Your Child’s Skin (Part 1) – PediaCast 518
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Show Notes
Description
- Our Pediatrics in Plain Language Panel returns to the studio to explore common skin conditions in babies, children and teens. We discuss diaper rash, eczema, poison ivy, insect bites, sunburns, warts… and more! We hope you can join us!
Topics
- Diaper Rash
- Heat Rash
- Cradle Cap
- Eczema
- Contact Dermatitis
- Poison Ivy / Oak / Sumac
- Insect Bites and Stings
- Tick Bites
- Sunburn
- Molluscum Contagiosum
- Warts
Guests
Links
- Primary Care Pediatrics at Nationwide Children’s
- What To Do When Your Child Gets Sick
- Discount Code: POD917 (40% Discount)
- Pediatrics in Plain Language Survey
- Pediatrics in Plain Language Playlist – SoundCloud
- Poison Ivy, Oak and Sumac Info and Pictures
Transcription
Announcer 1: This is PediaCast.
[Music]
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio.
It's Episode 518 for May 12th, 2022. We're calling this one "Your Child's Skin Part One". I want to welcome all of you to the program.
We have another episode with our illustrious Pediatrics in Plain Language Panel, which means that Dr. Alex Rakowsky and Dr. Mary Ann Abrams will be joining us shortly.
0:01:05
And it's sort of an exciting day because for the first time since the beginning of the pandemic, we will be recording in the PediaCast studio, the three of us that make up the Pediatrics in Plain Language Panel. We're going to do it together in person.
And this is exciting because I haven't seen Alex and Mary Ann face-to-face, in person in the same room in over two years, which is crazy to me. And we're all vaccinated. We're all healthy, so I'm thinking that hugs might be in order when I see them. But we'll see, I'll try to remember to report back on that.
Because it's a thing, right? It's been so long that you want to give your friends a hug, especially the ones you haven't seen in person in a very long time.
I mean, okay, fine, that was the social norm before the pandemic when you hadn't seen someone that your friends with and you like and it's been a while, you give them a hug. But now, after a couple of years of masks and isolation and Zoom meetings, hugging seems a little weird. Unsafe, maybe even risky.
0:02:07
I don't know. Does anyone else felt just way or is it just me? Maybe it's just me, I don't know. But I do feel like quick hugs are in order for the Plain Language Panel because it's been a rough couple of years for all of us. And we're good friends. And it really would be wonderful seeing them walk into the studio live and in person once again.
All right, we should move on. I did not mean to go off the rails with the conversation on hugging my guests. If you're an upcoming first time PediaCast guest, don't worry. There's no pressure. Hugs are not expected until you've been on the show a few times. If you don't want a hug, we don't have to hug. It's fine. Okay, now, it's getting a little weird.
All right, what are we talking about today? We have been covering body systems and common illnesses and injuries that impact those systems in our Plain Language Panel episodes. We've covered eyes, ears, nose, mouth, throat, lungs, also the stomach and intestines which we covered over the course of two episodes.
0:03:07
And we have another two-parter for you. Now, with the part one coming today and part two arriving later in this summer as we consider your child's skin. Now, the skin is the largest organ in the body and there is a lot that can go wrong with it. So today, we'll be covering some of those conditions. And then others, we'll explore during part two.
By the way, all of these Plain Language episodes can be found bundled together in one playlist on SoundCloud. And I'll put a link to the playlist in the show notes for this episode 518 over at over at pediacast.org.
For those of you who are new to the show, our Plain Language episodes cover basic topics that all parents really ought to know and we're intentional about using everyday language as we cover the topics.
Now, that does not mean that we hold back important details. We want you to be informed and understand but we try to avoid medical jargon when we can. And if that jargon is unavoidable, we make an effort to explain exactly what that medical jargon means.
0:04:07
Of course, this is the model really for every episode of PediaCast but in the case of the Plain Language Panel, we hold ourselves accountable to that plan and sometimes call each other out which can be interesting at times or perhaps annoying based on your individual expectations as an audience member. We try not to go overboard. Let me put it that way.
All right, before we get to Alex and Mary Ann, let's cover our usual quick reminders. I do want to remind you PediaCast is available wherever podcasts are found. That include the Apple and Google Podcast apps, iHeart Radio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android. And that includes GoodPods now. If you are a GoodPods user, we are available in that app these days.
If you like what you hear, please remember to subscribe or like our show or follow or whatever terminology your podcast app uses. That way you won't miss an episode. And also, please consider leaving a review wherever you listen to podcasts so that others who come along looking for evidence-based child health and parenting information will know what to expect.
0:05:08
We're also on social media. We love connecting with you there. You'll find us on Facebook, Twitter, LinkedIn, and Instagram, simply search for PediaCast. And then, there's the handy contact page over at pediacast.org if you would like to suggest a future topic for the program.
Also, I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider.
Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.
So, let's take a quick break. We'll get Dr. Alex Rakowsky and Dr. Mary Ann Abrams settled into the studio and then we will be back to talk about your child's skin. It's coming up right after this.
0:05:55
[Music]
Our Pediatrics in Plain Language Panel is in the house once again. You will recall that Dr. Mary Ann Abram is an assistant professor of Pediatrics at the Ohio State University College of Medicine and a pediatrician with Primary Care Pediatrics at Nationwide Children's Hospital.
Dr. Alex Rakowsky, also an assistant professor of Pediatrics at Ohio State and a pediatrician with Olentangy Primary Care at Nationwide Children's.
Let's give a warm welcome back to our friends. And this time, we are all in person together in the studio which is really exciting. It's been like two years, and so it's great to see your smiling faces. And of course, as always thank you both for stopping by.
Dr. Alex Rakowsky: Thank you so much. It's been two years.
0:07:01
Dr. Mary Ann Abrams: Yeah, happy anniversary. It's great to be back.
Dr. Mike Patrick: Yup. And in the intro, I mentioned I might give you guys a hug, and we did hug. So, I would report back. I'm like we're all vaccinated. We're all healthy. We haven't seen each other in two years. We're friends. Hugs just seem to be in order.
All right, well, we always begin with Mary Ann giving us a little bit of information on plain language since this is our Plain Language Panel. So, Mary Ann, what is plain language and why is that important?
Dr. Mary Ann Abrams: I thought I'd just keep it simple and basic this time and tell what I usually tell other, like if I'm giving a tuck, what do I say plain language is? And it's simple. It uses just a number and type of words that you need to get your point across. It allows people to focus on the message and not try to navigate and figure out all the other words and the flowery language or the technical words. And it lets us communicate effectively when we need to make sure that our message is heard.
0:08:04
And then I was trying to think of words that there's some technical words that when we talk about skin, which I think we're going to be talking about today, that we may not use routinely when we're seeing patients and families. But there are others that kind of trip out of our mouth just automatically.
So, epidermis is sort of the technical word for the skin, that part of the body. But we probably wouldn't use that term a lot, but we might use the word cutaneous. We might use the word topical. And I think those are words that basically mean on the skin or that we use on the skin, or the skin. So, I just try to kind of think ahead about what some of those words might be.
Dr. Mike Patrick: Yeah. I know for me, exanthem.
Dr. Alex Rakowsky: Yeah.
Dr. Mary Ann Abrams: Oh, yeah.
[Laughter]
Dr. Mike Patrick: We talk about a viral exanthem, and people are like, "Exanthem? What word was that?" And it's just a fancy word for rash, right?
Dr. Mary Ann Abrams: And we always talk about papules and pustules and erythema. We could have like a whole game right now. Name another word. And we say those words sometimes. And erythema means redness and papule means looks kind of like a pimple, so anyway.
0:09:13
Dr. Mike Patrick: Yeah, right. I mean, it's okay to still explain complex concepts but we want to use words that everybody is going to understand. And that's the heart of plain language.
We are loosely following book called What to Do When Your Child Gets Sick which is from the Institute for Healthcare Advancement. And we do have a discount code on the website. If you go to pediacast.org and look for this episode, 518, pod719 will get you a cheaper price. Of course, it's also available wherever books are found.
And then, this Plain Language episodes that we have, we'd love to get your feedback on how they're going, what you think about them, if there's any topic that you'd like us to talk about in the future, that sort of thing. And so, we do have a Pediatrics in Plain Language survey for you. I'll put a link to that in the show notes as well.
0:10:00
And then I also want to remind you we have all of our Pediatrics in Plain Language episodes packaged together on SoundCloud as a playlist. And I'll put a link to that, too. You can find all of the past episodes that we've done because there had been quite a few of them.
Today, we're going to cover your child's skin. And its so much information, so many different things that can be a problem with the skin, that we've broken it into two episodes. So, this is going to be part one and then later in the summer, I think it's in August or so, we're going to be doing part two. So, stay tune for that.
So, this week though, we're going to just kind of go down a laundry list of things that occur with the skin. The first one is diaper rash. And so, Alex, tell us what is your spiel when you see a kid with diaper rash in the exam room. What do you tell the parents about that?
Dr. Alex Rakowsky: First off, I want to say that we've done 10 or 12 of this Plain Language, so we need a world tour soon and a t-shirt or something.
Dr. Mike Patrick: Yeah, I think so too.
Dr. Mary Ann Abrams: Yeah, I hear you.
Dr. Mike Patrick: That's the next step. The pandemic’s over let's go travel.
Dr. Alex Rakowsky: Let's go travel. So, the way to explain diaper rash, in the dead of winter, we all get chapped lips or chapped hands because our skin gets exposed to a harsh environment. And if you think about a baby's skin, it's going to be thinner than adult skin. So, in general, that skin is going to be little more sensitive than thicker adult skin.
0:11:17
And then you put a diaper on top of it, so now it's going to be moist and it's also going to be hotter down there. So, you're already setting up a child for irritation. And then, they pee a lot. And then they poop a fair amount and a lot of poop that they have will have high acidity, which is going to be even like do more damage that skin.
So now I have a child whose diaper is wet, hot, exposed to fluid, exposes some acidity from the stools which is natural, and you get an irritation. So, diaper rash really is an irritation of a skin around it. So, when you have to poop or the urine kind of burns a little bit of the skin off. It's not really a burn, it's more like a chapping kind of phenomena.
And most diaper rash is going to be more an irritation diaper rash or an irritant diaper rash. But you can also have a fungus setup shop. And funguses grow in hot moist areas like your shower.
0:12:11
And so, parents freak out a lot of times. They're like, "Why does my child have a fungus down there?" It's just because there is in the air and will set up in a hot moist area. And so, the diaper's a hot moist area.
So, if it's a fungal rash, then we'll look at it. It has a specific appearance to it. It has this little like what we satellite lesions or a little like pinpoint lesions around the rash. And we'll treat that with an antifungal.
Or it can actually be a bacterial infection. It can be like really raw looking. And sometimes, that needs an antibiotic. And sometimes, you have a combination.
So, first step for diaper rash is essentially just keep the diaper area covered at all times. After every poop or pee, gently wash, cover like a thick cream. We tend use zinc oxide-based things like Desitin or Vitamin A and D, but there are a lot of really good ones out there. And we'd literally do it every time we change a child.
0:13:06
So, the key is just to prevent the rash from occurring. But once you get the rash, try to overly aggressive kind of cover it. If that doesn't work, then get seen by one of us just to make sure it's not a fungal or viral infection.
Dr. Mike Patrick: Yeah, that's a really great overall view of diaper rashes. I mean, most of these parents are going to be able to treat at home. But like you said, if it's not getting better, it could be yeast, it could be bacteria. And so, you may need more treatment than just what you can do at home.
Dr. Mary Ann Abrams: So, just when you say cover, you mean like protect it with like an ointment, a thick ointment? Because sometimes, babies, you can kind of leave their bottom to air to kind of keep that moisture from building up if there's a little time for that. Maybe a different…
Dr. Alex Rakowsky: And there's actually…
Dr. Mary Ann Abrams: Go ahead.
Dr. Alex Rakowsky: Yeah, and that's a great question. I think that there will be situations where you just cannot get rid of sensitive child, a child more sensitive skin to diaper rash just because they get exposed to things all the time. And we just had a child in clinic a couple of days ago that had the situation.
0:14:10
And fortunately, by a certain age, let's say by four or six months, they have almost like a pooping schedule. So, Joey will poop at first feed, afternoon feed, number two, and then right before sleep.
Dr. Mike Patrick: Yeah. A lot of parents have the same thing.
Dr. Alex Rakowsky: Yeah. So hopefully not three times a day.
[Laughter]
Dr. Alex Rakowsky: Even I poop, I have afternoon feed number two.
[Laughter]
Dr. Alex Rakowsky: So, but in this situation, you then kind of predict, "Okay, I won't have to worry about a stool incident." So, you can put the child on rag or let's say a towel. Or we have something called Chux which are little like blue things that absorb urine.
Have the child lie there or play there with an exposed area. And that kind of dries it out. It also get some of the moisture off and get some of the heat off.
So again, if you have a predictable situation, then I think it's a great idea to kind of air it out. But I think in infants, it's really hard because they can still eat ten times a day. And then it gets really frustrating for the parents.
0:15:11
Dr. Mike Patrick: Absolutely. The barrier cream is so important. So, you mentioned, the zinc oxide or the A&D ointment. And you're not only using that to soothe the skin. You're really creating a physical barrier, too, right? So that the pee and the poop and the diaper doesn't touch the skin. It's touching the cream instead.
Dr. Alex Rakowsky: And I think that's the most important thing, you're really setting up a barrier and just to kind of make sure that it doesn't give the damage. And some kids are going to be more sensitive to certain diapers, and not as much as a diaper allergy. Some diapers just do a better job of getting the urine out of there.
So, you may need to change diaper brands and sometimes to go for more expensive, which I think is difficult for a lot of families. So, we have families that cannot afford, let's say, a higher, like more expressive brand. So just be more aggressive just to kind of make sure that you're covering up to kind of avoid that.
0:16:00
Dr. Mary Ann Abrams: And that's one other point, I think. Sometimes, people are trying so hard to keep their babies clean and safe that they may over-clean their bottoms with extra wipes and rub harder. Even the wipes can be a little irritating if you use them too often or too hard and rub too much. If there could be such a thing as too much.
So, gentleness and if they do have a dirty diaper, gently cleaning that away, not scrubbing so hard because that can do some superficial damage to the skin. And that can let some of this other…
Dr. Alex Rakowsky: I like the water-based wipes. So, a lot of the wipes when we had our kids were alcohol-based. They just irritate more. So, there's a big push now for more of the water based. So, if you can get a water-based wipe or even ones that have some aloe, if it's affordable, that seems to help out a little bit.
Dr. Mike Patrick: Absolutely. As we move from the baby’s bottom to their face and trunk, we start to see, there's always that saying like, "Oh, you have skin as soft as a baby skin." But baby skin, oftentimes, is not so soft or pretty, right?
0:17:05
So, one of the things that they can get is a heat rash or a miliaria rubra is another name for it. That's the big name.
Dr. Mary Ann Abrams: That's not the plain language name.
[Laughter]
Dr. Mike Patrick: That's the ICD-10 code, which is also not plain language, sorry. That's just how we code things for the diagnosis in the chart. So anyway, heat rash, Mary Ann, tell us about that.
Dr. Mary Ann Abrams: I guess the main things is it's not a bad thing or a scary thing, but it may alarm parents. Sometimes, it's called prickly heat. And heat rash is probably a good name for it. Because in general, it's sort of a reddish rash, sometimes with little dots on it that is usually a result.
We don't know exactly what causes it, but we know it's more common when people of all ages but especially babies are kind of wrapped up and extra warm. And maybe swaddling can be good, but too much swaddling, and it just brings out this little red rash often on their faces. But it can be on their trunk. And again, older people can get it, too.
0:18:11
So, it doesn't bother babies much. It probably bothers grandparents and visitors and parents even more than the baby. And just take a look and see if you can lighten up what their clothing is, their blankets, their covering, and use things like cotton that may be more breathable. And it usually will fade away on its own in a few months.
Dr. Mike Patrick: It's not really anything you have to treat. It's not hazardous or dangerous. But if it's hanging around and you're not quite sure what it is, by all means, see your doctor and let them take a look at it. They may say, "Oh, it's nothing to worry about." But there are other things that can cause red bumps too that we'd may want to differentiate which was happening.
One of those other types of red bumps are baby acne. And that one, erythema toxicum neonatorum, see, I don't think anyone would say that accidentally in the room. So, babies get acne, Alex?
0:19:10
Dr. Alex Rakowsky: Yeah, people freak out when you actually put that code and it ends up in the after-visit summary. So, it's not really acne. If you step back, a baby inside mom's going to be living in the water environment. So that skin is going to be a little thicker and more waterproof.
And they are also a lot of fuzz on them. So, a lot of kids will be born fuzzier and have a different skin. And in the first few weeks, that fuzz is going to come off and that skin is going to change to normal outside-of-a-womb skin.
And just a quick story, I had a young baby yesterday and a three-year-old brother and we unwrapped the baby and looked at the back. And the kid had really lots of fuzz on the back. And the three-year-old's like, "He looks just like a grandpa." So, I was like…
[Laughter]
Dr. Alex Rakowsky: To which mom got quite red. She had miliaria rubra off her face. So, baby acne is essentially the change to the skin and the hair follicles basically coming off. Nobody's really sure why this occurs. It doesn't act like acne, even though it's called baby acne. So, acne medicines don't seem to help.
0:20:11
But it's essentially a process where you have a change in the skin, changing of the hair follicles. You actually think it's a hair follicle irritation that causes it. There's not really need to treat it. Some parents want to do something. So, if you want to put some cocoa butter on it or a moisturizer grape, it doesn't seem to kind of make it any better or any worse.
It always happens the day of baby picture. And it's sort of like a Murphy's Law. And then you just have to keep an eye on it. If it's really bad, because if the child's not acting, one thing that can look like this is a herpes infection. So, if doesn't look the way it should or if it's changing or the child's not acting normally, have one of us look at it, just to make sure we're not looking at a herpes infection.
Dr. Mike Patrick: Especially the real fuzzy, like it hurts because normal baby acne doesn't hurt that much.
Dr. Alex Rakowsky: And the books say two to four weeks. Well, that's really based on a larger study from Europe of more fair-skinned and more fair-haired individuals.
0:21:08
But I work in a clinic that's about 35% immigrant and a lot was Middle Eastern and West African. We'll see baby acne till up to two to three months sometimes. And so, all that skin comes off, and especially, some of the hair comes off. So, it's actually a lot more extensive timewise than people realized.
Dr. Mike Patrick: But this is another one that generally, you don't have to worry about. You don't do much for it, it's just there. And it will go away. You just need some tincture of time.
Okay, let's move on. We're still talking about baby skin. And another one that folks hear about is cradle cap or seborrheic dermatitis is the medical term for it. Mary Ann, tell us about cradle cap.
Dr. Mary Ann Abrams: Well, cradle cap falls in the same category of it's not a bad terrible disease. It can look rather impressive and worrisome and maybe annoying. But it doesn't really hurt, and it will go away on its own.
So, what is it? It's common in infants. It can last up to about a year of age, but usually, it's going to go away on its own within two or three months or sooner.
0:22:15
Usually, the baby feels fine, but what it looks like is sort of waxy, almost like little scales mainly on the baby's head and their scalp. It can also be on places on their face, like their eyebrows and a few other places occasionally. But it's primarily on that head and scalp piece.
And people are worried and concerned and, "Does it bother my baby?" That's always concerning. But in general, again, we aren't quite sure what causes it. But if it's kind of annoying, there are some things that you can do to kind of improve how it looks by using some mineral oil or baby oil or petroleum to kind of massage that into the scales and the scalp and the hair on their head. And then gently get a little baby brush or soft toothbrush and that oil will loosen those scales and try to brush it out to try and remove that.
0:23:20
And you can also do that by maybe using a little mild baby shampoo couple times a week. Again, trying to kind of work those scales a little bit loose. But don't go so overboard that it could cause damage to the skin underneath it which then could introduce the chance for infection and other problems.
Dr. Alex Rakowsky: Again, we have a couple of tricks. We have again a large immigrant population, especially Middle Eastern. They use olive oil. And that's a trick I learned from a lot of families. And just a couple of drops, rub it in and leave it overnight and then brush it out in the morning. So, I've been recommending that to almost everybody. It works really nice.
Dr. Mike Patrick: It just loosens up the dead skin flakes so that they come off a little easier.
Dr. Alex Rakowsky: And sometimes, the thick skin is there because you may have a little bit of again, going back to our friend, fungus which grows in hot moist areas, and you have a child who sweats a lot. And you may have a little bit of a fungal growth up there.
0:24:11
So, some people have looked at Selsun Blue or one of the dandruff shampoos. So, if one does not respond to the oil treatment, a lot of parents, they just take a little bit of the shampoo, froth it up in a ball and then take those bubbles, put them on the cradle cap. Let it sit there for like 30 seconds to a minute. Then wash it off, avoid the eyes.
You can put the oil on afterwards. That seem to kind of kill off some of the fungal overgrowth that maybe keeping the plaque on there a little bit longer.
Dr. Mike Patrick: Yeah, like you said, watch the eyes because the selenium sulfide, the active ingredient in like Selsun Blue and other anti-fungal shampoo is not No More Tears.
[Laughter]
Dr. Mike Patrick: There's lots more tears.
Dr. Alex Rakowsky: And it's frustrating. We've seen kids with cradle cap, they'll have it for a better part of three to four months. And parents get frustrated.
Dr. Mike Patrick: Yeah, absolutely. And then, atopic dermatitis is a fancy term for eczema. I think that's the common one that folks have heard of. That's another really common skin condition, not just in infants but now really in kids and teenagers and adults. Tell us about eczema.
0:25:18
Dr. Alex Rakowsky: So, eczema is I guess like a huge grab bag of any dry skin condition that just pops up and is chronic or happens more than just once or twice. And it can usually be in patches. It can be in certain areas of the body. It can run in families, so there seems to be like a genetic sort of component to eczema.
And kids that have allergies or asthma tend to be more prone to eczema because their immune system is a little more prone for these things. So, eczema, in and of itself, is just a dry skin part. And there are various types of eczemas out there.
There is infantile eczema which tends to be face, trunk primarily but it can also be on the back of the elbows compared to let's say toddler or adults’ eczema that's going to be more inside the elbows, the top of the knee compared to say behind the knee. And then can be they have big rough patches all over their lower legs and most of the back and chest.
0:26:24
Eczema's hard to treat if you just treat it once a day or only when it flares up. Also, the key to eczema is to kind of avoid it from flaring up. So, if you have an infant who's prone to it and has had a couple of weeks of dry skin, comes and goes or they're just prone to the dry skin, first, try to find a reason why. It could be a reaction to the detergent. I think we're talking about contact dermatitis next.
So, you're trying to avoid something that could be triggering the skin from having the sort of chronic dry skin condition. Make sure that you're not over-bathing the child. Another trick is to double-rinse your clothes so that the detergents completely washed off.
You may have to go to more cotton-based clothes. So, it's little less sort of allergic, a little less irritating on the skin. So, the first key is just try to find the reason for why the eczema occurred.
0:27:10
And then, the next is just to moisturize that area, literally three to four times a day. It could be Vaseline; it could be just any over-the-counter moisturizer. We use a lot of Aquaphor and DermaPhor because that's what's covered around here. But there is dozens of things out there. And some kids respond to some, and some kids respond to others. I usually start up with regular Vaseline because it's inexpensive and easy to find. And just be aggressive with moisturizing.
And then, lastly, if it's not getting better, then let one of us take a look at it. And you may need a steroid like a hydrocortisone, like Cortaid, two to three times a day for like ten days just to calm it down. The key is to keep it calm, because the longer you allow the eczema to kind of stay there, the longer the eczema stays on there let's say for several months, the more chance of you kind of having it long term. So, the key is to kind of be aggressive upfront. And most infant eczemas are going to clear.
0:28:06
Dr. Mary Ann Abrams: And another thing I was going to add, sometimes they talk about eczema as the itch that rashes. So that's one of the other piece is it's unlike some of these other things we've been talking about. It can be pretty miserable because it itches so much, and the babies can cry and trying to itch or scratch their arms or legs by rubbing them maybe against the mattress cover or whatever. So that's another part that it could be a hard thing to live with over time.
Dr. Mike Patrick: And that's a good reason to keep your baby's fingernails trimmed because it's so itchy and then they're scratching. And then you can get little micro-tears in the skin and then bacteria you can get in. And then you can get bacterial infection on top of the eczema.
So, if it's looking particularly bad and not going away, definitely you would want to let your doctor know. The other thing about young babies with eczema, that may make them at an increased risk for food allergies like peanut allergies. And so, rather than, you know, we now recommend that you start introducing peanut products at an earlier age for kids as young as six months. But if they have bad eczema, maybe they need to see an allergist first to determine if that's going to be a safe thing to do. Is that how you guys deal with it in your clinic?
0:29:18
Dr. Alex Rakowsky: Yeah, I agree.
Dr. Mary Ann Abrams: And just to be cautious, if someone introduces peanut products around six months of age, that does not mean to give babies peanut butter.
Dr. Mike Patrick: Or whole peanuts.
[Laughter]
Dr. Mary Ann Abrams: Or whole peanuts, both of which can be choking hazards, when the peanuts could get in the windpipe, and the peanut butter can also get in there.
Dr. Alex Rakowsky: And you must have had an eczema episode. You can literally spend an hour talking about various ways to treat this.
Dr. Mike Patrick: And peanut allergies as well.
Dr. Mary Ann Abrams: Yeah.
Dr. Mike Patrick: No, but there are products that you can use to introduce peanuts safely. And if you Google PediaCast and peanuts, you'll find an episode that talks all about introducing peanuts for babies.
Dr. Alex Rakowsky: And lastly for eczema is avoid fragrant things. So again, baby's skin or even toddler's skin tends to be very sensitive. So, try to keep to hypoallergenic, non-fragranted, am I saying that right?
Dr. Mary Ann Abrams: Have it scent-free.
Dr. Alex Rakowsky: Scent-free, there were go. Scent-free.
Dr. Mary Ann Abrams: The detergents to use.
0:30:18
Dr. Alex Rakowsky: And then, try not to use a sort of… Haven't use it for such a long time, after the detergent, you put in the…
Dr. Mike Patrick: Fabric softener.
Dr. Alex Rakowsky: The fabric softener, yeah. There we go. Like, you know, sounds like. So, avoid fabric softeners.
Dr. Mike Patrick: Or the dryer sheets.
Dr. Alex Rakowsky: Yeah.
Dr. Mike Patrick: Same thing.
Dr. Alex Rakowsky: And then double rinse, and that's actually another tray to the dermatologists says, to get all that detergent out of there. And when you're washing your baby, people always want to use the baby shampoo. A lot of baby shampoo has fragrance in it, so try to avoid and get a scent-free baby shampoo or baby…
Dr. Mike Patrick: Yeah, if it's a problem for your baby.
Dr. Alex Rakowsky: If it's a problem, yeah.
Dr. Mary Ann Abrams: Same with soaps. I mean, they don't need all those extra things that make all those smells because, over time especially, they can be irritating.
0:31:02
Dr. Mike Patrick: Now, sometimes, kids, this won't be a chronic problem that's going on for a long period of time or one that's covering the whole body. But there may be times when it's just in a particular area. Then we may call that contact dermatitis. Mary Ann, how's contact dermatitis different from eczema and what causes it and what do we do for it?
Dr. Mary Ann Abrams: Yeah, I feel like I'm walking in a bridge here. We start with eczema and now, I think we're moving on to poison ivy and poison oak and sumac, too. And in the middle of both of this, there's still contact dermatitis which is a great catch-all term, rather technical, too.
So, let's break it down. Contact means to come into contact with something to touch something. So, by definition, if we're talking about one of these type things, it means something has touched the skin and cause the skin to react with redness or itching or irritation. And just a little hint, whenever you hear itis, whether it's rhinitis or dermatitis or folliculitis, that itis means inflamed, meaning red, irritated, perhaps itching, maybe a little painful for whatever body part it's hook on to in terms of the first part.
0:32:15
And this is one is hooked on the word derm, which I said in the beginning, usually refers to our skin. So, we're talking about things that touch the skin and make it feel not good. So, you can break that down into sort of irritant and allergic-type contact dermatitis. And we've talked about several of those irritant ones. We've talked about diaper rash.
Also, think about things like when in wintertime, when your hands get really dry, or your lips get dry repeatedly. And that's often because people are washing their hands constantly. Every time they get wet, that removes sort of the protective barrier over the lips or the skin. Or if people just feel like they need to bathe too much or wash their hands too much, all that removes the protective barriers to the skin.
0:33:03
So just like Alex described it with the diaper, all over time that really irritates the skin and cause inflammation. So how do you manage that? You work to keep the skin moist. You do all those things to protect baby's bottoms. You can use the palm on the lips if you're older and you use a good moisturizer that doesn't have alcohol in it.
Watch out for lanolin because lanolin used to be I think it moisturizes more than it is now, but that can also be irritating or cause an allergic-type skin reaction. So, keeping the skin moist and protected.
So then allergic contact dermatitis, that's just different from the kind of allergies where you have trouble breathing and like to something life-threatening. It's a different kind of allergic reaction that basically happens when you come into contact with something that triggers special cells in your body to basically come to that site and produce chemicals and skin reaction that says this is a not a good thing for this particular body.
0:34:16
And the common things we think of are poison maybe and we're going to talk about that in more detail in a minute or two. But another really common one is nickel. A lot of people have allergic reactions to nickel. And they usually find that out by seeing like a back of a snap maybe on infant or toddler pajamas or on an inside of a pair of pants where the button or the buckle snap is. Earrings can be a problem when you're older. So, nickel is a really common one.
And then, some of the antibiotics that we use on our skin or take, neomycin is the most common one of those. And you heard me mention lanolin.
So, with the contact dermatitis, they're similar things. First of all, a lot times you can kind of tell what caused it. So, you can work to prevent coming into contact with it. You could do a little barrier if you really got a favorite pair of jeans or whatever. You don't want to not wear those, but you can protect against that contact with metal.
0:35:19
But then, you want to settle down that irritation to the skin. And usually, we use a steroid cream. Like Alex just mentioned, you can start out with mild ones and get stronger ones. You also want to keep it cool and away from the other repeated contact.
Dr. Mike Patrick: Yeah, absolutely.
Dr. Mary Ann Abrams: Sometimes, it gets really itchy. That was everything. So, keep in mind that as well. Sometimes, it can be really miserable for, and people have trouble sleeping. And there are ways to manage that as well.
Dr. Mike Patrick: You've mentioned poison ivy, and that's the one that we mostly see here in Ohio. But in other parts of the country, there's also poison oak and poison sumac that may be more common than poison ivy in those places. But regardless of which one it is, this is kind of an extreme versions of contact dermatitis.
So, Alex, talk to us about that, poison ivy.
0:36:19
Dr. Alex Rakowsky: So first, poison ivy is the state plant of Ohio, it's literally everywhere. So, there are three plants, and we'll talk about what oak and sumac look like. They produce a chemical called urushiol. And it gives a local irritation of the skin, so it gives a contact dermatitis. There are some people that actually have a true true allergy to it, and we'll talk about that in a second. They actually have a problem breathing or swelling because of an exposure.
Poison is three-leaved. It's more of a sort of vine that grows on trees. It grows on the woods. It grows literally everywhere in Ohio. And so, the rule of thumb is if it's three leaves, "three leaves, let it be." So, these are three let it be.
0:37:08
And it's very sort of irritating. It can be very irritating int he spring when all that urushiol toxin comes outs into the first leaves. And also, in the fall, we see a lot of it, because people start burning their leaves and some of the branches and there'll be poison ivy on it. And also, then, you release the urushiol sort of oil into the air, you can actually get a reaction in the lungs.
So, I think most people know what a poison ivy looks like. Poison oak is not really a tree, it's more of a bush. It goes around 20 to 30 feet tall. It also has three leaves. Looks like an oak leave with three leaves. I have a cool picture here, which I guess you can put into the show notes.
And so, it looks like poison ivy in a bush form but again, it has more of an oak-looking leaf. Not common in this area, but it is common throughout most of the United States.
And there's one called poison sumac which has a more like a sphere-like appearing leaf structure again, 20 or 30 feet tall. I grew up in Pennsylvania where poison sumac actually is probably is more common than poison ivy.
0:38:12
There are two types of sumac. One has red berries and that one's okay. I wouldn't go recommend it like rubbing yourself against it, but it's probably okay.
And then, this one actually has white berries. But since they don't get berries until about midsummer, please wait. But again, when they gust on your skin, it actually gives you a local reaction. And once it's on the skin, it's not contagious. You can probably spread some of the oil by scratching at it. But it's not like somebody's going to get… A lot of people think it's going to be like crossing from person to person. You actually have to have contact with the oil.
A couple of caveats here. The first is you can get a lot of it from pets. We have a Labrador who loves to run through the woods and into bushes and chasing things. And I've gotten poison ivy three times by hugging her. And I got it along my arms and upper chest, by just hugging Cordelia because Cordelia loves poison ivy, or she likes going wherever the poison ivy shows up.
0:39:06
So, if you have pet that's outside a lot, that's something to consider, how you're going to get exposed to poison ivy. And you have to be really careful burning things. So, if you're going to have a woodburning stove, bonfire, just make sure that all that wood is cleared of either ivy, sumac, or oak.
Dr. Mike Patrick: And I think regardless of the area of the country where you live, so you probably know, because you hear folks talk about it, whether you mostly have poison ivy, poison oak or poison sumac. So whatever one is most prevalent in your area, it's probably good idea to google it, look at pictures, show pictures with your kids.
And when you're out and about like taking a walk in the park, you said it's everywhere so you may find a fence road that's got it growing up against it, but when you see it, kind of point that out to your kids. Like "Hey, this is what you're wanting to avoid."
Dr. Alex Rakowsky: And this is oil. So, we hike a lot. So, my wife actually carries a fat-based soap with us, not an alcohol-based. It's a fat-based soap that you can squirt in your hands and kind of wash off in air because it kinds of get the oil off.
0:40:09
And they do sell a lot of these poison ivy soaps here in Ohio, almost every gas station has it. And its sort of a quick way to kind of wash off the poison ivy. Because it takes like an hour or two for that rash to kind of start setting in for the irritations to occur. But the sweatier and the hotter you are, the quicker that rash is going to kick in.
The key is to kind of wash it off. You'd get exposed as quickly as possible. If you cannot wash it off, you start getting a reaction. Be aggressive with it. You can put on like a 1% Hydrocortisone over the counter. You can take some anti-itch medicine, anti-itch sort of creams.
But when in doubt, just call one of us. Someone's need to go with oral steroid pack. This happened in our family I think four times where one of the kids or myself had to take oral steroids. It's because it got so bad.
Dr. Mike Patrick: And when it's on the face, your eyelids can get really swollen if it's down the groin area, it can swell. Or it may just be, you have so much of it in so many different places that it's not practical to put cream everywhere. You'd be going through a tube a day. And so, when that's the case, you want to be using something oral.
0:41:09
Dr. Alex Rakowsky: I mean, both of us do urgent care in ER. And this is one of the most common things we see in the summer, especially when soccer season kind of kicks in and kids are playing outside. Ball goes into the areas near the benches. And next thing you know, the kids are all over with it.
Dr. Mike Patrick: And the oil, once it's been on the skin a couple of hours, you can't really wash it off at that point, right? It's almost like a permanent… And that's why the rash lasts so long because you need to slough off the old skin and make new skin before it gets better. And when you do wash it off, don't take a bath.
Dr. Alex Rakowsky: Yeah, because then it will spread all over, yeah. I think that's a really good point.
Dr. Mary Ann Abrams: Couple of other things, too. I think those soaps you talked about are really good when you know you’ve been exposed. But sometimes, you don't, until the next day you're like, "Oh, this is not a good sign." By then, your clothes had been in the laundry or whatever.
And I know at least a couple of times when we've had that in our household where you did the laundry and suddenly you got this rash in your arms, and you were not even the one that was out walking or playing in the woods or whatever.
0:42:15
So, the oil can persist just like it can on the pets, like your clothing if you've been running through the woods. And the itching, that's one of the reasons sometimes for the oral steroids. If you're just covered with that, it makes it really hard to sleep. And we know that's important, so the oral steroids can help suppress those symptoms.
Dr. Mike Patrick: And the anti-itch medicines like cetirizine and loratadine used in Zyrtec, Claritin, those kinds of things, can also help control the itch.
Dr. Alex Rakowsky: And one more caveat, don't go hiking in open-toed sandals or flip-flops because it can actually get in your feet. And it's a bear, speaking from experience, when you get it down your feet because…
Dr. Mary Ann Abrams: Between your toes.
0:43:02
Dr. Alex Rakowsky: It's literally hard to work because now also, you're going to work with just like completely itchy foot. And I know that's like a gross image, but that's almost on always an oral pack of steroids just because you're like, "I can't take this."
Dr. Mary Ann Abrams: Because it's a very intense itch. And one other tip, just because say you're in the middle of winter and you know it's poison ivy, but it's brown and dead and dormant, that doesn't change the oil. The oil is still there, doesn't matter if the plants alive or living or active, the oils are still there. So don't think you can…
Dr. Mike Patrick: Even gardening gloves and gardening equipment, you get them out for the first time in the spring and they maybe have the oil on them too.
Dr. Mary Ann Abrams: Exactly.
Dr. Mike Patrick: I saw a kid many, many many years ago who is hiking in the woods and had to go to the bathroom. And he picked plant leaves to use as toilet paper. And of course, it's poison ivy. Had a horrible, terrible rash. And I asked him if he learned anything from this experience, and he said, "Yeah, I learned that I should pack toilet paper in my backpack." That wasn't the lesson we were looking for.
0:44:11
[Laughter]
Dr. Alex Rakowsky: He was getting there.
Dr. Mike Patrick: Yeah. All right, next on my list is insect bites and stings. Mary Ann, you're going to tell us about those.
Dr. Mary Ann Abrams: Well, there's an awful lot of bugs, a lot of insects. So, I'm sure maybe have an episode just on this. But if not, maybe you will.
It's kind of interesting when you actually think bites and stings. Okay, well, what's the difference? The bites are when the insect uses its mouth parts the way it uses them to eat or to attack something. And it uses their mouth as web or weapon and punctures the skin and may have some salivary juices that it might be using.
So, a bite is more of a puncture or literally like a bite. Whereas a sting is when the insect with the stinger actually injects venom and that's a little bit different kettle of fish because the venom is what cause the problem.
0:45:15
So, bites, depending on how big or what the insect is, you may not even know you have it. Maybe it look like it a red spot or whatever, but it can be painful. You can have multiple bites but usually not a whole ton of them. And really, it's a matter of letting it kind of get better on its own.
If it's very painful, you can take some over-the-counter ibuprofen or acetaminophen for the pain. It's always good to wash anything that breaks the skin at that site to get rid of the potential for infection with bacteria entering the skin through that open wound even though it's very small.
So, keep it clean, keep an eye on it. Manage the pain if it's an issue and a bite will usually kind of fade away.
0:46:03
And then stings, again, depending on sort of the circumstances, sort of like a one-off versus you accidentally swatted the beehive, the number of stings and whether you have any sensitivity to say bee stings, which is another discussion.
Bee sting allergies that can cause, again, local reaction that's just red and painful, a more large local reaction where maybe your whole arm gets red and swollen and painful. Or you can have a systemic allergic reaction where you really need to be treated with epinephrine. If you know you're allergic to bee stings, then you need to have your EpiPen right there.
Dr. Mike Patrick: When you say systemic, whole body.
Dr. Mary Ann Abrams: Whole body. In my head I was like, I missed that one. But I was starting to say that it's an emergency, right? Whole body because you're having trouble breathing, your blood pressure is dropping. You're feeling faint. Your heart's raising and you could collapse, and you could die.
Dr. Mike Patrick: And that's why we'd call that anaphylaxis. If you've heard that word before, that's a very severe life-threatening allergic reaction.
0:47:17
And if you have an EpiPen, don't be afraid to use it. Or epinephrine auto-injector. EpiPen's a brand name. There are other brands as well. But don't be afraid to use that and then call 911. And then go from there.
Dr. Mary Ann Abrams: And take it with you. Don’t think you don't really need it. You need to have it. And when we see someone, who for the first time, they have had a reaction to a bee sting, we always have them evaluated because that's one kind of allergy, A, that may be able to be treated. And B, it's critical that they get that EpiPen.
Dr. Alex Rakowsky: If I can just add a couple of caveat, so the EpiPen's job is to not stop the allergic reactions. It's really to open up the airway and to give better blood flow. So, you still need to get seen. So, if you use your EpiPen, you still need to get seen.
0:48:04
I've had a patient who came to urgent care like five hours later. I gave the EpiPen on the soccer field and all of a sudden, they're not doing well. And you still have to get something to stop the reaction. So EpiPen is there to kind of save your life. And then, you need some additional treatment for the anaphylactic reaction.
The second is if you happen to stumble on especially wasp nests that live in the ground, and you get bitten by multiple. And you don't know if it's a reaction or you have so much venom in you that you feel like you're having a reaction, it's okay to give an EpiPen but seek help because there are ways to kind of slow down the reaction.
So sometimes, we get so many injection. And again, we've seen this in the ER and urgent care where a child has so many injections of, you know, playing soccer…
Dr. Mary Ann Abrams: That is, yeah.
Dr. Alex Rakowsky: And get seen. And then, ants can give a lot of venom also. We don't have a lot of it here, but for our folks in the southeast state, fire ants can give as bad a reaction as wasp. So, something to consider when you go down to Florida a lot and live down there.
0:49:07
And then, the last thing will get a mosquito bite, so not a venom, and will have these huge welts. It's not really a reaction or an allergy but some kids are just more prone to whatever is coming out, saliva, whatever, out of the mosquito. And those are kids that you may need to start like hydrocortisone cream on them.
And we have one child in the clinic who has no skin conditions at all, plays a lot of sports and he walks around. Looks like had welts all over his body because he's so prone to swelling. He'll eventually outgrow it, but for some kids, it's like they want to go outside because of this. So be aggressive. If your child's going to get big welts, as soon as you see a mosquito bite, just put some hydrocortisone on it.
Dr. Mary Ann Abrams: And for whatever reasons, some people are much more attractive to mosquitoes, whether it's the smell of their body or the amount of carbon dioxide that they inhale, a part of their respiratory air, we don't really know. But as one of those people, it's like I always have to state… So, we haven't talked about prevention yet.
0:50:12
So, preventing exposure, so keep your skin covered. Don't go out at dawn and dusk for mosquitoes. Keep your eyes vigilant so you don't cross those nests. And then, use windows screens, things like that, to keep out the mosquitoes at night. And then we talked about DEET which is the insect repellant. That really, if you're going to be going out in the woods or hiking or going to be in an area where's there's going to be a lot of bugs. Even if maybe, you're playing soccer and there's a bunch of high grass right around nearby, you want to have that protection.
Dr. Mike Patrick: And when you're in that high grass or when you're in the woods, tick bites are definitely one possibility. I wanted to talk about them separately because a lot of times, when you get a tick bite, you find the tick on your skin. And so, parents wonder what's the best way to get the tick out and then do you need to be seen.
0:51:05
Dr. Alex Rakowsky: So, tick bites so as to have babies. So as female ticks, they will bite. And there are various ticks out there. But it's usually during brood season where they're producing the babies. At least in the Midwest, it tends to be sort of April, May and then in the early fall. Other parts of the country may have three seasons of them producing eggs and then young.
The tick bites can vary so there are bunch of different tick bites. Some's called the dog ticks which tends to be bigger. And that actually you can see like this big gross thing kind of attached to you. And there's something called deer ticks which can give you other infections like Lyme disease, which can tend to hide in more fold of the skin, and they tend to be very small.
So, rule of thumb is if you're going hiking somewhere, if you're going outside, if you're playing soccer, go for walk, just do a tick check when you get back home. If you have a pet, they will attract every tick in town. So just make sure that when they come home, just do a tick check as well.
0:52:04
Ticks can give infections. Actually, the most common infections also of tick bites is a local skin infection. So, dog ticks, people says it's not a big deal, it's not going to give me Lyme disease but can give you other sort of not as well-known infections as Lyme disease. But it can also give you a local skin infection.
So, rule of thumb number one is trying to wear clothes where the ticks can't get into you. If you go outside and let’s, say it's a nice day, you have t-shirts and shorts on, just do a tick check. And we actually do it almost every time we come home from a long hike. We'll tick check each other for places that you may not even expect to see a tick.
We were now in Connecticut for a music camp, not far from Lyme, which is where Lyme disease got first described. And sure enough, I end up having two tick bites from hiking in the woods with my wife. So, I was like, "Ooh, what happens now?" But I just had it probably for one day. But you know, it's one of those scary things like "Oh my gosh, I'm going to be having Lyme disease."
And then how do you get rid of ticks? You have to gently remove them. So don't burn them off. Don't have grandpa put a cigarette on them. Don't have somebody pour oil on it.
0:53:09
Don't use a credit card to kind of like flick them off. You almost had to get in there with a good pair of tweezers. Get in almost below the skin to kind of get those grasps that the ticks have, like the big graspers, and grab underneath the skin and then pull it out in one forceful jerk.
Dr. Mike Patrick: If you hike a lot, they do have tick removal tools that you can pack with you. It's the real thin piece of V-shaped metal that you can kind of slide between the skin and the tick and then gently pull out.
Dr. Alex Rakowsky: And then, most camping stores sell them. And we live east of here in a more rural area. Most every store has those around just because people hike a lot.
Dr. Mike Patrick: And the black-legged tick or deer tick, the population of them have been moving west. And so, we do see more Lyme disease in Ohio than we did 20 years ago.
Dr. Alex Rakowsky: Yeah, it's almost unheard of until… We've been here 18 years. So, 18 years ago, it was almost like unheard of. Now, we're seeing, we have to think about it when a child comes at the clinic for urgent care. So, I was like, "This can easily be Lyme disease."
0:54:10
Dr. Mike Patrick: So, we're definitely seeing that tick population moving this way.
Dr. Mary Ann Abrams: And we see Rocky Mountain spotted fever here even though we aren't near the Rocky Mountain.
Dr. Alex Rakowsky: Essentially, most common in Appalachian, right?
Dr. Mary Ann Abrams: Another tick form.
Dr. Mike Patrick: Yes, absolutely. All right, and then once you get the tick out, wash that area with soap and water really well and maybe even put an antibiotic ointment.
Dr. Alex Rakowsky: And if you see like a bullseye rash, then get seen by one of us because then you're worried about an infection brewing, especially Lyme disease, then you can start therapy quickly.
Dr. Mike Patrick: But if you don't have any rash or symptoms after the tick, you don't have to be seen someone unless there's a problem.
Dr. Alex Rakowsky: Yeah. In years past, I trained in for infectious disease, I trained in DC. We actually have a lab that you can bring a tick in to see they have Lyme because it was a big NIH study. And we've had people come to our clinic with a tick in a jar. We can't test for that anymore, so just crush the tick.
Dr. Mary Ann Abrams: But it's good to kind of take a picture of it now because if you do develop symptoms a week or so later, it may be helpful to know what kind of a tick.
0:55:17
Dr. Alex Rakowsky: Yeah, that's a good point to think.
Dr. Mike Patrick: And put something to it, like a pen or something. Just so you can get relative size, yeah.
All right, let's move on to sunburn, as we're here at the beginning of spring and we have summer ahead of us. Remind us about sun safety, Mary Ann.
Dr. Mary Ann Abrams: Yeah, so all this wonderful… I mean, we're talking about all this bad things which are associated with being outside. And being outside is great because it's good for your mental health. It's good for your physical health. So, the bottom line is I would say is be careful and take preventive measures but enjoy the great outdoors.
But one of the things is if you enjoy the great outdoors with sun protection, especially during the middle parts of the day when the sun is most high in the sky, you are susceptible to getting sunburn.
0:56:07
And sunburn is literally a burn to your skin, damage to your skin. And it runs the range from a mild redness and irritation and kind of burning, more serious kind, just almost like a secondary burn where you may even blister. And that really is a deeper damage to the skin.
So, it's uncomfortable and it's not good for your skin. Over time, it can lead to ageing of the skin and wrinkles which may or may not matter to you. Certainly, doesn't worry kids when they're five or ten years old or even 15 or 20 probably. And then also, it does increase your risk for getting skin cancer including melanoma, which is one of the most dangerous types of cancer and skin cancer.
So, like many of these things we've talked about, prevention is very possible and important. Trying to avoid the midday sun, wear longer sleeves or light clothes to reflect the sun, big, brimmed hats, sunglasses that also protects your eyes from the sun to keep you from developing maybe cataracts down the road.
0:57:16
And then using suns screen with SPF at least 30. And you can use that safely down to about six months old. Little babies, you should just keep out of the sun.
And one other thing is if you're doing sunscreen and DEET or insect repellent, I think the guidelines are put the sunscreen on first to let it protect the skin, and then add the insect repellent on top. And depending on which product you have depends on how often you have to reapply, usually within four to six hours depending on how much swimming or water you've been doing or how long you've been in the fields or in the sun.
Dr. Mike Patrick: Yeah, if you do get burnt, think of how long that was. And do it sooner next time, right?
0:58:04
Dr. Mary Ann Abrams: Or just do it before, right?
Dr. Mike Patrick: Yeah. Just frequent, frequent reapplication of the sunscreen but not the DEET. The DEET, just usually use once.
Dr. Mary Ann Abrams: And then, like all the other things we've been talking about, if it's really painful you can take an over-the-counter pain medicine. Make sure the skin stays cleans, sometimes cool. Well, soaks are cool. The cloth will help relieve that discomfort as well.
Dr. Alex Rakowsky: And just two caveats here, people like, "Why do I bring more at the beach?" It's because the sun will like to bounce the sunlight back.
Dr. Mary Ann Abrams: And the water.
Dr. Alex Rakowsky: And the water. So, you'll see more burns. And at least be especially careful if you're at the beach, if you go swimming because then all of a sudden, you have like a double risk, almost got double risk.
And then, try to avoid tanning oils. They seem to be a popular thing because they smell nice and you look at the picture and the teens thinking, "Well, I'm going to be looking like that." And they just burn your skin. We see that so often.
Dr. Mike Patrick: It's like a magnifying glass on your skin.
Dr. Alex Rakowsky: It is.
[Laughter]
0:59:04
Dr. Alex Rakowsky: So, they're going to go to the beach, put on tanning oil. You might as well be a piece of bacon in a frying pan. But just try to avoid the temptation.
Dr. Mary Ann Abrams: And you can get sunburn on a cloudy day. That's another important point. These ultraviolet rays come through the cloud. So just because it's a cloudy day, you should still wear the sunscreen.
Dr. Mike Patrick: All right, we're running short on time. We have two more topics to cover. And they are related in that they are caused by viruses. So, these are virus infections of the skin.
The first one, malloscum contagiosum, and unfortunately, I don't really have, that's the name for it. I don't think that there's a more common name.
Dr. Alex Rakowsky: They're like little warts that have… I'm not sure if people know the Pillsbury Doughboy, somebody like pushed him in the middle and they kind of like giggle and they have this little hole in the middle. So, it looks almost like a doughnut. It's like a wart that looks like a doughnut hole in the middle.
They're very common in kids. They tend to be smaller than the warts that Mary Ann is going to talk about. They can be almost anywhere on the body, and they are contagious. So, if you have one, you can easily scratch and spread it to other parts of your body.
1:00:12
The rule of thumb of malloscum is that it will clear with time. It can take up to nine months to a year to clear. If you want to get rid of it sooner, we actually try… I've had a patient with this a couple of days ago, one of the residents. We try Retin-A, which is a retinoic acid. It kind of irritates the skin a little bit. So now the body realizes there's something there. It helps clear it out.
And if it's really bad, really embarrassing, if you're a wrestler for example or a swimmer where you're not allowed to swim if you have some of these, you may have to go to the derm to kind of have something called cryotherapy, would actually freeze these things off.
The rule of thumb is again, they'll get better on their own. It's more common in smaller kids. Talk to one of us. We tried Retin-A for their first time and I haven't in a while. And we'll see what the response is. I tried in the past and seemed to work pretty well.
1:01:02
Dr. Mike Patrick: So, these are flesh-colored like a dome with a little…
Dr. Mary Ann Abrams: And they're small.
Dr. Mike Patrick: With a little dent in the middle.
Dr. Alex Rakowsky: Yeah, it looks literally like a doughnut sticking out that have a little hole in the middle. And sometimes it takes a lot to see the real hole, but if you have a good eyes, you can usually see it.
Dr. Mike Patrick: All right, well, compare that to regular warts, Mary Ann.
Dr. Mary Ann Abrams: So, you hear me kind of say, molluscum is they're usually pretty small. Like maybe about three to five millimeters. Five millimeters seems to be like that would be pretty big. But warts are usually bigger, although you can have little ones scattered around it, too.
So, warts are also caused by viruses. Common places are on the hands, sometimes on the bottom of the feet. And they're bigger, they sometimes almost look a little bit like cauliflower-y. I think it might be an example.
They can cause people be self-conscious, especially the bigger ones on their hands. So, people don't like to have them. But like the others, they will eventually often go away on their own. But that can be sped up with different kinds of treatment.
1:02:10
And some of that little irritation, just to kind of keep working it away helps. And that was sort of the duct tape phenomena which there's some evidence that maybe it actually works. So, if people want to give it a shot at home and you got a good kind of single one or two larger warts, the traditional duct tape, the silvery kind, seems to work better because it has a different kind of adhesive. It sticks on better and it's a little bit more irritating. You can have a piece of that and change it several times a week.
Dr. Mike Patrick: The MacGyver way of practicing pediatrics.
[Laughter]
Dr. Alex Rakowsky: But it works.
Dr. Mike Patrick: It does work.
Dr. Mary Ann Abrams: Yeah. And also, doing it yourself, you can get over-the-counter salicylic acid which has some aspirin in it as well as sulfur. And that can be applied frequently and kind of scrape it off a little bit before you put that on. We can do that also in the clinic system.
1:03:09
And then, there's also freezing it, the cryotherapy, what Alex mentioned or liquid nitrogen dry ice, that kind of things, which can be applied as well. But none of these does the job overnight. None of them is like single treatment, unless it's just a really teeny tiny wart, which you might not even know you have.
So, kind of count on it, even with an effective treatment that's working well, it's going to be several weeks.
Dr. Mike Patrick: And the virus that cause warts is the human papillomavirus or HPV. And so, folks may have heard of this in terms of its association with cervical cancer, some specific strains of human papillomavirus. So, I just want to put a plug in that HPV infections that can lead to cervical cancer are preventable with HPV vaccine that we would highly recommend.
There are some teenagers who hyperventilate and feel a little lightheaded and pass out after they get an immunization. But that doesn't mean that the immunization did something damaging to their brain, just sometimes, that happen. You've probably seen that in clinic, too. But one of the things on the internet, you'll find it causes brain damage and there's no evidence of that whatsoever.
1:04:19
Dr. Alex Rakowsky: And two caveats about warts, you could not get from frogs. You can't get warts from literally…
[Laughter]
Dr. Mary Ann Abrams: Or toad.
Dr. Alex Rakowsky: Or toad, yeah, there we go.
Dr. Mike Patrick: But they are contagious. In other words, as for example, wrestler aren't allowed to wrestle. Or they have to have to cover it up.
And the second thing is tell parents that there is some data for the duct tape. I remember a parent was quite upset with us in clinic because they waited like an hour and a half for us to see. It was really busy day. And it was like, "I was here an hour and a half and you're going to tell me to put a duct tape on my child's finger."
But there are some studies out there that have looked at it. And we do it all the time, do a little salicylic acid, a drop might get rid of it, and it seems to work. So why do something more aggressive when you can just do that?
Dr. Mike Patrick: And those wart pads I think have a similar adhesive in them. They also are medicated but the adhesive helps it work better.
1:05:13
Dr. Alex Rakowsky: It tells the body there's something there and then the body gets rid of it. And that's really the theory behind it.
Dr. Mike Patrick: All right, well, this has been a fantastic discussion on skin. As I mentioned, in August, we're going to have part two. And we have just as many things to cover then, things like impetigo, cellulitis, abscesses, ingrown toenails, lice, scabies, ringworm. Just there's a lot of things that…
Dr. Alex Rakowsky: All those fun stuff.
Dr. Mike Patrick: Yes. So, we're going to cover those items next time. Before we go, Alex, remind us about Primary Care Pediatrics at Nationwide Children's. I mean, you guys are like everywhere.
Dr. Alex Rakowsky: Yes, we're a large system. We have 14, soon-to-be 15, located areas. In other words, like a true true clinic, which covers around 14 times 60,000 unique patients. So, we have upwards of over a quarter million visits per year for those patients.
1:06:05
And we also have now 14 school-based clinics. Just got that data yesterday from one of our colleagues. And we have two mobile vans that kind of go around the area. So that's going to even expand further the number of children that we serve.
It's a nice system. We have a lot of teachings. So, we have six resident clinics. One of the six being a MedPeds clinic. We have four clinics that actually work with our medicine residents as well or nurse practitioner students. So, it's a lot to teaching in these clinics.
And I think when you go to clinics with trainees, you get very good care just because they're interested. They want to learn, and they get a lot of one-on-one attention from the trainees.
And then the non-training clinics tend to have very good physicians. So, we're busy. We have evening hours; we have Saturday hours. We're a busy lot.
Dr. Mike Patrick: Yeah, absolutely. And I'll put a link in the show notes to Primary Care Pediatrics at Nationwide Children so folks can find it easier.
1:07:02
There's a phone number if you're in Central Ohio and you want to get linked up with the clinic, 614-722-KIDS. And that's our physician referral line, and they'll fix you up with a Primary Care Clinic in your neighborhood because they're all over the place here in Central Ohio.
All right, well, once again, Dr. Mary Ann Abrams and Dr. Alex Rakowsky with Primary Care Pediatrics at Nationwide Children's Hospital, thank you both so much for stopping by.
Dr. Alex Rakowsky: Sure, thank you.
Dr. Mary Ann Abrams: Great to be here. Bye-bye.
[Music]
Dr. Mike Patrick: We are back with just enough time to say thanks to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
1:08:07
Also, thanks to our guests this week, Dr. Mary Ann Abrams, and Dr. Alex Rakowsky, both with Primary Care Pediatrics at Nationwide Children's Hospital.
Don't forget, you can find us wherever podcasts are found. We're in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android, including that new one, GoodPods. So be sure to check us out there.
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Also, don't forget about our sibling podcast, PediaCast CME. That stands for Continuing Medical Education. It's similar to this program. We turn the science up a couple notches. We don't always use plain language.
1:09:04
And we offer free Continuing Medical Education credit for those who listen. Of course, that includes doctors, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And since Nationwide Children's is jointly accredited by many professional organizations, it's likely we offer the exact credits you need to fulfill your state's Continuing Medical Education requirements. Of course, you want to be sure the content of the episode matches your scope of practice.
Shows and details are available at the landing site for that program, pediacastcme.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME.
Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.
[Music]
1:10:04
Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.
