SKIN PROBLEMS IN THE NEWBORN
SKIN PROBLEMS IN THE NEWBORN AND THE YOUNG BABY
Newborns and young babies often have tiny yellowish-white spots on their faces, especially around the nose. These are quite normal, and are due to little glands. Nearly always the spots disappear in a few days, although the glands may become blocked and the spots larger ('milia'), in which case they last a little longer. There is no need to do anything about them.
Nearly half of all babies develop a blotchy red rash, sometimes with tiny white blisters as well, about one or two days after birth. It shows over the chest, back and face. It is called erythema toxicum, and goes away in a few days without treatment.
Heat rash and sweat rash Young babies may also show a heat rash or sweat rash because their sweat glands are not yet properly formed and working. This red rash, in which there may be some raised bumps, is called milaria, and is more likely to appear in hot weather. It occurs especially in the groin and armpit. All you need to do is to keep the baby as cool as possible and the skin dry.
Nappy rash Almost all babies get some occasional bouts of redness and soreness in the area of their nappies. Treatment for skin which is irritated by being wet and in contact with urine and stools is to use disposable nappies and change them frequently. Whenever possible, allow your baby to go without a nappy to let the air get to his skin as much as possible, and use a zinc and castor oil cream at every nappy change. If the rash does not begin to clear in a week, it may have been complicated by a yeast infection — candidiasis or 'thrush'. This turns the skin a more fiery red colour with a scaly edge and does not respond to the usual treatments for nappy rash. Instead it needs cream prescribed by your doctor (usually Canesten or nystatin) and usually responds well to this.
Reactions to washing powders, especially the biological ones, can cause rashes, so if your child keeps getting sore and you are using terry nappies it is worth trying an enzyme-free powder.
SKIN PROBLEMS IN INFANTS AND OLDER CHILDREN
Dry skin If your child has dry skin this may become extra sensitive in the coldest part of the winter. Try using a water soluble cream (Unguentum Merck, aqueous cream or emulsifying ointment) instead of soap for washing; it will leave a protective, waterproof film. A thin smear of vaseline or zinc and castor oil cream will help to heal lips, cheeks or noses that have become sore. Avoid pure wool or nylon next to the skin if these irritate, and use cotton or cotton mixtures.
Eczema Doctors use the word eczema as a label for a group of skin problems, but there are actually different types of eczema with different causes. The common type dealt with here is called atopic eczema.
About one in eight of all children will show symptoms at some time and these can vary from transient dry patches to very severe symptoms which persist over years. For a full description of symptoms and treatments.
Itchy skin This is very common and there are a large number of different causes. Some of them are infections, usually produced by organisms such as bacteria and fungi, themselves invisible to the eye. Some are infections caused by worms or tiny insects — threadworm and scabies are examples. But there are also other skin conditions not caused by infections, of which eczema is the most common.
Impetigo This is a bacterial skin infection. It is itchy and very infectious and can easily spread through a playgroup, school or family. It begins with small blisters, and these turn into areas of pus covered with very thin skin. Raw, weeping patches then occur, and finally drying produces yellowish golden crusts. Healing usually starts from the centre and leaves temporary rings of red skin. Treatment with antibiotic cream or antibiotics by mouth will usually be necessary. Do not attempt to pick the crusts off or wipe them off. Be careful to wash hands very thoroughly after touching an infected area and keep the child's towels and flannels separate because impetigo spreads so easily. It is best to keep playgroup-age children at home and steer clear of other children until it is under control.
Molluscum contagiosum These are little whitish-yellow, pearl-like spots up to about half an inch across, but usually much smaller. They may occur singly or in clusters. They are caused by a virus. As they always go away within a few weeks or months, they do not need to be treated. If treatment is required, it involves freezing or the application of a drop of acid and both these procedures are uncomfortable. Even after treatment, it may come back and need treating again.
Moles These can be flat, raised, hairy or smooth. Moles present at birth should be seen by a doctor for checking. Moles appearing after birth in children are almost always harmless and should be ignored, unless someone in the family has had a malignant melanoma. In this case the opinion of a dermatologist should be sought.
Pimples and boils Redness, heat and pus-filled spots are signs of a skin infection. Sometimes infected spots occur when bacteria have been let into the skin after it has been broken by an injury, so keep cuts and grazes clean.
These infections do itch, but try not to let your child scratch because the infection will spread to other areas. Keeping pimples and boils covered with loose cotton clothes, so they can dry out, is better than putting plasters on. If the infection does not clear, visit your doctor, as an antibiotic cream or a course of antibiotics by mouth may be needed.
'Ringworm' This is not due to a worm at all, but a fungus, and in childhood it is often caught from an animal. It is most likely to affect the scalp, and little patches of hair may come out, leaving a sore patch. Your doctor will need to see it, and it can be successfully treated with medicine (griseofulvin) which your child may need to take for some weeks. Griseofulvin should be taken during the largest meal of the day.
Warts Warts are raised growths caused by a virus and are quite harmless. Children get them most between the ages of 6 and 12, although they can occur in younger children. Over half disappear by themselves within 2 years. If they do persist or grow very large they can be removed by your GP or local hospital outpatients' department, usually by freezing them. A verruca is a wart on the sole of the foot and may hurt because of pressure. They are readily picked up in swimming baths, but swimming pool attendants warn against wearing rubber protective socks because there is such a danger of slipping on wet tiled surfaces. Verrucas can be treated either by lotions or removed by freezing, but the treatment often fails, and unless a verruca is painful it is probably best left untreated, as it will eventually disappear naturally.
Babies may be born with a whole variety of marks on their skin, sometimes called naevi.
Stork marks These are pink areas that may appear on the back of the neck, the upper eyelid, the forehead or knee. They are not caused by bruising from the bird that carried the child to the labour ward, but that is how they got their name! Those on the knee, eyelid and forehead go away after a few weeks, but those on the back of the neck are usually permanent.
Strawberry marks These are raised red patches with white marks that may occur anywhere on the body. They are usually not present at birth, but begin to appear in the first month or six weeks. They may become quite large but then usually just fade away completely over the first few years of life, first going white in the centre. See chapter 4 for more details. If bleeding occurs, it can be controlled by pressing a wad of tissues hard over the bleeding area for about ten minutes.
Port-wine stains These are present at birth, usually on the side of the face, and they are much less common. They tend to be permanent, and, especially if they are large, your child may need cosmetic surgery later in life.
SUNBURN AND HEATSTROKE
Babies and children can easily get sunburnt because their skin is more sensitive — fair or red-haired children are likely to be especially susceptible. Skin only begins to burn and redden after the damage is done, so do not wait for signs but take preventive action in advance.
DO NOT leave a baby in a pram or pushchair in direct sunlight.
DO NOT let them go out in the midday sun abroad or for more than an hour or so on the first day of a holiday.
DO protect them with light cotton clothes and hat in strong sun and use a good protective cream with a high sun protection factor at other times.
DO NOT ever leave a child in a closed car in warm weather-the temperature inside can rise very quickly and could be dangerous.
DO give children plenty to drink in hot weather.
If they do get sunburnt, use a cold wet flannel to reduce pain and moisturiser to relieve tenderness. Find a cool place out of the sun and keep sunburnt skin covered with clothes until it has recovered.
Heat rash can appear as a reaction to the sun or because a baby has been wrapped up too warmly and has become overheated. Cool down as for a fever by loosening clothes, fanning and tepid sponging. Heat rash produces itching, so calamine lotion may help to ease this.
Heatstroke can be serious in babies and children. Children may not have sunburn but still be suffering from heatstroke. They look flushed and feel very hot. Their movements are often uncoordinated and they may seem confused. In serious cases where nothing is done they may even become delirious and fall into a coma. Early stages of heatstroke can be treated by tepid sponging and fanning, but very rapid cooling can cause other problems so if your child has heatstroke seek medical advice rapidly.