Q & A On Skin Conditions In Childhood
By Dr Asoka Thenabadu
MBBS DCH MRCPCH Retired Consultant Paediatrician-United Kingdom
Q1 My daughter got a present of a necklace. Since she started wearing it, she has had a reaction around her neck with itchiness, redness and swelling. What is this and what can we do?
A1 Stop wearing it immediately and the symptoms will go away. Nickel, which is used in most costume jewellery, can cause a severe contact dermatitis leading to all the symptoms you mentioned. If there is no contact with the necklace, the symptoms disappear. If they persist; you need to see a Dermatologist He may do some patch tests to identify the cause of the allergy or adopt a ‘wait and see’ policy as the symptoms may go away. If the symptoms are severe, emollients and moisturisers will bring some relief. Low dose corticosteroids will certainly accelerate the recovery process and may be prescribed by the Dermatologist.
Q2 My daughter has developed some very ugly looking lumps on her hands. My mother in law says that they are warts and will go away eventually. I feel that we must do something as it is unsightly. Please advise.
A2 Your mother in law is probably right. They sound like common warts which will disappear due to the body’s reaction. They are caused by the human papilloma virus and can be treated with salicylic acid or podophyllin applied locally. Cryosurgery which freezes the wart can also be used.
Q3 My newborn baby develops a large red patch over his forehead when he cries or strains at stools. This frightens me. What is it and what can I do?
A4 He has a Capillary Neavus which is a collection of blood vessels which fill up and become prominent when he cries. It will become less prominent when the baby grows up. It is a common condition and should not worry you.
Q4 My three month old baby has developed a greasy, crusty scaly rash over his scalp. It is quite upsetting. What is it and what can I do about it?
A4 Your description seems to fit ‘Cradle Cap’ which is not an unusual condition. About 50% of babies will have it in a greater or lesser form. It is probably due to the overactive sebaceous glands. Simple washing with a mild shampoo will clear up the problem. However, if it persists an anti fungal cream like Clotrim or Micanazol will clear up the cradle cap.
Q5 My teenage daughter has very bad acne. She is very upset about this and has become social phobic and depressed. Her school work has deteriorated perhaps due to her depression and has lost all interest in sports. Please advise as to what we should do. We are desperate.
A5 Acne has a wide spectrum of manifestations. The mildest can be treated with simple medications like Benzyol Peroxide and antibiotics (for the more serious cases) which acts against the organism that causes the infection in the sebaceous glands of the skin. Hormonal contraception has a beneficial effect but, you may not like your teenage daughter to be on the ‘Pill’. You need to consult a good dermatologist who will assess the condition and use all the newer medications and therapies to get your daughter’s acne under control. Her social phobia and depression will disappear miraculously!
Q6 My son has developed several red round patches over his body which are itchy and have raised blistery borders. I am quite concerned. Please advise.
A6 This sounds very much like ringworm. It is caused by a fungus and is spread by skin to skin contact with another human or animal. Sharing of towels is a common cause. It is easily treated by using an antifungal cream (which you can buy over the counter). But please consult your doctor or a dermatologist who may do a small biopsy to confirm the diagnosis before starting treatment.
Q7 My newborn baby has a very large dark brown mark over his buttocks and lower back. It does not cause him any distress but as parents we are worried. What is it? Is there a treatment for it? Will it turn cancerous in time to come? Please advise us as we are very worried.
A7 What you describe sounds very much like a ‘Mongolian Blue Spot’. It is a birth mark which is found in a large percentage of Sri lankan and other Asian babies. The Afro Caribbean’s have a very high incidence. They are harmless and fade away as the baby grows older. Most disappear between three to five years and definitely by puberty. They do not turn cancerous (like moles in adults). However, to reassure yourselves, consult a paediatrician.
Q8 My new maid seems to have head lice. I am afraid she would infect our family. What should I do?
A8 She needs to be treated for head lice as a matter of urgency. As she is ‘new’, she may not have had a chance to infect the children and family members. She could use the wet combing method which involves removing the head lice by systematically combing the hair using a special fine-toothed comb after washing the hair thoroughly with shampoo and conditioner. The comb’s teeth should be spaced less than 0.3mm, but at least 0.2mm, apart. Using medicated lotion or spray is an alternative method of treating head lice. However, no medicated treatment is 100% effective. Your pharmacist will be able to recommend an over-the-counter lotion or spray. The normal advice is to treat the hair and repeat the treatment after seven days. Some medicated products also supply a comb for removing dead lice and eggs. Check for baby lice hatching from eggs 3-5 five days after you use a product, and again 10-12 days afterwards. A minimum of two applications of lotion are needed to kill lice over the hatching period because the lotions do not always kill louse eggs.
Q9 My baby who is in the day nursery, has developed small, firm, raised spots on the skin, which usually form in little clusters. They are painless but itchy. I believe other toddlers at the nursery also have this condition. What is it and how shall I get it treated?
A9 What you describe sounds like Molluscum Contagiosum, a common skin condition in children, caused by a virus. The condition is highly infectious but not serious. It is contracted by close bodily contact (as in the nursery). The condition is not a serious threat to health, but it can be annoying and, in severe cases, it can look ugly.
The vesicles disappear by themselves most of the time due to reaction by the body. However, if there are a lot of vesicles and disfiguring the child, Cryotherapy can be used
Cryotherapy involves freezing the lesions with liquid nitrogen to remove them. Each lesion is frozen for 5-10 seconds so that a layer of ice forms over the spot and surrounding skin.
You may need several sessions of cryotherapy before each spot clears completely. You will need to wait two to three weeks between each treatment session.
Q10 My newborn baby has a long foreskin but has no problem in passing water. Does he need to be circumcised?
A10 NO! Definitely no! Circumcision is not needed! He is passing water well and his long foreskin does not seem to cause any problems. So why subject the child to mutilating surgery?
Dr. Thenabadu will be answering all your medical related questions. Please email any queries to firstname.lastname@example.org