Molluscum Contagiosum

Molluscum is a contagious virus, similar to a wart. The virus is spread with skin to skin contact and most children get it from other children.

To Treat or not to Treat?
Molluscum can go away on its own.
It can also spread, get infected with bacteria, or create a surrounding itchy rash.
I usually recommend treatment.

Treatment Options
There are many options for treatment. Here are my two favorites:
Cantharidin is a medicine that can be applied in the office. It causes the skin to blister and the spots can fall off. It works best for smaller molluscum spots.
Curettage is a method of scraping the lesions off the skin. I usually prescribe a topical numbing medicine to be applied before the procedure.

Using topical numbing medicine
Apply the cream liberally to cover the whole area to be treated. Do not rub in. Cover the area with a large piece of saran wrap. The sticky saran wrap (Glad Press-N-Seal) works particularly well. The medicine should be on the skin for at least one hour before the procedure.

Watch the video for more information.

Warts

There are many different kinds of warts. Plantar warts are found on the feet. Common warts can be found all over the body, often on the hands. Flat warts can also be found all over the body, sometimes even on the face.  All warts are contagious and they spread from person to person with skin contact. If not treated, they can spread on yourself or to others.  Good handwashing and keeping warts covered can help prevent their spread.  It is also a good idea to protect your feet by wearing sandals at pools and locker rooms because the wart virus can live on warm moist floors also. Warts can resolve on their own but sometime they don’t and we recommend treatment to prevent their spread.

Treatment
There are many ways to treat warts and treatment depends on the sizes and locations of the warts. You may have tried simple over the counter treatments like salicylic acid (Compound W), or even duct tape. If your home remedies haven’t worked, let us take a look. We can simply remove warts or try other therapies like cryotherapy (freezing), acid plasters, or candida immunotherapy.

Acne

Almost all teenagers will have acne at some point. Acne is common on the face but can even be seen on the back, shoulders and chest. Factors that contribute to acne include hormones, oil production, plugging of the pores, bacteria and inflammation. There are even some medications or hormonal imbalances that can cause acne. Contrary to popular belief, diet does not play a huge role in acne. We always encourage a healthy diet with lots of fruits and vegetables but even if you cut out all of the sweets and oils in your diet, you would probably still have acne. The good news is that most teens grow out of their acne as they get older.

Treatment
There are a lot of possibilities for treating acne, including topical creams and gels, washes, and pills. For milder acne, we usually start with topicals and for more severe or inflammatory acne, pills are often recommended. Our office does prescribe isotretinoin (Accutane) for more stubborn cystic or scarring acne.

For more information, see the Society for Pediatric Dermatology’s Acne Video or  Acne Handout

Eczema (Atopic Dermatitis)

This itchy skin disease can be very stubborn and persistent. Some kids inherit this skin disorder from their parents and others have no family history of itchy skin. The causes are not fully known but most physicians think there are two main factors that contribute: 1. The child is born with a weaker skin barrier causing skin dryness.  2.  The child has an overactive immune response in the skin that causes itch.  Sometimes food allergies and contact allergies play a role. There is no cure for atopic dermatitis but we do have many treatment options.

Skin Barrier Repair
At home, there are some things you can try. Lotions are very important to protecting the sensitive skin of atopic dermatitis. Some qualities to look for in a lotion include thickness- the thicker the better. Ingredients like ceramides can actually help replenish some skin barrier components that are missing. Many lotions can also help decrease the itch in the skin- the less scratching and breaking of the skin, the quicker the skin will heal. The type of lotion matters less than the consistency in applying it. Apply liberally and often!

Treatment
The main treatment for flares of atopic dermatitis is short courses of topical steroid therapy in combination with good skin hydration in the form of emollients. We also use oral antihistamines to decrease the itch in the skin. In more severe atopic dermatitis, we sometimes even use wet wraps to encourage good skin hydration.

       Want more information?  Check out the The Society for Pediatric Dermatology’s Videos

Eczema Video

Eczema Treatment Video

For young children with atopic dermatitis, sometimes we need to use certain clothing to  prevent them from scratching their skin.  See some examples parents have found helpful below.

www.scratchmenot.com (hand covers)

For more information, see the Society for Pediatric Dermatology’s Atopic Dermatitis Handout

Birthmarks

There are many types of birthmarks. Birthmarks are some of my favorite skin findings because no two are alike. Some can be signs of systemic medical diseases; others are benign and harmless. Most birthmarks we simply monitor and reassure, but some require treatment. If there is a birthmark that needs to be removed, we use many different stitching techniques including using dissolving stitches to leave a more appealing scar.

Hemangiomas

Infantile hemangiomas are quite common. They usually appear early in the first few weeks after birth. They grow most rapidly in the first 2 months of life, more slowly until age one and then slowly disappear over the next few years.  Most are essentially gone by about age five. Usually no treatment is needed. However, if they are especially large, ulcerating, or are located in certain areas of the body by the eyes, ears, nose, mouth or genital area, we often initiate treatment. Our office has used oral beta blocker medicine, specifically propranolol, with excellent success.  There is even a topical beta blocker called timolol gel that can sometimes help with ulcerated or problem area hemangiomas.

        For more information, see the Society for Pediatric Dermatology’s Infantile Hemangiomas Handout

Alopecia Areata

Alopecia areata is a frustrating condition of hair loss. Lots of kids will experience this to a variety of different degrees. Sometimes, a small patch of hair will fall out and just regrow again. Other times, hair just continues to fall out. It most commonly begins on the scalp but can also affect the eyelashes, eyebrows and sometimes the whole body. We offer many treatment options.

Resources:
The Society for Pediatric Dermatology Alopecia Areata Handout

Another Look Hair Institute: www.anotherlookonline.com
Locks of Love: www.locksoflove.org
National Alopecia Areata Foundation:  www.naaf.org 

Lichen Sclerosus et Atrophicus

Great info from the North American Society for Pediatric and Adolescent Gynecology:

Pediatric Vulvar Lichen Sclerosus

Rashes

There are many factors that can cause a rash. Some are itchy; some aren’t. Certain illnesses (vomiting and diarrhea bugs, colds and other illnesses with fevers) can result in rashes in kids. Medications and foods are other factors that can bring out rashes. Less commonly, rashes can be a sign of a more serious systemic illness. If you don’t have a good explanation for the rash in your child, let us take a look.

More rash information is available from The Children’s Hospital of Philadelphia Vaccine Education Center- Rashes Booklet

Nevi (Moles)

Moles are made up of modified melanocytes which are the pigment-producing cells in the skin. There are two types of moles, acquired moles and congenital (birthmark) moles. Birthmark moles with uneven color or larger than 1.5 cm may be at an increased risk for developing a skin cancer called melanoma and they should be evaluated. People who get more sun exposure and people who have many moles in family members get more acquired moles. The widespread use of tanning beds has probably increased the overall incidence of skin cancers. Avoid tanning beds and wear sunscreen to help protect your skin.

The A, B, C’s can help determine if a mole is a problem.

Is the mole Assymetrical?
Is the Border irregular?
Is there Color variation?
Is the Diameter larger than 5 mm?
Is the mole Evolving (changing)?

If the answer is Yes to any of these factors, the mole could be problematic.

Want to Practice?  Play Mayo Clinic’s Tap-a-mole game!

Wound Healing and Scars

See the American Academy of Pediatrics page on Cuts, Scrapes & Scar Management

 


Here are some other more in depth education modules for primary care physicians that Dr. Gallagher worked on with the Society for Pediatric Dermatology:

Online Education Modules