Scary Fevers: Roseola
Usually follows a high fever.
Roseola is a virus that affects babies and starts with symptoms that may stump you and your doctor. Most noticeable are the high fevers (up to 104 to 105), although other than acting feverish your baby probably seems just fine. As a smart parent you rush the baby to the doctor, where she is tested for strep, pneumonia, maybe even a UTI, which all turn up negative. The doctor will probably prescribe an antibiotic for an ear infection (ear drums in babies are often red when there’s fever). A few days go by without improving, even on the antibiotic, when one day the fever disappears. You breathe a sigh of relief… only to notice these small flat pink spots on the baby’s neck, chest, belly, and back. Back to the doctor you go, where she puts the pieces of the puzzle together and announces “Roseola!” and may even discontinue the antibiotic (it won’t do any good to fight the virus). I have caught a couple cases of this during the fever phase (yes, I started an antibiotic just to be safe), but when the rash showed up just like I said it might, the parents thought I could see the future or something.
- Ages: 6-24 months
- Seasons: All
- Treatment is for the fever only. If the baby is given an antibiotic during the fever phase, ask your doctor if you’re allowed to discontinue it (one of the RARE times you might be allowed to stop an antibiotic when the child is better).
The Itch that Scratches: Eczema
Dry, pink, rough rash.
In this I’m mostly referencing the “classic” childhood eczema that is often accompanied by a history of allergies and/or asthma. The “atopic triad” of eczema, allergies, and asthma often runs in families, so I’ll commonly see siblings with some combination of those. In babies this dry, pink, rough rash can be pretty much anywhere on the body, but especially the face, chest, and belly. In older kids it shows up in the folds of the elbows and knees, and anywhere else the child is prone to dry, itchy skin. Particularly long-lasting flares of eczema raise the skin lines and make them more noticeable.
- Ages: Babies on up. Usually improves after adolescence
- Seasons: All, with flare-ups in colder/drier months
- Treatment: Includes ALL of the following:
- 1. Changes in habits, like only giving baths every other day (or less) and patting, not rubbing, the skin dry.
- Avoid scratching! Smaller kids can wear socks on their hands in their sleep. Older kids can take zyrtec or prescription anti-histamines to calm the itching.
- 2. Prescription steroid creams: There is a ton of options, so it may take some trial periods to find out what works best. Steroids can eventually damage the skin, so I often give a stronger ointment or cream for flare-ups and a weaker lotion for milder rashes.
- 3. Moisturizing: Eczema needs the heavy-duty “emollient” moisturizers, like Eucerin or Aveeno Cream. If a “lotion” slides off your finger before you apply it, it’s not a rich enough moisturizer to use for eczema. Compounding pharmacists can also whip up some great stuff. The not-so-hidden secret to using moisturizers to improve eczema is that you HAVE TO KEEP USING THEM. Set up a routine and be diligent about sticking to it. Your child may hate it for a while, but if you just make it part of the day, like brushing his teeth, he’ll get used to it and enjoy not feeling itchy all the time.
Suffering in Silence: Acne
I wanted to include a quick word on treating your teen with acne. It may not bother him or her at all, but it often causes teens a great deal of distress, even if it seems “mild” to parents. The last thing a teen wants is for someone to point out anything about his or her body, even his skin. I would advise you speak to your teen’s doctor in private (over the phone or in the office prior to her appointment) and ask the doctor to suggest treatment for the acne to the teen during the visit. I usually broach this topic with a teen this way: “I know a lot of teenagers wish their acne could get better. How do you feel about your acne?” This lets her know she’s just like everyone else and opens up a conversation on the topic.
- Ages: Puberty and up
- Treatment: 1. Skin care regimen – GENTLE cleansers like Dove Liquid or Oil of Olay. Usually harsh cleansers like clearasil or neutrogena strip the skin of natural oils, making the inflammation that leads to acne worse. Your teen should wash NO MORE THAN twice a day unless they’ve been sweating or get visibly dirty. Again, cleansing more often increases inflammation. Follow each cleansing with any prescription cream and then moisturize. This should also be a gentle, oil-free facial moisturizer WITH SUNSCREEN. The prescription creams increase sensitivity to the sun. Obviously a sunscreen isn’t needed at night but why buy two different products? It is fine for teenagers with acne to wear make-up and it will often boost their self confidence until things improve. Go to the pharmacy or Ulta or the department store and have someone help her pick a foundation that, #1 is the right shade and, #2 is non-acne forming (aka non-comedogenic) and oil-free.
- 2. Salicylic acid or benzoyl peroxide – Chances are most teenage girls have tried everything under the sun that says “acne treatment” by the time they see me for help. If a teen has very mild acne and hasn’t tried anything yet, there are prescriptions available that have higher percentages of medicine than the OTC versions.
- 3. I almost always start with a topical retin-A for anything more than mild acne. There are a lot of generic options now so this type of treatment is much more affortable. This is used starting out at once a day after cleansing (usually at bedtime). The creams/gels/lotions are applied over the entire face in a thin layer. It is very common to have redness and flaking, sometimes even irritation, at the beginning stages of use. In these instances cut back use to every other day until it improves. These work very well but they do take time, usually about 4 weeks to notice a big difference. If your doctor doesn’t offer a baseline photograph then take one at home before starting treatment, to offer as encouragement to your teen during treatment.
- 4. Occasionally the acne has deeper and larger pustules that require a few weeks of oral antibiotic. These also increase sensitivity to the sun.
- 5. Birth control – This can be helpful for teen girls who have bad acne flare-ups with their periods, but I usually don’t prescribe birth control solely for acne treatment. If your teen has painful or irregular periods and would benefit in these areas from birth control, she can consider the improvement in acne a bonus.
- 6. Diet – Chocolate and fatty foods don’t cause acne. But, healthy foods going into your teens have a lot of other benefits. Drinking plenty of water makes the skin healthier.
I hope you’ve found this primer interesting and helpful in learning about some skin conditions you might encounter in your children.
