Introduction office (approximately 95%) have an inflammatory component

Introduction

Skin diseases are a
major health problem in the paediatric population and account for significant
morbidity.1 Annually, there are more
than 12 million office visits for rashes and other skin concerns in children of
which 68% are made to primary care physicians.2 In
various parts of India, the prevalence of paediatric dermatoses has ranged from
8.7-35% in school-based surveys.1      

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Skin diseases in the
pediatric age group can be transitory or chronic and recurrent. The chronic
dermatoses are associated with significant morbidity and psychological impact. In
case of pediatric dermatoses, a separate view from adult dermatoses as there
are important differences in clinical presentation, treatment and prognosis. Factors
such as socio-economic status, climatic exposure, dietary habits and external
environment influence dermatoses in children.1 Proper recognition of
the many common cutaneous disorders is important as correct diagnosis will help
in prescribing appropriate therapy or determining the need for referral to a
dermatologic specialist.3 Common
skin problems in paediatric population are discussed below.

Rashes and lesions

Rashes come in
many shapes and forms. A symmetric rash distributed equally over the entire body—including
extremities—indicates the possibility of a systemic cause. In contrast, a rash
that appears only on one part of the body such as contact dermatitis, sunburn, or
other nonsystemic cause. The cause of a rash can be determined by its shape and
distribution. For example, a rash located under the umbilicus or watchband
suggests nickel dermatitis. The other identifying factor is colour of the rash.
The majority of rashes seen in the primary care office (approximately 95%) have
an inflammatory component and, therefore, will be red. A rash that is not red
is unusual and may require referral to a dermatologist for accurate
identification. Scaly rashes involve inflammation in the epidermis, and, if the
rash is diffuse, the most common diagnosis is a form of atopic dermatitis (eczema).
Nonscaly rashes are a result of injury to blood vessels in the dermis and
usually are accompanied by some swelling.3

 

Molluscum contagiosum

Molluscum
contagiosum is a common, benign, self limiting viral infection of the skin that
is caused by poxvirus. The infection typically occurs in the 2-5 year age group
and is rare in children under 1 year of age. Infection follows autoinoculation
or contact with affected people and the incubation period is from two weeks to
six months. The condition is more common in young children and in children who
swim, who bathe together, and who are immunosuppressed. The lesions present as
multiple dome shaped pearly or flesh coloured
papules with a central depression (umbilication), which usually appear on the
trunk and flexural areas. The size of the lesions varies from 1 mm to 10 mm,
with growth occurring over several weeks. In immunocompetent patients lesions
may persist for six to eight weeks. Resolution is often preceded by inflammation.
Uncomplicated lesions heal without scarring. 4

 

Atopic Dermatitis

Atopic dermatitis is a
common childhood inflammatory skin disease. The disease typically presents in infancy and early childhood and may persist into
adulthood.  Children may present with a variety
of skin changes, including erythematous plaques and papules, excoriations,
severely dry skin, scaling, and vesicular lesions. Based on the age of the
child distribution of atopic dermatitis lesions can vary. In infants and
children lesions are on the extensor surfaces of extremities, cheeks, and scalp
while older children often present with patches and plaques on the flexor
surfaces. In severe cases thickened plaques with a lichenified appearance may
be seen.2

Impetigo

Impetigo is a primary
or secondary bacterial infection of the epidermis of the skin. The causative
organisms are Streptococcus pyogenes and Staphylococcus aureus. Although Streptococcus pyogenes was once considered
to be the most common cause of nonbullous impetigo, Staphylococcus aureus has surpassed it in more recent years. There
are bullous and nonbullous forms of the infection. Bullous
form typically occurs in neonates while nonbullous form is most common in
preschool-and school-aged children. Initially, children may develop vesicles or
pustules that form a thick, yellow crust. The face and extremities are most commonly
affected.2

Viral warts

Cutaneous viral
warts are discrete benign epithelial proliferations caused by the human
papillomavirus. Prevalence of viral warts increases during childhood, peaks in
adolescence, and declines thereafter. In healthy children, warts resolve
spontaneously and 93% of children with warts at age 11 show resolution by age
16. Resolution can be preceded by the appearance of blackened thrombosed
capillary loops. In immunocompromised patients warts may be widespread and
persistent. The clinical appearance of warts depends on their location. The hands
and feet are most commonly affected.4

Conclusion

Skin diseases in the
paediatric population are common all over the world including rural and urban
areas. The observation of individual lesions is of greatest significance since
each lesion is differently distributed, has specific patterning and morphology.
By properly diagnosing the condition appropriate treatment can be initiated.

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