The newest theory is that children with eczema have a defective skin barrier, which allows irritants through resulting in inflammation. Fotolia.com. By Sue Hubbard, M.D.
www.kidsdr.com
I received an email (and even photos!) the other day from a mother concerned after finding a “spot” on her 6-year-old son’s back. The boy was otherwise well and Mom didn’t see any other “spots” or rash.
Her son had complained that the “spot” was itchy, so the mother applied some over-the-counter cortisone cream (which I always tell patients to try). When the spots didn’t improve after two days (although they didn’t get worse), the mother thought the problem might be ringworm, so she applied an OTC anti-fungal cream. Again, the problem didn’t clear up, but did not worsen or spread.
Now, in medicine, you learn about red herrings that are part of a patient’s history, though they usually have no bearing on a current problem. In this case, the family dog had developed a lesion, which a veterinarian diagnosed as a staph infection. The vet told the patient’s mom that the skin problem was not contagious to humans. Are we talking red herring or have we found the problem?
After reviewing the photos, I began thinking the boy’s problem might be nummular eczema (nummular meaning “coin- shaped,” hence the round appearance of the spot), as the outbreak was not bothersome other than being itchy, and eczema is often called the “itch that scratches.”
With all of this cold, dry weather gripping much of the country right now, and heaters running full blast in homes, schools and businesses, eczema is having a heyday. I’ve seen a ton of these little inflamed patches on skin of all ages (my own hands are a mess!). The treatment of choice is to moisturize the skin and use of a topical steroid. However, it takes a long time to see improvement in such spots, and they may change on a daily basis depending on the weather, bathing, and how much lubrication and moisturizing you’re doing.
I would use an OTC moisturizer containing ceramides (Cetaphil Restoraderm, Cerave, Aveeno for eczema) liberally and frequently. I’d also suggest applying an OTC steroid several times a day (under the moisturizer). Eczema also sometimes requires a stronger topical steroid available by prescription.
If the problem does not improve after 7-10 days, it may be worth a visit to your pediatrician for an up close and personal diagnosis.
Dr. Sue Hubbard is a nationally known pediatrician and co-host of “The Kid’s Doctor” radio show. Submit questions at www.kidsdr.com.
This was printed in the March 9, 2014 – March 22, 2014 edition
