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Daily Dose

Red Cheeks In Winter

1:15 to read

Why do children get red cheeks in winter?

It is the time of year for cold temperatures, low humidity and dry skin. It is funny, every year as the temperatures drop, I we start seeing these cute little babies and toddlers who have those bright red cheeks. I always say that they “look like British babies”.

Dry skin is just one of the many issues we see with colder temperatures, and babies red cheeks are one of the most evident. During the winter months we all experience dry skin and using moisturizer becomes very important.

I have written previous blogs about eczema, and while chapped skin is not synonymous with eczema, there are some similarities. The most important thing to prevent dry skin while the weather is cold is to use a moisturizer, and applying moisturizer is best on damp skin. After bathing your baby or child, pat them dry until they are just “a tad bit moist” and then take a moisturizer and apply it to the almost dry skin. The thicker the moisturizer the better, so a cream is preferable to a lotion. It will take a little more time to rub the cream in when the skin is a bit moist, but it will help the moisturizer penetrate the skin. The same thing goes for the face.

I always found that the best time for me to moisturize those rosy cheeks was really after the child had gone to sleep. When my children were younger I found that if I put the cream on when they were awake, that they either rubbed their faces more, or if they were verbal, complained about lotion on their faces. So…I decided that it worked best to have their bedtime routine, with baths, books, and prayers, and then once they were asleep I would slip in and lather up their faces and also even used Chap Stick on their dry little lips. Now, there is no science in this routine, but it seemed to work, and they were much more tolerant of lubricants when asleep than awake.

We are definitely in the low humidity season and the heat is on in the house (I am typing this as I sit by the fire with a blanket over my feet), so you can expect several months of dry skin and chapped cheeks. If moisturizers like Vanicream, Cerave, Aquaphor and Eucerin go on sale, stock up!!  April is a long way away.

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Daily Dose

Summer Skin Infections

1:30 to read

I have been seeing a lot of skin infections and many of these are due to community acquired methicillin resistant staph areus (caMRSA). The typical patient may be a teen involved in sports, but I also see this infection in young children in day care, or summer camp. The typical history is “I think I have a spider bite” and that makes your ears perk up because that is one of the most common complaints with a staph infection, which is typically not due to a bite at all.

The poor spider keeps getting blamed, and how many spiders have you seen lurking around your house waiting to pounce? The caMRSA bacteria is ubiquitous and penetrates small micro abrasions in the skin without any of us every knowing it. The typical caMRSA infection presents with a boil or pustule that grows rapidly and is very tender, red and warm to the touch. The patient will often say that they “thought it was a bite” but the lesion gets angry and red and tender very quickly and typically has a pustular center.

For most of us pediatricians, you can see a lesion and you know that it is staph. It is most common to see these lesions in athletes on exposed skin surfaces such as arms and legs, but lesions are also common on the buttocks of children who are in diapers in day care. The area is angry looking and tender and the teenage boy I saw the other day would not sit on the chair, but laid on the table on his side as he was so uncomfortable. If the lesion is pustular the doctor should obtain a culture to determine which bacteria is causing the infection, but in most cases in my office the culture of these lesions comes back as caMRSA or in the jargon Mersa. When I say Mersa, I often cause widespread panic among my patients, but in most cases to date these infections may still be treated with an oral antibiotic that covers caMRSA, such as clindamycin or trimethoprim-sulfa. Many of the lesions improve dramatically once the site is drained and cultured. I will reiterate that if possible you want your doctor to obtain a culture to identify the bacteria that is causing the infection.

To prevent caMRSA remind your student athlete not to share towels, clothing or other items. Make sure that common areas are disinfected and once again encourage good hand washing. The closure of schools or disinfecting an entire football field or area with turf is not recommended. Lastly, this is a good reminder that you only want to take an antibiotic for a bacterial infection and that overuse of antibiotics leads to resistance. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Skin Rash: Fifth's Disease

Even though it already feels like summer across many parts of the nation, I’m still seeing typical spring illnesses like Fifth’s disease.  Fifth’s disease is a common viral illness seen in children, often in the late winter and spring.

Many of these children look like they have gotten a little “sunburn” on their faces as they often show up with the typical “slapped cheek” rash on their faces.  At the same time they may also have a lacy red rash on their arms and legs, and occasionally even their trunks. Fifth’s is also called erythema infectiosum and is so named as it is the fifth of six rash associated illness of childhood. Fifth’s disease is caused by Parvovirus B19, which is a virus that infects humans. It is NOT the same parvovirus that infects your pet dog or cat, so do not fear your child will not give it to their pet or vice a versa. In most cases a child may have very few symptoms of illness, other than the rash.  In some cases a child may have had a low-grade fever, or runny nose or just a few days of “not feeling well’ and then the rash may develop several days later. The rash may also be so insignificant as to not be noticed. When I see a child with Fifth’s disease it is usually an easy diagnosis based on their few symptoms and the typical rash. Although children with Fifth’s are probably contagious at some time during their illness, it is thought that by the time the rash occurs the contagious period has passed. This is why you “never know” where you got this virus. (the incubation period is somewhere between 4-20 days after exposure). Parvovirus B19 may be found in respiratory secretions and is probably spread by person to person contact.  During outbreaks it has been reported that somewhere between 10 – 60% of students in a class may become infected. Most adults have had Fifth’s disease and may not even have remembered it, as up to 20% of those infected with parvovirus B19 do not develop symptoms, so it is often not a “memorable” event during childhood. Fifth’s disease is another one of those wonderful viruses that resolves on its own. I like to refer to the treatment as “benign neglect” as there is nothing to do!  The rash may take anywhere from 7–10 days to resolve. I do tell parents that the rash may seem to come and go for a few days and seems to be exacerbated by sunlight and heat. So, it is not uncommon to see a child come in from playing on a hot sunny day and the rash is more obvious on those sun exposed areas.  Occasionally a child will complain of itching, and you can use a soothing lotion such as Sarna or even Benadryl to relieve problematic itching. A cool shower or bath at the end of a hot spring/summer day may work just as well too. Children who are immunocompromised, have sickle cell disease, or have leukemia or cancer may not handle the virus as well and they should be seen by their pediatrician. But in most cases there is no need to worry about Fifth’s disease, so it is business as usual with school, end of year parties, and summer play dates! That’s your daily dose for today.  We’ll chat again tomorrow!

Daily Dose

When Bug Bites Get Infected

1.00 to read

It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions. 

The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks.  This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed. 

Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that “baby fat” reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites. 

Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer. 

Severe local reactions are called “skeeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms  (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from infection.

Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins, but are extremely rare. 

The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion, Sarna lotion and Dommeboro soaks.  This may be supplemented by topical steroid creams (either over the counter of prescription) to help with itching and discomfort. 

An oral antihistamine (Benadryl) may also reduce some of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites. 

Due to an exceptionally warm winter throughout the country the mosquito population seems to be especially prolific. The best treatment is prevention!! Before going outside use a DEET preparation in children over the age of six months, and use the lowest concentration that is effective.  Mosquito netting may be used for infants in strollers.  Remember, do not reapply bug spray like you would sunscreen. 

Daily Dose

When Bug Bites Get Infected

1.00 to read

It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions. 

The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks.  This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed. 

Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that “baby fat” reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites. 

Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer. 

Severe local reactions are called “skeeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms  (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from infection.

Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins, but are extremely rare. 

The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion, Sarna lotion and Dommeboro soaks.  This may be supplemented by topical steroid creams (either over the counter of prescription) to help with itching and discomfort. 

An oral antihistamine (Benadryl) may also reduce some of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites. 

Due to an exceptionally warm winter throughout the country the mosquito population seems to be especially prolific. The best treatment is prevention!! Before going outside use a DEET preparation in children over the age of six months, and use the lowest concentration that is effective.  Mosquito netting may be used for infants in strollers.  Remember, do not reapply bug spray like you would sunscreen. 

Daily Dose

The Trials & Tribulations of Teen Acne

It doesn't matter if it is one zit or 100 pimples, most teens are bothered by bumps on their faces.Acne is one of the most perplexing issues for an adolescent. It doesn't matter if it is one zit or 100 pimples, most teens are bothered by bumps on their faces. The only thing they want their doctor to do is to "make my skin clear, NOW". As a 'tween enters adolescence, they may notice bumps on their forehead or nose. The first thing to combat early acne is getting the adolescent into the routine of washing their face twice a day.

Beginning with an over the counter soap or acne wash, something like Neutrogena, Purpose or Clean and Clear. There is even Neutrogena acne wash in a pump that is easy to use. If they are still having break out issues and need the next step, an over-the-counter benzoyl peroxide would be helpful. This comes in several strengths, begin low so as not to get too dry and increase strength as tolerated. Benzoyl peroxide is the medication that is "hyped" in pro-active, at the same strength, at a much less expensive price point. If washing the face and using benzoyl peroxide does not control the acne problem it may be time to see the pediatrician or dermatologist to decide if prescription strength medication is in order. The mantra for treating acne should be no picking, do to the risk of infection and scarring and patience, clearing up skin takes time, and a teen has little of that. That's your daily dose, we'll chat again soon!

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Your Teen

Acne

Teenage acne can be a traumatic experience for your child. It’s a very common condition, one that impacts over an estimated 17 million people. Dr. Robin Carder, chief of pediatric dermatology at Children’s Medical Center Dallas says acne can be due to a number of things. “Their follicles make more skin cells and that, combined with oil in our skin forms plugs. Once skin is plugged, you get a pimple.”

Dr. Carder says oil is stimulated more in skin during puberty which is sometimes why teens seem to be more impacted. Typically boys get more severe acne than girls. Parents can help their child by encouraging them to gently wash their face twice a day. Dr. Carder says to resist the temptation to scrub as that can aggravate the skin. Teens that have more oily skin should use a wash that contains salicylic acid, which will dry the skin out some. Teens with sensitive skin should use something more gentle like Cetaphil or a Neutrogena glycerin bar. She also says that if your child doesn’t see results from an over-the-counter product within three to four months they should see their pediatrician for a more aggressive treatment. Dr. Carder offers her teenage patients one final tip: “Squeezing and picking is probably the worst thing you can do and it’s probably the fastest way to reach scarring. They heal faster if you leave them alone.”

Daily Dose

8 Year Old Gets Botox! What?

8 year old is injected with botox for cosmetic reasons. What is her mother thinking? As you know, I rarely watch evening TV, but I tune in to morning news shows as I am getting ready for work. I often find myself talking to the TV about segments relating to parenting or medicine (always want to chime in) but today I was screaming! There was segment on “Good Morning America” about an 8 year old girl whose mother was injecting her face with botox!!!  Are you kidding me? At first I thought this was a joke, but unfortunately it wasn’t. As it turns out this 8 year old little girl participates in beauty pageants (that is another topic) and her mother has been injecting her daughter’s face with botox due to “wrinkles”. According to the mother, the little girl was “concerned” about wrinkles on her face. I must say, I have taken care of children for 25 years, and I have heard a lot of stories, but never about wrinkles on a child’s face!! Not only did they show pictures of the child receiving the botox, but they also showed pictures of the little girl looking unhappy and sore with ice packs on her face post injection! Ok, I’ll admit, I have had botox and it hurts!! Not a fun day at the dermatologist for this middle aged woman and I cannot understand a mother putting needles in her child’s face for any reason, yet alone cosmetic!  I think this borders on some sort of child abuse, both physical and emotional. This poor little girl is hearing “there is something wrong with your face and I will fix it with a shot”. There is not a thing in the world wrong with this little girl, except her mother!  It won’t be long until this poor child will be in therapy to deal with these issues that are being created by an over-zealous mother who needs to deal with her own issues and let her little girl go play dress ups, or run outside, rather than sit in a chair with ice packs on her swollen face. How could any parent put their child through this? What are her thought processes?  I have patients who have no choice but to have shots every day with insulin for their diabetes or for growth hormone, and I think it actually hurts the parent more than the child. My own child had to have heparin shots for a life-threatening blood clot and I could barely stand to watch him inject himself when I knew it was medically necessary, and we had no other choice. But to inject a small child with a drug (it is approved for use in children with neuromuscular disorders, or migraines) solely for cosmetic reasons is beyond my belief. There are no words. "Good Morning America" has reported the young girl has been removed from her mother's home and the mom is being investigated. What do you think? I would love your comments! Click below.

Daily Dose

Facial Rash

1:30 to read

Lots of babies and toddlers have problems with recurrent rashes around their mouths. It is most bothersome to their parents…who think it is “unsightly, especially in pictures”.  The problem is,due to the fact that babies and toddlers drool and they also always have their fingers and/or hands in their mouths.  Remember, a child is in their “oral phase” from birth through the toddler years….and everything goes into their mouths.

On top of the safety issues with a child putting everything into their mouths and the risks surrounding choking….all of this hand to mouth often leads to a rash which is a type of “peri-oral” dermatitis. It is usually a bit red (erythematous) and bumpy (papular) and will have good and bad days.   So how do you get rid of it?

It is not and “easy” fix but here are some things that help. Pacifiers are one of the biggest rash causing culprits as a child sucks and the drool accumulates around the outside of the mouth and under the pacifier.  I love pacifiers for younger children (<12-18 months), but if your child (like the one in the picture) still has a pacifier and is over 12 months of age taking away the pacifier (another post ) will absolutely help.  

Another reason for the rash is frequent face washing and wiping.  What parent is not constantly wiping their child’s face?  In fact, one night when I was seeing a mother with her child for this very rash and I “suggested” that she wipe his face less frequently she said to me rather emphatically “I do not wipe his face!! “  Well, I wonder why he did not have all sorts of leftover carrot, pears, peas and yogurt on his face?  At any rate, the less frequently you wipe off the “schmutz” the less drying and irritation to the skin.  Still hard to do as your child finger feeds often missing their mouth.

So the mainstay of treatment is a barrier/moisturizer as well as a topical steroid cream. I usually recommend something like Aquaphor or Vaseline and I apply it often and generously. Especially when your child is heading to bed, coat the area…even under that pacifier if necessary.  On days that it looks especially inflamed, I add an over the counter steroid cream, such as Cortaid or Cortizone.  When using the steroid a tiny amount “pea sized” is all you need, put that on first, followed by the layer of Aquaphor or Vaseline. The steroid cream will help “get the red out” but it is not to be used daily.  Use the steroid for several days, take the Christmas card picture and stop the steroid for awhile. I use the steroid “as needed” rather than daily. 

I recently learned that an occasional child is “allergic” or reacts to the lanolin alcohol in Aquaphor and the rash might get worse instead of better. If that seem to be the case and you have been using Aquaphor you might switch to simple pure petrolatum like Vaseline.  

The best news is that most of these rashes clear up on their own over time when your child moves out of the oral, messy mouth stage and won’t be drooling and having their face wiped all of the time….but next up is the “anal phase”!

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