Skin infections in children
Most children have had skin infections at least once in their life. This pathology is the main reason why children visit the clinic and dermatologists.
The most common infections affecting the skin in childhood include molluscum contagiosum, viral warts, impetigo and Fungal lesions of the scalp.
Molluscum contagiosum is a mild and resolving skin infection caused by poxviruses.
The disease rarely affects children under one year of age and most often occurs at the age of 2 to 5 years. Infection occurs by self-inoculation or by contact with the patient. The incubation period varies from 2 weeks to 6 months. The risk groups are young children, children who swim or take baths together, as well as people with immune deficiencies.
The infection manifests itself in the formation of multiple pearly or flesh-colored hemispherical papules with a central recess, occurring on the trunk or at the places of the folds. The sizes of the elements vary from 1 to 10 mm. The rashes can exist for several months and even years, new elements appear as a result of self-inoculation. Resolution occurs spontaneously, it is often preceded by inflammation. Simple elements heal without leaving scars.
Recommendations for the treatment of molluscum contagiosum are contradictory. The therapy is carried out by destructive methods: physical destruction, cryotherapy, curettage. Topical use of imiquimod cream may be appropriate for a routine or stubborn process, but efficacy and safety data have not been confirmed in the controlled trials.
Since this condition is mild and prone to self-resolution, treatment is optional, however, an accelerated resolution of the process in the context of treatment, a decrease in the severity of symptoms and risk of self-inoculation, as well as the prevention of scar formation, indicate its implementation. On the other hand, therapy is often painful and there is limited data on its higher efficacy compared to future management.
Thus, before obtaining reliable evidence of the safety and effectiveness of the treatment, it is recommended to follow the expected tactics.
Viral warts are benign epithelial growths caused by the human papillomovirus.
The infection is common, especially in children and adolescents. In healthy people, recovery occurs spontaneously, in people with immune deficiencies, the process can be generalized and persistent.
The clinical manifestations depend on the location; palms and soles are most commonly affected.
Although in most cases the warts go away on their own in 2 years, the individual elements can persist for a long time, increase and become painful, and therefore treatment is recommended.
Salicylic acid should be considered the drug of choice in the treatment of viral warts. It is used locally as part of creams, ointments, gels and colloids, while the concentration of the active component varies from 11% to 50%. Salicylic acid effectively dissolves hyperkeratotic masses, but irritates healthy skin.
Cryotherapy: the advantages of cryotherapy compared to salicylic acid have not been demonstrated. It is best to avoid this method of treatment in children due to the process of accompanying pain, swelling and blistering. After aggressive cryotherapy, scar changes in the skin remain.
Other methods: Although silver nitrate pencils and formaldehyde preparations are used in the treatment of viral warts, data on the efficacy and safety of their use in children are limited. The introduction of bleomycin into the affected area, local immunotherapy, photodynamic therapy and pulsed laser treatment can be used for resistant infections.
Impetigo is a superficial skin infection characterized by the formation of a golden crust. The responsible agents are Staphylococcus aureus and Streptococcus pyogenes.
Impetigo is the third most common skin disease in children after dermatitis and viral warts. Most often affects children aged 2 to 6 years. The infection is highly contagious, spreads more quickly with direct contact in families and groups of children. The disease is more common in children with atopic dermatitis, people living in a tropical climate, when they live in crowded conditions and do not follow the rules of personal hygiene. Colonization of the nasal mucosa by pathogenic microorganisms can contribute to a relapse.
Impetigo can occur both primary and secondary in violation of the integrity of the skin. Clinically subdivided into contagious (non-bullous) and bullous impetigo.
Treatment of impetigo involves the use of systemic and local antibiotics and antiseptics.
Systemic antibiotics are more effective in severe and widespread infections than topical antibacterial drugs, they are easier to use, but they have more unwanted drug reactions. The choice of antibiotic is determined by factors such as the local epidemiology of resistance, the presence in the history of data on allergies or intolerance to the drug, data on the sensitivity of the pathogen.
Flucloxacillin (the american analogue is oxacillin) is considered the drug of choice in the treatment of impetigo. A 7-day cure is recommended. In the presence of an allergy to penicillins, macrolides may be prescribed, but in some patients, adverse reactions from the gastrointestinal tract may occur, it is also necessary to take into account the increase in the resistance of S. aureus and S. pyogenes with macrolides. In the treatment of impetigo caused by strains resistant to erythromycin, the use of cephalosporins such as cephalexin is effective, although 10% of patients allergic to penicillin are also allergic to cephalosporins. Amoxicillin / clavulanate is effective for infections caused by β-lactamase producing strains of S. aureus.
Topical antibiotics such as mupirocin and fusidic acid are safe and effective in the treatment of mild forms of impetigo.
Although there is no reliable evidence of the effectiveness of local antiseptics in the treatment of impetigo, they help in the elimination of exudates and can be used for mild lesions. In more severe cases, antibiotics should be used.
Mycosis of the scalp is a highly contagious infection caused by dermatophyte fungi.
The disease can occur in all age groups, but occurs mainly in children. The main causative agent of fungal infection of the scalp is Microsporum canis; in recent years the role of Trichophyton tonsurans in the development of this group of diseases has increased. Unlike M.canis, T.tonsurans is an anthropophilic fungus and is transmitted from person to person.
The infection leads to the development of focal alopecia, the specific clinical manifestations vary. There are 6 main types of yeast infections:
It is necessary to differentiate fungal infections of the scalp with seborrheic dermatitis, atopic dermatitis, psoriasis, focal and follicular alopecia.
Since the goal of treatment is to ensure rapid clinical and microbiological recovery and to reduce the risk of infection, it is necessary to use oral medications, the additional use of local antimycotics may also prevent spread of infection.
The main treatment for fungal infection of the scalp is griseofulvin. The drug is very effective against T.tonsurans and M.canis. The recommended dose for children is 10 mg / kg / day, although some authors suggest 25 mg / kg / day. Treatment is carried out until complete clinical and microbiological healing, which usually takes 8 weeks. Side effects include the appearance of nausea and rashes (about 10%), the use of griseofulvin is contraindicated during pregnancy.
A good effect of the use of terbinafine in the treatment of mycosis caused by T.tonsurans has been demonstrated, the drug is less effective against M.canis. The dose varies from 3 to 6 mg / kg / day for 4 weeks. Adverse effects from the gastrointestinal tract and the appearance of skin rashes (about 5%) may be observed. There is evidence of the efficacy of itraconazole, fluconazole and ketoconazole in the treatment of fungal infection of the scalp, but this has not been sufficiently confirmed.