SUMMER SKIN

What is the best means of protecting my 6 month-old from sun-burn?

Sunburns are one of the more common skin conditions seen during the summer months in pediatric offices.  Burns typically consist of reddened areas and occasionally blistering which result in pain, itching, and eventually peeling of the skin.  The most effective means of treatment consist of cool compresses or baths (I like to recommend colloidial oatmeal baths), fluids, moisturizers, and occasionally topical antibiotics.  Prevention includes a sun-block with SPF of 15-30, avoiding midday exposure, and light protective clothing.  While previous recommendations included using sun lotion after 6-months of age, I generally recommend sunblock for areas of the skin that can’t otherwise be protected at any age greater than 2 months.  Remember to reapply after swimming!

Is it common for a 4 year-old to develop welts every time he gets a mosquito bite?

There are many common skin reactions that occur in response to insect bites.  In addition to the more serious insect-borne infections that can be transmitted through a bite, reactions to flies, mosquitoes, bees, and other insects include hives (or urticaria), itchy papules (small red bumps), blisters, and less frequently anaphylaxis.  Skin reactions may occur at the site of the insect bite or may be more diffusely spread.  Treatment includes cleaning the site and controlling symptoms with topical steroids, cool compresses, oral antihistamines, and topical antibiotics.  More serious infections (cellulitis) may require oral antibiotics.  Those with known sensitivity to bee stings or other insect bites should be encouraged to take precautions, using DEET based repellants (intended for children) on the skin and clothing, early use of antihistamines at the first sign of welts, and carrying an epi-pen for more serious reactions involving the mouth or airway.

My son has a rash that looks a lot like a bull’s-eye, but he is only being treated for a skin infection.  Is this okay?

The rash associated with Lyme Disease does not always consist of a classic “bull’s-eye.”  In fact, a large number of patients with Lyme never develop a rash.  In children, however, a rash is fairly common and may occur 1-3 weeks following a tick bite.  Early in the course, the rash consists of a single flat red rash that may expand.  The center occasionally pales (forming a bull’s eye) or may often become dusky with areas of secondary infection.  Later in the course of untreated Lyme, multiple erythema migrans rashes may occur, representing more wide-spread disease.  More serious symptoms can develop but are beyond the scope of your question.  The treatment consists of oral antibiotics for a period of 2-3 weeks for early disease, and longer (or perhaps intravenous antibiotics) for more serious disease.  Many local skin infections resemble Lyme Disease, but often occur during the first few days after a bite (of any sort) and are often warm and painful.  Many of the antibiotics used to treat Lyme may also cover bacteria causing a cellulitis.  It would be best to discuss these concerns with your child’s doctor.

How safe is it to use oral steroids for poison ivy?

Contact rashes, including that caused by poison ivy, are fairly common.  The oil contained in the leaves and roots of the plant can often cause irritation when applied to the skin.  Often a true allergic sensitization / reaction can occur at the site of contact.  The reaction is not contagious; nor should it spread once the skin has been washed.  Spreading is likely the result of re-exposure to clothing, pets, or other objects which were previously exposed to the oil.  While recognition and avoidance are the mainstay of both prevention and treatment, topical antibiotics, moisturizers, cool compresses, and colloidial oatmeal baths may alleviate the discomfort and expedite recovery.  Oral antihistamines and topical steroids may be useful.  Oral steroids are generally considered safe and effective.  If a child has a severe exposure, or one that involves the face or genitalia, I often will prescribe a course of steroids for a week to ten days.  The steroid helps decrease the inflammatory response to the irritant.  If given for a short period of time, steroids have little in the way of significant consequences.  If given for a week or more, it is recommended to taper or decrease the dose slowly so as to avoid more significant side-effects.  Remember, “Leaves of three, let it be…”