Skin Disorders in Young Children

Young children may be prone to skin disorders. Here’s what you need to know about common problems like discoid eczema, diaper dermatitis and white patches on children.

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Discoid Eczema

Discoid eczema appears as round, red patches of eczema, or skin inflammation, located mainly on the arms and legs. The lesions are coin-like, hence the term “discoid” eczema.

 

Types of Discoid Eczema

The condition appears in two forms. Both are persistent, lasting for months if untreated:
Wet form — with oozing and crusting lesions
Dry form — with redness and scaly lesions

Treatment for Discoid Eczema

The condition is frequently mistaken for ringworm, but does not respond to antifungal creams. Treatment is with moderate-strength steroid creams. Lesions are slow to heal and treatment takes a considerable time before the discoid eczema improves.


Diaper Dermatitis (also known as Nappy Rash)

This is a childhood skin disorder that affects children under the age of two years. It is an inflammation of the skin resulting from prolonged skin contact with urine and faeces.

Types of Diaper Dermatitis 

The most common type is "chafing dermatitis". This is most frequently observed at seven to 12 months of age, when the baby's urine volume exceeds the absorbing capacity of the diaper and it affects the thighs, buttocks and waist area.

Perianal dermatitis is limited to the area around the anus. This is seen in newborns who have experienced diarrhoea.

The third type is characterised by shallow ulcers scattered throughout the diaper area.

The fourth type consists of redness and lesions around the groin and genital area. This is due to a secondary yeast (fungal) infection.

Treatment for Diaper Dermatitis 

Consult your doctor for advice; do not try to treat your baby’s dermatitis yourself. The basic treatment for diaper dermatitis is to remove urine and faeces from the skin surface and keep the diaper area dry.
Lubricating the skin under the diaper with a greasy ointment lessens the severity of diaper dermatitis and protects the skin from urine and faeces
Very frequent diaper changes, followed by application of ointment, limits the problem and prevents recurrences
Changing the baby’s diaper a few hours after he/she goes to sleep and reducing fluids just before bedtime may help
Avoid plastic and rubber pants
Yeast infection in the diaper area requires antifungal creams; your doctor will prescribe the appropriate medication
In severe dermatitis, your doctor may prescribe hydrocortisone one percent cream twice daily to help reduce the infant's discomfort.

White Patches In Children

The common causes of white patches on the skin of children are pityriasis alba and vitiligo.

What is Pityriasis Alba?

Pityriasis alba is a mild dermatitis (skin inflammation). This is characterised by multiple oval, mildly scaly, flat hypopigmented (white) patches on the face, arms and upper torso. The borders of these patches are indistinct. 

Pityriasis alba occurs in children between the ages of three and 16 years and up to 30 percent of children may be affected during their childhood. The patches are not itchy. While pityriasis alba is often mistaken for a fungal infection, it is actually a harmless condition. The condition tends to become more prominent by sun exposure.

It can last for months to years with slow spontaneous recovery. Sometimes, steroid creams may help. It is important to avoid self-medication, antifungal creams and excessive washing of the skin with soaps.

What is Vitiligo?

Vitiligo is a patchy loss of skin pigment. The patches are flat, completely white and have distinct borders. Hair within the patches of vitiligo is often white as well.

 
                                  

Figure 5: Vitiligo before treatment           Figure 6: Segmental vitiligo


In type B, the vitiligo presents as localised patches in a segmental distribution. This type is common in children (Figure 6).

Treatment for Vitiligo

Treatment for vitiligo includes the use of topical steroid creams, which can induce repigmention in some patients.

Another treatment option is PUVA, a combination treatment involving the use of a drug called Psoralen (P) and then exposing the skin to ultraviolet A (UVA). Psoralen can either be used in the lotion form to be applied on the skin or as tablets to be taken orally to make the skin sensitive to UV light. Patients treated with PUVA must be prepared to undergo therapy for a year or longer for optimum results. Such treatment is best supervised by a dermatologist.

While camouflage cosmetics cannot induce repigmentation, some cosmetics can provide very good colour match to normal skin. Camouflage cosmetics are particularly useful for white patches on the face and back of the hands.

Sunscreens can be helpful as well, as areas affected by vitiligo are prone to sunburn. It is advisable to use sunscreens on affected areas which are exposed to sunlight.

The response to treatment varies with each person and the site affected.

What is Alopecia Areata?

Alopecia areata is a common skin disorder seen in children and young adults. It is characterised by hair loss in localised round areas on the scalp and occasionally on the eyebrows. A positive family history for alopecia areata is found in 10 percent to 20 percent of patients.

The prognosis for most children is excellent. Complete regrowth of the hair occurs within a year in 95 percent of children with alopecia areata. About 30 percent will have a future episode of alopecia areata. Rarely, all the scalp hair or all the scalp and body hair are lost in the disease.

The cause of alopecia areata remains unknown. An immune mechanism is postulated in which autoantibodies are produced against the hair follicles, which then results in premature shedding of the hair.

Treatment for Alopecia Areata

Please consult your doctor if your child has alopecia areata. There is no reliable treatment for alopecia areata since spontaneous regrowth occurs in most patients. Many forms of therapy including intralesional or topical steroids, anthralin or contact sensitisation have demonstrated short-term hair regrowth, but they do not alter the long-term course of alopecia areata. In complete hair loss, wearing a wig may be helpful.

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