Skin problems care and prevention - Protecting your child's skin

Protecting your child's skin

ParenThots - Features

If your child has any skin disorder, go to the doctor instead of trying to self-medicate. - Photo ©iStockphoto.com/ LeventKonuk

By BRIGITTE ROZARIO

Children are prone to skin problems like rashes, eczema and allergies. Often it's hard for parents to distinguish between what is a minor problem and something urgent that needs immediate attention.

Dr Chow: 'In families with a positive history of such disorders it would be wise to be vigilant.'

Dr Steven KW Chow, senior consultant dermatologist at Hospital Pantai Kuala Lumpur, answers common questions on children and skin problems.

What are the skin problems that children and teenagers in Malaysia face?

The common skin problems in children are eczema, skin infections and allergies. This is particularly so in children whose parents or siblings have an existing history of such disorders. House dust mite allergy reactions are common and must be identified early so that prevention can be instituted.

Towards teenage years, problems relating to hormonal changes at puberty like acne start to be noticeable. When the teenagers start using cosmetic items, we then start seeing problems related to adverse contact reactions to cosmetic ingredients including tattoos.

What sorts of symptoms should parents look out for?

In families with a positive history of such disorders it would be wise to be vigilant.

A itchy skin rash is the commonest presentation in many skin disorders like allergies and eczema. It can be severe and affect sleep patterns not only for the child but also the rest of the family especially if the child is fretting and scratching through the night.

Uncontrolled scratching breaks the surface of the skin and results in recurrent and frequent skin infections. The other pattern of presentation is that the skin can be extremely itchy when the child comes back from school scratching and sweaty and exposed to house-dust mites in the school environment.

In teenagers with significant acne disorder, do look for signs of loss of self-esteem, withdrawal and psychological maladjustments. This will affect their performance in school as well as inter-personal relationships at home and well as outside the home. Do regularly have heart-to-heart talks with the affected child to help understand and support him/her through this problem. Do not trivialise their acne problems.

When should parents bring their child to the doctor? In which cases can they treat the child themselves at home?

It is best to see a doctor early to establish a proper diagnosis and to seek proper advice. If the child does not respond to simple measures like the use of emollients, avoidance of harsh soap and triggering factors like house-dust mite, then seeing the family doctor is a wise first step.

Do they need to see a dermatologist or can they see a GP? In which situations should they see a dermatologist?

The family GP must be the first point of care. In most instances they will be able to control the symptoms with appropriate treatment. A dermatologist’s intervention is only needed if this fails.

How serious and what is the treatment for the following skin conditions?

* Diaper rash

- Common.
- Prevented by regular change of diapers, keeping the area meticulously dry and use of bland moisture-absorbent powders.
- Cleanse the affected areas regularly with either plain water or normal saline. Avoid using harsh antiseptics on baby’s bottom.
- The skin must not be allowed to be constantly wet and macerated.
- Secondary infection by bacteria and yeast can be troublesome.

* Cradle cap

- Distressing to look at.
- Parents tend to want to physically peel off the adherent scales. This will tear the thin epidermis and promote infection.
- Best to soften the scales with a light oil-based lotion and then gently remove the scabs at bath time.
- Usually improves as the child grows up. Severe cradle cap in infants is a reflection that the child may have difficult eczema/psoriasis later in life.

* Eczema

- Common. Mostly are mild and can be easily controlled.
- When severe, it significantly affects quality of life. Specialist care is required when eczema is generalised and does not respond to first-line treatment.
- Emollients are the mainstay of long-term treatment.

* Boil

- This is a skin infection when painful nodules filled with pus occur on the skin. The common bacteria are the streptococci and staphylococci. When the child presents with chronic recurrent boils it is useful to have the family screened for scabies. Recurrent skin infections are also seen in children with juvenile onset diabetes.

* Rosacea

- This is less common and when it occurs during the teenage period can be mistaken for acne.
- The severe forms can lead to disfiguring scarring of the face.
- Specialist treatment is usually needed.

Insect bite.

* Insect bite

- Common, usually mild.
- Can be persistent in allergy-prone individuals.
- Sensible prevention is best.
- Watch out for sandfly bites.

* Allergy

- Allergic skin disorders are common. They can result from common items like house dust mite and also reactions to medications and food items.
- Allergies to food items can be very misleading as most parents have already a pre-set socio-cultural belief of the causative items. Often the parental diagnosis of the allergy is presumptive.
- In cases of doubt, testing for specific allergen will be of some value as a negative test virtually excludes a particular suspected item.
- Anti-allergy medications including anti-histamines are useful to control symptoms. Newer anti-histamines are generally safe and can be use for day-time as well as they are non-sedating.
- The dermatologist is usually called in to help unravel the possible cause of the allergy.

* Athlete's foot

- Common. Often not diagnosed as it may be asymptomatic.
- It is a fungal infection of the feet especially in the toe-web areas. In some people, a bacterial component also sets in and makes treatment more complicated. The wearing of close tight shoes for long periods of time is a major contributory factor.
- Important to disinfect all shoes and foot-wear by sun-drying whenever possible as dampness and moisture will allow these bugs to grow in the shoes and be a source of recurrent infection.
- A good broad-spectrum antifungal used for sufficient length of time helps to clear the disease.

* Dandruff

- Presents as constant shedding of loose white flakes from the scalp. Can mean a few conditions ranging from fungal infections to scalp eczema and psoriasis.
- The commonest and most treatable is seborrhoeic dermatitis which is caused by a immune reaction to the yeast growing on the scalp. They respond well to anti-yeast treatment and can be maintained well with a anti-yeast shampoo.

* Lice

- Not so common in urban areas, more so in rural areas especially among the poorer socio-economic group.
- They can be very infectious and can cause outbreaks in hostels and dormitories.
- The commonest will be scalp lice.

Rashes.

* Rashes

- Just a common term meaning a skin eruption.

* Acne

- This occurs starting from teenage to early adulthood. Some cases carry on until late adult life.
- When mild, patients describe them as pimples, zits, breakout, blackheads and whiteheads.
- Can be very severe like in acne conglobata where big cysts and painful red pustules occur on the face.
- Acne scarring will be life-long and proper and early medical treatment is advised.
- If there is a family history of severe acne scarring in the parents or older siblings seek dermatologist help early.
- Today’s medical treatment is very effective and can prevent acne scarring. Parents should not trivialise the concerns of the teenage with acne. It hurts them more than what the eye can see.

* Psoriasis

- Can be a difficult problem to treat in children. In some situations it can be triggered following common bacterial infection.
- Be prepared for a long history of remission and relapses. Often ends up in the dermatologist’s office. There are no quick fixes for psoriasis.
- Psoriasis can be precipitated by stress and the disease itself can be stressful to the child. Parents must be aware of this and understand what the child is going through. He will refuse to expose his affected skin during school activities and shun sports like swimming.

What can parents do to prevent children from getting skin problems?

A simple hygiene routine is most useful. However do not over-wash the skin. When the child is back from school, sweaty and itchy, a brief shower with a soft soap followed by a light moisturising cream will help cool down the symptoms and lessen scratching.

Do not use harsh scrubs for the child’s skin at bath.

Keep the environment free from house dust as much as possible. The most effective is still the traditional sunning and dusting of household items especially in the tropics. Good and proper ventilation of all rooms is better than 24-7 air-conditioning.

Give the child a wholesome balanced diet and avoid foods with artificial colourings and flavourings.

Will staying out of the sun and moisturising the skin help?

Yes, this is a useful preventive policy.

How about a good diet and Vitamin E?

Good diet – yes. Vitamin E supplements – not likely to work.

What is the best way to ensure healthy skin?

Treat your skin well as it is your most important visible and invisible protector of your health. The visible bit is all the physical parts that make up the skin like the skin cells, the skin fat, sweat glands, sebum secreting glands, hair and nails, etc.

The invisible component is called the acid-mantle, a robust bio-physical system that forms as a result of the close and coordinated interaction of all the physical and biochemical components. It also includes health-friendly micro-organisms and naturally produced antibiotics and probiotics.

In simple terms, it is a very complex system that keeps unwanted things out and preserves the important functions of your skin.

Scratching is a no-no at all times. It damages your skin surface and introduces germs into the deeper layers of skin. It is better to numb the itch sensation with an ice-pack.

Remember the skin has its own filtering and excretory system so there is no need to over-wash your skin.

Take time to dry your skin after bath especially over the hidden areas. Retained moisture in folded areas of skin favours the growth of harmful germs.

Don’t sunburn your skin. Practise good sun-protection hygiene always.

For adults, don’t take up smoking. It's bad for the skin as well as internal health.

In climates that are harsh and dry, add regular moisturising to your daily regime.

If your child has a problematic skin, seek medical advice early. Avoid self-diagnosis and avoid experimenting with unproven treatments.

Always live life in moderation.

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