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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”!

Daily Dose

How to Treat Poison Ivy

1.15 to read

With the vacation season here many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your childhas come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

Daily Dose

Monitoring Moles In Children

Everybody gets moles, even people who use sunscreen routinely. Moles can occur on any area of the body from the scalp, to the face, chest, arms, legs, groin and even between fingers and toes and the bottom of the feet.

So, not all moles are related to sun exposure. Many people inherit the tendency to have moles and may have a family history of melanoma (cancer), so it is important to know your family history. People with certain skins types, especially fair skin, as well as those people who spend a great deal of time outside whether for work or pleasure may be more likely to develop dangerous moles. Children may be born with a mole (congenital) or often develop a mole in early childhood. It is common for children to continue to get moles throughout their childhood and adolescence and even into adulthood. The most important issue surrounding moles is to be observant for changes in the shape, color, or size of your mole. Look especially at moles that have irregular shapes, jagged borders, uneven color within the same mole, and redness in a mole. I begin checking children’s moles at their early check ups and look for any moles that I want parents to continue to be watching and to be aware of. I note all moles on my chart so I know each year which ones I want to pay attention to, especially moles in the scalp, on fingers and toes and in areas that are not routinely examined. A parent may even check their child’s moles every several months too and pay particular attention to any of the more unusual moles. Be aware that a malignant mole may often be flat, rather than the raised larger mole. Freckles are also common in children and are usually found on the face and nose, the chest, upper back and arms. Freckles tend to be lighter than moles, and cluster. If you are not sure ask your doctor. Sun exposure plays a role in the development of melanoma and skin cancer, so it is imperative that your child is sun smart. That includes wearing a hat and sunscreen, as well as the newer protective clothing that is available at many stores. I would also have your child avoid the midday sun and wear a hat. Early awareness of sun protection will hopefully establish good habits and continue throughout your child’s life. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

White Patches on the Skin

1.15 to read

I saw a 10 year old patient last week for her routine physical. One of her mother’s concerns was that her daughter had “white patches” under both of her arms.  Once I examined her I told her mother that the “white patches” were actually due to Vitiligo, which is an acquired disorder of pigment loss. 

Vitiligo is caused by a reduction in functional melanocytes, the cells that cause pigmentation in the skin. Vitiligo often develops before the age of 20 and there is no difference in predilection for male over female cases.  In children the hypopigmented areas are often first noted on sun exposed areas like the face (around the eyes and mouth) and well as on the hands.  The underarm area (axilla) is often involved, as are areas around the genitalia. In many cases the depigmentation is symmetrical (both arm pits, or hands or knees). 

Although the exact cause of Vitiligo is not clear, it is known that it has an immunogenetic basis, as there is a positive family history of others with vitiligo in 30 -40 % of patients. There are numerous theories as to different reasons that the melanocytes (pigment cells) are not working. The genetics of vitiligo is also being studied with changes seen on certain chromosomes. 

So why doctors are not clear as to how and why Vitiligo occurs, in most cases it does seem to be slowly progressive. There is spontaneous repigmentation in 10-20% of patients, especially in sun exposed areas of young patients. 

The problem with Vitiligo is that treatment is often lengthy and is frequently unrewarding. There is not “one way” to treat Vitiligo that will ensure repigmentation and resolution. Dermatologists have used phototherapy for treatment, but facial areas and small patches seem to be most responsive. A recent study showed that narrow band UVB therapy was superior to UVA therapy, but studies continue. 

Potent topical corticosteroids are also used to help promote re-pigmentation.  Topical immune modulators such as Tacrolimus have also been tried. 

With all of this being said, a referral to a dermatologist that is familiar with treating Vitiligo is of upmost importance. The sooner the treatment for these “white patches” the better. 

That’s your daily dose for today.  We’ll chat again tomorrow. 

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