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Eczema or Dermatitis

How does eczema or dermatitis present in newborns and children?

Eczema (or dermatitis, this means the same as eczema) is very common and affects around 20% of children at some time. It can start at any age but quite often starts in the first year of life. The hallmark features are of redness, dry and flaky skin. In small babies it commonly starts on the face, neck or scalp, but can spread to other areas over time. In toddlers and older children it often tends to affect the folds of the skin like the elbows, knees and ankles but can be more widespread and cover large areas of skin. Some children get so called discoid or nummular eczema where there are small patches of extremely itchy and inflamed skin which can get sore and weepy. All eczema is very itchy and can disturb sleep in babies and children, and lead to a lot of scratching in the day time.

What causes it?

In many cases, eczema has a genetic predisposition so it may be that other close relatives have also had eczema, or the associated conditions of hayfever or asthma. In the majority of cases, there are no other causes but occasionally there may be food allergy driving the eczema. Babies and children in whom food allergy is a factor in their eczema often have early onset and more severe skin changes. If allergy is suspected, assessment by a paediatric allergist may be recommended. Certain things in the environment may make eczema worse, for example soaps and bubble baths, woollen clothing and overheating, so care should be taken to avoid these.

How can it be treated?

The treatment of eczema relies on using two approaches simultaneously. Firstly, the barrier of the skin need to be improved through the use of moisturising creams or ointments. These should be part of the child’s daily skincare routine. Secondly, an anti-inflammatory cream or ointment such as a topical steroid should be used to target the red, inflamed areas of skin. The type of steroid cream and the frequency of use will vary depending on the site and type of eczema but your dermatologist will be able to recommend an effective treatment which will settle the eczema down effectively and not cause any damage to your child’s skin.

Cradle cap

What is cradle cap?

Cradle cap, also called seborrhoeic dermatitis,  is a common skin condition in babies and children where there are yellowy scales of skin, sometimes with underlying redness and inflammation, affecting the scalp. Sometimes it can spread to the forehead or behind the ears.

What causes cradle cap?

In this condition, there is a slight overgrowth of tiny yeasts on the skin and the child’s skin reacts to these by becoming flaky and red. This is limited to the skin and does not cause any problems elsewhere

How can it be treated?

Often cradle cap will resolve on its own. Softening the scales with mineral oil or petroleum jelly then removing with a soft brush or toothbrush will help. Using a gentle baby shampoo can also be useful. If there is a lot of inflammation or scaling that isn’t resolving, your doctor may recommend an antifungal shampoo or cream or a mild topical steroid cream.

Nappy rash

What causes nappy rash?

Nappy rash is a common problem where there is redness and irritation over part or all of your baby’s nappy area. Certain things that can trigger it or make it get worse include prolonged contact with wee or poo in their nappy, the use of soaps or bubble baths, or the use of baby wipes with harsh chemicals that can irritate the skin.

How can it be treated?

The best approach is to try and prevent nappy rash occurring. Making sure that dirty nappies are changed frequently, using water-based of gentle baby wipes for cleaning and avoiding soap and bubble baths are all key. Use a barrier cream at each nappy change to your baby’s nappy area. Washing your baby in a bath with plain water once a day will also help. If nappy rash occurs and doesn’t settle despite these measures, your doctor may prescribe your baby some creams to help it settle.

Neonatal acne

What is neonatal acne?

Neonatal acne is not true acne but a common skin rash affecting the face in babies in the first month or so of life. There are little red spots and pimples over the cheeks, nose and forehead.

What causes neonatal acne?

It is caused by the blockage of the baby’s hair follicles on the face giving rise to little bumps and pustules. It may be that the mother’s hormones circulating in the baby may predispose to this. Sometimes there may be some growth of harmless little yeasts on the skin in the affected spots.

How can it be treated?

Baby acne is not serious and usually just settles on its own. Gentle washing and a light moisturiser may help. It is important to avoid using any medication for acne in older children or adults as this is likely to irritate the skin. Occasionally, if things do not clear, your doctor may recommend using an anti-yeast cream to help settle it.

Skin and scalp infections

What are the most common scalp and skin infections in newborns and children and how can they be treated?

Bacterial infections of the skin like impetigo and folliculitis are common and can affect any part of the skin. Impetigo typically presents with red areas of skin that become weepy and dry with a yellow crust. Folliculitis presents with little pimples and pustules in the hair follicles with surrounding inflammation. Often topical washes or creams from your doctor will help settle both impetigo and folliculitis down but if an infection is more widespread or severe, oral antibiotics may occasionally be needed.

Molluscum contagiosum is a very common viral infection of the skin giving little flesh-coloured bumps on the skin that can be spread to close contacts. Usually these will clear on their own but if they are persistent a topical treatment such as potassium hydroxide solution can be used to encourage them to clear faster. Your doctor will be able to advise you.

Scalp ringworm (tinea) is common in children and can be spread between siblings and close contacts. It usually presents with areas of scaling and sometimes inflammation in the scalp. If suspected, scrapings should be sent to confirm this. Oral antifungal medicine for 4 weeks is usually needed to clear it. Ringworm of the skin (not the scalp) will usually settle with antifungal cream in a week or two.

Warts and verrucas

What causes warts and verrucas in newborns and children?

Warts and verrucas (warts affecting the feet) are extremely common in children and are caused by a viral infection with the human papilloma virus. They are spread by direct contact with someone with warts or through the use of e.g. towels, used by someone with warts. They can be spread or get bigger if they are picked or scratched so this should be discouraged. Warts usually look like slightly thickened, warty bumps in the skin, commonly on the hands and fingers, but they can affect any area. On the feet, verrucas often look like localised areas of very thick skin that can, if big enough, dig into the skin and cause pain when walking.

How can they be treated?

Warts and verrucas would tend to clear on their own eventually but can linger for many months so people are often keen to treat them. Use of an over the counter preparation containing salicylic acid and paring the warts down can be helpful. Alternative approaches include using glutaraldehyde solution or duct tape to cover them. If they are very persistent, your doctor may suggest freezing them (cryotherapy) although this is painful and therefore only suitable for older children.

Birthmarks

What causes birthmarks?

Birthmarks are areas of skin that are different to the background skin, noticeable at birth. They will usually be checked by the paediatrician before your baby leaves hospital or at their 8-week check.

There are many different kinds of birthmarks. Sometimes babies are born with one or more moles; these are called congenital naevi. They are usually entirely harmless and will grow with the child as they get bigger. Dermal melanocytosis (Mongolian blue spots) affect most babies with darker skin types in particular. They are blue/grey flat marks on the skin, most commonly over the back and buttocks. They improve spontaneously over time and are of no concern. Coffee-coloured flat marks on the skin called cafe-au-lait macules are also common and usually of no significance. If you child develops multiple ones, however, you should ask your doctor the check them.

Sometimes babies can have vascular birthmarks, where there are pink or red areas of skin from birth or shortly afterwards. Naevus simplex is extremely common, usually called a stork mark (on the back of the neck) or an angel’s kiss (over the forehead or eyelids). This is a harmless entity and will tend to resolve over the first year from the face although around half of those on the back of the neck may persist. A port wine stain is a slightly deeper red flat vascular mark that can occur anywhere on the body. Although usually small and harmless, larger lesions, especially those on the face, may need to be investigated to rule out any eye or other problems.

Infantile haemangiomas, sometimes called strawberry marks, may not be visible at birth or may be just a small flat red mark in the skin. These lesions, that affect around 4% of babies, characteristically grow rapidly in the forst several months of life. They then gradually get smaller and less bright red, a stage termed involution. Although in themselves they are not usually problematic and will settle by mid childhood, occasionally they can cause problems because of where they are e.g. obscuring the vision if on an eyelid, or because of how they behave e.g. if the surface breaks down and they ulcerate. If your child has an infantile haemangioma that is growing and you are concerned about, you should see your doctor who may need to refer you to a dermatologist for assessment and treatment.

Do they need to be treated? If so, how?

Most birthmarks are harmless and do not need to be treated. Large congenital naevi on visible areas like the face can be surgically removed when the child is older, but the resultant scarring can be significant and would need to be carefully weighed up with the child whether this would be better than living with the naevus itself. Port wine stains on visible areas can be lightened with laser treatment but this would usually not be done in babies or small children as it would require multiple general anaesthetics and the lesions tend to darken again over time. Infantile haemangiomas in places where they are prominent or interfering with function e.g. vision or feeling, or if they are large or ulcerated need urgent referral to a dermatologist. They will consider treatment with a drug called a beta blocker (by mouth or topically) to help the haemangioma involute rapidly.