Paediatric Dermatology in Jammu

Which childhood skin concerns can be assessed?

Common concerns include:

• Eczema or atopic dermatitis
• Diaper rash
• Contact dermatitis
• Fungal infection and ringworm
• Scalp ringworm
• Impetigo
• Folliculitis
• Boils and abscesses
• Molluscum contagiosum
• Viral warts
• Scabies
• Hand, foot and mouth disease
• Acne
• Dandruff and scalp scaling
• Patchy hair loss
• Alopecia areata
• Birthmarks
• Pigment changes

• Nail infections and nail disorders
• Insect-bite reactions
• Unexplained itching
• Persistent or recurring rashes

Some common childhood conditions are harmless and settle naturally, while contagious, infected, painful or persistent conditions may need treatment.

How is a child’s skin different from adult skin?

A baby or young child’s skin can be more sensitive to:

• Irritating products
• Heat
• Fragrance
• Excessive cleansing
• Strong medicines
• Occlusion beneath nappies
• Changes in temperature and humidity

Medicine strength, treatment area, duration and the child’s age all matter. Adult acne creams, steroid combinations, acids or home remedies should not be applied to a baby or young child without medical advice.

The AAD specifically advises parents not to apply acne medicines to a baby’s skin unless recommended by a dermatologist.

Childhood eczema and atopic dermatitis

Atopic dermatitis is a common inflammatory skin condition that often begins during childhood.

Possible signs include:

• Dry skin
• Intense itching
• Red, brown, purple or grey inflamed patches
• Roughness
• Cracking
• Oozing or crusting
• Thickened skin from repeated scratching
• Disturbed sleep
• Repeated flares

Eczema is not contagious. It can usually be controlled through a personalised plan involving gentle bathing, frequent moisturising, trigger management and suitable medicine when needed.

What skin care helps childhood eczema?

Parents may be advised to:

• Use warm rather than hot bath water
• Keep baths brief
• Use a mild, fragrance-free cleanser
• Avoid bubble baths
• Pat rather than rub the skin dry
• Apply a thick moisturiser soon after bathing
• Moisturise again whenever the skin feels dry
• Use fragrance-free laundry products
• Dress the child in soft, loose clothing
• Keep fingernails short to reduce scratching injury

AAD guidance recommends moisturising within a few minutes of bathing and avoiding fragrance and rubbing, which can trigger eczema flares.

Are steroid creams safe for children?

Topical corticosteroids are commonly used to control inflammation and itching in childhood eczema.

They come in several strengths. The correct choice depends on:

• Child’s age
• Body area
• Severity
• Skin thickness
• Duration of use
• Whether infection is present

When used according to a dermatologist’s instructions, side effects are uncommon. Problems are more likely when a strong steroid is used on the face, beneath a nappy, over a large area or for longer than advised.

Parents should not use combination steroid-antifungal-antibiotic creams repeatedly without diagnosis.

Does every child with eczema need allergy testing?

No.

Allergy testing may be discussed when:

• Eczema remains difficult to control despite following the treatment plan
• A specific food repeatedly causes an immediate reaction
• The child is not growing as expected
• Contact allergy is suspected
• Symptoms follow exposure to a particular product or material

Routine testing is not necessary for every child with eczema. Avoiding allergens alone usually does not control eczema without appropriate skincare and treatment.

Should foods be removed to cure eczema?

Parents should not remove milk, eggs, wheat, nuts or several other foods merely because a child has eczema.

Unnecessary elimination diets can contribute to:

• Poor growth
• Weight loss
• Protein deficiency
• Vitamin and mineral deficiency
• Nutritional imbalance

Food testing or dietary restriction may be appropriate for a child with a genuine immediate food reaction or selected difficult-to-control eczema, but this should be planned medically.

Diaper rash treatment

Diaper rash commonly causes red, tender or irritated skin beneath the nappy.

Helpful measures may include:

• Changing wet and soiled nappies promptly
• Cleaning gently with water or fragrance-free wipes
• Avoiding alcohol-containing wipes
• Allowing the skin to air-dry
• Providing diaper-free time
• Applying an appropriate barrier cream
• Avoiding vigorous rubbing

A doctor should assess the rash when there are blisters, pus, fever, significant pain, worsening inflammation or failure to improve.

A persistent diaper rash may be caused by irritation, Candida infection, bacterial infection, eczema, psoriasis or another condition.

Ringworm and fungal infection in children

Ringworm is a fungal infection, not an actual worm.

It may appear as:

• A circular or expanding scaly patch
• Itching
• A raised edge
• Central clearing
• Scaling between toes
• Groin rash
• Scalp scaling
• Broken hairs or patchy hair loss

Fungal infection on the body may respond to a suitable topical antifungal. Scalp ringworm usually requires prescription oral antifungal medicine because creams alone do not adequately reach infection within the hair follicle.

Steroid-containing combination creams can temporarily reduce redness while allowing fungal infection to spread or become difficult to recognise.

Impetigo and bacterial skin infections

Impetigo is a contagious bacterial skin infection seen commonly in children.

It may cause:

• Blisters
• Raw sores
• Honey-coloured crusts
• Itching
• Spreading lesions around the nose or mouth
• Infection after scratching eczema or an insect bite

Treatment may involve an antibiotic applied to the skin or taken by mouth, depending on the extent and severity. Covering the affected area and washing hands can help reduce spread.

Children with rapidly spreading redness, fever, pain or swelling may need urgent assessment for a deeper infection.

Molluscum contagiosum

Molluscum contagiosum is a viral infection that causes small, firm bumps, often with a central dimple.

It is especially common in children aged approximately one to ten years and can spread through:

• Skin-to-skin contact
• Shared towels
• Clothing
• Sports equipment
• Scratching and transferring the virus to another body area

The bumps often clear naturally, but treatment may be considered when they are numerous, inflamed, spreading, located near the eye or causing significant eczema.

Parents should avoid squeezing or cutting the bumps at home.

Viral warts in children

Warts are caused by human papillomavirus and may develop on the:

• Hands
• Fingers
• Knees
• Feet
• Face
• Around the nails

Many childhood warts eventually clear naturally, but this may take months or years.

Treatment may be considered when warts:

• Are painful
• Keep spreading
• Bleed
• Affect walking
• Develop on the face
• Occur around the nails
• Cause embarrassment
• Do not respond to suitable home treatment

Cryotherapy can be uncomfortable and is more commonly used in older children. Several sessions may be required, and temporary darkening or lightening can occur.

Scabies in children

Scabies is caused by mites that burrow into the skin and commonly causes severe itching, often worse at night.

Possible affected areas include:

• Finger webs
• Wrists
• Underarms
• Waist
• Groin
• Buttocks
• Feet
• Scalp and face in babies and young children

The child and close household contacts usually need coordinated treatment, even when some contacts have no symptoms. Treating only the visibly affected child can lead to reinfection.

Treatment instructions differ for babies and young children, so agricultural insecticides or repeated unprescribed applications must never be used.

Hand, foot and mouth disease

Hand, foot and mouth disease is a contagious viral illness seen especially in children younger than five years.

It can cause:

• Fever
• Sore throat
• Painful mouth sores
• Reduced eating or drinking
• Rash or blisters on the palms and soles
• Spots on the buttocks, arms or legs

Most children recover within about seven to ten days. Medical assessment is needed when the child cannot drink adequately, appears dehydrated, has severe symptoms, has fever lasting longer than three days or does not improve as expected.

Acne in babies, children and teenagers

Newborn acne

Acne beginning before six weeks of age often clears without treatment and rarely leaves scars.

Infantile acne

Acne beginning after six weeks of age should be assessed because other conditions may resemble acne and some children can develop permanent scarring.

Teenage acne

Teenage acne may include:

• Blackheads
• Whiteheads
• Red pimples
• Pustules
• Painful nodules
• Dark post-acne marks
• Early scarring

Early treatment can help reduce marks and scars. Adult acne products should not be applied to a baby’s skin without dermatologist guidance.

Hair loss and scalp conditions in children

Childhood hair loss may result from:

• Scalp ringworm
• Alopecia areata
• Hair pulling
• Traction from tight hairstyles
• Illness-related shedding
• Nutritional deficiency
• Inflammatory scalp disease
• Congenital hair disorders

Alopecia areata commonly begins as one or more smooth, round or oval bald patches and can also cause nail changes. Scalp ringworm may produce scaling, broken hairs or inflamed patches and requires antifungal treatment.

Treatment should follow diagnosis rather than automatically using oils, supplements or minoxidil.

Birthmarks in babies and children

Birthmarks may be:

• Red or vascular
• Brown or pigmented
• Flat
• Raised
• Present at birth
• Visible shortly after birth

Most birthmarks are harmless, but early examination can identify the type and determine whether observation, treatment or further investigation is appropriate.

Earlier assessment is particularly important when a birthmark:

• Is near the eye, nose or mouth
• Grows rapidly
• Ulcerates or bleeds
• Causes pain
• Interferes with feeding, sight or breathing
• Covers a large area
• Is accompanied by several café-au-lait spots
• Appears unusual or changes

Some infantile haemangiomas require early treatment because of their location or growth pattern.

Nail problems in children

Children may develop:

• Nail biting damage
• Ingrown toenails
• Fungal nail infection
• Nail-fold infection
• Warts around the nails
• Nail changes associated with eczema or psoriasis
• Nail pitting associated with alopecia areata
• Trauma-related nail changes

Not every thick, white or irregular nail is fungal. Treatment may require examination, nail testing or assessment of the surrounding skin.

Diagnosis before treatment

Rashes that look similar may result from eczema, fungus, bacteria, viruses, allergy or another condition.

Age-appropriate treatment

Medicine strength, dose, body area and duration are selected with the child’s age and skin sensitivity in mind.

Skin, scalp, hair and nail evaluation

Children can be assessed for more than rashes, including hair loss, birthmarks, nail changes and skin infections.

Parent-friendly instructions

The treatment plan can explain bathing, moisturising, medicine application, infection prevention and warning signs.

Additional cost may depend on:

• Medicine prescribed
• Fungal scraping
• Bacterial culture
• Blood tests
• Patch testing
• Skin biopsy
• Wart or molluscum treatment
• Dressing or minor procedure
• Follow-up after the included 10-day period

The treatment plan and any separate charges are explained after the child has been examined.