Impetigo is a very common bacterial infection of the skin in young children. It commonly presents with honey coloured crusts in the face, arms and body. It can be red, itchy and sore or asymptomatic. It is common in children with eczema.
It is caused by a bacteria called staphylococcus aureus. These germs like to reside (commensals) in our nostrils, armpits and groin where they do not cause any problems. However, when there is damage to our skin (for example, cuts, grazes, insect bites and eczema) these germs invade the affected skin and cause problems. It can also spread within the patient and from person to person by direct skin to skin contact.
Swabs from the skin can be sent to confirm the diagnosis. The affected area will require topical medications and oral antibiotics in severe cases. Most of the patients recover from the infection. However, a small minority of patients can progress to a more severe disease. Thus, impetigo should be quickly diagnosed and managed.
Molluscum is a common viral infection of the skin that affects children and young adults. It appears as small dome-shaped spots and can be mildly itchy. It is common in children with eczema.
It is caused by a pox virus. It can spread to other parts of the skin or to others when there is direct contact with the spots or if they share clothing and towels.
The condition can self resolve but it can take up to 6 – 18 months. However, during this time there maybe development of new ones whilst old spots are clearing and it can spread to other children in the family as well. Thus, treatments are recommended to speed up the recovery. Treatments aim to induce inflammation and include topical medications, scraping and freezing the lesions.
Viral warts are small thick rough lumps on the skin, hands and feet and nails. They are common in children and adults. They are non cancerous but can be unsightly and cause pain or discomfort when pressed on.
It is caused by human papillomavirus. It spreads directly by close skin-to-skin contact with the affected lesions. The risk is increased in damaged, macerated and wet skin.
Common warts most commonly occur on the hands and around the nails. They may occur as single or multiple lesions, and appear as flesh coloured papules with a rough surface. They may bleed if the surface is scratched or pared. Flat warts occur commonly on the face, neck, arms and legs. They are usually smooth and flesh coloured papules. Plantar warts occur on the soles of the feet and toes and maybe painful on applying pressure over the areas.
Ano-genital warts occur around the genitals. In view of the location, it is important to consider STI, although it can be transmitted through non sexual contact as well.
Although some studies have shown that some warts can spontaneously resolve, this can take months to years and often there can be new lesions before the old ones disappear. Hence, the warts can be treated to hasten the recovery process. Treatments for young children include topical medications and cryotherapy treatment. However, these require multiple visits and take a long time to clear. For adults and older children, electrocautery or laser treatments can be used to clear the lesions quickly.
This is a highly effective therapy for warts. This maybe painful and not suitable for younger patients. Liquid nitrogen, at a temperature of -196oC to the wart with a cotton tipped applicator or via a spray gun, for 10 to 20 seconds. The number of applications per treatment session depends on the size of the wart and its location. Treatment is best repeated 1-3 weeks interval until the wart resolves. A blister may form at the site of the cryotherapy. If the blister is small, it maybe left alone. If the blister is large and painful, come back to the clinic for treatment of the blister.
Tinea or ringworm is a type of skin infection caused by a fungus. It looks like a red skin rash that forms a ring around normal-looking skin.
A ringworm infection is not caused by an actual worm. It is caused by fungi on the skin, hair and nail beds called dermatophytes. Different types of dermatophytes affect different parts of the body. Children are at risk of Tinea infections if they share the clothes, personal items with infected people. A weak immune system either due to illness/ medications can also increase the risk of Tinea infections.
Ringworm is usually diagnosed based on a medical history and physical examination of your child. The lesions of ringworm are unique, and usually allow for a diagnosis simply on physical examination. In addition, a culture or skin scraping of the lesion to confirm the diagnosis.
Because the fungi can live indefinitely on the skin, recurrences of ringworm are likely and treatments are often repeated. Specific treatment will be determined based on:
Topical treatment are used most commonly in children - anti fungal shampoo, powders and creams.
Oral anti-fungals are used for persistent cases that do not respond to topical treatments.
Scabies is a common skin infection on kids caused by the mite, Sarcoptes Scabiei. This mite only lives on human skin, where it lays its eggs. The eggs take a week to hatch and the mite lives for 30 to 60 days.
Scabies is transmitted by direct contact with an infected person. It can spread through shared bedding and clothing. Re-infection can occur if other infected family members are not treated at the same time. It spreads very fast in nursing homes and crowded facilities
Sometimes, the mites may be seen from scrapings of the skin rash. However, a negative result does not exclude presence of scabies and if there is a clinical suspicion then it should be treated first.
MBBS(NUS, SINGAPORE), MRCP(RCP, UNITED KINGDOM)