Non-Infectious Skin Conditions

There are many different non-infectious skin conditions that require clinical care by a physician or other healthcare professional.

Dermatitis

Dermatitis refers to a number of skin conditions that inflame the skin. Dermatitis is characterized by skin that may be red, swollen, blistered, scabbed, scaly, oozing, or itchy. Some types of dermatitis are caused by allergies, but the majority do not have known causes.

The most common forms of dermatitis include:

  • Contact Dermatitis
  • Atopic Dermatitis (eczema)
  • Diaper Dermatitis
  • Seborrheic Dermatitis (cradle cap)

What is contact dermatitis?

Contact dermatitis is a physiological reaction that occurs when skin comes in contact with certain substances. Irritants to the skin cause 80 percent of these reactions, while the remaining 20 percent are caused by allergens, which trigger an allergic response.

Adults are affected by allergic contact dermatitis more than young children or the elderly.

What causes irritant contact dermatitis?

The most common causes of irritants to children include the following:

  • Soaps
  • Saliva
  • Different foods
  • Detergents
  • Baby lotions
  • Perfumes

Plants, as well as metals, cosmetics, and certain medications, may also cause contact dermatitis. These include:

  • Poison ivy. The plant family that also includes poison oak and sumac, is a common cause of contact dermatitis.
  • Metals. Nearly 3,000 chemical agents are capable of causing allergic contact dermatitis. Nickel, chrome, and mercury are the most common metals that cause contact dermatitis.
    • Nickel is found in costume jewelry, belt buckles, and wristwatches, as well as zippers, snaps, and hooks on clothing. Contact with objects that are chrome-plated, which contain nickel, may also cause skin reactions in children who are sensitive to nickel.
    • Mercury, which is found in contact lens solutions, may cause problems for some children.
  • Latex. Some children have an allergy or sensitivity to latex (rubber). Latex is found in products made with natural rubber latex, such as rubber toys, balloons, bells, rubber gloves, and pacifiers or nipples.
  • Cosmetics. Many types of cosmetics can cause allergic contact dermatitis. Permanent hair dye that contains paraphenylenediamine is the most common cause. Other products that may cause problems include clothing dyes, perfumes, eye shadow, nail polish, lipstick, and certain sunscreens.
  • Medications. Neomycin, which is found in antibiotic creams, is a common cause of contact dermatitis. Local anesthetics, such as novocaine or paraben, are other possible causes.

What are the symptoms of contact dermatitis?

The most severe reaction is usually at the contact site. The following are some of the other symptoms associated with contact dermatitis. However, each child may experience symptoms differently.

  • Mild redness and swelling of the skin
  • Blistering of the skin
  • Itching
  • Scaling and temporary thickening of skin

The symptoms of contact dermatitis can resemble other skin conditions, so always consult a physician for the correct diagnosis.

What is the treatment for contact dermatitis?

The best treatment is to identify and avoid the substances that may have caused the allergic contact dermatitis. The following recommendations from the American Academy of Allergy, Asthma, and Immunology are geared for mild to moderate reactions:

  • Thoroughly wash skin with soap and water as soon after the exposure as possible
  • Wash clothing and all objects that touched plant resins (poison ivy/oak) to prevent re-exposure
  • Use wet, cold compresses to soothe and relieve inflammation if blisters are broken
  • For severe reactions, always contact a physician or call 911

Atopic Dermatitis

What is atopic dermatitis?

Atopic dermatitis, also called eczema, is a skin disorder that usually appears in babies or very young children, and may last until the child reaches adolescence or adulthood. Eczema causes the skin to itch, turn red, and flake.

Parents with eczema are more likely to have children with eczema. Different triggers can make eczema worse, including environmental stress, allergies, and sweating. Of the children with eczema, 65 percent will show symptoms in the first year of life and 90 percent will show signs of eczema within the first 5 years.

What are the symptoms of eczema?

The locations where eczema occurs may change with age. In infants and young children, eczema is usually found on the face, outside the elbows, and on the knees. In older children and adults, eczema tends to appear on the hands and feet, the arms, and on the back of the knees.

Every each child may experience symptoms differently, but the main symptoms include the following:

  • Dry, scaly skin
  • Small bumps that open and weep when scratched
  • Redness and swelling of the skin
  • A thickening of the skin (with chronic eczema)

Excessive rubbing and scratching can tear the skin, which can in turn cause an infection. Some children only have a few episodes or flare-ups, while other children will have eczema throughout adulthood.

The symptoms of eczema may resemble other skin conditions, so a physician should always diagnose eczema.

How is eczema diagnosed?

Eczema is very common. The National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that at least 10 percent of infants and children have atopic dermatitis. Diagnosis is usually based on a physical examination and medical history, but may also include the following:

  • Family history (children born to a mother who has allergic conditions are more prone to eczema)
  • Personal history of allergies or asthma
  • Blood tests

What is the treatment for eczema?

Specific treatment for eczema will be determined by the child's physician based on the following:

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

Note: There is no cure for eczema. The goals of treatment are to reduce itching and inflammation, moisturize the skin, and prevent infection.

Developing Treatments

A new class of medications, called topical immunomodulators (TIMs), offers a steroid-free treatment option for treating atopic dermatitis. These medications can be used anywhere on the body to relieve the itching, redness, and pain caused by eczema.

Tacrolimus is the first TIM approved by the US Food and Drug Administration (FDA) (link to www.fda.gov) Another promising new TIM is called pimecrolimus.

The FDA does not advise using TIMs on children under the age of two. Be sure to consult with the child's physician for more information.

How can eczema be managed?

The following list includes a variety of suggestions for managing eczema:

  • Avoid contact with irritants, as determined by the child's physician
  • Bathe the child regularly, use moisturizers, and practice good skin care techniques
  • Keep the child's room cool at night to prevent sweating that can irritate the skin
  • Avoid harsh soaps. Ask the child's physician to recommend a brand name
  • Make sure the child's fingernails are short, as scratching may contribute to an infection
  • Use lubricating lotions at least once a day. Ask the child's physician to recommend a brand name

What is the treatment for severe eczema?

In severe cases the child's physician may also prescribe medications. The following medications are most commonly used to treat eczema:

  • Antihistamines. These medications help to decrease the amount of itching. Examples include diphenhydramine (Benadryl®) or hydroxyzine (Atarax®). These medications may cause drowsiness, but several new antihistamines are available that do not cause sleepiness. Consult the child's physician for more information.
  • Steroid creams. These topical medications help decrease the inflammation in the skin, thereby decreasing itching and swelling. Many topical steroids in various strengths are available. Steroids, if overused, are potentially damaging to the skin, so follow the advice of the child's physician.
  • Oral antibiotics

Diaper Dermatitis

What is diaper dermatitis?

Diaper dermatitis, commonly known as a diaper rash, is a term used to describe different skin rashes in the diaper area. The rash is usually red and scaling, but rarely ulcerated. It is most commonly seen in infants between the ages of 9 to 12 months, can also begin in the first 2 months of life.

What causes diaper dermatitis?

Possible causes of diaper rash include the following:

  • Irritation - from urine and feces trapped in the diaper
  • Candida diaper dermatitis - dermatitis caused by a yeast infection in the diaper area, often preceded by diaper dermatitis
  • Seborrheic diaper dermatitis - a common, chronic skin condition that can affect the diaper area as well as other locations on the body

Other less common causes of dermatitis in the diaper area include the following:

  • Impetigo - dermatitis caused by a bacterial infection
  • Perianal streptococcal disease - dermatitis caused by a streptococcus
  • Allergic dermatitis - a type of dermatitis that is rare in the first 2 years of life, but that can be caused by soaps and detergents, or the diaper

What are the symptoms of diaper dermatitis?

The symptoms of diaper dermatitis vary depending on the cause of the rash, and may be different from child to child. The following are common characteristics of diaper rash:

  • Candida diaper dermatitis - this rash usually begins in the creases or folds of the thighs and in the diaper area, and then spreads. This is usually a deep, red, shiny rash with red, satellite lesions, and it may be associated with thrush, a yeast infection in the baby's mouth.
  • Seborrheic diaper dermatitis - this rash also affects the skin folds in the groin area and is usually pink. Infants can also have this rash on their face, scalp, or neck at the same time.
  • Contact diaper dermatitis - this rash is mostly seen on the buttocks and may extend to the thighs, stomach, and waist area, but does not generally involve folds in the area. The rash is usually red and shiny.

The symptoms of diaper dermatitis may resemble other skin conditions. Always consult a physician for the correct diagnosis.

How is diaper dermatitis diagnosed?

Diaper dermatitis is usually diagnosed based on the location and appearance of the rash during physical examination of the child. In addition, the physician may do skin scraping to aid in the diagnosis.

What is the treatment for diaper rash?

The treatment for diaper dermatitis varies, depending on the cause of the rash. Specific treatment for diaper dermatitis will also be determined by the physician 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

Treatment may include:

  • Removal of the diaper for a few days
  • Medicated diaper cream (as prescribed by the child's physician)
  • Anti-inflammatory creams
  • Moisture-resistant diaper creams

Proper skin care is also very important in preventing diaper dermatitis. This includes:

  • Keeping the diaper area clean and dry
  • Changing diapers frequently
  • Allowing the diaper area to air dry from time to time
  • Limiting the use of soap and other harsh cleaners in the diaper area

Seborrheic dermatitis (cradle crap)

What is seborrheic dermatitis (cradle cap)?

Seborrheic dermatitis, also known as cradle cap, is characterized by fine white scales on the head and scalp. However, seborrheic dermatitis can also occur in the diaper area or on the face, neck, and trunk. Seborrheic dermatitis is most common in infants, but usually clears within the first year.

What causes cradle cap?

The exact cause of this skin condition is not known.

What does cradle cap look like?

Each child may experience symptoms differently, but the main symptoms include dry or greasy scales on the scalp.

How is cradle cap diagnosed?

Cradle cap is usually diagnosed based on physical examination of the child. The rash involved with cradle cap is unique, and can usually be diagnosed using a physical examination.

What is the treatment for cradle cap?

The specific treatment for cradle cap 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
  • Parent’s opinion or preference

Although the condition responds to treatment, it may recur. Treatment is usually effective in helping symptoms and may include:

  • Rubbing the scalp with baby oil or petroleum jelly (to soften crusts before washing)
  • Special shampoo, as prescribed by a physician
  • Corticosteroid cream or lotion

Acne

What is acne?

Acne is the term for plugged pores, pimples, and deeper lumps that occur on the face, neck, chest, back, shoulders, and even the upper arms.

Acne is very common: nearly 17 million people in the US are affected by this condition. Acne most often begins in puberty. During puberty, the male sex hormones increase in both boys and girls, causing the sebaceous glands to become more active. This, in turn, causes the sebaceous glands to produce more sebum, or oil.

How does acne develop?

Acne is caused by clogged sebaceous glands in the pores of the skin. The sebaceous glands produce oil (sebum), which normally travels via hair follicles to the skin surface. If skin cells plug the follicles, blocking the oil, skin bacteria (called Propionibacterium acnes, or P. acnes) grow inside the follicles, causing inflammation. Acne progresses in the following manner:

  • Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug).
  • Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug).
  • Infection and irritation cause whiteheads to form.
  • The plugged follicle bursts, spilling oil, skin cells, and the bacteria onto the skin surface. In turn, the skin becomes irritated and pimples or lesions develop.

Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

What causes acne?

Rising hormone levels during puberty may cause acne. In addition, acne is often inherited. Other causes of acne may include the following:

  • Hormone level changes during the menstrual cycle in girls and women
  • Certain drugs (such as corticosteroids, lithium, or barbiturates)
  • Oil and grease from the scalp, mineral or cooking oil, and certain cosmetics may worsen acne
  • Bacteria inside pimples
  • Squeezing the pimples or by scrubbing the skin too hard can aggravate acne

What are the symptoms of acne?

Acne can occur anywhere on the body. However, it usually appears in areas where there is a high concentration of sebaceous glands, including:

  • Face
  • Chest
  • Upper back
  • Shoulders
  • Neck

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

  • Blackheads
  • Whiteheads
  • Pus-filled lesions that may be painful
  • Nodules (solid, raised bumps)

What is the treatment for acne?

Acne treatment is designed to minimize scarring and improve the appearance of the skin. The specific treatment will be determined based on the following factors:

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

Acne treatment may include topical or systemic drug therapy. Depending on the severity of the acne, the doctor may prescribe medications that are applied to the skin (topical) or medications taken orally (systemic). In some cases, a combination of both types medications may be used.

Topical medications come in creams, gels, lotions, or solutions. Specific topical medications that are used to treat acne include the following:

  • Benzoyl peroxide (kills the bacteria)
  • Antibiotics (helps stop or slow down the growth of P. acnes and reduces inflammation)
  • Tretinoin (stops the development of new acne lesions and encourages cell turnover, unplugging pimples)
  • Adapalene (decreases acne formation)

Systemic medications, which can be used to treat moderate to severe acne, include the following:

  • Doxycycline
  • Erythromycin
  • Tetracycline

If the acne is severe, cystic, or inflammatory, doctors may prescribe Isotretinoin (Accutane®), an oral medication that can reduce the size of the sebaceous glands that produce the skin oil, increase skin cell shedding, and affect the hair follicles to reduce the development of acne lesions.

Isotretinoin can clear acne in 90 percent of patients, but the drug has major unwanted side effects, including psychiatric symptoms. It is very important to discuss this prescription medication with a physician prior to use.

Drug rashes

What are drug rashes?

Drug rashes are the body's reaction to a certain medication. The type of rash that occurs depends on the type of drug that is causing it. Rashes can range from mild to severe.

Rashes caused by drugs can be categorized in the following groups:

  • Rashes caused by an allergic reaction to the medication
  • Rashes produced as an unwanted side effect of a particular medication
  • Rashes due to hypersensitivity to sunlight caused by the medication

Drug rashes may be severe and require hospitalization. Call the child's physician or 911 immediately if the child experiences any acute symptoms in addition to the rash.

What are the different types of rashes caused by drugs?

Rash Type Symptoms Possible Causes
Acne pimples and red areas that appear most often on the face, shoulders, and chest anabolic steroids, corticosteroids, bromides, iodides, and phenytoin
Exfoliative dermatitis red, scaly skin that may thicken and involve the entire body antibiotics that contain sulfa, barbiturates, isoniazid, penicillins, and phenytoin
Fixed drug eruption a dark red or purple rash that reacts at the same site on the skin antibiotics and phenolphthalein (found in certain laxatives)
Hives raised red bumps aspirin, certain drug dyes, penicillins, and many drugs
Morbilliform/ Maculopapular rash a flat, red rash that may include pimples similar to measles
antibiotics and barbiturates are the more common causative drugs, but any drug can cause this rash
Purpuric eruptions purple areas on the skin, often on the legs certain anticoagulants and diuretics
Stevens-Johnson syndrome blisters or a hive-like rash on the lining of the mouth, vagina, or penis antibiotics that contain sulfa, barbiturates, penicillins, and other antibiotics

How are drug rashes diagnosed?

Diagnosing a rash caused by a reaction to medication is complicated. Even a small amount of a drug can cause a major reaction in the skin. In addition, the reaction can occur after the patient has taken a medication for a long period of time.

The physician will usually recommend stopping any medication that is not necessary to sustain life, to see if the reaction stops. Other medications may be substituted, if possible.

What is the treatment for drug rashes?

The specific treatment for drug rashes 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
  • The opinion or preference

The condition usually clears up if the patient stops taking the medication that is causing the reaction. Other treatment may include:

  • Corticosteroids
  • Antihistamines

Allergic reactions can be serious and even fatal. Call the child's physician or 911 immediately if the child experiences any acute symptoms in addition to the rash, including:

  • Wheezing
  • Difficulty breathing
  • Tightness in the throat or chest
  • Fainting
  • Nausea
  • Vomiting

Poison ivy/poison oak

What is poison ivy/poison oak?

There are three native American plants that collectively can be called poison ivy:

  • Poison ivy
  • Poison oak
  • Poison sumac

These plants cause an allergic reaction in nearly 85 percent of the population. To be allergic to poison ivy, a child must first be sensitized to the oils. This means that next time there is contact with the plant, a rash may occur.

What causes an allergic reaction?

The resin in poison ivy contains an oily substance called urushiol. Urushiol is easily transferred from the plants to other objects, including toys, garments, and animals. What’s more, this chemical can remain active for a year or longer. The oil is also present in the smoke when poison ivy is burned.

What are the symptoms of an allergic reaction to poison ivy/poison oak?

The reaction caused by contact with poison ivy is usually contact dermatitis, which may occur several hours, days, or even weeks after exposure.

Poison ivy usually causes a rash followed by bumps and blisters that itch. Occasionally swelling occurs in the area of contact. Eventually, the blisters break, ooze, and then crust over.

What is the treatment for poison ivy/poison oak?

Avoiding the poisonous plants is the best prevention. It is important to teach children what the plants look like and not to touch the plants.

If contact with the plants has already occurred, remove the oils from the skin as soon as possible. Cleaning with an ordinary soap within six hours after the initial exposure is effective, but be sure to repeat the cleaning with the soap three times. Alcohol-based wipes can also be used to remove the oils. Wash all clothes and shoes to remove any trace of the oils.

If the blisters and rash are on the face, near the genitals, or all over the body, a physician should be notified. After a medical history and physical examination, the physician may prescribe a steroid cream, oral steroids, or steroid injections to help with the swelling and itching.

Is poison ivy/poison oak contagious?

Poison ivy/ poison oak cannot be spread from person to person by touching the blisters, or from the fluid inside the blisters. It can be spread, however, if the oils remain on the skin, clothes, or shoes. This is why washing the child's hands, clothes, and shoes as soon as possible is very important.

To prevent poison ivy/poison oak, follow these tips:

  • Teach all family members to recognize the plants
  • Wear long pants and long sleeves when poison ivy or poison oak are in the vicinity
  • Wash all clothes and shoes immediately after anyone has been outside
  • Teach children not to touch a pet that might have been in contact with a poisonous plant
  • Wash children’s hands thoroughly

Topic epidermal necrolysis

What is toxic epidermal necrolysis?

Toxic epidermal necrolysis is a life-threatening skin disorder characterized by blistering and peeling of the skin. This condition can be caused by a reaction to certain drugs, including antibiotics or anticonvulsives, but about one-third of all cases of toxic epidermal necrolysis do not have an identifiable cause.

What are the symptoms of toxic epidermal necrolysis?

Toxic epidermal necrolysis causes the skin to peel in sheets, leaving large, raw areas. The loss of skin allows fluids and salts to ooze from the damaged areas, and the exposed areas can become infected.

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

  • Peeling skin without blisters
  • Raw areas of skin
  • Discomfort
  • Fever
  • Condition spread to eyes, mouth, and genitals

The symptoms of toxic epidermal necrolysis may resemble other skin conditions. Always consult a physician for the correct diagnosis.

What is the treatment for toxic epidermal necrolysis?

This disease progresses fast, usually within three days. Treatment usually includes hospitalization, often in the burn unit. If a medication is causing the skin reaction, it is immediately discontinued.

Specific treatment for toxic epidermal necrolysis 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

Treatment may include one or more of the following:

  • Isolation to prevent infection
  • Protective bandages
  • Intravenous fluid and electrolytes
  • Antibiotics
  • Intravenous immunoglobulin G (IVIG)
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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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