Safety and prevention

Children skin care

Birthmarks

Types of birthmarks

• Salmon Patches
• Hemangiomas
• Port-Wine Stains (Capillary Malformations)

There are many types of birthmarks that are often present at birth, or appear within a few weeks of birth. Certain types of raised or flat red, pink or bluish birthmarks may require close monitoring by a qualified medical expert as your child grows.

These types of birthmarks are called vascular birthmarks. They get their name from blood vessels close to the surface of the skin that make the birthmark. There are three types of vascular birthmarks: salmon patches, hemangiomas, and port-wine birthmarks or stains. Your pediatrician or health care provider can usually tell if the birthmark requires further evaluation by a pediatric dermatologist. New treatments now available at the Yale Dermatology Clinic offer options that just a few years ago did not exist.

Salmon patches
Salmon patches are harmless birthmarks commonly found on newborns. Newborns may have faint red marks on their eyelids or foreheads that are called "angel kisses." When these same red marks are located on the back of the neck, they are called "stork bites." The neck marks may last into adulthood but require no treatment.

Hemangioma
Hemangioma is a broad term that is most often used to describe a type of vascular birthmark that appears a few weeks after birth. These birthmarks may be red and raised, or bluish in color, and can be found anywhere on the body. These birthmarks, which often start as flat red spots, begin to grow rapidly when the infant is only about six weeks old. In most children, they stop growing around the first birthday. Then, the birthmark often begins to fade. By age five, the birthmarks fade almost completely in half the children, reaching 90 percent fading by age nine.

Though no treatment is needed in many of these cases, a child with a hemangioma should be seen frequently by a physician skilled in pediatric skin disorders. Often the hardest part is for parents to watch and wait until the birthmarks begin to fade on their own. Parents should contact the physician if they notice signs of bleeding from the birthmark or development of a sore on the birthmark.

When treatment is necessary
Treatment may be recommended for children who have more than one hemangioma, who have exceptionally large birthmarks, or whose birthmark threatens to interfere with vision, hearing, breathing, hand function or is on the lip, ear or nose, or in the diaper area. Very large hemangiomas may cause heart problems if left untreated.

Certain hemangiomas respond very well to treatment with a pulsed dye laser available at the Yale Dermatology Clinic. The laser provides a safe method of removing or treating excess blood vessels. Another method of treatment involves using steroids to stop the growth of the blood vessels. Steroids may be injected into the birthmark or given by mouth for a month or two. All of these treatments carry risks and you should be sure you understand the benefits and disadvantages of each before treatment begins.

Port-wine stains (capillary malformations)
Port-wine stains are visible at birth and are usually found on the face, legs, neck, or arms, but may occur anywhere on the body. The stains are due to an increased number of dilated blood vessels in the upper layers of the skin. They grow gradually as the child grows and unlike hemangiomas do not go away by themselves.

Treatment
Because of medical and emotional factors, port-wine stains that are large, or are cosmetically sensitive are most easily and best treated at a young age. The stains are smaller and not as thick in children, making them more responsive to treatment with lasers. Flat stains respond well to treatment with a pulse dye laser available at the Yale Dermatology Clinic. The laser – one of three in Connecticut – provides a relatively safe method of reducing the size of the stain by reducing the number of blood vessels. Most stains improve in appearance after the first treatment. Depending on the size and depth and nature of the stain, three or more treatments may be required. Steroids are not used to treat port-wine stains.

Complications
Port-wine stains may be associated with other complications in a small number of children. Stains on the forehead, sides of the face, or eyelids can on occasion be associated with an increase of blood vessels in the brain or glaucoma, an increase in pressure in the eye that can lead to blindness if not treated. Port-wine stains on the legs or arms may be linked to an overgrowth of that extremity.

• YNHH Health Library: Birthmarks

Eczema

• Triggers
• Age of appearance
• Role of bacteria
• Ways to help

Eczema is a group of chronic, itchy skin rashes that can develop in infancy and last through adolescence. The most common form of eczema that affects children is called atopic dermatitis. Children with eczema have very dry skin and develop red patches that itch intensely. Children may have mild or more severe cases but if you suspect your child has eczema, he or she should be evaluated by a pediatric dermatologist or pediatrician.

The Yale Dermatology Clinic sees many children with all forms of eczema and reassures parents that steps may be taken to make living with eczema much easier. For information or to make an appointment, call (203) 785-4632.

What triggers eczema?
As many as 8 percent of all children develop eczema but many show improvement by the time they reach age five. The exact cause of eczema is unknown, but it appears to be linked to immunological problems. Children with eczema are often predisposed to asthma and allergies. A very small percentage of children may have eczema that is aggravated by certain foods, including eggs, peanuts, fish and milk.

When does eczema show up?
Eczema usually is often seen in the first year of life, sometimes later, but generally not later than age five. There is often a family history of eczema, allergies or asthma. Many children have mild cases that can be controlled by using the right type of soap and moisturizers. As children grow, their bodies are better able to handle the eczema and many "grow out" of eczema by adulthood.

There are two forms of atopic dermatitis: infantile eczema and childhood eczema. In infantile eczema, the skin appears red and irritated on the cheeks, forehead, upper arm, abdomen, inner thighs and forearms. Once they become toddlers, children are affected in the areas more typically associated with eczema, including inside the elbows, behind the knees, at the back of the neck and at the wrists and ankles.

Eczema is extremely uncomfortable and babies and children will do anything to scratch, even rub up against their crib or other furniture. In fact, some children scratch so hard that their skin changes. It may become thicker and may turn darker or lighter. The rash varies from child to child. It may be weepy or – especially in African American children – dry and bumpy.

Seasonal changes
The majority of children do worse in winter months because the air is dryer in houses and outside. The drier the skin, the worse the irritation for many children. However, some children do worse in the summer because of increased sweating.

The role of bacteria
Doctors at Yale-New Haven now know that bacteria found on the skin plays a role in causing eczema. For some unknown reason, children with eczema have many more times the amount of Staphylococcus aureas bacteria on their skin than most people. By taking steps to reduce the bacteria, eczema may be better controlled.

These steps include:

• When eczema flares up, giving children a short course of oral antibiotics to reduce bacteria.
• Applying special antibiotic ointments to areas where large amounts of bacteria are often found, including the nose, belly button and under fingernails.

Because their skin may be raw and inflamed, it is common for children with eczema to get additional skin infections, including impetigo.

Ways to help

• Keep your child's nails clipped short to avoid scratching and infection.
• Use only water when cleaning red areas. Soap may further dry the skin.
• Moisturize the skin with recommended creams or ointments after a bath to retain moisture in the skin.
• Bathe your child with tepid, not hot, water.
• Loose, cotton clothing may be most comfortable.

If you suspect your baby or child has eczema, a pediatrician or health care provider should make the diagnosis and provide ongoing care. Your doctor may prescribe ointments to decrease the inflammation and the itching.

• YNHH Health Library: Atopic dermatitis

Hives

Most of the time, hives are caused by an allergic reaction to something children have eaten or come in contact with. Hives, also called "urticaria," are red lumps on the skin that usually disappear within a few hours to a couple of days. They can be itchy. Antihistamine medication can relieve the itchiness and swelling due to hives. If your child also has swelling of the lips, eyes or throat, it may be an emergency. Get help immediately.

Children most often develop hives when they have:

• Eaten certain foods, especially nuts, eggs, citrus, berries or fish.
• Have taken certain medications, especially penicillin.
• Been stung by an insect.
• Come in contact with certain plants or animals to which they are allergic.
• Been exposed to heat, cold, sunlight or exercise, which can trigger an allergic reaction in some children.
• Certain infections and other diseases.

The tricky part may be figuring out what caused the hives. If you are not sure of the cause, try to remember if:

• The child ate new or unusual foods, or a certain food in a large amount.
• The child is taking a new medication.
• You are using new soaps, detergents, skin lotions or cremes, makeup or other products.
• Your child was where she or he could have come in contact with plants or animals that caused the hives.

Once your child has had hives, if possible, avoid having your child eat or come in contact with the cause in the future. Tell your physician if you know what caused them. If the reaction was serious, your physician can tell you how to prepare for a future exposure. It may be necessary for your child to wear an identification bracelet indicating such an allergy.

• YNHH Health Library: Urticaria / Hives

Lice

Lice are tiny parasites that are easily spread from person to person. They are most often found in parts of the body covered by hair and cause great itching and discomfort for people who are infested. Lice live off human blood, biting into the skin and releasing saliva into the bite that causes the intense itching.

There are three different types of lice that live off humans: head lice, body lice, and pubic lice.

Head lice live on the head and are easily spread from child to child by sharing hats, combs or brushes with a person who has lice. Symptoms of lice infestation include itching and scratching in these parts of the body. Look for lice eggs, called nits, where the hair meets the skin. These tiny eggs look like dandruff, but don't easily brush off. The scalp may also be red and inflamed. Because head lice pass from child to child so easily, you should notify the school nurse if your child becomes infested.

Treatment usually consists of using specialized shampoos or creams to kill the lice. Then, you must wash all hairbrushes, hats, clothing, bedding and toys in hot water. Because lice can spread within your family, check your own hair and the hair of other children.

Body lice live in bedding and clothes and only go on people to feed. They can be killed by drying linens and clothing in hot water or using a hot iron on the clothes afterward.

Pubic lice are found in moist places like the groin, under the arms and in eyelashes. These are usually spread by sexual contact.

• YNHH Health Library: Lice

Poison ivy/Poison oak/Poison sumac

• Sources of poison ivy
• Take a look at poison ivy/poison oak
• The rash
• Does everyone get it?
• Treatment
  

Where did this poison ivy come from?
Poison ivy is how we refer to a group of plants that include poison ivy, poison oak or poison sumac. These plants contain an oil called uroshiol, which causes the rash that made the plant famous. Sometimes it's easy to remember having come in contact with the plant. But because it is so common in the Northeast, it's one of the most common forms of "contact dermatitis," which simply means reacting to something with which you have come in contact. In fact, poison ivy and its cousins are found in every state in the U.S. except Alaska, Hawaii and some parts of Nevada.

Coming in contact is easy considering that uroshiol can easily be carried by:

• Fur on pets
• Clothing
• Golf bags
• Tents or sleeping bags
• Garden tools
• Sports equipment
• Smoke from burning poison ivy
• Your hands

What does poison ivy look like?
Poison ivy and this family of plants grow as vines or bushes. Poison ivy and poison oak have three leaves, while poison sumac has rows of paired leaflets.

What does the rash look like?
A rash begins to show up fairly quickly after exposure to uroshiol, usually within eight to 48 hours, and lasts up to 10 days. It often starts out like itchy blisters that form in lines, usually where a person has come in contact with the plant. The blisters break and the yellow fluid comes out. This fluid, by the way, will not spread poison ivy. Then the rash begins to crust and complete healing takes two or three weeks.

Does everyone get poison ivy?
No. Some people are naturally immune. But those people (about 15 percent of all people) are the exceptions! If you have never had poison ivy, don't think that this is a guarantee you will never get it. Many more (up to 40 percent) are quite allergic and may need to see a doctor if their poison ivy rash is severe.

The good news is that for many people, their reaction to poison ivy diminishes over time if there is no further contact with poison ivy. However, repeated contact may cause the reaction to become worse each time. The best way to not get poison ivy is to avoid poison ivy if at all possible.

How is it treated?

• Most children are treated with Calamine lotion, cool baking soda or oatmeal colloid baths and oral antihistamines. If the symptoms are severe, a doctor may prescribe special creams and oral corticosteroids.
• Cool compresses applied to the rash will make the child more comfortable.
• Heat and sweating make the itch worse, so try and stay as cool as possible.

If symptoms are severe, or are not going away, contact your doctor or health care provider.

• YNHH Health Library: Poison ivy / poison oak

Scabies
Scabies is an itchy, highly contagious skin infection caused by tiny mites that are barely visible. Scabies causes little bumps with raised lines on the skin. The lines are where the mites burrow under the skin and lay their eggs. Areas that are most often affected include creases in the skin at the wrists, ankles, between the fingers, in the armpits, behind the knees, in the elbows and in the groin area. Mites can also hide in the skin under rings or watch bands or under fingernails.

In babies, scabies may appear differently as itchy bumps on the face, palms or scalp. The itching may be most intense at night or when it is warm and children may be tired from scratching all night long. There is also a chance that the skin may become infected with bacteria.

Who is at risk?
Scabies is very contagious and is spread by person to person contact. Because it is so contagious, an entire family may be affected. Scabies affects people of all ages, but most often is seen in children, their mothers and elderly people in nursing homes. It is seen in rich and poor people alike and is not a reflection of housecleaning habits.

Diagnosis
If there is any question to whether scabies is present, a simple test can be performed by applying a drop of sterile mineral oil to the suspected area. The site is then scraped lightly and the scrapings are examined under a microscope. A diagnosis is made if scabies mites or their eggs are found.

Treatment
If one family member has scabies, often all members are treated, even if they are not yet affected. Medicated lotions and permethrin creams are available from your doctor to kill the mites. The cream is used to cover the entire body at night, including the palms and soles of feet, then washed off the next morning. Infants and pregnant women may use milder creams that have less risk of side effects. Since itching can last for as long as a month after the mites are gone, anti-itch medications and cool baths may be necessary. All sores should be healed within four weeks of starting the creams.

• All bed linens and clothing should be washed in hot water to stop the scabies from coming back.
• Anything that cannot be washed should be put away from human contact for four days, since the mites cannot live longer than that on their own.

• YNHH Health Library: Scabies

For more information see Children skin care.

Physician Referral Online A free and confidential service of Yale-New Haven Hospital. Physician Referral Online Using your own criteria, you can request information from a database of 900 area physicians who have registered to participate. Request an appointment We would be happy to assist you in scheduling an appointment with a member of the hospital's medical staff. Use the link above or call: (203) 688-2000 or toll-free 1 (888) 700-6543 to talk with a referral coordinator.

Reviewed: Robert LaCamera, MD
Last revised: May 30, 2007 (dh)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.