Infections In Children

Dr Melanie Majaham, Damai Service Hospital, Jalan Ipoh is a well-known paediatrician in Malaysia. She gave a talk on Common Skin conditions in Childhood at at event conducted in collaboration with Applecrumby & Fish earlier this year.  Here are some excerpts from the talk, in parts. In this article, we cover infections that commonly occur actions in children.

Ringworm 

Ringworm is actually not a worm at all! It is caused by a fungal infection called Trichophyton or Microsporum. When you see a patch on your baby’s skin that starts out as a flat red patch and suddenly becomes bigger like a ring. As it gets bigger, the centre part gets lighter in colour and scaly. This should give you an idea that this is most likely ringworm infection.

It can spread from an infected person or an infected pet. The treatment is once again – to keep the area clean and dry as well as an anti-fungal cream as prescribed by the doctor. Sometimes this infection can look like eczema, so when the doctor gives some low-steroid creams for eczema, it makes the rash become worse. So this gives you an idea that this could be a fungal rash rather than eczema.

Tinea (Panau)

Also called as infection of Malassezia furfur.

Tinea

It is otherwise called as Tinea versicolor. Microscopically it looks like meatballs in a bowl of spaghetti! Time to time, you may observe some white patches on your kids skin and wonder what it is. It is basically a fungal infection and tends to happen in very damp areas like the back of the neck or under the armpits, near the private parts because these areas are usually hot and sweaty. The skin appears lighter as the affected area doesn’t tan. When the child goes in the sun, the surrounding skin gets tanned but not the infected region and that’s why the difference in skin colour. Treatment is basically anti-fungal cream, it can take a few weeks to heal but it can take a few months for the skin to come back to normal tone.

Molluscum contagiosum

This is another interesting, common rash. This is a pearly looking rash (the rashes resemble pearls) – pearly white bumps on the skin and in the middle there is a little depression. It is caused by a virus. It is harmless, painless but can be itchy and contagious.  It goes away on its own but it takes about 6-9 months sometimes even 12 months to go completely. It may start on the baby’s left hand and then spread to say the right leg. It spreads but heals on it own. This condition can be seen in adults also, but adults can go for cryotherapy – nitrogen ice to burn off the lesion or use salicylic acid to burn it off. In children this will cause a lot of pain and discomfort. Its painless to leave it alone than to get it treated.

Chicken pox

Caused by a virus called Varicella zoster. It starts with a fever, cold and cough. So most often we dismiss it off as a flu. But after 3 days, rashes start appearing. The hallmark of the chicken pox rash is that it comes in 3 stages. It starts with a little red pimple and then water starts collecting inside this pimple and forms a blister. This blister then breaks and becomes ulcerated and dries up to form a scab. One fact to take note of in this disease is that all 3 stages happen at the same time. So at the same time in the same child, you can see pimples, blisters as well as scabs. Chicken pox is contagious – from 2 days before rash appears and continues to be contagious until all the rashes become scabs. It is safe to let the child move around with other non-infected people only when all the blisters have dried up. Chicken pox vaccine is available and this reduces the intensity of the disease. Most often the pox heals on its own but doctors do give symptomatic treatment. In some children, this disease can become complicated by brain/lung and bacterial infection. This is less but still important to take note of. For the itchiness, you can apply calamine lotion or anti-histamine for it. Sometimes antiviral drug called Acyclovir is given to the patient, it doesn’t stop the symptoms but probably reduce the length of the disease by a couple of days. If the child scratches the rash and it becomes an infection, you may need to give antibiotics.

Measles

This disease is becoming rare these days because most of the children are vaccinated. But doctors do encounter a few non vaccinated cases now and then. It can also be seen in children below 9 months of age (who have not yet reached the vaccination age for the disease). Rashes are often associated with measles, most often it can be a mild rash that we mistake for measles. Some of the common signs and symptoms are the 3Cs – Conjunctivitis, Coryza (runny nose) and Cough. Most patients with measles start off with red eyes and nose, bad cough along with fever. The child becomes very miserable. By the 4^th day the rashes appear – it starts from the head and spreads very quickly to the rest of the body (moves downwards). There is no treatment per se. Doctors may give anti-histamine for the itchiness, or maybe a drip or so. For adults, they can prescribe paracetamol but sometimes secondary bacterial infections do develop and antibiotics may be needed, but not always. This condition can be highly prevented with vaccinations.

Hand Foot and Mouth Disease

We encounter it almost every day online especially and also in our children. The rashes appear on the hand, foot and the mouth. Very occasionally, this disease affects the mouth only , the hand, foot don’t get affected. It is the same disease. Treatment is symptomatic. HFMD is caused by Coxsackie and Enterovirus. Highly contagious – spreads through infected blisters, potty and secretions from throat and nose. Hand hygiene is very important, very difficult to prevent. There is no vaccine available as of now. The child can be infective for weeks – sometimes even after the rashes have disappeared and the child is playing with other kids, it can still cause HFMD among the other kids.

Roseola

Named after the colour of the rash.  This is very common, seen in children between ages 6 to 24 months. The child has very high fever (39 to 40 F) but otherwise a very active baby. The hallmark of this disease is extremely high fever for 3 to 5 days, after which the fever subsides and the rashes start appearing (especially after 3^rd day). This is caused by a virus called HHV 6. Rashes disappear within a week, need not do anything about it. The rash is an indication that Roseola has occured, there is no need to specifically treat the rash.

Impetigo

Caused by bacterial infection (Streptococcus or Staphylococcus). Very common bacterial skin infection. Children develop this rash because their immune system is still not as strong. The rashes are yellow, crusting and watery, can be smelly sometimes. Fever can occur along with these rashes. This infection spreads very easily and needs proper treatment – antibiotics, and also keep it clean and dry.

To make an appointment with Dr Melanie Majaham, head over to GetDoc.

Tags

• child diseases
• panau
• ringworm
• tinea