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Child Allergic Dermatitis

General PracticePaediatrics

The immune system of infants and young children is not yet fully developed, and their skin is very delicate, making them susceptible to allergies, hormonal changes, or other external irritants. It can lead to symptoms such as redness, itching, and rash, collectively called allergic dermatitis.

Common skin problems in new-born babies

Infant Milia

Symptoms	- Pinhead-sized white or yellowish bumps that feel flat to the touch. Commonly appear on infants' forehead, cheeks, chin, and nose. - Some new-borns may also have these white pearls on their oral gums, known as Epstein's pearls.
Cause	- Believed to be associated with underdeveloped sebaceous glands.
Care	- Typically resolves naturally within two to three weeks after birth, requiring no special treatment or care. - Avoid squeezing or applying any creams.

Neonatal Acne

Symptoms	- Small raised red rash. - Often appears on the forehead and cheeks of infants. - Common within the first few days or weeks after birth.
Cause	- Maternal hormones are transmitted to the baby through the placenta during pregnancy.
Care	- Usually resolves naturally within the first three months after birth, requiring no special treatment. - Keep the skin clean and dry, avoiding squeezing or applying creams.

Neonatal Urticaria/ Toxic Erythema

Symptoms	- Pinhead-sized white or yellowish raised bumps surrounded by a red rash. - Mostly found on new-borns' cheeks, body, back, and extremities. - Common within two to three days after birth.
Cause	- Unknown.
Care	- Typically resolves naturally within several days to weeks after birth, requiring no special treatment or care. - Avoid squeezing or applying any creams.

Heat Rash

Symptoms	- Small raised red rash. - Commonly occurs on a baby's neck, back, and chest. - Often seen in hot weather. However, prickly heat can also occur if a baby becomes overheated (e.g., by wearing excessive clothing) in cooler weather.
Cause	- Sweating due to overheating causes sweat to accumulate on the skin, leading to prickly heat.
Care	- Clean the baby's skin with plain water. - Dress the baby appropriately to keep the skin dry and cool, reducing sweating. - See medical advice if the condition does not improve or becomes severe.

Diaper Rash

Symptoms	- Initially, redness, followed by a slight raised red rash. - Mostly occurs within the area covered by diapers/cloth, such as genitals, perineum, buttocks, lower abdomen, and upper thighs.
Cause	- Irritation of the skin due to urine and faeces.
Care	- Change diapers frequently to keep the baby's buttocks clean and dry. - When changing diapers, cleanse the buttocks with warm water, and if necessary, use soap/body wash to clean off faeces stuck to the skin. Avoid using wet wipes as much as possible to reduce irritation to the baby's skin. - After cleaning the baby's buttocks, do not rush to put on a new diaper; let the baby's skin air dry. Parents can also apply a thin layer of moisturizer to the baby's skin to create a barrier against faeces. If the skin is slightly red after each diaper change, you can use a barrier cream, such as zinc oxide ointment, to form a protective film. - Do not use baby powder, as it can block pores when mixed with urine or sweat, worsening diaper rash. - See medical advice if the condition does not improve or becomes severe.

Atopic Dermatitis / Infantile Eczema

Symptoms	- Skin becomes red and dry. Sometimes, small blisters may form, which will scab over after the blisters burst. - Extremely itchy, scratched skin becomes thick, complex, and rough. - Mostly occurs on the baby's cheeks, elbows, knees, and trunk. - After two years old, it is more common in skin folds such as the neck and wrists. - The condition may fluctuate, often seen in babies aged two to three months. - Mostly appears before age five and subsides after age fifteen, but a small portion may persist into adulthood.
Cause	- The leading cause still needs to be fully understood. It is believed to be related to genetics but is not contagious. - Family members may suffer from allergic diseases such as nasal and asthma or have allergies to certain substances, such as detergents, pollen, dust, or food.
Treatment	- Besides skincare, doctors may prescribe appropriate treatment based on individual conditions, such as creams containing steroids or antibiotics.
Care	- Use moisturizers: Use fragrance-free, specially designed moisturizers for sensitive skin several times a day, especially after bathing when the skin is slightly damp, to help lock in moisture. - Gentle bathing: Avoid hot water and prolonged bathing, use gentle cleansing products, and pat the skin dry gently to avoid friction. - Choose suitable bath products: Use mild, non-irritating shower gels or soaps, avoiding products with fragrances or irritating chemicals. - Maintain a comfortable temperature: Keep indoor temperature and humidity within a comfortable range, avoiding prolonged exposure of children to excessively hot or cold environments. - Reduce sweating and friction: Choose loose-fitting, breathable cotton clothing, avoiding tight or rough fibre clothing directly contacting the skin. - Dietary management: Observe and identify foods or allergens that may trigger eczema flare-ups and try to avoid contact as much as possible. - Maintain a healthy diet: Balanced intake of various nutrients helps support skin health and the immune system. - Short nails: Keep the child's nails short and smooth to reduce the chance of scratching and prevent infection.

Seborrheic Dermatitis

Symptoms	- Erythema: Skin appears red or pink in patches. - Scaling: Yellow or white flakes appear on the scalp, eyebrows, and behind the ears. - Greasiness: Affected skin areas may look greasy. - Itching: Itching sensation may range from mild to moderate.
Cause	- Genetic factors: Children with a family history are more likely to develop seborrheic dermatitis. - Excess sebum: Overproduction of skin oils is a common cause. - Fungal infection: Associated with overgrowth of specific fungi on the skin, such as Malassezia. - Immune system issues: Children with compromised immune systems may be more susceptible.
Treatment	- Antifungal shampoo: Use shampoos or skin cleansers containing antifungal ingredients. - Corticosteroid creams: Help reduce inflammation and erythema. - Avoid irritants: Choose mild skincare products and avoid using products that may irritate the skin.
Care	- Clean the skin: Regularly wash affected areas with a mild cleanser. - Moisturize: Use fragrance-free moisturizers suitable for children to keep the skin hydrated. - Avoid overwashing: Excessive cleansing may irritate the skin and worsen symptoms.

Contact Dermatitis

Classification	Irritant Contact Dermatitis: Occurs when the skin comes into direct contact with a particular irritant (such as soap, laundry detergent, or prolonged water exposure), leading to skin damage. Irritant contact dermatitis typically appears shortly after contact with the substance. Allergic Contact Dermatitis: Caused by an allergic reaction of the immune system to certain substances (known as allergens), such as certain metals (especially nickel), rubber, cosmetics, or certain plants (like poison ivy). Allergic contact dermatitis may take several days to weeks to appear after exposure to the allergen.
Symptoms	- Erythema - Swelling - Itching - Dry or cracked skin - In severe cases, blisters or oozing may occur
Treatment	- Use corticosteroid creams to reduce inflammation. - In some cases, oral medications or other treatment methods may be necessary.
Care	- Cleanse the skin to remove any residual irritants or allergens. - Use moisturizers to keep the skin hydrated.

Roseola

Symptoms	- High fever: Typically lasts 3 to 7 days. - Rash: Rash usually appears shortly after the fever subsides, characterized by pale pink spots, initially typically appearing on the trunk and may spread to the face, limbs, and neck. - Enlarged lymph nodes - Mild sore throat or other symptoms of upper respiratory tract infection
Cause	- Roseola is caused by human herpesvirus types 6 and 7 (HHV-6, HHV-7), often transmitted via droplets or direct contact. It mainly affects infants and toddlers between 6 months and two years but can sometimes be seen in older children.
Treatment	Roseola typically does not require special treatment in children. Treatment mainly focuses on relieving symptoms, including: - Using antipyretics to control fever. - Maintaining adequate fluid intake. - Using moisturizers to relieve itching.
Care	- Roseola usually resolves on its own within about a week after the rash appears, and most cases have no sequelae. It should be noted that babies infected with roseola do not usually exhibit discomfort. If signs of illness, such as irritability, they may have developed meningitis, prompt medical attention and further examination are recommended.

Hand, Foot, and Mouth Disease (HFMD)

Symptoms	HFMD is a common viral infection that primarily affects infants and young children, with mild to moderate symptoms being the most common: - Fever - Reduced appetite - Sore throat - Painful ulcers appearing inside the mouth, on the tongue, and gums - Red spots on the palms, soles, and sometimes buttocks, which may develop into small blisters
Cause	- HFMD is usually caused by enteroviruses, especially Coxsackie virus and Enterovirus. The mild to moderate symptoms, including fever, oral ulcers, and rashes on the hands, feet, buttocks, and sometimes knees and elbows.
Treatment	HFMD typically do not require special treatment; symptoms usually resolve within 7 to 10 days. Treatment mainly focuses on relieving symptoms, such as: - To relieve pain and fever, use acetaminophen (for adults and children) or ibuprofen (for children over six months). - Maintaining adequate fluid intake to prevent dehydration. - Using mouth gels containing magnesium or aluminium salts to alleviate the pain of oral ulcers.
Care	- Wash hands frequently, especially after handling food, using the toilet, and changing diapers. - Avoid direct contact with respiratory secretions and faeces from infected individuals. - Clean and disinfect frequently touched surfaces and items. - Educate children on maintaining good hygiene practices.