Common paediatric skin disease
Emma King
Nurse Practitioner
Dermatology Department and Private Suites
The Royal Children’s Hospital
Melbourne, Australia
Diagnosis?
Hand Foot and Mouth Disease
(Coxsackie virus)
•
An abrupt onset of scattered papules that
progress to oval or linear vesicles in an
acral distribution
•
Children are not usually ill and are
normally afebrile
•
Incubation period is 3-5 days
•
Virus enters via the enteric route
•
Contagious from 2 days before to 2 days
after the onset of the eruption
•
But… virus is excreted in faeces for up to
2 weeks
•
NO TREATMENT needed unless flaring
eczema.
Diagnosis?
Pityriasis Rosea
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Absent or minimal prodrome
'Herald patch' in 80%
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Eruption occurs hours to days later
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usually near proximal joint
larger than other patches
symmetrical and proximal
long axis of patch in Christmas tree distribution
free edge of scale internally
Usually lasts 3-6/52

topical steroids and/or UVB for symptoms
Diagnosis?
Pityrosporum Folliculitis/6 week rash
• Otherwise known as ‘milk spots’, infantile
acne
• Is really a yeast folliculitis
• Fades as sebaceous glands settle to
quiescent childhood levels
Treatment
•
•
•
Sebizole shampoo 1:5 water
• Apply to affected areas with a cotton ball
• Leave on for a couple of hours then rinse off in the bath
• Wash the face, body and scalp with the sebizole and rinse off
Hydrozole cream to affected areas bd until clear
Usually clears within 3 days
Diagnosis?
Scabies
•
•
•
•
•
•
•
•
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Caused by a mite – Sarcoptes
scabiei
Direct skin-to-skin contact, close
physical contact
Not from animals
Burrows a tunnel and releases
toxic secretions
Incubation – 3 weeks
Itching develops after 4-6 weeks
due to sensitisation, allergic
reaction to the presence of the
mite
Eczematous changes
Itch exacerbates at night
Scaly burrows on fingers and
wrists
Scabies treatment
•
Lyclear (Permethrin) – wash off after 8-24hrs
•
Repeat treatment one week later
•
Treat the whole family
•
Wash linen and clothes day after treatment
•
Remove soft toys
•
Mites survive for a max. of 36 hrs away from
host
•
Eczema treatments
•
Return to school after 2 treatments completed
•
Itching may take 3 weeks to resolve
Diagnosis?
Irritant Napkin dermatitis

The skin barrier function is impaired > increased irritation
by urine, faeces, Candida albicans, bacterial overgrowth,
soaps and nappy wipes

Settle inflammation

Treat any secondary infection; Hydrozole cream bd

Use disposal nappies

10%Olive oil in zinc paste/Bepanthan ointment
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Frequent nappy changes
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Nappy free time when possible
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Wash with diluted bath oil/olive oil using cotton balls or
Rediwipe towels

Dab gently rather than wipe vigorously
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Bath oil and no other irritants in bath
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No antiseptics/cleansers/napkin wipes etc
Diagnosis?
Molluscum Contagiosum
•
Caused by a harmless virus (MCV)
•
Poxvirus
•
Very common in children
•
Transmitted by swimming pools, sharing baths, towels and direct
contact
•
In adults most often a sexually acquired infection
•
Pearly papule
•
Central dimple and core
Treatment
•
Self limiting, but may take up to 2 years
•
Complicated by atopic eczema
•
Treatment involves irritating the lesions – Burow’s solution diluted
1:10, Benzac gel, occlusive tape, Aldara, Cantharone
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Squeeze, curette, cryotherapy - ? scaring
•
Shower rather than bath
•
Infection control measures
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Atrophic scarring with or without treatment
Diagnosis?
•
Treatment
•
•
Capitis
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Oral griseofulvin or Lamisil (give with fatty food)
•
Identify sources if possible
•
No sharing of hair combs/brushes or head wear
•
Hair growth is slow
•
Antifungal shampoo – reducing shedding of spores
Corporis
•
•
Topical antifungals – ketoconazole, miconazole
Pedis
•
Oral griseofulvin or Lamisil
Diagnosis?
Eczema (atopic and discoid)
•
The most common skin disease, especially in early childhood (30%)
•
Onset is most common in the 1st year of life.
•
The hall marks are chronic, pruritic and relapsing skin dryness,
inflammation and erythema
•
Improves with time most children grow out of it
•
It can be linked with asthma and allergic rhinitis
•
An associated immune response to environmental and food allergens
and irritants
•
If not managed effectively secondary bacterial skin infections are
common.
•
It can affect any part of the skin however it is most common on the face
and flexures.
•
A primary disturbance of the epidermal barrier function
• Dry skin (decreased filaggrin and ceramides)
• Staph Aureus
• Signs
• Papules and Vesicles
• Erythema
• Secondary erosions and lichenification
• Skin infection
• Dry skin
• Itch
Assessment
Look for
1.
2.
3.
4.
5.
6.
7.
8.
Extent %
Infection /3
Broken skin /3
Erythema /3
Lichenification /3
Xerosis /3
Sleep pattern /10
Itch /10
(SCORAD http://adserver.sante.univnantes.fr/Scorad.html )
Principles of management
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Manipulation of environment
•
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Education on removal of heat, dryness, prickle, allergies
Adequate skin care
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Regular application/use of emollients; even on clear skin
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Aggressive use of adequate topical steroids
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•
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Trial hydrocortisone for mild eczema and face otherwise need a prescription for
elocon or advantan
Wet dressings/clothes within 24-48 hours if the eczema is not
controlled with emollients and steroids
Adequate treatment of skin infections
•
Removal of crusts ASAP, by bathing and wiping away
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Oral antibiotics if needed
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Bathing with bleach and salt
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Adequate education, demonstration and support
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If not responding to these measures consider other options
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Referral to GP or Hospital
Infected eczema
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Crusted
Weeping
Acute flare
Itchier
Plan;
• Remove crusts ASAP in the
bath with a wet soft towel
• Apply steroids and moisturisers
to open areas once crusts
removed
• +/- oral antibiotcs
• May also need wet dressings
and cool compressing
The role of allergy in eczema
• Allergic contact dermatitis
• Look for patterned eczema
• Environmental allergen
• Older children/adults
• House dust mite, grasses, pollens
• Foods
• Babies rather than older children
• Urticarial eczema
• Flare within 2 hours of ingesting
food
Food intolerance
•
•
•
•
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Reaction to food through non-allergic means
Perioral eczema
18/12 to 5yo
May have hand involvement
May have napkin dermatitis
•
Consider acidic and junk foods
•
Consider using SLS free toothpaste
Topical Treatments
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Steroids use aggressively and NOT THINLY when flaring
• Face- hydrocortisone 1%(Sigmacort) or pimecrolimus (Elidel),
bd, prn
• Body- mometasone furoate (Elocon) ointment, cream or
methylprednisolone aceponate (Advantan) fatty ointment,
ointment, lotion, nocte, prn
•
Emollients- use often every day
• QV Kids Balm, QV Cream, Cetaphil cream, Dermeze,
Hydraderm, aqueous cream, Avene cream, good quality
sorbolene CREAM, 10% liquid paraffin, 10% soft white paraffin,
10% glycerine in aqueous cream, Stelatria, Stelatopia, Kenkay
• Bath oils, QV, Hamiltons, Avene, Dermaveen, Kenkay
•
Use wet dressings within 48 hours if the eczema has NOT improved
with the above.
•
Tar for lichenified or discoid eczema (not to face or groin). e.g.
Hamiltons eczema cream.
Bathing
• Very important, 1-2/day
• Assists by
• Physically removing staph
• Cool temperature assists in reducing
inflammation
• Salt (pool); less stinging, cooling,
antiseptic, anti inflammatory
• 100 grams/10 litres water
• Bleach; antisepetic
• 12 ml/10 litres water
• Every day for 1 month then reduce if possible
• Cool – 29-31 degrees
Why apply wet dressings?
Tubifast OR Chux
• Reduce itch
• Treat Infection
• Moisturise the skin
• Protect the skin
• Promote sleep
Wet clothes can be used to reduce cost and if other
not available
Treatment for moderate and severe facial eczema
1.
Advantan for 3-5 nights
2.
Elidel bd of not improving with
hydrocortisone. Then if not
improving.
3.
QV Kids Balm/ Stelatria/QV
Cream or Cetaphil cream QID
4.
Cool compressing QID
5.
Antibiotics if infected
Treatment for mild facial eczema
• Hydrocortisone bd prn
• QV cream/Cetaphil/Avene/Kenkay, Sorbolene bd-tds
Case four. What is the plan?
ACUTE FLARE
• Advantan ointment to face nocte for 3-5 nights, then
hydrocortisone bd prn or Elidel cream if still moderate
• Cool compressing to the face QID, QV Balm post
• QV Kids Balm/Stelatria to the face QID for 3-5 days
then cream
• Cool bleach, salt and oil bath daily
• Advantan ointment to limbs and trunk nocte prn
• QV/Cetaphil cream to limbs and trunk tds
• Wet Dressings nocte
• Wet singlet bd until clear
• Keflex 7/7
If the above is undertaken there will be 90%
improvement in 3 days.
Thank you
Dermatology nurses; Emma King, Liz Leins, Robyn
Kennedy, Danielle Paea, Leigh Fitzsimons, Claire
Borlase, Lauren Weston
Email;
emma.king@rch.org.au
Phone; 9345 4803
Web; www.rch.org.au
RCH Private Suites; 9345 6438
Outpatient clinics; Mon am, Wed pm, Thurs pm
Eczema Workshops; Tues and Wed am
phone; 9345 4691
Eczema Community clinics; Monday; Collingwood,
Thursday; Broadmeadows