What Are the Most Common Skin Conditions in Children? Professor Caitriona Ryan Explains

A rash at the school gate, a blister that will not settle, a patch of scaly skin that keeps coming back. Few things send parents searching online faster.

Writing for the Irish Examiner, Professor Caitriona Ryan, Consultant Dermatologist and Cofounder of the Institute of Dermatologists, set out what parents need to know about three of the skin conditions she is asked about most often.

Hand, foot and mouth disease, impetigo and psoriasis are three of the most common skin conditions seen in children. Hand, foot and mouth is a viral illness that usually settles on its own within a week or so. Impetigo is a contagious bacterial infection treated with antibiotics. Psoriasis is a lifelong inflammatory condition that can now be very well controlled with modern treatment.

What Is Hand, Foot and Mouth Disease?

Hand, foot and mouth disease is a common viral infection in young children. It often starts with a fever, sore throat and a drop in appetite, followed by painful ulcers in the mouth and small red spots or blisters on the hands and feet. Spots can also appear on the bottom and groin.

“Hand, foot, and mouth is a typical skin condition children pick up in creche,” says Professor Caitriona Ryan.

“There is no specific antiviral treatment, but because it's viral, antibiotics are of no benefit,” explains Professor Ryan. Care is about keeping your child comfortable while it runs its course:

• Offer plenty of fluids, little and often.
• Use paracetamol or ibuprofen for pain and fever, following the dosing guidance for your child's age and weight.
• Choose soft, cool foods that are gentle on a sore mouth.
• Avoid acidic drinks such as fruit juice, which can sting mouth ulcers.

When Should You Worry About Hand, Foot and Mouth?

The main thing to watch for is dehydration, particularly if mouth ulcers are making your child reluctant to drink.

Professor Ryan advises seeking a medical review if your child becomes more unwell, stops drinking or passing urine as usual, has a fever that will not settle, or is not improving after a week.

Does My Child Need to Stay Home Until the Blisters Are Gone?

No. “Children are usually most infectious during the first few days of the illness, but they don't need to remain at home until every blister has disappeared,” says Professor Ryan.

Children can usually return to childcare or school once they feel well again, even if some spots remain. The virus spreads through saliva, coughs and sneezes, and stools, so careful handwashing at home matters, especially after nappy changes.

What Does Impetigo Look Like?

Impetigo is a highly contagious bacterial skin infection, most common in younger children. “The classic appearance is a sore or blister that develops a distinctive golden or honey-coloured crust,” explains Professor Ryan. It often appears around the nose and mouth.

Treatment depends on how widespread it is. A small, localised patch usually responds to an antibiotic cream. More extensive impetigo needs oral antibiotics, which your GP or pharmacist can advise on.

How Do You Stop Impetigo Spreading?

• Keep the affected skin clean and dry.
• Discourage scratching and keep nails short.
• Do not share towels, face cloths or bedding.
• Keep your child home while contagious. Most children can return 48 hours after starting antibiotic treatment.

Can Children Get Psoriasis?

Yes. Psoriasis affects around 2 to 3% of the population and roughly 1% of children. Around a third of people with psoriasis first develop it in childhood or adolescence, so it is far from an adult only condition.

“Psoriasis is my special interest,” says Professor Ryan. “It's an auto-inflammatory condition that's caused by a combination of genetic and environmental factors.”

In practice, that means a combination of genetic susceptibility and environmental triggers, such as stress, a sore throat or a viral infection. Genes alone do not decide it. As Professor Ryan points out, one identical twin can have psoriasis while the other never develops it.

How Is Psoriasis Treated in Children?

Treatment is matched to how much of the skin is affected:

• Mild psoriasis: prescription topical treatments applied to the skin.
• More extensive psoriasis: phototherapy is often used for children, where adults may be offered tablets or injections.
• Severe psoriasis: targeted systemic medicines, including biologics, can be used in children from around four to six years of age. Biologics work by blocking specific pathways in the immune system.

“Now, we can clear pretty much everyone, even those with severe psoriasis,” says Professor Caitriona Ryan.

With today's options, the vast majority of people, including those with severe disease, can achieve clear or nearly clear skin. It is not a cure, however. Treatment needs to continue to keep psoriasis under control.

Why Is Psoriasis More Than Skin Deep?

This is the part of the conversation many families never hear.

“Psoriasis is not simply a skin disease. It is a systemic inflammatory disease,” says Professor Ryan. “People with more severe psoriasis have an increased burden of cardiovascular disease, including heart attack and stroke.”

Psoriasis is also associated with obesity, high blood pressure, raised cholesterol and diabetes.

Professor Ryan's advice is for anyone with moderate or severe psoriasis to make sure their GP is aware of this link, and to have the following checked regularly:

• Blood pressure
• Cholesterol and blood lipids
• Blood sugar, including HbA1c
• Weight and waist measurement
• Smoking status
• Exercise and physical activity levels

There is good news here too. “There is increasing evidence that controlling severe psoriasis with systemic or biologic agents reduces cardiovascular risk,” says Professor Ryan.

For parents, that makes good psoriasis control an investment in long term health, not only in comfortable, clear skin.

Frequently Asked Questions

Is hand, foot and mouth disease serious?

For most children it is a mild illness that settles within about a week. The main risk is dehydration if painful mouth ulcers stop a child drinking, so seek medical advice if fluid intake or wet nappies drop.

Do antibiotics help hand, foot and mouth disease?

No. It is caused by a virus, so antibiotics have no effect. Care focuses on fluids, pain relief and soft, cool foods.

How long is impetigo contagious?

Impetigo remains contagious until it is treated. Most children can return to school or childcare 48 hours after starting antibiotics.

Can psoriasis be cured?

Psoriasis cannot be cured, but modern treatments can clear or nearly clear the skin for most people, including those with severe disease, as long as treatment continues.

Is psoriasis contagious?

No. Psoriasis is an inflammatory condition linked to genes and environmental triggers. It cannot be passed from one person to another.

Read the Full Article

Thank you to Gemma Fullam and the Irish Examiner for featuring Professor Caitriona Ryan. Read the full article on the Irish Examiner website, and explore more expert skin advice from the Institute of Dermatologists on the ID News blog.

This article is for general information only and is not a substitute for individual medical advice. If you are concerned about your child's skin, speak to your GP or pharmacist.