COMMON SKIN INFETIONS IN
CHILDREN
DR.JOEL KIMERA (MBChB(MUST),MMED(MUK)
10th May 2021
Lecture lay out
Bacterial skin infections
Fungal skin infections
Viral skin infections
Parasitic/ arthropod bites and infestations
Bacterial skin infections
IMPETIGO
It’s the most common skin infection in children
Classified into Bullous and Non bullous impetigo
Caused by S.aureus and Strep (GABHS)
Spreads from nose to normal skin
Non bullous Impetigo
Accounts for > 70% of cases
Begins from traumatized face or extremities
Can follow insect bites, abrasions, chicken pox,
scabies and pediculosis and burns
Can take form of vesicles, pustules or crusted plaques
May involve pruritus with or without regional
lymphadenopathy
Bullous Impetigo
This occurs in infants in infants and young children
Flaccid transparent bullae on face buttocks, trunks,
perineum and extremities
Can start from diaper area in neonates
With regional lymphadenopathy and surrounding
erythema
Note: This form develops on intact skin and is localized
as opposed to non bullous impetigo
Differential Diagnoses of Impetigo
neonates
Epidermolysis bullosa
Bullous mastocytosis
Herpetic infections
Early SSSS
Older children
Burns, erythema multiforme, pemphigous, bullous
pemphigoid and Linea IgA dermatitis
Complications of Bullous Impetigo
Pneumonia
Septicaemia
Osteomyelitis
Cellulitis especially following Non bullous Impetigo
Scarlet fever
APSGN for nephritogenic GABHS;
Note : Acute Rheumatic Fever doesn’t occur as a result
of Impetigo
Treatment
Depends on extent of lesions
Topical mupirocin 2%, fusidic acid
Systemic treatment for wide spread involvement and
for deep involvement e.g in cellulitis, furunculosis,
abscess, or suppurative lymphadenitis
Cephalexin
Do swab and culture for MRSA
cellulitis
A non necrotizing inflammatory infectious process of
subcutaneous tissue
Limited involvement of the dermis with relative sparing
of the epidermis
Can follow breaks in the skin due to previous trauma,
surgery
Common in underlying immunosuppression
Can be caused by Strep pyogenes, S.aureus
Consider fungal, P.aerugunosa, Cryptococcus
neoformans, Legionella and Enterobacteriaceae in
immunocompromised
Clinical features
• Oedema,
warmth,erythema
and tenderness
• Pitting edema
• Fever, chills and
malaise are
uncommon
• Staph cellulitis is
normally localized,
may suppurate
Complications of cellulitis
Sub cutaneous abscess
Bacteraemia
Osteomyelitis
Endocarditis, thrombophlebitis
Necrotising fascitis
Lymphangitis
Glomerulonephritis
Treatment
Depends on extent and character of infection
Vancomycin and aminoglycoside or cephalosporin in neonates
Consider L.P in children < 1year and those with systemic signs
Cephalexin, Clindamycin for MRSA
Immobilization and elevation of affected limb
Necrotising Fascitis
This involves deep layers of superficial fascia sparing largely
adajacent epidermidis, deep fascia and muscle
Has polymicrobial cause with more than 4 organisms e.g Staph,
Strep, Klebsiella, E.coli and anaerobes
Strep pyogenes is associated with most fulminant type
Crepitance points to Clostridium spp or gram negative organisms
Clinical Features
Can occur any where
Polymicrobial in trunk and perineal areas
Can occur in immunocompromised
Can follow Varicella lesions, omphalitis and
circumcision
Can present as Compartment Syndrome
Diagnosis
Made on surgical exploration
Necrotic fascia and subcutaneous tissue are gray and
offer little resistance to blunt probing
MRI is vital
Treatment
Supportive care
Surgical debridement
Parenteral antibiotics
Repeat exploration in 24-36 hours
Vancomycin, Linezolid for Gram negatives and
quinolones for gram negatives
Case fatality rate is approximately 60% for Strep
pyogenes but death is less common in children
Folliculitis
Its one of the Erysipelas
Its superficial infection of the hair follicle
Caused by S.aureus
Small discrete dome shaped pustules with
erythematous base
Impairment of hair growth
Occur mostly on scalp, buttocks, and extremities
Risk Factors and Differential
diagnoses
Poor hygiene
Drainage of wounds
Post shaving
Ddx
-Candida
Melassezia furfur
Furuncles and Carbuncles
Caused by S.aureus
Can occur in hair bearing areas of face, neck, axillae,
buttocks and groin
Lesions on upper lip or cheek can lead to Carvenous
Sinus Thrombosis
Risk factors are low serum iron levels, DM,
malnutrition, and HIV infection
Carbuncle
Defined as infection of a group of contiguous follicles
with multiple drainage points, accompanied by
inflammatory changes in the surrounding tissue
Treatment
Regular bathing with antimicrobial soaps
Wearing loose fitting clothing
Hot moist compression
Systemic antibiotics
Cutaneous Fungal Infection
Tinea Versicolor
Also called Pytriasis Versicolor
Caused by Melassezia gilobosa/Pityrosporum
ovale/orbiculare
Clinical features
Reddish brown lesions, hypo/hyperpigmented macules
covered with a fine scale
Lesions may coalesce with or without ensuing pruritis
Diagnosis, differentials and treatment
KOH preparation is diagnostic, Skin bx and culture
with PAS
Differentials include Dermatophyte infections,
Seborrheic dermatitis, Pytriasis alba, secondary
syphilis
Treatment involves topical Selenium sulfide,
Imidazole/Terbinafine, Ketoconazole/fluconazole and
Itraconazole
Dermatophytes
These are caused by Tricophyton, Microsporum and
Epidermophyton
Tricophyton spp cause lesions of all keratinized tissue
e.g nails, hairs and skin
Dermatophyte infections are designated by the word
Tinea followed by the Latin word for the anatomic site
Tinea Capitis (Ringworm)
Occurs on scalp
Caused by Tricophyton tonsurans mostly
Can cause alopecia
Diagnosed with woodlamp exam, KOH and culture
Treatment involves Oral Griseofulvin for 8-12 weeks,
oral Itraconazole, Terbinafine (has ltd activity against
Microsporum canis)
Carriers in the family may be treated with Topical
Ketoconazole shampoo
Tinea Corporis
Caused by Tinea rubrum and T.metagrophytes
Presents as a dry, mildly erythematous, elevated scaly
papule/plaque with centrifugal spread and clears
centrally to form a x-tic annular lesion responsible for
designation of ringworm
Differentials: Granuloma annulare, nummular eczema,
pytriasi rosea, S.dermatitis, errthema chronicum
migrans and Tinea versicolor
Treatment involves Terbinafine, Imidazole, Griseofulvin
and Itraconazole
Other Tinea forms
Tinea pedis (atheletes foot)
Tinea Unguium/ Onychomycosis for nails. Treated with
Terbinafine not Griseofulvin
Tinea nigra palmaris
Candida infections or Candidosis
Oral Candidiasis; treated with nystatin oral
suspension, miconazole suspension/paint, oral
ketoconazole
Vaginal candidiasis: not uncommon in adolescent
girls, caused by C.albicans which is a normal flora in
5-10% of women. Risk factors are antibiotic therapy,
steroid therapy, DM, pregnancy and use of oral
contraceptives
Vaginal candidiasis
Cheesy white plaques on an erythematous vaginal
mucosa and a thick white yellow discharge, sever
itching and burning in the vaginal area
Diagnosis is by microscopy and culture
Treatment is with Nystatin pessaries, Imidazole
vaginal suppositories, creams and a start dose of
150mg oral Fluconazole
Candida Diaper Dermatitis
This is an ubiquitous problem in infants and although
relatively benign it is often frustrating because of its
tendency to recur
Predisposed infants carry C.albicans in their intestinal
tract and the warm, moist occluded skin of the diaper
area provides an optimal environment for its growth
Can follow S.dermatitis, atopic primary contact
dermatitis and or profuse waterly diarrhoea
Treatment
Imidazole cream
Combine Steroid and antifungal cream
Zinc oxide protection after applying anticandidal
preparation
With recurrent forms, a short course of oral
anticandidal therapy to reduce yeast population in the
gi tract
Other forms of Candidiasis
Intertriginous
Perianal and Candidal paronychia
Cutaneous Viral Infections
Molluscum Contagiosum
A discrete pearly skin colored smooth dome shaped
macule varying in size from 1-5mm
Has a central umbilication from which a plug of
cheesy material can be expressed
Mostly occur on the face, eyelid, neck, axillae, thigh or
on genitals in the groin of adolescents. Can be
associated with other STIs in sexually active
individuals
Treatment of Molluscum
Its self limiting (6-9mo) but can persist for years
High risk of inter and intra transmission
Don’t share baths, towels, clothes with infected person
Curettage is treatment of choice
Cantharidin application with adhesive banadages
On the face molluscum is upsetting to the children and
parents
Imiquimod topically applied is beneficial
Herpes Simplex Virus / HSV
Can present in the oral cavity or on the skin
Can follow immune suppression events in young children
Lesions in the mouth are very painful, with
erythematous patches on the tongue, gingivae
resembling scurvy lesions, surrounded by edema
Sometimes lesions can occur on the skin in older
children and can spread by contact to others with or
without pruritus occurring any where including genitals
Oral lesions will respond to oral acyclovir with lignocaine
topically applied
Cutaneous lesions will require systemic aciclovir
Arthropod Bites and Infestations
Bedbug bites
Purpura urticuria following fleas, mites, bedbugs, gnats,
mosquitoes, lice. Occurs mainly in first decade of life
Treatment includes antihistamine orals, cool
compressions, topical steroids
Avoid topical antihistamines
A short course of systemic steroids
Insect repellants like DEET (Diethyltoluamide)
Permethrin impregnated clothing
Identify and eradicate etiologic agent
Scabies
Caused by burrowing and release of toxic antigenic
substances by the female mite Sarcoptes scabiei
vr.hominis
Characterised by intense pruritus worse at night, red
papules, crusted, excoriating or scaling thread like
burrows, bullae and pustules in infants, wheals, papules
and vesicles and a superimposed eczematous
dermatitis
Palms, soles and scalp are often affected
Interdigital spaces, wrist flexors, anterior axillary folds,
buttocks, groin, genitals, areola in women and beltline
in adolescents and adults
Treatment
Permethrin 5% cream apply to the entire body from
neck down for 1 week focusing on intensely involved
area
Benzylbenzoate ointment 50%; avoid mucous
membranes
Lindane 1% lotion / cream
Oral Ivermectin
Topical corticosteroid for pruritus
Oral antibiotics for more spread lesions
Follow up patient for nodules and treat entire family
Complications
Eczematous dermatitis
Impetigo
Folliculitis, Furunculosis, cellulitis, GN from
Streptococcal impetiginization of scabies
Pyoderma
ecthyma
Other forms of scabies
Norwegian scabies; common in immunosuppressed,
mentally handicapped
Canine scabies from S.scabiei var.canis from dog
exposure
Avian scabies
Pediculosis
Caused by lice
Other parasitic infestations
Tunga Penetrans/gigger
Myasis/Codolobia arthropophaga
