Pediatric Skin Conditions

Common Pediatric Skin Conditions
by Dr. Jim J. Gould, MD

kin conditions are diagnosed and treated regularly in any busy pediatric practice. The dermatologic issues we see may range in seriousness from a mild nuisance to a life threatening condition. It would take a full medical text book to cover the entire gambit of conditions we see even at a superficial level. I would like to address just 5 of the more common skin findings or diseases we see in general pediatrics. I will cover the following conditions in my article: Molluscum Contagiosum, Hand, Foot, and Mouth Disease (HFMD), Infantile Seborrheic Dermatitis of the scalp (“cradle cap”), Tinea Corporis (“ringworm”), and Fifth’s Disease.

Molluscum Contagiosum: Molluscum Contagiosum is a common viral skin infection of childhood. The virus typically enters the skin through a small break in its integrity. This skin problem most commonly occurs between the ages of 3-16 years of age. The lesions appear as single or multiple umbilicated (indented center), pearly-white or sometimes pink lesions. The lesions will typically appear anywhere from 14 days to 6 months after exposure.Transmission is most commonly by skin to skin contact. The lesions may spread from one part of the body to another. Most people develop anywhere from 1 to 20 lesions. Molluscum is typically asymptomatic or in some cases, mildly itchy. Lesions may look inflamed just prior to spontaneous resolution. The lesions may appear anywhere on the body but seem to be more prevalent in the axillary (“armpit”), and the crease between the upper and lower arm. The health care provider will most frequently diagnose the lesions by their characteristic appearance. Most cases in children self-resolve anywhere from a few months to 18 later. The most common treatment options include: observation, liquid nitrogen, cantharone (“blistering beetle extract”). In severe, extensive cases curettage with local anesthesia is sometimes done.

Hand, Foot, and Mouth Disease:

HFMD is a childhood illness caused by an Enteroviral infection. It classically causes lesions on the mouth, hands and feet. Anyone may get HFMD but it most commonly found in children less than 10 years of age. Most, but not all adults were exposed in childhood and have immunity. The illness is highly contagious and is generally spread from person to person via oral-oral and fecal-oral contact. Spread of the illness can be minimized through regular hand washing and disinfection of contaminated surfaces. Avoid close contact with affected individuals and avoid sharing utensils with infected individuals. The child typically will become ill 3-4 days after exposure. Initially, the child may have low grade fevers, abdominal pain and possibly mild respiratory symptoms. Oral ulcerative lesions may develop which often leads to a decrease intake of solids and liquids. Next, extremity lesions may arise. The lesions usually begin as flat or slightly raised red bumps that then progress to small fluid filled sacs. These lesions typically quickly ulcerate and crust. No scarring typically occurs with resolution of the lesions. Less common body wide symptoms may include high fevers, fatigue, diarrhea and joint pains. Lesions typically resolve within 7-10 days. Although tests such as viral cultures exist for documenting infection the diagnosis is typically made on history and physical exam findings. Treatment is focused on symptomatic control of pain and fevers, encouragement of fluids, and monitoring of hydration status. Antibiotics do not provide benefit.

Cradle Cap (Infantile Seborrheic Dermatitis of the scalp):

This condition typically begins in the first 10 weeks of life. Males are affected more commonly then females. The underlying cause of this condition is not known but some believe that the overgrowth of a particular fungus on the skin may contribute to the condition. The affected child is generally asymptomatic but

can have mildly itching. The lesions may be yellow-red and often appear “greasy”. They tend to coalesce into plaques of lesions. Although the involvement of seborrhea on the scalp is what is known has “cradle cap”, the condition can also affect the face and diaper area. Yeast infection, other fungal infection and eczema may sometimes look like seborrheic dermatitis of the scalp. Infantile Seborrhea of the scalp most often spontaneously resolves within a few months. Treatment often involves observation or sometime removal of the thick scale using mineral/baby oil and a fine tooth comb to help loosen the flakes.

Fifth’s Disease (Human Parvovirus B19 infection):

The Fifth’s Disease rash is also called Erythema Infectiosum. This rash is characterized by a “slapped cheek” appearance and thus is also known as “Slapped Cheek Syndrome.” People of all ages may be affected by this illness but it is most commonly seen in children 3-12 years of age. Females are affected at a greater rate than males . . . Many adults have already been exposed to this virus. This is known by the fact that 60% of adults have antibodies to the B19 virus. The illness is most commonly seen in late winter and early spring. It is spread by aerosolized respiratory droplets during certain stages of the infected child’s illness. The illness typically begins approximately 6-14 days after exposure to infected people. Fevers, fatigue, headaches, chills and joint discomfort may occur. Typically 3-4 days into the course the characteristic rash appears. The facial rash is typically quite red and either flat or slightly raised. It is located across both cheeks sparing the skin around the mouth and the bridge of the nose. The facial rash can be accompanied by a “lacy” red flat rash on the extremities. Diagnosis is generally by physical exam and history but testing of blood for antibodies may also be helpful in certain situations. Contrary to popular belief by the time the typical rashes of this illness appear the child is commonly no longer infectious. The rashes may take anywhere from 1-3 weeks to completely resolve and may reoccur with exposure to heat or sunlight. The symptoms

joint discomfort can occur in young children but are more common symptoms in older individuals that may contract this illness. For most individuals, this illness is self-limited and does not lead to any significant complications. There are exceptions to this general rule, however. Pregnant women who have come in contact with individuals with known Fifth’s Disease should contact their Obstetrician immediately to discuss possible complications that may occur with the fetus. In addition, individuals with certain underlying blood diseases such as Sickle Cell Anemia, Thalassemia and other blood disorders should contact their personal physician if exposed.

Tinea Corporis (“Ringworm”):

The Tinea Corporis lesions are typically red, slightly raised, and with frequent scaling of the skin at the site. The rash tends to be annular and grow by spreading outward at the outer border while the center of the rash may start to clear. This skin infection is common to all ages. The most common causes of ringworm include three different types of fungi. Lesions may be singular or occasionally multiple and scattered. The diagnosis is suspected by appearance but is confirmed by testing scraping of skin at the site of the lesion. Various topical and oral antifungal regimens exist for treatment of this condition. Infections with superficial fungi typically do not lead to life threatening conditions but do regularly affect the quality of life of those that have this condition.


JIM J. GOULD, MD is a board certified pediatrician who has practiced in Tooele Utah. He completed medical school at University of Washington and a pediatric residency at the Marshfield Clinics in Wisconsin. Jim practiced in Layton, Utah prior to moving to Tooele. He has lived and practiced in Tooele County since 2004. His office is located at 2356 N 400 E in Suite 202. He is in Building B of the Northpointe Medical Complex. His office number is (435) 843-8380.