Skin lesions in children can be due to sweat rashes, viral, bacterial or fungal infections or even  secondary to sinister causes like malignancies. Finding an abnormal patch of skin on their child’s body, can be a concerning issue for parents. Today in Health Capsule we are discussing some skin conditions which are commonly seen in childhood. Joining us in discussion is Dr. Maheshaka Wijayawardena, Consultant Paediatrician, Base Hospital, Wathupitiwala. 

An abnormality of the skin can present at any stage of life. But the conditions differ with age of the child. First, let’s go through some skin conditions common in neonates, ie: Babies who are less than one month of age.

Erythema Toxicum
 This is very commonly seen in neonates after the first few days after birth. A reddish rash with small vesicles scattered all around the body, which is harmless. It does not need any special treatment as it would settle spontaneously within few days.

Nappy Rash
 Usually appear in the nappy area, due to the prolonged contact of ammonia, present in urine. This could appear as a result of infrequent changing the nappies. It’s important to differentiate this from fungal infections, which also can have a similar presentation. Treatment is usually with barrier cream containing zinc oxide and antifungal creams if indicated. Maintaining proper hygiene is important to prevent the rash from recurring.

Infantile Eczema
Another common skin condition in infants, occurring usually in skin creases like neck and groin area, and it appears as pinkish skin lesions. The cause for this condition is usually dry skin and a resolving lesion looks paler in colour when compared to the surrounding skin. The condition usually wears off after a few months and can be treated with moisturizer and a short term steroid application.

Seborrheic Dermatitis
 This condition mainly manifests as scaly lesions on the scalp, with occasional involvement of the surrounding skin. It can be treated with therapeutic shampoos and application of olive oil to the scalp.

 Skin Conditions Common in older Children

 Fungal Rashes
Fungal rashes are a very common skin condition in children. They usually present as dry scaly skin lesions, sometimes with an elevated edge with a reddish tinge. It can affect skin folds as well, so can sometimes be mistaken as infantile eczema. The condition is common amongst children who experience excessive sweating. 

Viral exanthem
 Viral exanthems are a diverse group of lesions which occur due to various viruses. The appearance and the timing of the exanthem differ from virus to virus. Sometimes, as in the case of hand foot and mouth disease, the rash occur while the infection is still going on, while, in other conditions like in Dengue fever, the recovery rash appear when the infection is settling. 

Chicken Pox
 Varicella Zoster, commonly known as chicken pox is a common viral skin condition in childhood, with blistering itchy rashes appearing all over the body. Treatment is with antivirals and skin applications. Varicella zoster can rarely cause severe conditions like pneumonia and brain lesions, therefore vaccinating children against Varicella zoster is important.

 Hand Foot & Mouth Disease
Hand foot & mouth disease is another common viral exanthem commonly present in children. It is caused by Coxsackie virus and causes lesions in hands, feet, face, knees, mouth and buttocks. These lesions can increase in number over the first few days and usually dry out after 5-6 days. When associated with lesions in mouth, children may have difficulty in feeding and may need intra venous fluids to keep them hydrated. Hand foot & mouth disease is highly infectious and usually affects young children.

COVID Toes
Found in the fingers and toes of some children presenting with COVID. This condition may or may not be associated with other symptoms of COVID 19. 

Urticarial Rash
Another common presentation of childhood, which occur due to an allergy to drugs, foods or inhaled substances. However in most cases the offending agent cannot be identified. These children present with sudden onset generalized itchy body rash with reddish appearance and raised edge. This skin rash can appear & disappear over a period of one to two weeks. The condition is usually treated with oral antihistamines, steroids and local applications. The lesions themselves are harmless but if the child develops lip swelling, difficulty in breathing, cold hands & feet with fainting, he/she should be taken to a healthcare facility urgently. They heed Adrenaline injection which is a lifesaving medication.

 Rashes in some children can persist for many months and needs assessment by an immunologist.

Scabies
 Caused by a microscopic parasite which lives in sand, usually occurs in hands and feet, in the webbed area between fingers and toes, but severe infections can affect the whole body including the genital area. It is caused by the parasite burrowing into the skin and there is severe itching of the lesion due to certain chemicals in the parasite’s feces. The condition is usually associated with poor hygiene and as it is highly contagious, the whole family has to be treated for the infection to prevent recurring. 

 Sinister skin rashes
 Skin rashes themselves are rarely sinister, but can present as a symptom of serious underlying conditions. Rheumatic Fever, Kawasaki disease and Steven Johnson Syndrome are some such conditions presenting with disease specific rashes. Therefore, a recent onset rash in an ill child always require special attention.