We live with germs on our skin all the time. Don’t get grossed out, but there may be as many as 1 trillion germs of various species living with every human, every day, and yes, that includes your children. For the most part, these germs live quiet lives and never cause us a moment of concern. In fact, some are actually helpful by preventing dangerous germs from invading.
Without skin and its helpful germy inhabitants (such as after a large burn injury), overwhelming infections can make us very sick, very fast. Skin is a great defense, but occasionally, the germs that usually live with us get a little out of control.
Impetigo (pronounced with the emphasis on the third syllable, im-pe-TY-go) is a common skin infection in children age 2-6. It is usually found on the face, arms and legs and starts after a break in the skin from an insect bite, scrape or skin irritation like dermatitis or eczema. At first it looks like a blister with surrounding redness. Eventually an amber- or honey-colored crust forms where the blister was. It’s usually painless, but it may itch. Impetigo is highly contagious. It can move between people through touch, clothing or towels, or a child may spread it around on his or her own body. It spreads quickly through day care centers and preschools.
Treatment is with antibiotic creams or ointments, or antibiotics by mouth, depending on the exact circumstances of the infection. Current recommendations suggest that children with impetigo stay home from school or day care for 24 hours after antibiotics are started. Serious complications are rare.
Cellulitis is another common skin infection that is more painful and potentially more serious than impetigo. This is a spreading infection that causes a firm, painful, red, swollen and warm area. Some children will develop a fever. Just like with impetigo, bacteria enters the skin through a puncture, scrape or cut, but very small breaks in the skin from dryness or irritation are enough to allow infection. Sometimes it’s hard to figure out the entry point.
Cellulitis can spread rapidly with the red area growing in size. Sometimes there are red streaks running through the skin away from the infection. As the body drains the area, you may notice swollen lymph nodes in the area. These are small, firm and pea-shaped and they can be felt through the skin.
If you think your child has cellulitis, be sure to see your doctor. Most patients are treated with oral antibiotics and recover completely, but cellulitis can be serious so it’s best to have your child checked out if you have any concerns.
Candida (CAN-di-duh) is a yeast fungus that lives naturally inside of humans from the mouth to the anus. It prefers warm, moist places. Usually Candida growth is in balance with our bodies, and we live comfortably without knowing about its existence. But when the body’s natural balance is disturbed, for example, by antibiotics or excessive sweating, Candida can grow, spread and cause infection.
When Candida overgrowth occurs in the mouth, it is called thrush. This is often seen in babies and looks like white, velvety areas on the inside of the cheeks and on the tongue. Candida overgrowth in the diaper area causes diaper rash that is beefy red and tender. It can be very uncomfortable for a baby. Candida infections are treated with anti-fungal medications applied directly to the infected area. With proper treatment they heal quickly.
If your child is a nail biter, this is one infection you’ll want to know about. Acute paronychia (per-a-nee-kee-ya) is an infection around the nail bed that is red, warm and very painful. Paronychia can also happen after a hang nail or ingrown nail, or in children who suck their fingers. Sometimes pus develops that separates the skin from the nail. You may feel lymph nodes around the elbow or armpits as the area drains.
Warm soaks three to four times a day can help the area drain, which will relieve some of the pain. Once pus drains from the area, the infection may go away on its own, but sometimes antibiotics by mouth are needed. Ointments on the skin usually don’t help. Rarely, a portion of the nail may need to be removed.
Dr. Lisa Thornton, a mother of three, is director of pediatric rehabilitation at Schwab Rehabilitation Hospital and LaRabida Children’s Hospital. She also is assistant professor of pediatrics at the University of Chicago. E-mail her at firstname.lastname@example.org