Just home from the office and on call. Once again, I keep on learning and laughing with my patients. I saw a mom, dad and their two young boys last evening. The boys were about 4 and 6. When I walked into the room, it was so quiet, and then I realized that their clever mother had them playing the quiet game. Seems I lost as I talked first!
She brought the boys in that evening as she had just gotten a note from the school that there had been several cases of scabies in her son's class. In her words, she freaked out and decided a trip to the pediatrician was necessary.
So, when I asked her if the boys had a rash or had been complaining of being itchy, she just looked at me? No there was none of that, it was just the whole idea that they might have SCABIES?! Of course she had been online and could identify the mite if necessary. She was certain that I needed to treat the boys, and maybe she and her husband? She just said ,do whatever you have to do!
She then decided that maybe we should worry about lice as well, as don't these yucky bugs go together? Luckily, her precious little boys had crew cuts, so that was an easy rule out.
So, seeing that they did not have any rashes, really no complaints other than maternal anxiety (we moms are good at that), I told her all was well. She seemed okay with that except she didn't want to send her children back to school until the school exterminated the whole building and she thought she would wash all of their sheets and vacuum her house that night.
I had to laugh as I told her there would always be germs and bugs around, no matter how clean we try to be. In fact, one of my own children had scabies many years ago and it took an allergist to diagnose him - no one had thought about scabies, but boy did he have a rash!
I guess she fel
Just back from an evening call night in the office and it was like dermatology clinic! But the funniest thing was that 4 of the children I examined, all of different ages, had the same thing: Lip Lickers Dermatitis.
It is beginning to be the time of year when the weather gets cooler, the humidity drops and children who are in the habit of licking their lips develop dry cracked and chapped lips. Not only do children lick their lips, they also tend to lick the skin around their lips which results in more chapping and irritation, and the cycle begins. One little girl I saw could actually lick all of the way up to her nostrils!! She had to show me for me to believe that this is why her nose was chapped, I foolishly thought it was from blowing her nose.
Every one of the kids habitually licked their lips while I examined them, even before telling them of their diagnosis. Several of the concerned parents doubted the diagnosis of lip lickers dermatitis, but I pulled out a derm book and proudly showed them pictures that looked just like their child. The rash can get quite raw and inflamed and if irritated and rubbed enough may even get secondarily infected.
The problem with lip lickers dermatitis is that it is a habit, just like thumb sucking, nail biting and hair twirling. As you know habits are hard to break, even when they cause discomfort. It is so hard not to moisten you lips when they are dry and are becoming drier. Licking your lips seems to improve the dryness but only for a moment.
The treatment of choice is to try and break the habit as well as to use a protective barrier on the lips and around the mouth. This is best accomplished with a thick layer of Aquaphor or Vaseline that must be reapplied quite frequently. For an older child you can give them a pocket tube to carry so that they may apply the moisturizer as often as need be, even every 30 minutes to an hour.
To aid in the treatment the thicker the layer of Aquaphor
Despite every parent's best efforts, most babies will develop a bothersome diaper rash sometime during their days in diapers. Diaper rashes may be treated with numerous creams and lotions and everyone seems to have their favorites. I have always been a fan of the zinc-based preparations as I think they coat the skin and provide more protection. I recently had a phone call from a patient who said she had "tried everything" and her son's bottom was still red, raw, bumpy and causing him discomfort. Of course it was over the weekend, so she wanted to see if we could figure this out before the office opened on Monday. If your child develops a diaper rash that does not respond in the first couple of days to the usual "potions" then you might assume they have developed a secondary fungal infection with their diaper rash. Yeast diaper dermatitis is more common than even pediatricians think and doesn't always look like the classic picture of "satellite lesions" on a red base. In a recent article it was estimated that more than 50% of persistent diaper rashes involve yeast, so I think it would make sense to try an over the counter anti-fungal cream in addition to your usual diaper cream. So for that bothersome diaper rash a trial of a zinc-based diaper cream mixed with a little Maalox (yes, the antacid) and a yeast cream may just do the trick and get rid of the red and the yeast. If the rash persists, it's time for a visual diagnosis by your pediatrician. That's your daily dose, we'll chat again tomorrow.
Fever blisters are fairly common and are also often called cold sores, but have nothing to do with a cold. These sores typically appear on the outside of the mouth, on the lips. The majority (about 95%) of fever blisters are due to a virus, typically herpes type 1. Because the fever blister is due to a virus they are contagious and most people will be exposed to the virus during their lifetime. Children are typically exposed via contact from an adult, a sibling or a relative who has a fever blister, or by other children who have mouthed toys etc that may have been contaminated with the virus. In many cases the exposure may be asymptomatic while others will develop painful vesicles appearing both inside the mouth, on the tongue and gums, as well as on the lips about 3 -5 days after their exposure. This initial illness is called herpetic gingivostomatitis. The initial infection tends to be more uncomfortable and may take up to two weeks for the lesions to resolve. The most difficult problem is due to oral discomfort so it is important to make sure that these young children stay hydrated. Popsicles are often helpful for this. Once you have been exposed to the herpes virus the virus remains in nerve endings where it may be dormant and asymptomatic for years. About 60% of children are positive for HSV -1 by adolescence. At other times the virus may become active (times of stress, sun exposure, fever, menstrual periods) and result in a fever blister. If a child develops a fever blister, they too are contagious and may spread the virus to others by touching or picking at the lesion and then touching other people or objects with their mouths. Fever blisters may be treated in most cases by using a topical antiviral that may be applied to the lesion. These are prescription medications that may shorten the duration of the fever blister by a day or two, especially if started early and applied frequently. If children experience recurre
Some teens are just blessed with good skin, and when you ask them what they do to their skin their reply is nothing. That is not the norm. Adolescence is the prime time for acne and whether the breakouts are mild or persistent, good skin care is the beginning for everyone. The first thing that all adolescents need to do is to wash their face twice a day. You do not need fancy skin potions or lotions either, the drugstore has more than enough choices to begin a good cleansing program. Using a mild soap- free cleanser may be enough to begin with , something like Purpose, Basis, Aquanil or Neutrogena. If the skin is more oily and acne prone try a cleanser that contains glycolic or salicylic acid , products like Neutrogena Acne wash, or Clean and Clear, you will need to read labels to look at the ingredients. These provide gentle exfoliation of the skin surface. Wash with a soft cloth but don't scrub or buff, just wash. After washing your face in the morning, always apply a gentle non-comedogenic moisturizer WITH sunscreen. This will not cause acne, but will prevent sun damage that we all get on a daily basis. This is not the same as applying sunscreen for a day at the beach or lake. Again, I like Oil of Olay complete, or Neutrogena but there are many others out there, so find your favorite. At bedtime, after washing your face, if skin seems to be getting break outs begin using a 5% benzoyl peroxide lotion (you only need a dime size amount for the whole face) applied after your face has completely dried from the washing. If it is applied to a wet or damp face it may cause redness. Benzoyl peroxide products come in several strengths and may be titrated up in strength as tolerated. If this regimen is not working well it is probably time for a visit to the doctor to discuss some prescription products. More on that another day. That's your daily dose. We'll chat tomorrow. Send your question to Dr. Sue!
Lots of new babies and one frequent question that comes up early on is, how often do I need to bathe my baby?. Good question and I don't think there is a right answer.
Babies are frequently born with dry and peeling skin, especially on their hands and feet. This is one way that the doctor can tell that the baby is term. Despite being bathed or not bathed, the infant will peel and flake off this little bit of dry skin and then will be left with that beautiful baby skin all over.
Some people say not to bathe a baby everyday, but I honestly think it is totally up to the parent. I bathed all of my babies everyday, as I loved the way they smelled after a bath, and I was also convinced that a daily bath before bed would make them sleep better!! (not so sure this helped at all).
Whatever you decide to do about bathing, you want to make sure you are using a mild soap, and I like Aveeno and Cetaphil products, especially if your baby is prone to dry skin. I always started by washing the baby's face, then their body and lastly did their hair and scalp. Babies lose most of their heat through their heads, so I did this last so that I could bundle them up right after the bath.
After a bath it is a good idea to apply a moisturizer to the skin and again there are a lot of good products out there. Many of the baby products just smell good as well (what beats the smell of the pink baby lotion), but some are not as good moisturizers as others. If your baby has really dry skin and needs the hydration use one of the newer products that contain ceramides ( Aveeno, Cetaphil, Cerave). They may not smell as good, but they are hypoallergenic and are better for dry skin and babies who are prone to eczema.
Bath time is a fun time for both baby and parent! Before you know it your baby will no longer be getting baths in the infant bathtub, but they will be splashing away with toys in yo
Everybody gets moles, even people who use sunscreen routinely. Moles can occur on any area of the body from the scalp, to the face, chest, arms, legs, groin and even between fingers and toes and the bottom of the feet. So, not all moles are related to sun exposure. Many people inherit the tendency to have moles and may have a family history of melanoma (cancer), so it is important to know your family history. People with certain skins types, especially fair skin, as well as those people who spend a great deal of time outside whether for work or pleasure may be more likely to develop dangerous moles. Children may be born with a mole (congenital) or often develop a mole in early childhood. It is common for children to continue to get moles throughout their childhood and adolescence and even into adulthood. The most important issue surrounding moles is to be observant for changes in the shape, color, or size of your mole. Look especially at moles that have irregular shapes, jagged borders, uneven color within the same mole, and redness in a mole. I begin checking children's moles at their early check ups and look for any moles that I want parents to continue to be watching and to be aware of. I note all moles on my chart so I know each year which ones I want to pay attention to, especially moles in the scalp, on fingers and toes and in areas that are not routinely examined. A parent may even check their child's moles every several months too and pay particular attention to any of the more unusual moles. Be aware that a malignant mole may often be flat, rather than the raised larger mole. Freckles are also common in children and are usually found on the face and nose, the chest, upper back and arms. Freckles tend to be lighter than moles, and cluster. If you are not sure ask your doctor. Sun exposure plays a role in the development of melanoma and skin cancer, so it is imperative that your child is sun smart. That includes wearing a hat and sunscreen
Mosquitoes are out in full force and while we are seeing higher than normal cases of West Nile Virus (WNV) in many states, we pediatricians are more often diagnosing impetigo secondary to bug bites, than a case of WNV (thank goodness!).
Those pesky mosquito bites, or any other type of insect bite (hopefully you are applying bug spray to your kids as well) just scream for a child to scratch them. With scratching comes abrasion to the surface of the skin and those little fingers (even if washed) harbor bacteria that can penetrate the breaks in the skin and set up an infection. Once those fingers go on to scratch yet another bite the infection can be moved from place to place (the name for the spread of the infection by the fingers is auto-inoculation) and before you know it you see several to many little inflamed, honey crusted, weeping lesions on the skin surface. This is classic impetigo (not INFANTIGO as some like to call it).
Impetigo is typically caused by the bacteria staph or strep and even frequently washed hands harbor bacteria. If you notice one or two bites that are looking inflamed and weepy it may just take a prescription antibiotic ointment to treat the infection.
In some cases the area of infection involves multiple areas on the face, arms, legs, and buttocks (where kids typically pick and scratch) and your doctor may want to prescribe an oral antibiotic to treat the infection.
The best treatment is always prevention, so continue to use insect repellant appropriately, trim those fingernails, discourage scratching and picking and use an antibacterial soap for bathing. If you see an area looking like it is getting infected treat it early and you may be able to avoid taking an oral antibiotic.
It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions.
The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks. This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed.
Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that baby fat reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites.
Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer.
Severe local reactions are called sweeter syndrome and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from infection.
Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito