Common Skin Infections in Children

Dr.Rohit Batra,MD
Consultant Dermatologist, Sir Ganga Ram Hospital
www.drrohitbatra.com
Dr. Rohit Batra
Skin Specialist | Pediatric Dermatologist

BACTERIAL
VIRAL
FUNGAL
PARASITIC
MISCELLANEOUS
Dr. Rohit Batra

 Impetigo
 Ecthyma
 Folliculitis, carbuncle
Cellulitis, erysipelas
 Staphylococcal scalded skin syndrome
Peri anal streptococcal infections
Dr. Rohit Batra

Superficial, contagious bacterial
infection with honey colored
crust.
Two forms –
 Bullous
 Non bullous
 Non bullous form –
 children and young adults,
 streptococcal and
staphylococcus(MC)
 Transient vesicle or pustule
 honey colored crusts
Dr. Rohit Batra

What is the treatment of choice ?
Dr. Rohit Batra

 Contagious - As long as the rash continues to drain.
 TREATMENT
 For mild disease – topical mupirocin or fusidic acid for seven
days
 For serious or extensive disease - Oral antibiotics better than
topical preparations –
 Flucloxacillin - treatment of choice
 Macrolides, cephalosporins, and coamoxiclav are also reported
to be effective,
 Topical antiseptics - soften crusts and clear exudate in mild
disease
Dr. Rohit Batra

Take home message –
Hand washing is the best way to
stop the spread of infections
Dr. Rohit Batra


Dr. Rohit Batra

 Deeper variant of impetigo
Treatment –
warm soaks to remove
crusts.
 Systemic antibiotics -
moderate or refractory
cases.
Dr. Rohit Batra

Dr. Rohit Batra

 Pyoderma of hair follicle
 Types – superficial and
deep
 Superficial - inflammation
of the terminal part or
ostium of the hair follicle
of infective or
noninfective origin.
 MC - S. aureus,
Pseudomonas
Dr. Rohit Batra

 SSSS is a toxin-mediated
epidermolytic disease
characterized by erythema and
widespread detachment of the
superficial layers of the
epidermis.
 Synonyms: Pemphigus
neonatorum, Ritter’s disease.
“scalded” appearance"
heal without scarring
Dr. Rohit Batra

 TOC - beta lactamase-
such as, dicloxacillin,
cloxacillin, or
cephalexin for 7 days.
Topical
 gentle cleansing baths
 compresses,
 topical emollients
 antibiotic ointments
Dr. Rohit Batra

 TINEA CAPITIS
TINEA FACIEI
TINEA CORPORIS
TINEA CRURIS
TINEA PEDIS
TINEA MANNUM
PITYRIASIS
VERSICOLOR
ORAL CANDIDIASIS
Dr. Rohit Batra

Fungal infection (Microsporum or
Trichophyton) of the scalp and hair
2 to 10 years; rarely seen in infants
or adults.
Dr. Rohit Batra

DIAGNOSIS:
*Wood's Lamp:
*bright green - M.
audouinii
* dull green –
T.schoenleinii
Dr. Rohit Batra

*Treatment of Choice?
Dr. Rohit Batra

*Antifungal shampoos (ketoconazole 2% or
selenium sulfide 2.5%) - lather the
shampoo and keep it on the scalp for 5 to
10 minutes before rinsing 2 to 3
tymes/wk.
*Oral griseofulvin is the gold standard for
tinea capitis in children.
*itraconazole
* terbenifine
Dr. Rohit Batra

 Treatment:
 topical antifungals (applied bid. atleast
2 cm beyond the advancing edge) X
typically 6 weeks
 To continue topical medication for 1
more week after clinical clearing to
ensure clinical cure
In severe cases: systemic fluconazole,
griseofulvin, itraconazole, or terbenifine
Dr. Rohit Batra

*ORAL ANTIFUNGALS
*TOPICAL IMADAZOLES
Dr. Rohit Batra

 topical antifungals such as
ciclopirox, imidazoles (applied
at least 2 cm beyond the
advancing edge)
refractory or recurrent cases:
systemic fluconazole,
griseofulvin, itraconazole, or
terbenifine
Dr. Rohit Batra

 Acute episodes:
 open wet compresses (Burrow’s solution 1:80)
 topical antifungal creams
To reduce hyperkeratosis: keratolytic creams
(glycolic acid, lactic acid, or urea)
 PREVENTION
 Keeping the feet dry
 open footwear
 absorbent socks/antifungal foot powder
Dr. Rohit Batra

*Etiology: P. ovale (aka.
P. orbiculare and
Malassezia furfur).
 Present as
hypopigmented or
hyperpigmented
patches distributed
over Sebaceous areas
(trunk, arms, neck,
axillae, groin, thighs,
genitalia)
Dr. Rohit Batra

 TREATMENT:
Topical agents -
selenium sulfide 2.5%, ketoconazole
2%) shampoos
 Imidazole creams
oral antifungals
Dr. Rohit Batra

 (HSV-1)
Painful grouped
vesicular lesions
on the oral mucosa
or oropharynx
Dr. Rohit Batra

DIAGNOSIS
 Tzanck smear – multinucleate giant
cells
 Treatment of choice for
oral or IV acyclovir and
 Symptomatic measures:
Pain: Acetaminophen and 2% viscous
lidocaine
Dehydration: IV fluids
Dr. Rohit Batra

INSIGHT
Any oral ulceration should be evaluated
for herpes infection
Dr. Rohit Batra

“dewdrops on a rose petal
Dr. Rohit Batra

Oral acyclovir,
valacyclovir, or
famciclovir
administered within
the first 24 to 72
hours of the
exanthem can
lessen the severity
of outbreak
Prevention:
Varicella-zoster
immune globulin
VZV vaccine (live
attenuated virus,
Oka strain)
Dr. Rohit Batra

discrete, pearly white or flesh-colored
umbilicated papules
Dr. Rohit Batra

 Benign keratotic
papules
HPV types 2, 4
person-to-person
skin contact or
indirectly through
contaminated
surfaces
Dr. Rohit Batra

 Treatment:
 curettage, cryotherapy, electrosurgery,
scalpel excision, or laser surgery
 Topical
imiquimod,
retinoids,
5-FU,
diphenylcyclopropenone,
Dr. Rohit Batra

 self-limiting
Oral fluids
Topical application of dyclonine HCl
solution, lidocaine, or benzocaine may
help reduce oral discomfort
Dr. Rohit Batra

 TREATMENT:
 5% Permethrin to all household
members
 Antihistamines: for itching
 Disposal of all linen recently used
Dr. Rohit Batra

Wood’s Light Nits will fluoresce pearly
white and are not movable.
Treatment:
1% permethrin applied to scalp and washed
off after 10 minutes, should be repeated
after 10 days
 Two applications 0.5% malathione to scalp
- 12 hours gap
Dr. Rohit Batra

 Irritant contact
dermatitis
 may result from:
 macerated skin
rubbing and wiping
 ammonia in urine and
 proteases and lipases
in stool
Dr. Rohit Batra

 mild erythema to
diffuse beefy redness.
 Diaper area, convex
surfaces involved,
folds often spared
 Severe cases may
involve folds and have
characteristic
 C. albicans satellite
 Most episodes: self-
limited
Dr. Rohit Batra

MANAGEMENT
 Keeping the diaper area clean and dry
 Prompt after defecation and urination.
 hypoallergenic or cloth diapers may be less irritating.
 Exposing the skin to air
 Creams and ointments such as zinc oxide, petroleum, mineral oils,
baby oils, lanolin, or vitamins A and D.
 For severe inflammation, mild topical steroids (2.5% hydrocortisone
ointment) may be used sparingly
 Bacterial infections may be treated with topical mupirocin; (bacitracin
and neomycin preparations as the incidence of allergic contact
dermatitis is very high).
 Oral antibiotics: in severe cases
 Powders to absorb moisture and reduce friction
Dr. Rohit Batra

TAKE HOME MESSAGE
washing the soiled area under a running
tap of warm water rather than using
abrasive wipes said to prevent diaper
dermatitis
Dr. Rohit Batra

 C. albicans
Predisposing factors: systemic
antibiotics
 Erythema appear first in the
perianal area and then spread to
perineum and inguinal creases.
 Rash involving perineum is sharply
demarcated with elevated rim and
variable scaling along the border.
 Pinpoint satellite vesico- pustules
often present.
Distribution - Genitocrural area,
buttocks, lower abdomen, and
inner aspects of the thighs, does
not spare folds. Dr. Rohit Batra

LABORATORY EXAMINATION:
 Potassium hydroxide, Gram stain or periodic acid-Schiff
 Culture on Sabouraud’s or Nickerson’s medium: White
mucoid colonies within 48 to 72 hours.
MANAGEMENT
 Topical nystatin or clotrimazole creams tid to area will
clear rash
 Care should be taken to (avoid preparations with
cortisones)
 Oral nystatin suspension: to treat oral thrush or
gastrointestinal candidal overgrowth  reduces chance of
candidal recurrence
Dr. Rohit Batra

Common Skin Infections in Children

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