Framingham Pediatrics | Common Skin Problems

The skin is the largest organ in the body and has three primary functions: protection, regulation and sensation.   The skin:

• PROTECTS everything internally from damage or infection
• REGULATES temperature and prevent excess fluid loss
• Provides the SENSATION of touch

Skin problems often occur when one of these three functions is disrupted.  They may also occur as an external manifestation of an internal trigger.

Brief Overview of Common Disorders

Diaper rash:

Cause:
Diaper rashes are often caused by moisture from stool or urine sitting on the skin for an extended period of time.  They may also be caused by sensitivity to products, overgrowth of bacteria or fungus, or other causes of irritation. Sometimes, diaper rashes develop without any obvious triggers.

Course:
Diaper rashes may come and go.  How long a diaper rash lasts depends on the cause and treatment, as well as how sensitive the skin is.

Signs and symptoms:
There is no classic look of a diaper rash.  How a rash looks, where it’s located, and the symptoms depend on the cause.  The rash may be red dots or patches, flat or raised, dry or oozing or have many other descriptors.  Additionally, diaper rashes range from being asymptomatic to being itchy and/or painful. 

Management/treatment:
Primary treatment and prevention of diaper rashes centers on keeping the diaper area clean and dry. More frequent diaper changes and avoiding the use of irritating products often helps. Additionally, it may help to keep the diaper area exposed to air, to use warm water instead of diaper wipes and/or to have your child sit in a warm bath.  The best topical treatment depends on the cause, but zinc-based diaper creams provide a good barrier to keep moisture off of the skin. Aquaphor or Vaseline helps re-moisturize dry irritated skin.

• Additional information on diaper rashes from the AAP

Eczema

Cause:
Common causes include topical, environmental or internal allergens, cold weather, and excess moisture on the skin.  These irritants weaken the barrier function of skin, allow water to escape and cause inflammation. This leads to the classic dry, red, itchy eczema rash.

Course:
Eczema is a chronic condition where the rash comes and goes.  The rash may be consistently in one or a few locations, or develop in different locations with each flare.

Signs and symptoms:
Rough, dry, itchy skin is the most common complaint.  The location of eczema often varies by age:

• Infants – face, behind the ears, scalp, outer surfaces of the arms and legs
• 2 years and over – cheeks, surfaces that bend (elbow crease, behind the knee etc.)

Management/treatment:
Treatment is aimed at repairing the skin barrier and reducing inflammation. Topical steroids are the primary treatment for eczema. The strength of the steroid depends on the location and severity of eczema. If an allergen is contributing to eczema, removal of the allergens exposure and/or treatment of the allergy with anti-histamines will help eczema resolve faster. Oral steroids are NOT useful for eczema.

• Additional information on eczema from the AAP

Hives:

Cause:
Hives are the body’s external response to an internal allergic trigger.  The allergen may be environmental, topical, or ingested.  Additionally, viral and bacterial infections may trigger hives. The cause of hives is not always obvious, but the treatment is always the same.

Course:
Acute hives can come and go for up to 6 weeks. Hives lasting longer than 6 weeks are called chronic hives. If there is a known allergic trigger, removal of the trigger helps shorten the course of hives.

Signs and symptoms:
Hives are itchy, red, slightly raised splotches.  They often appear darker red near the border and more pink at the center.  Hives come and go randomly and often develop in new spots.  The location of hives sometimes helps determine the underlying cause.

Management/treatment:
Primary treatment for hives includes antihistamines to reduce the itch and possible allergic response.   Benadryl is the most commonly recommended antihistamine.  Although hives may appear to resolve with Benadryl, they often return when the medication wears off; thus, repeated treatment with Benadryl is often necessary. In rare and severe cases, an oral steroid may be used to reduce the inflammation associated with hives.

• Additional information on hives from the AAP

Molluscum contagiosum

Cause:
Molluscum are small sores that develop in response to a virus.  There is not one single virus that causes Molluscum.  Additionally, the virus can shed on the skin, so they may spread by skin contact.  They are most common in young children and are often found in clusters.

Course:
Molluscum typically resolves within 6-24 months without treatment.  They go through different stages of self-healing and often grow before they resolve. 

Signs and symptoms:
Molluscum  are small, often pinpoint, dome-shaped pink lesions.  They are often asymptomatic, but children sometimes complain of itching or pain. An eczema flare around Molluscum may increase any itching.  Molluscum can become infected or just may grow and become painful as a normal part of the healing process. 

Management/treatment:
There is no way to treat Molluscum, however many home remedies exists that may help shorten the duration of Molluscum infection.  Please consult our office for advice on at home treatments, as improper use can cause significant skin irritation. If an eczema flare occurs with Molluscum, it’s important to treat the eczema with a topical steroid to repair the skin barrier; however, if your child is itchy but there is no evidence of eczema, topical steroids are best avoided as they may cause Molluscum to spread. In the case of itchy Molluscum without eczema, Vaseline or Aquaphor may help. 

• Additional information on Molluscum Contagiosum from the AAP

Warts

Cause:
Warts are viral sores that may be found anywhere on the body. They may seem to develop randomly, but are usually triggered by either an internal or topical exposure to a virus.  They may develop at any age.

Course:
Warts will resolve without treatment but may take up to 2 years. 

Signs and symptoms:
Most warts are asymptomatic.  Sometimes children will complain of itching or pain around a wart, especially depending on the location of the wart, any recent treatments tried or other local skin issues. 

Management/treatment:
There are various over the counter treatments available for warts, all aimed at irritating the wart so your body fights against the virus that causes the wart.  We are also able to freeze warts in our office.  All treatment of warts, including freezing treatment, may need to be done multiple times to see full resolution.

Additional information on warts from the AAP

The AAP provides information on many common skin problems.  If the problem your child has isn't listed, click the above link to explore topics on the AAP website.

When to call

Call our office with any questions or concerns about skin problems.  Additionally, if you would like advice on treatment of any skin problems please call to discuss with your provider or one of our nurses.