condition, vitiligo can be linked over time to the development of other autoimmune conditions, the most common being thyroid disease. In some cases, Dr. Douglas may check labs related to thyroid function and specific antibodies as part of the vitiligo workup.
Vitiligo is common, affecting up to 2% of the population worldwide. Vitiligo is partially genetic and may run in families, however, the risk of a sibling or child developing vitiligo is only about 6%. People of all ages and skin types can be affected. It can affect all areas of the body, especially areas that are “bumped” or rubbed frequently (i.e., areas of friction like the elbows, hands, waist, knees and top of the feet). It can also affect the skin around the eyes, nose and mouth, genitals, as well as the inner lining of the nose and mouth.
For most people with vitiligo, white patches develop and expand slowly over time; however, every person is different. Some patients will never progress, rarely patients will worsen rapidly, and 10-20% will develop spontaneous repigmentation (return of normal color). Some patients may experience increased darkening (i.e., hyperpigmentation) of the skin in areas where repigmentation occurs. A variant called segmental vitiligo seen in one-third of children with vitiligo is localized to a single strip of skin, and it is not usually associated with widespread loss of color.
What are the symptoms of vitiligo?
Vitiligo does not usually cause symptoms, but it can sometimes cause itching. It is not life-threatening and is not contagious/cannot be spread from one person to another. Some patients find that vitiligo negatively impacts their quality of life. For example, they do not like the appearance of their skin and find it stressful, upsetting or that it affects their social interactions. Some children may be bullied for looking different with vitiligo. In these settings, age-appropriate psychological intervention may be needed. For this and other personal reasons, treatment may be sought.
Tips for managing vitiligo:
»Avoiding tanning of normal skin can make areas of vitiligo less noticeable by decreasing the difference in color contrast between normal and affected skin.
»The white skin of vitiligo has far less natural protection from sun and can be very easily sunburned. Therefore, sunscreen (SPF 50 or more) should be used on all areas of vitiligo not covered by clothing.
»Disguising vitiligo with make-up or self-tanning compounds is a safe way to make it less noticeable. Waterproof cosmetics to match almost all skin colors are available at many large department stores. These products gradually wear off. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan color. The color from self-tanning creams also slowly wears off. None of these can change the actual disorder, but they can improve appearance.
What are warts?
Warts are common viral infections caused by the human papilloma virus (HPV). There are many different strains of this virus causing different types of warts and specific tests are usually not necessary. Warts are much more common in children than adults. Warts can go away without treatment as our own immune system learns how to fight them. About 60% of warts will disappear within about 2 years. There are many possible ways to treat warts and sometimes several different treatments are needed to get the warts to go away completely. There is no single perfect treatment for warts, and successful treatment can take many months. Your health care professional will help you find the right treatment tailored to your individual needs. For in-office treatments, multiple visits are usually required.
Common In-Office Wart Treatments
Cryotherapy
This is a cold spray (usually liquid nitrogen) used to freeze the wart. It may cause a blister.
Candida
(“yeast”) antigen injections. These are extracts of the common yeast (Candida) that cannot cause an infection. The medication is injected into/under the wart. It is thought to stimulate the immune system to recognize the wart virus and attack it. Multiple injections are needed about one month apart.
Paring
Scraping or filing down a wart can help make other wart treatments more effective.
Other
less common office treatments include laser treatment and contact immunotherapy (DPCP, squaric acid).
- Acne
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What is acne and why do I have pimples?
The medical term for “pimples” is acne. Most people get at least some acne, especially during their teenage years. Why you get acne is complicated. One common belief is that acne comes from being dirty. This is not true; rather, acne is the result of changes that occur during puberty.
Your skin is made of layers. To keep the skin from getting dry, the skin makes oil in little wells called “sebaceous glands” that are found in the deeper layers of the skin. “Whiteheads” or “blackheads” are clogged sebaceous glands. “Blackheads” are not caused by dirt blocking the pores, but rather by oxidation (a chemical reaction that occurs when the oil reacts with oxygen in the air). People with acne have glands that make more oil and are more easily plugged, causing the glands to swell. Hormones, bacteria (called P. acnes) and your family’s likelihood to have acne (genetic susceptibility) also play a role.
Skin Hygiene
Washing your face is part of taking good care of your skin. Good skin care habits are important and support the medications your doctor prescribes for your acne.
» Avoid over-washing/over-scrubbing your face as this will not improve the acne and may lead to dryness and irritation, which can interfere with your medications.
» In general, milder soaps and cleansers are better for acne prone skin. The soaps labeled “for sensitive skin” are milder than those labeled “deodorant soap.”
» “Acne washes” may contain salicylic acid. Salicylic acid fights oil and bacteria but can be drying and can add to irritation, so hold off using it unless recommended by Dr. Douglas. Scrubbing with a washcloth or loofah is also not advised as this can irritate and inflame your acne.
» If you use makeup or sunscreen make sure that these products are labeled “won’t clog pores” or “won’t cause acne” or “non-comedogenic,” which means it will not cause or worsen acne.
» If you play sports, try to wash right away when you are done. Also, pay attention to how your sports equipment (shoulder pads, helmet strap, etc.) might rub against your skin and be making your acne worse!
What can I do to help the acne go away?
Some lifestyle changes can be beneficial in helping acne as well. Stress is known to aggravate acne, so try to get enough sleep and daily exercise. It is also important to eat a balanced diet. Some people feel that certain foods (like pizza, soda or chocolate) worsen their acne. While there aren’t many studies available on this question, strict dietary changes are unlikely to be helpful and may be harmful to your health. If you find that a certain food seems to aggravate your acne, you may consider avoiding that food.
Tips for using your acne medications correctly
» Apply your medication to clean, dry skin.
» Apply the medicine to the entire area of your face that gets acne. The medications work by preventing new breakouts. Spot treatment of individual pimples does not do much.
» Sometimes it is the combination of medicines that helps make the acne go away, not any single medication. Just because one medication may not have worked before does not mean it won’t work when used in combination with another.
» The medications are not vanishing creams (they are not magic!) – they take weeks to months to work. Be patient and use your medicine on a daily basis or as directed for six weeks before you ask whether your skin looks better. Try not to miss more than one or two days each week.
» Don’t stop putting on the medicine just because the acne is better. Remember that the acne is better because of the medication, and prevention is the key.
» When applying topical medications to the face, use the “5-dot” method. Take a small pea-sized amount
and place dots in each of 5 locations of your face: mid-forehead, each cheek, nose, and chin. Then rub in. You should not see a “film” of the medication on your skin; if you do, you’re probably using too much.
» Topical medications may lead to dryness where you use them. This almost always improves as your skin
gets used to the medication (about 2-3 weeks). Some tips to get you through this time include waiting 15-20 minutes after washing before applying the topical medication and starting out with use every 2-3 days, gradually working up to “every day” use.
» Taking oral medications with food often helps with symptoms of upset stomach.
- Alopecia
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What is alopecia areata?
Alopecia means hair loss, and there are several types. Alopecia areata is one of the most common hair loss disorders characterized by loss of hair in round patches, usually on the scalp.
What causes alopecia areata?
The exact cause of alopecia areata is unknown, but it seems to be caused by the immune system attacking the hair follicles by mistake. The hair follicle is the pocket at the base of the skin that grows and holds the hair. When the follicle is attacked, this causes the hair to fall out just below the surface of the skin. The scalp itself is usually perfectly normal. Occasionally, the scalp itches slightly, but usually there are no associated symptoms.
Treatment of alopecia areata
Dr. Douglas may decide not to give your child any treatment for alopecia areata at first. Sometimes the hair can grow back on its own. A “wait and see” approach may be the best option in some children. Other times, Dr. Douglas might decide to treat. Some treatments for alopecia areata include:
» topical steroid creams or ointments
» steroid injections into the bald patches
» contact sensitizers, such as squaric acid or DPCP
» other topical medications, like anthralin or minoxidil
These treatments are helpful in some patients, but not all children respond to therapy. Even with a good response to treatment, the hair may fall out again in the future. Treatment may help treat the bald patches that already exist, but these treatments do not prevent new ones from forming.
How can I help support my child with alopecia areata?
» Educate your child about alopecia areata. Be open and honest and support your child.
» Discuss the diagnosis with your child’s teacher and principal. If they know what your child has, they will be better able to support your child in the school setting as well. Give your child the option of informing classmates.
» Help your child learn what to say if someone asks about the hair loss. This can be a simple answer such as “I have alopecia” or anything they are comfortable responding. Having a prepared response helps some children to handle questions more easily.
» Provide your child with positive messages and praise. Your outlook has a great impact on how your child feels about themselves. Self-esteem is crucial.
» Model good problem solving and ways to cope. This means that it is alright to show and share your feelings. If you or your child have a hard time coping and it affects your everyday life, you may want to consider speaking with a counselor.
» Give your child the choice to interact with other children who have alopecia. This allows them to share their experiences and know they are not alone.
Additional resources for families with alopecia:
»National Alopecia Areata Foundation
Website: www.naaf.org
E-mail: info@naaf.org
»The Childrens Alopecia project
childrensalopeciaproject.org
»National Alopecia Areata Registry
The National Alopecia Areata Registry collects patient information in an effort to identify the cause(s) of alopecia areata. Toll-free number: (866) 837-1050
- Contact Dermatitis
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Allergic Contact Dermatitis
Contact dermatitis is an itchy rash that is caused by something touching(contacting) your skin. The rash is usually red, bumpy, and itchy. Sometimes there are blisters filled with fluid.
There are two types of contact dermatitis:
1. Some things that contact skin are very irritating and will cause a rash in most people. This rash is called irritant contact dermatitis. Examples are acids, soaps, cold weather, and friction.
2. Some things that touch your skin give you a rash because you are allergic to them. This rash is called allergic contact dermatitis. These are items that do not bother everyone’s skin. They only cause a rash in people who are allergic to those items.
Why do some people get allergic contact dermatitis?
People often ask a question like: “Why am I getting a rash from my favorite earrings now? I have been wearing them for a year with no problem!” This can be very confusing. The answer is that you are not born with allergies. Allergies start after your body has become familiar with something. This can take days, months, or even years to happen. Thus, allergies appear during childhood and adulthood.
Patch Testing
If a rash seems like it may be allergic contact dermatitis (it does not go away or it keeps coming back in the same place) but the exact cause is not clear, a patch test may help figure out what is causing the rash.
A patch test is a special allergy test to find out if something touching the skin is causing an allergic rash. Tiny amounts of many items are taped to the skin on the back. The back is used because it is a large area. Two days later, the tape is removed and the skin is checked to see if there is a small rash in any of those spots. Sometimes reactions are delayed so the skin is checked again after two or three more days. If the test shows you are allergic to something, that may be what caused your rash. You will be given information on those items including where they are found and how they can be avoided.
How is allergic contact dermatitis treated?
Treatment depends on how bad the rash is. If the rash is only on small areas of skin, steroid ointments are usually prescribed. If the rash has spread or is severe, oral steroids are sometimes used. Oral antihistamines can help with itching. Many antihistamines are sold over the counter such as diphenhydramine and cetirizine. Others require a prescription.
To prevent the rash from coming back, you must avoid contact with whatever caused the rash. This can be hard but is extremely important. Once you are allergic to something, you will always be allergic to it. The rash can get worse each time it comes back. You can even get a rash all over the body including areas that have not been in contact with what you are allergic to. This is called “autosensitization dermatitis” or “id reaction.”
- Eczema
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What is atopic dermatitis?
Atopic dermatitis, also called eczema, is a common and chronic skin condition in which the skin appears inflamed, red, itchy and dry. It most commonly affects children.
Atopic dermatitis is most likely caused by a combination of genetic and environmental factors. Genetic causes include differences in the proteins that form the skin barrier. When this barrier is broken down, the skin loses moisture more easily, becoming more dry, easily irritated, and hypersensitive. The skin is also more prone to infection (with bacteria, viruses, or fungi). The immune system in the skin may be different and overreact to environmental triggers such as pet dander and dust mites.
Allergies and asthma may be present more frequently in individuals with atopic dermatitis, but they are not the cause of eczema. Infrequently, when a specific food allergy is identified, eating that food may make atopic dermatitis worse, but it usually is not the cause of the eczema.
In infants, atopic dermatitis often starts as a dry red rash on the cheeks and around the mouth, often made worse by drooling. As children grow older, the rash may be on the arms, legs, or in other areas where they are able to scratch. In teenagers, eczema is often on the inside of the elbows and knees, on the hands and feet, and around the eyes. There is no cure, but there are recommendations to help manage this skin problem.
Skin Care to Prevent Dryness
» Bathe daily or every-other-day in order to wash off dirt and other potential irritants (the optimal frequency of bathing is not yet clear).
» Water should be warm (not hot), and bath time should be limited to 5-10 minutes.
» Pat-dry the skin with a towel and immediately apply moisturizer while the skin is still slightly damp. The moisturizer provides a seal to hold the water in the skin.
» Finding a cream or ointment that the child likes or can tolerate is important, as resistance from the child may make the daily regimen difficult to keep up.
» The thicker the moisturizer, the better the barrier it generally provides.
» Ointments are more effective than creams, and creams more so than lotions. Creams are a reasonable option during the summer when thick greasy ointments are uncomfortable.
Treating the Rash
The most commonly used medications are topical corticosteroids (“steroids”). There are many different types of topical corticosteroids that come in different strengths and formulations (for example, ointments, creams, lotions, solutions, gels, oils). Therefore, finding the right combination for the individual is important to treat and to minimize the risk of unwanted side effects from the corticosteroid, such as skin thinning. In general, these topical corticosteroids should be applied as a thin layer and no more than twice daily. It is very unusual to see any side effects when a topical corticosteroid is used as prescribed.
Treating the Itch
Your child may be very itchy. Sometimes the itch will affect your child’s ability to sleep through the night. Oral anti-itch medicines (antihistamines) can be helpful for inducing sleep, but usually do not reduce the itch and scratching.
Avoiding Triggers
Some children have specific things that trigger episodes of itchiness and rashes, while others may have none that can be identified. Triggers may even change over time. Common triggers include: excessive bathing without moisturization, low humidity, cigarette or wood smoke exposure, emotional stress, sweat, friction and overheating of skin, and exposure to certain products such as wool, harsh soaps, fragrance, bubble baths, and laundry detergents.
Recognizing Infections as a Trigger
Because the skin barrier is compromised, individuals with atopic dermatitis can also develop infections on the skin from bacteria, viruses, or fungi. The most common infection is from Staphylococcus aureus bacteria, which should be suspected when the skin develops honey-colored crusts, or appears raw and weepy. Infected skin may result in a worsening of the atopic dermatitis and may not respond to standard therapy. Diluted bleach baths can be helpful to reduce infection by S. aureus and thereby help better control atopic dermatitis. Some patients require oral and/or topical antibiotics or antiviral medications for these types of flares
The Role of Foods in Atopic Dermatitis
Children with atopic dermatitis have an increased incidence of food allergies. It is common for parents to look to food as the possible cause for their child’s eczema. However, studies have shown that food allergy often exist side-by-side with atopic dermatitis, but it is not causing the atopic dermatitis.
- Fungal Infections
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What is tinea?
Tinea is a fungal infection of the skin, hair or nails. These fungal infections are named for where they occur on the body. Some examples are:
» Tinea capitis (scalp)
» Tinea corporis (body)
» Tinea cruris (groin) – “jock itch”
» Tinea faciei (face)
» Tinea pedis (feet) – “athlete’s foot”
» Tinea unguium or onychomycosis (nail)
Is tinea contagious?
People usually get tinea by touching a person who has it. Family members and close contacts may pass the fungus back and forth. Wrestlers are particularly at risk because of skin contact during the sport. The fungus that causes tinea can also live on sheets, brushes, hats, damp floors, gym mats, in the soil, and on pets. People can get tinea from touching these things too.
Some tips to prevent spreading tinea to others or back to yourself:
» Avoid sharing combs, hair brushes, hats, pillowcases and towels.
» Keep combs and hair brushes clean.
» Towel dry well after baths or showers. Pay special attention to body folds and feet, including the skin between toes.
» Wear sandals or flip flops in locker rooms, public showers and around the pool.
» Change your socks at least once daily.
Why is tinea sometimes called ``ringworm``? Is it caused by a worm?
On much of the body and face, tinea can look like a red, scaly ring. Because of the ringed shape, it is sometimes called “ringworm” even though it is not caused by a worm.
What does tinea look like?
The appearance of tinea, as well as the symptoms, may be different on different parts of the body.
Tinea capitis (scalp):
The scalp may show flakes of skin resembling dandruff. There may also be pus bumps or patches of hair loss or broken hairs. In some people, the fungus causes more inflammation with redness, crusting and weeping on the scalp, and there may be enlarged lymph nodes in the neck (“swollen glands”). When hair loss occurs, it is usually temporary, and the hair will grow back. However, if the fungus has caused too much inflammation or scarring, the hair may not grow back completely.
Tinea corporis, faciei, and cruris (body, face and groin):
These are typically the areas where the name “ringworm” is used, as the fungal infection looks like a red, scaly ring with clearing in the center. Sometimes there are multiple rings or partial rings or rings that have come together to become irregular shapes, still with the edge being red and scaly and notably clear areas in the center.
Tinea pedis (“athlete’s foot”):
The skin is usually moist and flaky between the toes. There are sometimes also the red, scaly rings on top of the toes and feet, as well as flaky skin on the bottoms or sides of the feet. Sometimes, blisters may be present.
Onychomycosis (nail fungus):
This type of fungus is more common in adults than in children. Children with onychomycosis frequently have a household member who also has nail fungus. In this type of tinea, the nails get thick and yellow, and there is a buildup of loose skin and fungus under the affected nails, especially at the outer edge of the nails.
How is tinea treated?
There are a variety of over-the-counter and prescription medications to treat tinea infections. The type and length of treatment that is recommended or prescribed will differ depending on the type of tinea.
Tinea on the face, body, groin and feet is usually treated with medications that you apply directly to the skin (topical medications). These include creams, lotions and gels. Examples are terbinafine, ketoconazole, ciclopirox and oxiconazole. These medications generally need to be used for several weeks. If the infection is extensive, oral antifungal medications may be needed.
Tinea capitis (scalp) and onychomycosis (nail fungus) usually need to be treated with prescription medications taken by mouth. These medications need to be taken for several weeks to months. Examples include griseofulvin, terbinafine, fluconazole and itraconazole. A medicated shampoo is also recommended for tinea capitis both for the person with the infection and people who live in the same house. The shampoo will not clear the infection but can prevent spread to other people.
- Hemangiomas
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What are infantile hemangiomas?
Infantile hemangiomas are benign (non-cancerous) collections of blood vessels in the skin. They typically undergo a period of rapid growth for several months before they eventually begin to slowly improve.
When do infantile hemangiomas need to be treated?
Most hemangiomas do not require any treatment; however, a small number do require treatment because of complications potentially caused by the hemangioma. Sometimes treatment is needed if the hemangioma is growing too large or if there is a risk of permanent scarring or disfigurement (damage to the appearance). Treatment may also be necessary if the hemangioma is affecting a vital function, such as vision, eating or breathing, or to help with healing when the skin overlying the hemangioma starts to break down; this is called ulceration. Propranolol has become the most widely used medication for the treatment of serious complications from hemangiomas.
What is propranolol and how does it work?
Propranolol is a “beta-receptor blocker”. Beta-receptors are present on many tissues in the body including the heart, lungs, eyes and blood vessels. Propranolol has been used for many years in the treatment of high blood pressure and irregular heartbeats as well as migraine headaches. While the exact way in which it works on hemangiomas has not been identified, it is known that propranolol can constrict blood vessels (make them narrower), decreasing the amount of blood flowing through them. This can make the hemangioma softer and less red. Propranolol also seems to limit the growth of hemangioma cells, so that the size of the hemangioma is reduced over time. The effects of Propranolol can be quite rapid, with most patients showing improvement within the first few days to weeks on the medication. Propranolol has been approved by the Food and Drug Administration (FDA), specifically for the treatment of hemangiomas.
Are any tests needed before starting propranolol?
Occasionally, Dr. Douglas will order tests to be sure your child can safely take the medication. These may include an electrocardiogram (EKG), or occasionally other laboratory tests, depending upon your child’s history and physical examination, and the family history. If there are several hemangiomas on your child’s skin, an ultrasound of the abdomen may be ordered to check for hemangiomas in the liver or spleen. Dr. Douglas will discuss with you about what specific testing, if any, may be needed for your child.
- Hives
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What are hives?
Hives typically appear as pink or red puffy spots (“welts”) on the skin. They can be different sizes, from very small to quite large. They are usually itchy. Hives can appear anywhere on the body. If you draw a circle around a single hive on the skin, it will usually have moved, changed shape, or disappeared completely within 24 hours, though new hives may have popped up in other locations. In young children, hives can look like big circles or rings on the skin. The rings may have normal skin in the middle, or look purplish like a bruise. Sometimes this purple patch will last longer than the hive itself.
It is common for young children with hives to also get swelling of the hands and feet. This can be uncomfortable, and may cause the child to avoid walking. When hives occur after scratching or rubbing the skin, it is called dermatographism, which literally means “skin writing.” These marks usually go away in less than an hour. Dermatographism is a normal finding that happens in over 5% of healthy people and may also become more noticeable during breakouts of hives.
What causes hives?
Hives are a skin reaction to many different causes. Infections are the most common cause of hives in young children. Often the child seems well and has no or very few other symptoms of an infection before the hives begin. Other common causes of hives include medicines and foods. Less common causes include additives to foods such as preservatives and color dyes, exercise, stress, sunlight, and contact with cold substances like ice. In most cases, hives occur in perfectly healthy people, but occasionally hives may be a sign of a more serious condition like an autoimmune disease. Often, a specific cause for hives cannot be found.
How long do hives last?
In over 80% of children, outbreaks of hives will end within 2 weeks. Occasionally hives will continue to break out for longer. The term “chronic urticaria” is used when the breakouts continue for longer than 6 weeks.
When should I be worried about hives?
Call 9-1-1 or go to the nearest emergency room if your child has swelling or tingling of the mouth, tongue or throat, trouble breathing, trouble swallowing, and/or vomiting with the hives. These are signs of anaphylaxis, which is an emergency.
How are hives treated?
Hives related to infections will go away on their own. If there is another known cause for the hives, it should be avoided. Antihistamines are the main treatment for hives. Your healthcare provider may recommend over-the-counter cetirizine (Zyrtec), loratadine (Claritin) or fexofenadine (Allegra) during the daytime because they do not cause sleepiness. Over-the-counter diphenhydramine (Benadryl) or prescription hydroxyzine may be recommended at night. These medications work best when taken on a regular schedule each day so that hives are suppressed, rather than taking the medicine once the hives appear. Dr. Douglas may prescribe other treatments for hives that don’t respond to antihistamines.
- Molluscum
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Molluscum Contagiosum
Molluscum contagiosum is a viral skin infection seen most commonly in young to school-age children. It typically causes small bumps on the skin, which can occur anywhere on the body. The virus is contagious and spread by direct contact with the skin of an infected person or sharing damp towels, clothing, personal items and gym mats (e.g., wrestlers, gymnasts, etc.) with someone who has molluscum. Siblings bathing together and swimming together (especially when sharing kickboards and towels) also seem to be risk factors to develop the bumps, but this is not a reason to limit swimming.
What are molluscum?
Molluscum are usually small, flesh-colored to pink bumps with a shiny appearance and slightly depressed center. They can develop on the face, eyelids, trunk, extremities, and genitalia but usually do not involve the palms or soles. Molluscum bumps can only affect the skin and mucous membranes (fleshy lining of the eyes and genitals) – the virus never affects the internal organs. Molluscum bumps are painless, but may be itchy and can last for several months to sometimes years. Molluscum virus is extremely common in children.
After contact with the virus that causes them, molluscum may incubate for 2-8 weeks before appearing in the skin. Scratching or picking the bumps is one way the virus can be spread. Areas of the body where rubbing/friction of skin surfaces occurs (for example, the inner arm and sides of the belly) are common locations for molluscum infection.
In some patients, the bumps will become red and form pus bumps resembling pimples. This change in appearance is usually good and signifies that the patient’s immune system is recognizing the virus and is starting to clear the viral infection. If there is no pain or fever, the molluscum bump is unlikely to be “infected”.
Prevention
As the virus is contagious through direct contact, it is best to take measures to avoid the spread of the virus.
» Try to prevent your child from scratching or picking at the bumps. If eczema/rash is forming around the bumps, topical steroid preparations can be helpful to reduce the inflammation and the urge to scratch.
» Do not have children with molluscum bumps share towels or clothing; you may want to consider having siblings bathe separately.
» Avoid direct contact with a known infection.
» Molluscum is not dangerous. In general, it is not a reason a child should be held out of daycare or school activities.
- Nevus Sebaceus
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What is a nevus sebaceus?
A nevus sebaceus (also known as “nevus of Jadassohn”) is an uncommon type of birthmark seen in about 0.3% of newborns. This type of birthmark is a small area of skin that has too many oil glands that grow larger than normal. Most of the time a nevus sebaceus is noticed right at birth, but sometimes it might be subtle and not noticed until later in childhood.
Why does a nevus sebaceus appear?
We now know that a nevus sebaceus is the result of a localized genetic change in the skin. This means that the genetic material in the area of the nevus sebaceus is different than the rest of the body. This is not passed from generation to generation and appears by chance in a person. No risk factors have been identified.
Are there any complications of a nevus sebaceus?
Most individuals with a nevus sebaceus do not have any complications from their birthmark. Occasionally, growths might develop within them. The vast majority of growths associated are not dangerous (i.e., benign), but very rarely the growths can be cancerous (i.e., malignant). It is extremely unlikely that these changes would happen in childhood; they are more likely seen after adolescence. Very large, extensive nevus sebaceus may be associated with changes in the eyes, brain and skeleton. This is referred to as nevus sebaceus syndrome, and it is exceedingly rare.
- Perioral Dermatitis
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What is perioral dermatitis?
Perioral (or periorificial) dermatitis is a common acne or rosacea-like rash that develops around the mouth, nose and eyes of children and young adults.
What causes perioral dermatitis?
We don’t know the exact cause of perioral dermatitis. Sometimes perioral dermatitis is triggered by steroid medicines that are taken by mouth, applied to the skin or inhaled. One possible cause is an overgrowth of normal skin mites and yeast.
Perioral dermatitis facts:
» Perioral dermatitis looks like many tiny pink or skin-colored bumps that usually come close to the lips, but don’t go onto the lips.
» Perioral dermatitis may appear at any age in childhood and adolescence. Girls and boys both get it.
» The rash of perioral dermatitis is usually not very bothersome, although it can cause mild itching or burning.
» Many people with perioral dermatitis have a history of eczema or asthma. This may be because patients with eczema and asthma need to use steroid medications (and may have skin barrier problems).
» Topical steroids may at first seem like they help perioral dermatitis, but the rash often comes back and may even get worse as soon as topical steroids are stopped. Because of this, many people want to start the topical steroids again, but it is important to try to break this cycle.
How is perioral dermatitis treated?
There are many ways to treat perioral dermatitis, and sometimes you need to try several different medications before finding the one that works best for you. The rash needs to be treated for at least 3-6 weeks to fully improve. Dr. Douglas will decide which medications to start with based on how severe the rash is and which treatments have helped before. The following treatments have all been used to successfully clear perioral dermatitis:
» Remove triggers
» Topical antibiotics
» Topical non-steroid anti-inflammatory creams
» Anti-mite therapies
» Oral antibiotics
What should be expected after treatment?
Even after the rash clears with the right treatment, there is still a chance the perioral dermatitis may eventually come back. Scars from the rash are unlikely but have been seen in a few patients. Follow up with PDKC regularly and let us know if the rash comes back.
- Pilomatricoma
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What is a pilomatricoma?
Pilomatricoma or pilomatrixoma is a benign (non-cancerous) bump under the skin. It usually forms on the head or neck of school-aged children, but can grow anywhere on the body. Typically, only one pilomatricoma forms at a time. Some people are prone to getting them and may get several at one time or over their lifetime.
What causes a pilomatricoma?
Pilomatricomas grow from cells in the hair follicle (where the hair forms). The exact cause of pilomatricomas is not known. Some people have an injury or irritation at the site before the pilomatricoma forms.
How is a pilomatricoma diagnosed?
Dr. Douglas can diagnose a pilomatricoma with a physical examination. A biopsy can be done to confirm the diagnosis, but is often not needed.
What does a pilomatricoma look like?
Pilomatricomas are often more easily felt than seen because they are under the skin. They feel like a small, hard lump (like a pebble) under the skin. The skin over the lump looks normal or can be a purple or blueish color. If the pilomatricoma becomes irritated, it can appear red or swollen. Pilomatricomas can be tender to touch, but usually do not cause a lot of pain or other problems.
What is the treatment?
Pilomatricomas do not usually go away on their own. They can slowly grow over time. If needed, pilomatricomas can be removed with a minor surgery. The surgery leaves a small scar.
- Port-Wine Stain
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What is a port-wine stain?
A port-wine stain is a type of birthmark made of dilated small blood vessels in the skin. It is also called a capillary malformation. This type of birthmark is usually present at birth. It can appear as light red or darker red to purple discolorations on any part of the body but is most common on the forehead, nose, cheek and chin. Port-wine stains usually grow in proportion to the growth of the child. Unlike hemangiomas, a more common type of vascular birthmark in children, port-wine stains are flat, do not grow quickly, and do not go away on their own.
For most children with this type of birthmark, there are no other associated health problems. In a small group of children, port-wine stains can be associated with brain and eye problems. This occurs in a condition called Sturge-Weber syndrome.
Port-wine stains can occur on other parts of the body including arms and legs and can be associated with overgrowth of the soft tissues and bones underlying the stain.
Over time, port-wine stains become darker red or purple in color and the involved skin may get thicker. The teeth, gums, and jaw underneath a port-wine stain may slowly enlarge over time, which often requires surgery.
What causes port-wine stains?
In the past few years, an important discovery was made about the cause of port-wine stains. In most children, a small genetic change occurs in the birthmark in a gene called GNAQ. Port-wine stains occur spontaneously, and are not inherited from parents.
How are port-wine stains treated?
Laser therapy with a pulsed dye laser (PDL) can help lighten the color of the port-wine stain and may prevent darkening and thickening of the stain with time. The laser works by targeting a part of red blood cells called hemoglobin. When the laser hits the skin, the energy from the laser is absorbed by the red blood cell, which causes it to become hot and, in turn, destroys the red blood cell and the surrounding abnormal dilated blood vessels. Complete clearance of the port-wine stain is difficult, however, even with laser treatment.
Generally 4 to 8 laser treatment sessions are performed on the skin, about 6-8 weeks apart. Some experts believe that starting treatment before 1 year of life can yield better results because the skin of a young infant is thinner, allowing the laser to penetrate more effectively. Stains on the extremities do not respond to the pulsed dye laser as well as stains on the face or neck.
Some patients describe the pulse of the laser as similar to a rubber band snapping against the skin. Depending upon the size and location of the stain, laser therapy may be performed without anesthesia, with topical anesthesia, or under general anesthesia. This is an important point to discuss with your doctor.
Immediately after the laser treatment, the port-wine birthmark will look bruised and may feel sore. Redness, swelling and itching may also occur immediately after the procedure and last for a few days. An ice pack may be applied to reduce discomfort. The bruising may last for 2-3 weeks. Although rare, blistering of the skin may occur. Protection of the treated area from the sun is important to avoid brownish discoloration of the skin after the bruising has resolved. It is also necessary to minimize tanning, which can decrease the usefulness of laser treatments. The risk of scarring from the pulsed dye laser is very small. With time, the remaining stain can begin to darken again and retreatment may be necessary.
- Psoriasis
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What is psoriasis?
Psoriasis is a common, chronic condition in which red plaques with thick scales form on the skin. Psoriasis is a fairly common skin condition that affects 1-2% of all people. It is chronic, meaning the symptoms can come and go at any time throughout a person’s life. Psoriasis can develop at any age – from infancy to adulthood. In fact, one-third of psoriasis patients develop the condition before the age of 20. Psoriasis varies from person to person, both in severity and how it responds to treatment. There is no cure for psoriasis, but many treatment options are available depending on where it is located on the body and the severity of the disease.
What causes psoriasis?
We do not yet know what causes psoriasis, but we do know that the immune system and genetics play major roles in its development. In patients with psoriasis, the immune system is mistakenly activated, resulting in a faster growth cycle of skin cells. Normally, the skin goes through constant renewal by shedding the outer, dead layer of skin cells while new skin cells are made underneath. Normal skin cells mature and fall off the skin in three to four weeks. Psoriasis skin cells only take three to four days to go through this cycle. Instead of falling off, the cells pile up and form thick, red, scaly patches.
Psoriasis tends to run in families. If one parent has the condition, there is a 25% chance that each child will have it. Certain triggers can bring out psoriasis or make it worse. In children, injury to the skin and infections are common triggers. Up to half of children with psoriasis will have a flareup of psoriasis 2-6 weeks after illnesses such as ear infections, strep throat, or a common cold. Psoriasis itself, however, is not contagious.
Emotional Considerations in Children
For many children, the main problem with psoriasis is its visibility and the effect it may have on the child’s self-esteem and confidence. Children with psoriasis are at risk of depression and anxiety. Though psoriasis is not contagious, and the patches do not leave permanent scars on the skin, it can leave emotional scars. Caregivers are encouraged to keep a close eye on their child’s emotions and maintain open communication about their mood.
Other concerns for children with psoriasis:
Children with psoriasis are at risk of suffering from obesity, diabetes (high blood sugar), high cholesterol, and heart disease later in life. It is important to maintain a healthy weight by eating a good, balanced diet and staying active. The whole family should be part of this healthy lifestyle.
- Pyogenic Granuloma
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What is a pyogenic granuloma?
A pyogenic granuloma (PG) is a benign (not cancerous) red bump made of newly formed small blood vessels. Another medical name for pyogenic granuloma is a “lobular capillary hemangioma.” PGs can happen anywhere on the skin, and they can appear at any age. PGs often grow quickly, and they may get a scab over the top. With time, PGs might bleed, especially if they are bumped or scratched.
What causes a pyogenic granuloma?
PGs often appear after an injury. Sometimes it is hard to remember the injury as it may have been minor, for example, an insect bite or scratch. More rarely, PGs may appear with the use of certain medications, such as isotretinoin, or in birthmarks, such as port-wine stains. Sometimes a specific cause is not found.
What do I do if my child's pyogenic granuloma is bleeding?
When a PG is bleeding, it may seem like a lot of blood and may be frightening. However, PGs do not bleed enough to cause problems from blood loss.
To stop the bleeding, put some ointment (like petroleum jelly) on a cold washcloth and apply firm pressure to the PG for at least ten minutes. Watch the clock and try not to peek, because ten minutes feels like a long time. To make a cold washcloth, you can dampen the washcloth with cold water or put an ice pack in the washcloth. In most cases, just applying pressure will make the bleeding stop. If the bleeding cannot be stopped, call your healthcare provider.
- Scabies
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What is scabies?
Scabies is a common skin problem caused by the human itch mite. People of any age, race and social group can get scabies, regardless of personal hygiene.
The mite is transmitted by close skin-to-skin contact. The mite burrows into the skin, where it feeds and lays eggs. The mite only lives in the upper layers of the skin; it does not go into the bloodstream or other body organs. After a few weeks, the patient develops an allergic reaction causing the very itchy scabies rash.
What does scabies look like?
The rash can look like hives, pimples, blisters or scaly and crusted bumps. Any body area can be affected, but it is common to see the rash on the hands, feet, underarms, belly button and genitals. In children less than 2 years old, the rash can be all over the body. The rash tends to be worse in the elderly or in people with a weakened immune system.
The rash and itching can be very mild or very severe; it depends on how the immune system responds to the mite. Not everyone reacts in the same way. This is why some people may have the mite but do not yet have a rash. It is common to see that only one or two people in the house have the rash, even though everyone has been exposed to the mite. It is important to treat all close contacts, not only those who have the rash.
How is scabies diagnosed?
Dr. Douglas can diagnose scabies by doing a careful head-to-toe skin exam. Special tests are not always needed to make the diagnosis. Dr. Douglas may perform a skin scraping to look for the mite or other clues under the microscope.
How is scabies treated?
There are different medications that can be used to treat scabies. 5% permethrin cream is the most commonly used and is the first line treatment for most patients. This cream needs to be applied on the entire skin surface, from neck to toes, making sure it covers all body folds and the space between fingers and toes. The face is usually not affected in children and adults and doesn’t usually need the cream unless specified by your doctor. However, in children less than 2 years old, permethrin cream should be applied to the whole body, from head to toe, as the head and neck areas can also be affected in this age group. Permethrin cream is left on the skin overnight for 8-14 hours before it is rinsed off the next day. The treatment needs to be repeated in one week.
There are other creams and oral medicines that can be used in special situations. These include specially made sulfur cream or ointment, other topical creams and oral ivermectin. Not all medications can be used in young infants and pregnant women. You and Dr. Douglas will determine which medication is safe for you and your family.
Dr. Douglas may also prescribe other creams and oral medicines to help calm the itch and irritation from the rash. The itch and rash may persist for several weeks after treating scabies. If you are getting new bumps after one month, you should be evaluated again.
In addition to the person with the rash, treatment is required for all household members and close contacts, such as grandparents or babysitters. Everyone should be treated at the same time to prevent re-infestation, even if contacts don’t have a rash.
The mite lives in the skin, but it can also survive outside of the body in clothes and bed linens. Therefore, careful cleaning of bed linens, clothing, towels, strollers, car seats, etc. following the skin treatment is very important to help eradicate the infestation.
Steps for successful treatment
» Follow the medication instructions carefully.
» Repeat the treatment when instructed by your doctor (usually in 7 days).
» Treat all close contacts and household members.
» Treat everyone at the same time.
» Wash clothing, bed linens and towels using hot water and dry using the hot cycle the day after skin treatment.
» Items that cannot be washed can be decontaminated by dry-cleaning or placing in a sealed plastic bag for at least 72 hours.
» Vacuum furniture, carpets, car seats and strollers.
» Fumigation of living areas is not necessary.
» Pets do not need to be treated.
- Spitz Nevus
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What is a Spitz nevus?
Nevus (Nee vis) is a medical name for a mole. A Spitz nevus is a type of mole named after Dr. Sophie Spitz who first described it. In the past, Spitz nevi were called “benign juvenile melanoma.” This name is no longer used since melanoma is a type of skin cancer and Spitz nevi are benign moles.
A Spitz nevus often looks like a pink, raised bump. It can also be a blue, brown, or black flat mark or raised bump. When a Spitz nevus first appears, it will typically grow for a few months. After that time, the Spitz nevus should stop growing and stay the same size, shape, and color. After a few years, Spitz nevi sometimes get smaller, flatter, or even disappear.
How is a Spitz nevus diagnosed?
Some Spitz nevi can be diagnosed by Dr. Douglas examining them. Sometimes they need to be biopsied (a skin test where the mole is removed and evaluated) to be diagnosed.
What is the treatment?
Not all Spitz nevi need treatment. Most of the time, they are watched over time for changes. Measuring the mole’s size and taking photographs of it will help the doctor monitor for changes in size, color, and shape. Spitz nevi can be removed surgically. Surgical removal is recommended for Spitz nevi with concerning features or changes. Spitz nevi should not be removed or treated by burning, scraping, freezing, or laser. Dr. Douglas will help you decide the best treatment for your child’s moles.
How can I protect my child's skin?
When your child is outdoors, protect the skin with hats and clothing. Wear long sleeves and pants when possible. Look for sun-protective clothing like rash guards (swim shirts), and clothes with a high UV Protection Factor (UPF). When possible, avoid mid-day sun and seek shade. Use sunscreen on exposed skin, and reapply often to prevent sunburns and skin damage. Protecting from the sun helps prevent changes in your child’s nevi.
- Vitiligo
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What is vitiligo?
Vitiligo (vit-ih-LIE-go) is a condition where individuals develop patches of white or lighter-colored skin. This results from destruction or reduction of melanocytes, the cells that produce pigment in our skin, so that they cannot properly function. The cause of vitiligo is not clearly understood, but it appears in most cases to be an autoimmune condition limited to the skin. In other words, the body’s own immune system attacks the normal pigment-making cells in the skin. As an autoimmune condition, vitiligo can be linked over time to the development of other autoimmune conditions, the most common being thyroid disease. In some cases, Dr. Douglas may check labs related to thyroid function and specific antibodies as part of the vitiligo workup.
Vitiligo is common, affecting up to 2% of the population worldwide. Vitiligo is partially genetic and may run in families, however, the risk of a sibling or child developing vitiligo is only about 6%. People of all ages and skin types can be affected. It can affect all areas of the body, especially areas that are “bumped” or rubbed frequently (i.e., areas of friction like the elbows, hands, waist, knees and top of the feet). It can also affect the skin around the eyes, nose and mouth, genitals, as well as the inner lining of the nose and mouth.
For most people with vitiligo, white patches develop and expand slowly over time; however, every person is different. Some patients will never progress, rarely patients will worsen rapidly, and 10-20% will develop spontaneous repigmentation (return of normal color). Some patients may experience increased darkening (i.e., hyperpigmentation) of the skin in areas where repigmentation occurs. A variant called segmental vitiligo seen in one-third of children with vitiligo is localized to a single strip of skin, and it is not usually associated with widespread loss of color.
What are the symptoms of vitiligo?
Vitiligo does not usually cause symptoms, but it can sometimes cause itching. It is not life-threatening and is not contagious/cannot be spread from one person to another. Some patients find that vitiligo negatively impacts their quality of life. For example, they do not like the appearance of their skin and find it stressful, upsetting or that it affects their social interactions. Some children may be bullied for looking different with vitiligo. In these settings, age-appropriate psychological intervention may be needed. For this and other personal reasons, treatment may be sought.
Tips for managing vitiligo:
»Avoiding tanning of normal skin can make areas of vitiligo less noticeable by decreasing the difference in color contrast between normal and affected skin.
»The white skin of vitiligo has far less natural protection from sun and can be very easily sunburned. Therefore, sunscreen (SPF 50 or more) should be used on all areas of vitiligo not covered by clothing.
»Disguising vitiligo with make-up or self-tanning compounds is a safe way to make it less noticeable. Waterproof cosmetics to match almost all skin colors are available at many large department stores. These products gradually wear off. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan color. The color from self-tanning creams also slowly wears off. None of these can change the actual disorder, but they can improve appearance.
- Warts
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What are warts?
Warts are common viral infections caused by the human papilloma virus (HPV). There are many different strains of this virus causing different types of warts and specific tests are usually not necessary. Warts are much more common in children than adults. Warts can go away without treatment as our own immune system learns how to fight them. About 60% of warts will disappear within about 2 years. There are many possible ways to treat warts and sometimes several different treatments are needed to get the warts to go away completely. There is no single perfect treatment for warts, and successful treatment can take many months. Your health care professional will help you find the right treatment tailored to your individual needs. For in-office treatments, multiple visits are usually required.
Common In-Office Wart Treatments
Cryotherapy
This is a cold spray (usually liquid nitrogen) used to freeze the wart. It may cause a blister.
Candida
(“yeast”) antigen injections. These are extracts of the common yeast (Candida) that cannot cause an infection. The medication is injected into/under the wart. It is thought to stimulate the immune system to recognize the wart virus and attack it. Multiple injections are needed about one month apart.
Paring
Scraping or filing down a wart can help make other wart treatments more effective.
Other
less common office treatments include laser treatment and contact immunotherapy (DPCP, squaric acid).
