Common Skin Disorders

There are many common skin disorders that require the clinical care of a physician or other healthcare professional.

Common skin conditions are grouped into the following categories:

What are fungal infections?

Skin fungi live in the top layer of skin cells in moist areas of the body, such as between the toes or in the groin and diaper area. Sometimes, the normal balances that keep fungi in check are upset, resulting in an infection.

Some fungal infections cause only a small amount of irritation, while other types penetrate deeper and can cause itching, swelling, blistering, or scaling.

In some cases, fungal infections can cause reactions elsewhere on the body. A child can develop a rash on the finger or hand associated with an infection of the scalp or foot, for instance.

Tinea Infections (Ringworm)

What is ringworm (tinea infection)?

Different fungi, depending on their location on a child's body, cause ringworm. Ringworm is characterized by ring-shaped red, scaly patches with clear centers. The risk of contracting ringworm increases if the child:

  • Is malnourished
  • Has poor hygiene
  • Lives in a warm climate
  • Has contact with other children or pets that have ringworm
  • Is immunocompromised by disease or medication

What are the most common types of ringworm?

The most common types of ringworm include the following:

  • Athlete's foot (tinea pedis or foot ringworm)
    This common condition mostly affects teen and adult males, and is rarely found in children before puberty. Many things can cause athlete’s foot, include sweating, not drying the feet well after swimming or bathing, wearing tight socks and shoes, and warm weather conditions. Symptoms of athlete's foot may include:
    • Whitening of the skin between the toes
    • Scaling of the feet
    • Itchy rash on the feet
    • Blisters on the feet
  • Jock itch (tinea cruris or groin ringworm)
    This condition is more common in males and occurs more often during warm weather conditions. It is very rare in females. Symptoms of jock itch may include:
    • Red, ring-like patches in the groin area
    • Itching in the groin area
    • Pain in the groin area
    • Does not usually involve the scrotum
  • Scalp ringworm (tinea capitis)
    Scalp ringworm is highly contagious, especially among children. It occurs mainly in children between the ages of 2 and 10, but rarely in adults. Symptoms of scalp ringworm may include:
    • Red, scaly rash on the scalp
    • Itching of the scalp
    • Hair loss on the scalp
    • Rash elsewhere on the body
  • Ringworm of the scalp can also develop into a kerion, a large, tender lesion over the area of the initial ringworm. This is caused by a hypersensitivity to the ringworm and may be associated with a rash elsewhere on the body and tender lymph nodes in the neck.
  • Nail ringworm (tinea unguium)
    Nail ringworm is an infection of the finger or toenail, characterized by a thickened, deformed nail. This condition is found more often in toenails than fingernails, and is more common in adolescents and adults than young children. Symptoms of nail ringworm may include:
    • Thickening of the ends of the nails
    • Yellow color to the nails
  • Body ringworm (tinea corporis)
    This skin infection is characterized by a ring-like rash on the body or the face. This occurs in all ages and is more common in warmer climates. The symptoms of body ringworm may include:
    • Red, circular lesion with raised edges the middle of the lesion may become less red as the lesion grows
    • Itching of the affected area

Ringworm resembles many skin conditions. Always consult a physician for a diagnosis.

How is ringworm diagnosed?

Ringworm is usually diagnosed based on a medical history and physical examination of the child. The lesions of ringworm are unique, and usually allow for a diagnosis simply on physical examination. The physician may also order a culture or skin scraping of the lesion to confirm the diagnosis.

What is the treatment for ringworm?

Because the fungi can live indefinitely on the skin, recurrences of ringworm are likely, and treatment may need to be repeated. Specific treatment will be determined by the physician based on:

  • The child's age, overall health, and medical history
  • Extent of the condition
  • Location of the ringworm
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Child or parent’s opinion or preference

Treatment for scalp ringworm (tinea capitis) may include the following:

  • Oral anti-fungal medication - this medication is usually prescribed for four to eight weeks. Some children require longer treatment
  • Use of a special shampoo (to help eliminate the fungus)
  • If a kerion is present (a large, tender, swollen lesion), the physician may order additional medications, such as steroids, to help reduce the swelling
  • Ringworm of the body, groin, and foot is usually treated with a topical anti-fungal agent or an oral antifungal medication. The length of the treatment depends on the location of the ringworm

Tinea Versicolor

What is tinea versicolor?

Tinea versicolor is a common fungal skin infection characterized by lighter or darker patches on the chest or back. This infection, which prevents the skin from tanning evenly, occurs most often in adolescence and early adulthood.

What are the symptoms of tinea versicolor?

Typically the only symptom of tinea versicolor is white or light brown patches. The patches may scale slightly, but they rarely itch or hurt. Other common characteristics of the infection include:

  • White, pink, or brown patches
  • Infection only on the top layers of the skin
  • Rash on the trunk
  • No rash on the face
  • Patches worsen in the heat or humidity
  • Patches worsen if the child is on steroid therapy or has a weakened immune system
  • Patches are most noticeable in the summer

The symptoms of tinea versicolor may resemble other skin conditions. Always consult a physician for diagnosis.

How is tinea versicolor diagnosed?

Tinea versicolor is usually diagnosed based on a medical history and physical examination of the child. The patches are unique, and usually a diagnosis can be made on physical examination. The physician may also use an ultraviolet light to see the patches more clearly or take skin scrapings of the lesions to confirm the diagnosis.

What is the treatment for tinea versicolor?

Treatment usually includes the use of dandruff shampoo on the skin as prescribed by the physician. The shampoo is left on the skin overnight and washed off in the morning, and may be required for several nights.

Tinea versicolor usually recurs, requiring additional treatments, and sometimes improves temporarily. The physician may prescribe topical creams, oral antifungal medications, or monthly shampoo treatments.

This infection can also cause a change in skin color, which can take several months to return to normal.

Viral Skin Infections

Many childhood viral infections are called viral exanthems. Exanthem means rash or skin eruption. Childhood viral exanthems include the following:

  • Measles or rubeola
  • Rubella
  • Varicella (or chickenpox)
  • Fifth disease
  • Roseola

Three main groups of viruses cause the majority of viral skin infections, including the following:

  • Human papillomavirus
  • Herpes simplex virus
  • Poxvirus
Other childhood viral skin infections include the following:

Herpes Zoster (Shingles)

What is herpes zoster?

Herpes zoster, or shingles, is a reactivation of the varicella-zoster virus (chickenpox). The virus causes a painful rash of small blisters on a strip of skin anywhere on the body. On some occasions, the pain may continue for a prolonged period of time even after the rash is gone.

After a person has had chickenpox, the virus lies dormant in the nerves. If the virus reactivates, however, it causes shingles. Herpes zoster is more common in people with depressed immune systems or over the age of 50. It is very rare in children, and the symptoms are mild compared to what an adult may experience.

Children who have weakened immune systems may experience the same, or more severe, symptoms as adults, however.

What are the symptoms of herpes zoster?

Herpes zoster most often occurs on the trunk and buttocks, but can also appear on the arms, legs, or face. Each child may experience the symptoms differently. The most common symptoms may include:

  • Skin hypersensitivity in the area where the herpes zoster appears
  • Mild rash, which appears after five days and first looks like small, red spots that turn into blisters
  • Blisters that turn yellow and dry
  • Rash which usually goes away in one to two weeks
  • Rash localized to one side of the body

The symptoms of herpes zoster may resemble other skin conditions. Always consult a physician for a diagnosis.

How is herpes zoster diagnosed?

Diagnosis usually involves obtaining a medical history of the child and performing a physical examination. Diagnosis may also include:

  • Skin scrapings (gently scraping the blisters to determine if the virus is shingles)
  • Blood tests

What is the treatment for herpes zoster?

Specific treatment for herpes zoster will be determined by a physician based on:

  • The child's age, overall health, and medical history
  • Extent of the condition
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Child or parent’s opinion or preference

Medication may help alleviate some of the pain, but the condition has to run its course. Immediate treatment with antiviral drugs may help lessen some of the symptoms. Use of medication will be determined by a physician based on the age of the child and the severity of the symptoms.

Pityriasis Rosea

What is pityriasis rosea?

Pityriasis rosea is a mild, but common, skin condition that is characterized by scaly, pink, inflamed skin. The condition can last from four to eight weeks but usually leaves no lasting marks.

What causes pityriasis rosea?

The cause of pityriasis rosea is not known, but it is likely caused by a virus. It usually occurs in children, adolescents, and young adults (more than 75 percent of people with the rash are 10 to 35 years of age.) In addition, pityriasis rosea is more common in spring and fall.

What are the symptoms of pityriasis rosea?

Pityriasis rosea usually starts with a pink or tan oval area (sometimes called a herald or mother patch) on the chest or back. The main patch is usually followed (after a few weeks) by smaller pink or tan patches elsewhere on the body, usually the back, neck, arms, and legs. The scaly rash usually lasts between four to eight weeks and will often disappear without treatment.

Each child may experience the symptoms differently. Common symptoms include:

  • Headaches
  • Fatigue
  • Aches
  • Itching

The symptoms of pityriasis rosea may resemble other skin conditions or medical problems. Always consult a physician for a diagnosis.

How is pityriasis rosea diagnosed?

Pityriasis rosea is usually diagnosed with a medical history and physical examination of the child. The rash of pityriasis rosea is unique, and the diagnosis is usually made on the basis of a physical examination. In addition, the child's physician may order the following tests:

  • Blood tests
  • Skin biopsy the removal of some of the diseased skin for laboratory analysis. The sample of skin is removed after a local anesthetic is administered.

What is the treatment for pityriasis rosea?

Specific treatment for pityriasis rosea will be determined by a physician based on:

  • The child's age, overall health, and medical history
  • Extent of the rash
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the rash
  • Child or parent’s opinion or preference

There is no cure for pityriasis rosea, and the infection usually goes away on its own. The goal of treatment is to relieve symptoms associated with the condition, such as itching. Depending on the severity of the condition, treatment may include one, or more, of the following:

  • Medicated lotions and creams (to soothe the itching)
  • Medications by mouth (to soothe the itching)
  • Cool baths with or without oatmeal (to soothe the itching)
  • Ultraviolet exposure (under a physician's supervision)
  • Cool compresses (to soothe the affected skin)

Warts

What are warts?

Warts are non-cancerous skin growths caused by the papillomavirus. Warts are more common in children than adults, although they can develop at any age.

Warts are contagious, and can spread to other parts of the body or to other people. There are many different types of warts, due to the fact that there are more than 60 types of the papillomavirus. Warts are typically not painful, except when located on the feet, and most warts go away without treatment over an extended period of time.

What are the common types of warts?

The more common types of warts include the following:

  • Common warts are growths around nails and the back of hands; usually have a rough surface; grayish-yellow or brown in color.
  • Foot warts are located on the soles of feet (plantar warts) with black dots (clotted blood vessels that once fed them); clusters of plantar warts are called mosaic. These warts may be painful.
  • Flat warts are small, smooth growths that grow in groups up to 100 at a time; most often appear on children's faces.
  • Genital warts grow on the genitals, are occasionally sexually transmitted; are soft and do not have a rough surface like other common warts.
  • Filiform warts are small, long, narrow growths that usually appear on eyelids, face, or neck.

What is the treatment for warts?

The specific treatment for warts will be determined by a physician based on:

  • The child's age, overall health, and medical history
  • Extent of the growths
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the growths
  • Child or parent’s opinion or preference

Warts in children often disappear without treatment. Treatment of warts depends on several factors, including:

  • Length of time on the skin
  • Location
  • Type
  • Severity

Treatment for more stubborn or recurring warts may include:

  • Application of salicylic and lactic acid (which softens the infected area)
  • Freezing with liquid nitrogen
  • Electrodesiccation (using an electrical current to destroy the wart)
  • Immunotherapy
  • Laser surgery

Molluscum Contagiosum

What is molluscum contagiosum?

Molluscum contagiosum is a viral disease of the skin that causes small pink- or skin-colored bumps on the skin of your child. It is not harmful and usually does not have any other symptoms. The virus lives inside the bumps and is mildly contagious. The bumps usually clear up without treatment over six to nine months.

What causes molluscum contagiosum?

Molluscum contagiosum is caused by a virus called the poxvirus. It is most common in children and adolescents, although it can also affect adults.

What are the symptoms of molluscum contagiosum?

The bumps are small and are usually pink- or skin-colored. Over time, the bumps may develop a small, sunken center. Children usually develop between two and 20 lesions, often in clusters. They are not harmful, but may cause some cosmetic concern for the child if they appear on the face or other visible areas.

How is molluscum contagiosum diagnosed?

Molluscum contagiosum is usually diagnosed based on a medical history and physical examination of the child. The lesions are unique and usually are diagnosed on physical examination.

What is the treatment for molluscum contagiosum?

Specific treatment for molluscum contagiosum will be determined by the physician based on:

  • The child's age, overall health, and medical history
  • Extent of the condition
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Child or parent’s opinion or preference

In most cases, the lesions will heal without treatment over six to nine months. Additional treatment options may include:

  • Removal of the lesions
  • Use of topical medications (to speed up healing)

Viral Exanthems (Rashes)

The most common childhood viral exanthems include the following:

Immunizations have decreased the number of cases of measles, mumps, rubella, and chickenpox, but all viral skin infections require clinical care by a physician or other healthcare professional. Each of the viral exanthems listed here have a distinct pattern, which can aid in the diagnosis.

Measles (or Rubeola)

What is measles (rubeola)?

Rubeola, also called 10-day measles, red measles, or measles, is a very contagious viral illness that results in a distinct rash. It is spread from one child to another through direct contact with discharge from the nose and throat, or via air-borne droplets from an infected child. Measles is a highly contagious disease that usually consists of a rash, fever, and cough.

What causes measles?

The measles virus, which causes the disease, is classified as a Morbillivirus. It is mostly seen in the winter and spring, but measles is preventable with proper immunization.

The measles vaccine is usually given in combination with the mumps and rubella vaccine. It is called the MMR and is usually given when the child is 12 to 15 months old and then again between 4 and 6 years of age.

What are the symptoms of measles?

After exposure to the disease, it can take between 8 to 12 days for a child to develop symptoms of rubeola. Children are contagious 1 to 2 days before the onset of symptoms and 3 to 5 days after the rash develops. This means that children can be contagious before they even know they have measles.

During the early stages of measles (which lasts between 1 to 4 days), symptoms usually resemble those of an upper respiratory infection. Each child may experience symptoms differently, however. Common symptoms may include:

  • Hacking cough
  • Redness and irritation of the eyes
  • Fever
  • Small red spots with white centers on the inside of the cheek (these usually occur 2 days before the rash on the skin appears)
  • A deep, red, flat rash that starts on the face and spreads down to the trunk, arms, and legs. The rash starts as small distinct lesions, which then combines to form one big rash. After 3 to 4 days, the rash will begin to clear, leaving a brownish discoloration and skin peeling.

The most serious complications from measles include the following:

  • Ear infections
  • Pneumonia
  • Croup
  • Inflammation of the brain

The symptoms of rubeola may resemble other skin conditions or medical problems. Always consult a physician for a diagnosis.

How is rubeola diagnosed?

Measles is usually diagnosed based on a complete medical history and physical examination of the child. The lesions of rubeola are unique, and usually allow for a diagnosis simply on physical examination. In addition, a physician may order blood or urine tests to confirm the diagnosis.

What is the treatment for rubeola?

Specific treatment for measles will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the disease
  • The child's tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease
  • Child or parent’s opinion or preference

Because measles is caused by a virus, there is no cure for rubeola. The goal of treatment is to help prevent the disease, or decrease the severity of the symptoms.

  • Increased fluid intake
  • Acetaminophen for fever (DO NOT GIVE ASPIRIN)

If the child was exposed and has not been immunized, the physician can give the vaccine to the child within 72 hours to help prevent the disease.

Other ways to prevent the spread of rubeola include:

  • Children should not attend school or daycare for 4 days after the rash appears
  • Confirm that the child's contacts have been properly immunized

Rubella (German Measles)

What is rubella (German measles)?

Rubella is a viral illness that causes a rash on the skin. It is spread from one child to another through direct contact with discharge from the nose and throat.

Warning

Pregnant women who have been exposed to rubella need to seek medical attention immediately.

Infants and children who develop the disease usually only have a mild case of the rash and side effects. However, children who contract rubella from their mother while she is pregnant can have severe birth defects and consequences. It is also very dangerous for pregnant women to come in contact with someone who has rubella, because it can cause a miscarriage.

What causes rubella?

Rubella is caused by a virus called a Rubivirus. It can be spread from a pregnant mother to the unborn child, or from secretions from another infected person. It is most prevalent in late winter and early spring. Rubella is preventable by proper immunization.

The rubella vaccine is usually given in combination with the measles and mumps vaccine. It is called the MMR vaccine and is usually administered when the child is 12 to 15 months old, and then again between 4 and 6 years of age.

What are the symptoms of rubella?

The disease itself does not have any long-term consequences. The biggest concern is to prevent an infected child from infecting a pregnant woman. Take note of the following facts:

  • It can take between 14 to 21 days for a child to develop signs of rubella after coming in contact with the disease
  • Children are most contagious when the rash is erupting
  • A child can be contagious beginning 7 days before the onset of the rash and 14 days after the rash has appeared
  • Children may be contagious before they even know they have rubella.

The following are the most common symptoms of rubella. However, each child may experience symptoms differently.

Childhood rubella

  • Rubella may begin with a period of not feeling well, a low-grade fever, and diarrhea. This may last one to five days.
  • The rash then appears as a pink rash with areas of small, raised lesions.
  • The rash begins on the face and then spreads down to the trunk, arms, and legs.
  • The rash on the face usually improves as the rash spreads to the arms and legs.
  • The rash usually fades by the third to fifth day.
  • Lymph nodes in the neck may also become enlarged.
  • Older children and adolescents may develop some soreness and inflammation in their joints.

Congenital rubella

Rubella that is present at birth where the child contracted it from the mother while in utero, can result in many problems, including the following:

  • Cataracts in the eyes
  • Heart problems
  • Mental retardation
  • Growth retardation
  • Enlarged liver and spleen
  • Skin lesions
  • Bleeding problems

The symptoms of rubella may resemble other skin conditions or medical problems. Always consult a physician for the proper diagnosis.

How is rubella diagnosed?

Rubella is usually diagnosed based on a medical history and physical examination of the child. The lesions of rubella are unique, and usually the diagnosis can be made on physical examination. In addition, the child's physician may order blood or urine tests to confirm the diagnosis.

What is the treatment for rubella?

Specific treatment for rubella will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the disease
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Child or parent’s opinion or preference

Since it is a viral infection, there is no cure for rubella. The goal of treatment for rubella is to help prevent the disease, or decrease the severity of the symptoms. Treatment may include increased fluid intake or rest.

Other ways to prevent the spread of rubella:
  • Children should not attend school for 7 days after the onset of the rash.
  • Children who are born with rubella are considered contagious for the first year of life.
  • Check that a child's contacts have been properly immunized.

Roseola

What is roseola?

Roseola is a contagious viral illness that is marked by a high fever and a rash that develops as the fever decreases.

What causes roseola?

Roseola is likely caused by more than one virus, but the most common cause is the human herpesvirus 6 (HHV-6). Roseola occurs mostly in children under the age of 3, and occurs more often in the spring and fall.

What are the symptoms of roseola?

It can take between 5 and 15 days for a child to develop symptoms of roseola after being exposed to the disease. Children are most contagious during the period of high fever, before the rash occurs.

The following are the most common symptoms of roseola. However, each child may experience symptoms differently.

  • High fever that starts abruptly
  • Fever (may last three to four days)
  • Irritability
  • Swelling of the eyelids
  • Rash (as the fever decreases, a pink rash, with either flat or raised lesions, starts to appear on the trunk and then spreads to the face, arms, and legs.)

What are the complications of roseola?

The most serious complication of roseola is febrile seizures. As the child's temperature rises, there is a chance that the child will have a seizure.

The symptoms of roseola may resemble other skin conditions or medical problems. Always consult a physician for the proper diagnosis.

How is roseola diagnosed?

Roseola is usually diagnosed based on a medical history and physical examination of your child. The rash of roseola that follows a high fever is unique, and often the diagnosis is made simply on physical examination.

What is the treatment for roseola?

The specific treatment for roseola will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the disease
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Child or parent’s opinion or preference

Since it is a viral infection, there is no cure for roseola. The goal of treatment for roseola is to help decrease the severity of the symptoms. Treatment may include increased fluid intake or acetaminophen for fever (DO NOT GIVE ASPIRIN).

Fifth Disease

What is fifth disease?

Fifth disease is a moderately contagious viral illness that causes a rash on the skin, but no fever, as with other viral illnesses. It is spread from one child to another through direct contact with discharge from the nose and throat and can also be spread through contact with infected blood.

What causes fifth disease?

Fifth disease is caused by the human parvovirus. It is most prevalent in the winter and spring and is usually seen in children ages 5 to 14. Outbreaks of the disease frequently occur in school settings.

What are the symptoms of fifth disease?

It can take between 4 to 14 days for a child to develop symptoms of fifth disease after being exposed to the disease. Children are most contagious before the rash occurs, meaning they are often contagious before they even know they have the disease. In addition, about 20 percent of people with fifth disease do not have symptoms but can still spread the disease.

The following are the most common symptoms of fifth disease. However, each child may experience symptoms differently.

  1. There may be an early phase with the following symptoms, although this is not very common. If this happens, symptoms may include the following:
    • Fever
    • Headache
    • Red eyes
    • Sore throat
  2. The rash is usually the primary symptom of fifth disease. The rash:
    • Starts on the cheeks and is bright red. The rash looks like slapped cheeks.
    • Spreads to the trunk, arms, and legs, and lasts two to four days.
    • May continue to reappear if the child is exposed to sunlight, very hot or cold temperature, or trauma to the skin. This may continue for several days.

Warning

Pregnant women who have been exposed to fifth disease need to seek immediate medical attention.

Fifth disease is usually a mild illness. However, parvovirus B19 infection can cause an acute severe anemia in persons with sickle-cell disease or immune deficiencies. Also, there is a small risk of fetal death if fifth disease is acquired during pregnancy.

The symptoms of fifth disease may resemble other conditions or medical problems, so consult a physician for proper diagnosis.

How is fifth disease diagnosed?

Fifth disease is usually diagnosed based on a complete medical history and physical examination of the child. The rash and progression of fifth disease is unique, and usually allows for a diagnosis simply on physical examination. The physician may also order blood tests to aid in the diagnosis.

What is the treatment for fifth disease?

The specific treatment for fifth disease will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the disease
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Child or parent’s opinion or preference

Since it is a viral infection, there is no cure for fifth disease. The goal of treatment for fifth disease is to help decrease the severity of the symptoms. Treatment may include increased fluid intake or acetaminophen for fever (DO NOT GIVE ASPIRIN).

Chickenpox

What is chickenpox?

Chickenpox is a highly infectious disease, usually associated with childhood. By adulthood, more than 95 percent of Americans have had chickenpox.

The disease is caused by the varicella-zoster virus (VZV), a form of the herpes virus. Transmission occurs from person-to-person by direct contact or through the air.

Chickenpox most commonly occurs in children between the ages of 5 and 9. In the US, in areas with a large number of children in daycare settings, chicken pox in children between the ages of 1 and 4 is common.

What is the chickenpox vaccine?

Since 1995, a chickenpox vaccine has been available for children 12 months of age and older. Adolescents and adults who have never had chickenpox can also get the vaccine. The vaccine has proven very effective in preventing severe chickenpox.

The Center for Disease Control & Prevention’s Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians recommend that all children be vaccinated with the chickenpox vaccine between 12 and 18 months of age.

A booster vaccination is recommended again between 11 and 12 years of age. Many schools now require vaccination prior to entry into preschool or public schools.

What are the symptoms of chickenpox?

Symptoms are usually mild among children, but may be life threatening to infants, adults, and people with impaired immune systems.

The following are the most common symptoms of chickenpox. However, each child may experience symptoms differently. Symptoms may include:

  • Fatigue and irritability one to two days before the rash begins
  • Itchy rash on the trunk, face, under the armpits, on the upper arms and legs, and inside the mouth
  • Fever
  • Feeling ill
  • Decreased appetite
  • Muscle and/or joint pain
  • Cough or runny nose

The symptoms of chickenpox may resemble other skin problems or medical conditions. Always consult a physician for a diagnosis.

How is chickenpox spread?

Once infected, chickenpox may take 10 to 21 days to develop. Chickenpox is contagious for one to two days before the appearance of the rash and until the blisters have dried and become scabs, which usually happens within 4 to 5 days of the onset of the rash.

Children should stay home and away from other children until all of the blisters have scabbed over. Family members who have never had chickenpox have a 90 percent chance of becoming infected when another family member in the household is infected.

How is chickenpox diagnosed?

Chickenpox is usually diagnosed based on a complete medical history and physical examination of the child. The rash of chickenpox is unique, and usually a diagnosis can be made from a physical examination.

What is the treatment for chickenpox?

The specific treatment for chickenpox will be determined based on:

  • The child's age, overall health, and medical history extent of the condition
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition child or parent’s opinion or preference

The treatment for chickenpox may include:

  • Acetaminophen for fever (DO NOT GIVE ASPIRIN)
  • Antibiotics for treating bacterial infections
  • Calamine lotion (to relieve itching)
  • Antiviral drugs (for severe cases)
  • Rest
  • Increased fluid intake (to prevent dehydration)
  • Cool baths with baking soda or Aveeno (to relieve itching)

Children should not scratch the blisters, as this can lead to secondary bacterial infections. Keep the child's fingernails short to decrease the likelihood of scratching.

What is immunity from chickenpox?

Most individuals who have had chickenpox will be immune to the disease for the rest of their lives. However, the virus remains dormant in nerve tissue and may reactivate, resulting in herpes zoster (shingles) later in life.

Occasionally a secondary case of chickenpox does occur. Blood tests can confirm immunity to chickenpox in people who are unsure if they have had the disease.

What complications are commonly associated with chickenpox?

Complications can occur from chickenpox. Those most susceptible to severe cases of chickenpox are infants, adults, pregnant women (unborn babies may be infected if the mother has not had chickenpox prior to pregnancy), and people with impaired immune systems. Complications may include:

  • Secondary bacterial infections
  • Pneumonia
  • Encephalitis (inflammation of the brain)
  • Cerebellar ataxia (defective muscular coordination)
  • Transverse myelitis (inflammation along the spinal cord)
  • Reye syndrome (a serious condition which may affect all major systems or organs)
  • Death

Parasitic Skin Infections

What are parasitic skin infections?

Skin parasites are small insects or worms that burrow into the skin to live there or lay their eggs.

There are many types of parasitic skin infections that require clinical care by a physician or other healthcare professional. They include:

Scabies

What is scabies?

Scabies is an infestation of mites (tiny insects) characterized by small red bumps and intense itching. This highly contagious infection often spreads from person to person while they are sleeping together in the same bed or have close personal contact.

The itching is caused by the mites burrowing into the skin where they lay eggs that hatch a few days later. Scabies can affect people of all ages. Scabies occurs mostly in children and young adults.

What are the symptoms of scabies?

It may take between 4 to 6 weeks for a child to develop symptoms of scabies after coming in contact with an infected person.

In children younger than 2 years of age, the lesions caused by the mites tend to occur on the head, neck, palms, and soles. In older children, the lesions are usually between the fingers, on the hands or wrists, along the belt line, on the thighs or belly button, in the groin area, around the breasts, and in the armpits.

The following are the most common symptoms of scabies. However, each child may experience symptoms differently. Symptoms may include:

  • Itching, usually severe
  • Rash, with small pimples or red bumps
  • Scaly or crusty skin (with advanced conditions)

How is scabies diagnosed?

In diagnosing scabies, the skin and skin crevices are examined by a physician. A sample of skin, obtained by scraping the skin, may be examined under a microscope to confirm the presence of mites.

What is the treatment for scabies?

Scabies is treatable and usually all members in a family are treated at the same time. Specific treatment will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the infestation
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the infestation
  • Child or parent’s opinion or preference
Treatment may include:
  • Applications of prescription creams and lotions, such as permethrin and lindane solutions
  • Oral antihistamine medication (to help relieve itching)
  • In some cases, topical ointments are recommended

In addition, it is important to wash all clothes and bedding in hot water and dry in a hot dryer in order to kill the mites. Clothing and other objects that cannot be washed (i.e., pillows, stuffed animals) should be placed in a plastic bag for at least one week.

Also, the itching may continue for many weeks after the initial treatment of the scabies.

Lice

What are lice?

Lice are tiny insects that can infest the skin anywhere on the body. Lice infection is characterized by intense itching.

Lice are highly contagious, spreading from person to person by close body contact, shared clothes, and other items (such as hats, hairbrushes, and combs). There are three types of human lice:

Head lice

  • Head lice are seen mostly in child-care settings and among school-aged children
  • The child usually has itching in the head area
  • Lice, or the eggs (called nits), can usually be seen on the hair, behind the ears, and on the neck

Body lice

  • Body lice are usually seen in people with poor hygiene
  • Body lice are rare in children
  • Body lice cause severe itching, which is often worse at night
  • In some cases, lice and eggs can be found in the seams of clothes

Pubic lice

  • Pubic lice are very contagious and can be transmitted through sexual contact or by contaminated items such as towels and clothes
  • Pubic lice can affect the pubic hair, but also can cause infections of the hair on the chest, abdomen, thighs, and eyebrows
  • Itching of the affected area is a common symptom of pubic lice

How are lice diagnosed?

The eggs laid by lice are usually visible to the naked eye, making it easy for a child's physician to diagnose. Pubic lice leave small brown spots on the parts of clothing that come into contact with the genitals or anus.

What is the treatment for lice?

The specific treatment for lice will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the infestation
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the infestation
  • Child or parent’s opinion or preference

Lice are very treatable. Treatment may include:

For head lice and pubic lice:

Application of a medicated cream rinse or shampoo is usually an effective treatment for head and/or pubic lice. The specific instructions need to be followed. Examples of medicated cream rinses or shampoos include the following:

  • Permethrin or Nix® cream rinse
  • Lindane
  • Kwell® shampoo
  • Pyrethrins or RID® gel
  • Nits need to be removed from the hair with a fine-tooth comb.

Combs and brushes should be soaked in hot water with the shampoo for at least 15 minutes.

Children can return to school or daycare the day following their first treatment for head lice.

For body lice:

  • Medications are usually not needed to treat body lice
  • Treatment for body lice usually consists of improving hygiene and washing clothes
  • Bed sheets and blankets should be washed in hot water and dried in a hot dryer
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Dermatology

The Division of Dermatology at Children's National Health System continues to expand services as more families seek our expertise in the diagnosis and treatment of disorders of the skin, hair, and nails.

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