The various skin conditions in children.

Nappy rash is a very common skin condition in infants, affecting approximately eight out of ten babies. Also known as diaper dermatitis, it is recognised by the presence of red patches on the buttocks and inner thighs. Although benign, nappy rash is nonetheless uncomfortable for the baby as it causes itching and pain. This condition is primarily due to a drying out of the child's skin, often caused by friction from nappies.

Nappy rash can also develop in response to an allergy to a compound present in a product applied to the nappy area (creams, soaps, wipes...). Finally, it has been identified that digestive or urinary disorders are aggravating factors. Diarrhoea indeed perpetuates the irritation by causing an increase in the activity of faecal enzymes, which damages the epidermis.

How to prevent and alleviate nappy rash?

Good hygiene is essential in preventing nappy rash, as well as avoiding its worsening. The first instinct should be when it comes to the choice of toiletries for your baby. We recommend opting for gentle products formulated without alcohol, essential oils, or fragrances, substances that can prove to be irritating for the delicate skin of children. Moreover, paediatricians advise cleaning the area from front to back and drying by lightly dabbing to avoid irritating the epidermis. Finally, wearing loose clothing can be wise as it helps to reduce friction.

The seborrheic dermatitis in infants, also known as cradle cap, is characterised by crusty patches of white to yellow colour, sometimes surrounded by redness, primarily on the scalp. Occasionally, cradle cap can be present in the folds of the arms and buttocks. They are generally observed in babies aged under six months. As a rule, these crusts dry out in a few days to form scales that naturally detach. Seborrheic dermatitis is benign and can be compared to the dandruff observed in adults.

Cradle cap is the result of an accumulation of dead cells on the skin's surface, following an overproduction of sebum by the sebaceous glands. This sebum-rich environment then promotes the growth of the yeast Malassezia furfur, a microorganism that feeds on certain fatty acids present in the sebum and transforms them into irritating fatty acids. These trigger inflammatory mechanisms, leading to abnormal flaking. It appears that seborrheic dermatitis may be due to a certain genetic predisposition.

What can be done to prevent and treat cradle cap?

While it is challenging to prevent cradle cap, dermatologists agree that maintaining a good hygiene routine for the infant is crucial. The use of gentle care, suitable for their scalp, also helps to limit the formation of patches. If these are already present, it is possible to apply vaseline to soften the crusts and promote their natural removal in the bath. They should then fall off in the following days.

It happens that some children exhibit red spots and whiteheads on their face. Approximately 80% of children affected by infantile acne are boys. The spots are often located on the cheeks, forehead and scalp of the child. Several triggering factors have been identified in the etiology of infantile acne, among which are an increase in seborrhea, the stimulation of sebaceous glands by maternal androgens, transmitted through the placenta, and a colonisation by the parasites Malassezia.

A benign condition, infantile acne spots often disappear spontaneously after a few days without leaving any marks. If this is not the case, the treatment for this condition is the same as that for adult acne, namely the topical application of creams based on retinoids (tretinoin, adapalene...) or benzoyl peroxide and the oral intake of erythromycin, an antibiotic.

The eczema in children manifests exactly as it does in adults, that is, with the formation of red patches on the skin followed by scales and crusts accompanied by itching. The symptoms are the same as for nappy rash, but the red patches will also affect the face, scalp, hands, arms, feet and legs. Atopic eczema can appear from the first months of life of an infant. It should be noted that this skin disorder is not contagious and parents do not need to take any particular measures to protect themselves.

Atopic dermatitis is linked to an inability of the infant's skin to defend itself against its environment and often has a genetic origin. Indeed, it is due to a dysfunction of the skin barrier, which is characterised by a deficiency of sebum, lipids and other molecules essential for the integrity of the skin's horny layer. This alteration of the epidermal barrier makes the skin more vulnerable to irritants and environmental allergens, which can trigger inflammatory reactions.

How to soothe your child when they are suffering from atopic eczema?

The first instinct when dealing with atopic dermatitis should be to consult a doctor so they can prescribe suitable treatments that will alleviate your child's discomfort. Depending on the severity of the eczema, they may advise you to use a lotion, cream or emollient ointment, sometimes in conjunction with a low-strength topical corticosteroid . When used regularly and in accordance with the healthcare professional's advice, these treatments can help to reduce redness and soothe itching.

Commonly seen as a childhood eruptive disease, chickenpox is typically considered a mild condition that affects approximately 90% of children. Highly contagious, it is characterised by a moderate fever up to 38 °C, headaches, red spots filled with a clear fluid and intense itching. The lesions usually first appear on the torso before gradually covering the rest of the body. The palms of the hands and the soles of the feet are generally spared.

Given that chickenpox is a viral disease, the administration of antibiotics is unnecessary, except in cases of bacterial superinfection. Only antihistamines in case of itching and the application of an antiseptic solution can be prescribed. In the vast majority of cases, chickenpox heals within 10 to 12 days even when the chickenpox spots are very numerous. The spots gradually turn into scabs during the course of the disease and fall off spontaneously. If the child has not scratched, they leave no scars. Chickenpox almost invariably provides permanent immunity : one can only catch it once in a lifetime, with rare exceptions.

Important : While chickenpox is generally mild in children, it can be severe when contracted in adulthood and can lead to respiratory difficulties. Doctors therefore recommend that individuals who have not had chickenpox in childhood get vaccinated. This vaccination is possible from the age of 12 onwards.

Roseola is another benign viral disease common in children. It presents itself with a very high fever, which occurs suddenly, followed by a brief skin rash. This latter is referred to as sudden exanthema and is predominantly located on the chest and face, rarely affecting the arms and legs. The spots disappear on their own within 12 to 24 hours and do not itch, unlike those caused by chickenpox. In over 90% of cases, infant roseola occurs before the age of two, with a peak incidence between 7 and 13 months.

The healing of roseola is spontaneous within about ten days and does not require the administration of antibiotics, as the disease is of viral origin. To alleviate the child, the doctor generally prescribes a antipyretic medication, aimed at reducing the fever. The use of paracetamol is often favoured, this substance being one of the few authorised for children under three years old.

Dermatophytosis, commonly referred to as ringworm, is a fungal infection of the skin caused by dermatophyte fungi Trichophyton and Microsporum. The most common symptoms in children include red, scaly patches on the scalp, feet, and nails. These patches may be accompanied by itching, or even sensations of burning or pain. The causes of dermatophytosis in children are primarily related to direct contact with infected individuals or contaminated objects such as combs and towels, or with animals.

The fungi responsible for ringworm thrive particularly in warm and humid environments, therefore it is recommended to frequently change your bath towels to prevent contamination.

How to treat dermatophytosis?

The treatment of dermatophytosis in children typically relies on the topical application of antifungal creams such as terbinafine or itraconazole. If the ringworm persists, oral antifungals may be used. It is also important to implement strict hygiene measures to prevent the spread of the infection to the rest of the household, such as frequent hand washing, cleaning of personal items, and treating infected pets if applicable. Dermatophytosis generally heals within three to four weeks.

Scabies is an infection of the skin caused by a microscopic mite from the Sarcoptes family. This parasitic infection is characterised by intense itching, primarily at night, and skin lesions. In children, symptoms of scabies can include skin rashes in the form of small red bumps or blisters, as well as crusts and nodules in advanced cases, primarily in the skin folds and fingers. Scabies is primarily transmitted through direct contact with an infected person, although sharing clothing, bedding or other personal items can also contribute to the spread of the infection.

Once again, it is essential to consult a doctor as soon as the first symptoms appear so that they can prescribe antiparasitic medications such as permethrin or ivermectin. Alongside medicinal treatments, it is important to thoroughly wash all your child's clothing and bedding at 60°C to prevent the spread of scabies and any subsequent re-infestation. It usually takes two weeks to eliminate scabies.

Impetigo is a bacterial infection of the skin. The bacteria responsible for impetigo is a golden staphylococcus and/or a streptococcus. It's worth noting that in France, it is estimated that 90% of impetigo cases are due to golden staphylococcus. This skin condition is common among children aged two to five years and is highly contagious. Impetigo usually occurs following the infection of a pre-existing inflammation, with the transmission of the bacteria occurring after contact with lesions. Impetigo can appear in two forms: crusty or blistering.

• Crusted impetigo is characterised by yellow-coloured crusts surrounded by a red inflammatory halo and is not accompanied by fever. If the impetigo is mild, a topical antibiotic treatment involving the application of mupirocin twice a day for five days can lead to its complete cure. In the case of severe disease, an oral antibiotic treatment targeting staphylococcal and streptococcal bacteria is necessary (amoxicillin or cefadroxil).

• Bullous impetigo presents itself through soft and transparent blisters, surrounded by a red halo. They persist for two to three days before rupturing. This condition can be accompanied by fever, diarrhoea, and extreme fatigue. Bullous impetigo invariably requires a oral antibiotic treatment such as amoxicillin or cefadroxil.

Among the common skin conditions in children, milium is also frequently found. It is characterised by the appearance of small white to yellowish bumps, primarily located on the forehead, nose and cheeks. These tiny bumps are the result of the accumulation of keratin, a fibrous protein naturally present in the epidermis, in the hair follicles or sebaceous glands of the skin. Unlike acne, milium is not associated with inflammation or pore obstruction.

Non-contagious and benign, milia gradually disappear on their own without requiring treatment after a few weeks. To aid healing, we recommend very gently washing the affected areas of your child's face, taking care not to burst the spots. By doing so, your child will avoid retaining scars from this condition. For drying, pat gently with a soft towel.

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