Skin is the largest organ in the human body, constituting about 16% of total body weight. It has various functions like protection, thermoregulation, immunologic response, secretion of waste and sensation. Skin disorders in children may cause anxiety to parents. General practitioners should be familiar with the common skin problems as immediate pediatric dermatology consultation may not be possible. In addition to wide variety of skin disorders in childhood, skin is a marker of underlying systemic diseases and hereditary syndrome. Infections, infestations and dermatitis are the most prevalent diseases among Indian children. Skin diseases of children should be managed by consulting a dermatologist or pediatrician. Common Skin problems in children can be briefly divided as bacterial, viral, fungal infection and other infestations.
BACTERIAL INFECTION OF SKIN
- Impetigo
Impetigo is the most frequently encountered bacterial skin infection, which is caused by Staphylococcus aureus and Streptococcus pyogenes. It occurs in two clinical forms, the non-bullous impetigo or impetigo contagiosa and bullous impetigo. Lesions are highly contagious and can spread rapidly by direct contact, through a family, nursery, or class. The condition is more common in children with atopic dermatitis, in those living in tropical climates, and in conditions of overcrowding and poor hygiene. Nasal carriage of organisms may predispose to recurrent infection in an individual. It occurs in two clinical forms, the non-bullous impetigo or impetigo contagiosa and bullous impetigo. Although impetigo contagiosa occurs on any part of body surface, the exposed parts especially, face and the extremities are frequently affected. It evolves from small vesicles that rapidly rupture to form the typical honey colored crusted plaques with surrounding redness. Impetigo can be spread through close contact or by sharing things like towels and toys. Scratching can spread it to other parts of the body.
Home remedies for mild conditions
In mild conditions, it can be treated with some home remedies, whereas severe conditions need medical attention of an expert dermatologist.
- Maintain personal hygiene -clean clothing and toys and other baby products in warm water.
- Honey act as an antibiotic, apply it directly to the wound or infected area. It can help to kill off the bacteria and aid in the healing process
- Wash the affected area with water boiled in Neem leaf.
- Apply pure aloe vera gel which counter itching and dryness in impetigo
- Grapefruit seed is available in liquid extract or tincture form. Dilute it with water and then apply the mixture topically to impetigo sores
- Tea tree oil can be applied externally.
- Apply turmeric paste directly to impetigo sores, it has antimicrobial and anti-inflammatory property.
- Scabies
Scabies is a common infestation caused by the mite Sarcoptes scabiei . It is transmitted by direct contact or by fomites (things used by babies like cloths, toys etc). Untreated, these microscopic mites can live on your skin for months. They reproduce on the surface of your skin and then burrow into it and lay eggs. This causes an itchy, red rash to form on the skin. The clinical manifestations usually develop 3 week after the primary infestation. The earliest symptom of scabies is nocturnal pruritus (night itch), which may manifest as extreme irritability in infants. Face, palms and soles are particularly affected in younger children, while waists, wrists, ankles, interdigital spaces, penis and areola are commonly affected in older children.
Pediculosis Capitis (Head Lice)
Head lice usually affect children between 3 and 12 year. It spreads through direct head to head contact. Itching in the posterior scalp is the primary symptom and there may be redness, papules, excoriated lesions and secondary bacterial infections. Occipital and cervical lymphadenopathies are frequently present. Diagnosis is confirmed by the presence of nits or lice in the scalp and hair.
Treatment
- Removal of nits from hair and eyelashes
- Cleaning yourself and any personal belongings that may be contaminated. Wash infested bedding, clothing and towels with hot, soapy water.
- Deworming (krimighna chikitsa)
- Wash the affected areas with water boiled with curry leaves, Tulsi (Ocimum sanctum)
- Apply the neem seed paste over the affected area for few minutes
- Viral Warts
VIRAL INFECTIONS
Warts
Verrucae are common viral infections caused by Human Papilloma Viruses (HPV). Verruca
vulgaris, verruca plana, plantar warts and condyloma acuminata are the four major types of warts. Verruca vulgaris (common warts), occur predominantly on the hands, fingers, around the fingernails or toenail, and sometimes on the lips and nostrils. The lesions are skin to flesh colored rough surfaced papules. It may occur as single or multiple lesions. Warts ma be itchy and scratching may lead to linear array of lesions, indicative of auto-inoculation. Most resolve by itself in due time, but over-thecounter preparations are available to accelerate resolution. Treatment include topical salycilic acid,cryotherapy etc. self treatment should be avoided in case of inflammation and other painful warts.
Ayurveda describes warts as Charmakeela, painless elevated skin eruptions, which is either black or white in color. It can be treated with cauterization and removed by sharp instrument.
Molluscum Contagiosum
Molluscum contagiosum is a poxvirus infection, common in school aged children. It presents as multiple asymptomatic, flesh colored or pearly white papules with central umbilication. Sometimes the lesions are inflammatory, indicating the impending spontaneous resolution due to host immune response. Face, neck, axillae, trunk and extremities are the common sites of involvement. Many treatments for molluscum contagiosum have been reported, including physical destruction or manual extrusion of the lesions, cryotherapy, and curettage. Treatments are painful, and there is limited evidence that they are more effective than watchful waiting. In Ayurveda the disease Ajagallika is included under Kshudra Rogas. The features of Mollusca can be correlated with Ajagallika. It is mentioned as childhood disorder with eruptions arising from kapha , Vata,which are unctuous, of the same colour as of skin, nodular, painless and resembling mudga(green gram) in size. Unripe stage should be treated with applying leeches (jalukavacharanam) and then coated with the paste of yavakshāra, sukti, and saurāstri
FUNGAL INFECTIONS (Tinea)
Ringworm
Ringworm of the body (Tinea corporis) is a rash caused by a fungal infection. It’s usually a red, itchy, circular rash with clearer skin in the middle. Ringworm gets its name because of its appearance. No worm is involved. Ringworm of the body is related to athlete’s foot (Tinea pedis), jock itch (Tinea cruris) and ringworm of the scalp (Tinea capitis). Ringworm often spreads by direct skin-to-skin contact with an infected person or animal. Mild ringworm often responds to antifungal medications that you apply to your skin. For more-severe infections, you may need to consult a dermatologist.
Which children are at risk for ringworm?
- Children may be at risk for ringworm if they:
- Are malnourished
- Have poor hygiene
- Live in a warm and humid climate
- Have contact with other children or pets that have ringworm
- Have weak immune systems because of illness or medicines
- Use shared bathrooms or locker rooms
Home remedies for fungal infections
- Clean the affected area with soap and water twice daily
- Apple cider vinegar has antifungal properties. You could mix two tablespoons in warm water and drink it up or dip a cotton ball in it and dab over your skin. Doing this thrice a day should produce beneficial results.
- Tea tree oil is naturally antifungal and antibacterial. Mix it with any carrier oil like coconut oil or olive oil and dab over the infected area about three to four times a day.
- Coconut oil works as a potent antifungal agent. Applying it over the skin makes it a good, safe topical medicine. Since it is easy on the skin, it is also useful to treat scalp ringworm
- Neem leaves have effective antifungal properties and is extremely good for the skin. Washing the infected area with neem water helps in treating fungal infections
You can also follow certain precautions to prevent or treat fungal infections like:
- Always wear clean clothes.
- Avoid using harsh detergents to clean clothes.
- Avoid wearing clothes that are too tight. Prefer breathable cotton clothes.
- Avoid scratching the affected area as it can worsen the infection and also increase the chances of spreading.
- Wash the affected area at least 2 to 3 times a day.
- Keep the affected area as dry as possible.
When to visit a doctor for fungal infections?
- Even after following home remedies, there is no improvement.
- The fungal infection worsens or recurs.
- The infection starts spreading.
- Fungal infection is accompanied by fever or discharge of pus
Atopic dermatitis or eczema is a chronic relapsing inflammatory skin disorder. The hallmark of atopic dermatitis is dry skin and itching. It usually starts in the first few weeks or months of life. The clinical phase of atopic dermatitis is divided into 3 groups, based on the onset and distribution of the lesions; infantile; childhood and adult phases. In the infantile phase, the dermatitis usually begins on the face and then may spread to trunk. The affected infants will be irritable or scratching due to intense pruritus. It is characterized by symmetrical erythematous papules, vesicles, edema, oozing and crusting. The extensor aspect of the extremities is affected around 8 month of age when they start crawling. Infantile atopic dermatitis usually spares the diaper area and groin. In the childhood phase, the lesions become chronic and thickened over the flexural areas. In the face, around mouth and eyes may also show chronic dermatitis and thickening of skin.
How to keep skin healthy
- Drink 2 litres of water daily
- Keep skin hydrated by applying moisturizing cream.
- Eat a healthy diet -A healthy diet can help you look and feel your best. Eat plenty of fruits, vegetables, whole grains and lean proteins.
- Maintain personal hygiene. Wear clean dresses made from good quality fabric.
- Avoid strong soaps. Strong soaps and detergents can strip oil from your skin. Instead, choose mild cleansers.
Ayurvedic Aspect
According to Ayurveda, Skin (twak) is originated from the superficial portion of Rakta. It consists of seven layers and the diseases affecting each layer have been mentioned by the Acharyas. In Ayurveda, various skin disorders are detailed under the heading of Kushta & Kshudra rogas. Kushta is a raktapradoshaja vikaara, occurs with pitta predominance and rakta and twak as adhishtaana. Fungal infections can be considered under, Dadru kushta, vicharchikaa type of kushta that is classified under both categories due to quick invading nature. As per the definition, the reddish coloured pidaka (lesion) in the form of mandala (rounded lesion) with elevated borders and itching is known as Dadru. Vicharchika is (“sa kandu pidaka syava bahusrava vicharchika”) the eruptions with itching, oozing, black discoloration. Various treatment methods have been mentioned in Ayurvedic treatise for skin ailments. According to the severity of disease, proper management should be followed. Body purification (sodhana) is very effective in the management of skin diseases, along with the intake of blood purifying and skin rejuvinating Kashayas (decoction), applying medicated lepas (oinments), oils, are found to be useful.
Skin is the primary barrier of human body; it has a great connection with our mind. Nowaday human beings are giving a special care to their skin, by modifying food habits and daily activities. Childhood skin disorders have developed due to by several factors like, hereditary, nutritional deficiency, lack of hygiene, worm infestation, auto- immune disorders etc. Children are more susceptible to various types of skin infection, so parents should take a special care to their children in every case.