Skin problems in children: symptoms, causes & treatment

Skin problems in children include a wide range of conditions that can affect the skin of babies, toddlers, and older children. Children's skin is different from adult skin: it is thinner, more sensitive and responds differently to stimuli. As a result, skin disorders in children can have a different appearance and sometimes require a different approach.

Children's skin is more vulnerable to dehydration, irritation, and infections. The protective barrier function of the skin is still developing, especially in young babies. This makes them more sensitive to external stimuli such as friction, humidity, chemicals in detergents or care products, and microorganisms such as bacteria, viruses and fungi.

Skin problems in children can have various causes. Some are hereditary, such as atopic eczema, which often occurs in families with allergy problems. Others are caused by contact with irritants, such as diaper eczema or contact eczema due to certain substances in clothing. Infections caused by bacteria, viruses, fungi or parasites are another major group. Hormone changes can also play a role, such as acne during puberty. Fortunately, the most common skin problems are usually mild and temporary, such as atopic eczema, diaper eczema, warts, impetigo and various viral rashes.

In the event of a skin problem, it is important to not only look at the skin itself, but also at the context. Does your child have a fever? Is the child sick? Are there other children in the area with similar symptoms? These factors help to determine the cause. Also, check the entire skin: not only look at the conspicuous areas, but also inspect the palms, soles, scalp, nails, and the inside of the mouth

The development of skin problems in children depends heavily on the underlying cause. Atopic eczema has a strong hereditary component and often occurs in combination with other atopic disorders such as asthma or hay fever. In atopic eczema, the skin barrier is disturbed, so that moisture evaporates easily and the skin becomes dry. At the same time, stimuli and allergens can enter more easily, triggering inflammatory reactions.

Irritant contact eczema occurs due to direct damage to the skin by irritants. In babies, diaper eczema is the most common form, caused by prolonged contact with urine and faeces in a wet diaper. The moist, warm environment makes the skin soft and vulnerable, while friction from the diaper adds extra damage. Around the mouth, contact eczema is common due to saliva, food debris, and frequent wiping. Eczema on the hands can occur due to frequent washing, especially in combination with soap.

Infectious skin problems develop when microorganisms invade the skin. Impetigo, caused by bacteria, often occurs around small wounds or irritated skin and causes characteristic yellow scabs. It is highly contagious and spreads easily through crabs. Viral rashes occur when viruses circulate in the body and the immune system responds to them, leading to inflammatory reactions in tiny blood vessels. This appears as red spots and bumps that spread across the body. In chickenpox, the virus produces blisters filled with virus particles, which later dry in and form scabs.

Fungal infections thrive in warm, humid environments. Babies with diaper eczema often have an additional yeast infection because the moist diaper area is ideal for mold growth. Ringworm is a fungal infection that causes typical ring-shaped lesions with a red, scaly border. Parasites such as scabies mites and lice cause itching due to their presence. Scabies mites dig tunnels in the skin to lay eggs, especially between fingers and in skin folds, causing intense itching, especially at night. Lice live on the scalp and cause itching from their bites.

Allergic reactions may be acute or chronic. Acute allergic reactions occur soon after exposure to the allergen, where the immune system switches to an exaggerated immune response. This leads to sudden rash, swelling, and sometimes hives. Chronic allergic reactions develop more gradually after repeated exposure.

Symptoms vary widely depending on the specific disorder, but there are general patterns that help with recognition.

Atopic eczema appears as red, dry patches that can be intensely itchy. In babies, the spots are mainly seen on the face, scalp, neck and wrists. As children get older, injuries shift to elbow and knee creases. The skin feels rough and may flake. Scratching causes scratches and can thicken the skin. Diaper eczema shows up as redness in the diaper area, especially on the buttocks, genitals and groin. The skin is inflamed and may be sore. In the case of an additional fungal infection, the folds themselves are also affected, with bright red spots and small bumps.

Impetigo starts as small red bumps that quickly turn into blisters. These burst open and leave yellow, honey-colored scabs, especially around the mouth and nose. The lesions can be itchy, which encourages the spread by scratching. Viral rashes in childhood diseases usually present as scattered red spots with bumps that are symmetrically distributed across the body. The rash often starts on the torso and spreads to the arms and legs. In chickenpox, characteristic vesicles filled with clear liquid develop, which later become cloudy and dry into crusts.

Scabies causes intense itching, especially at night. In young children, you mainly see blisters on the palms and soles. In older children, the characteristic corridors are visible between the fingers, on wrists, or in other skin folds. Lice manifest themselves with itching on the back of the head and neck. When inspecting the scalp, you may see the lice themselves, but more often you will see the nits, small white eggs that are firmly attached to the hair close to the scalp.

Warts are raised, rough bumps that are usually on fingers or feet. Plantar warts on the soles of the feet are flat due to the pressure of walking and can be painful. Molluscum contagiosum, or pearl warts, are small white or skin-colored balls with a characteristic dimple in the middle. They do not cause symptoms but are contagious. Ringworm appears as round, red spots with a raised, scaly edge. The center heals gradually, creating the ring-shaped pattern. On the scalp, ringworm may be associated with hair loss in the affected area.

Hives present as sudden, itchy bumps that can coalesce into large red areas. The bumps can change location within hours and are often accompanied by swelling, especially around the eyes and lips.

The location of skin problems provides important clues about the possible cause. The face is frequently affected, with babies with atopic eczema often having their cheeks red and dry, and impetigo typically appearing around the mouth and nose. Seborrheic eczema occurs on the scalp, forehead, and around the ears as yellow, oily flakes. The scalp is important for detecting ringworm with bald spots and lice that are mainly active in the back and neck.

The torso is often involved in rashes from viral infections, usually distributed symmetrically across the chest and back. Molluscum contagiosum often appears on the torso, arms, and legs, while hives can occur anywhere but are often prominent on the torso. The limbs have different characteristic locations: atopic eczema in older children is concentrated in elbow and knee folds, warts are frequent on fingers and hands, and plantar warts affect the soles of the feet. Scabies shows blisters on the palms and soles, with corridors between the fingers.

The diaper area is specific to babies and toddlers. Diaper eczema affects the buttocks, genitals and groin, but typically spares the skin folds themselves. In the case of fungal infection, it is precisely the folds that are affected, which helps to distinguish between the two disorders.

The treatment of skin problems in children always focuses on the specific cause, but there are general principles that apply to many disorders.

For atopic eczema, the basis is intensive skin care. Use mild, fragrance-free laundry products and avoid long, hot baths. Gently pat the skin dry instead of rubbing. Apply soothing cream or ointment to dry skin several times a day. In the case of active eczema spots, the doctor may prescribe a mild anti-inflammatory cream. Avoid familiar triggers such as certain foods, pets, or irritants.

You can prevent diaper eczema by changing diapers frequently, ideally every two to three hours and immediately after a bowel movement. Wash the diaper area gently with lukewarm water and pat dry thoroughly. Protective zinc ointment forms a barrier against moisture and irritation. In case of a yeast infection, the doctor prescribes an antifungal cream that you should use for a few weeks.

Impetigo requires antibiotic treatment. An antibiotic cream is sufficient for minor injuries, but in case of more extensive impetigo or if your child is ill, antibiotics in drink or tablet form are necessary. The injuries are contagious up to 24 hours after the start of treatment, so keep your child home from school or daycare. Prevent spread with good hand hygiene and separate towels.

Viral rash in childhood diseases usually does not require specific treatment. The rash heals on its own when the infection is over. Ensure comfort: cool bathing can relieve itching, make sure you get plenty of fluids and rest. In case of fever, you can give antipyretics. Watch for signs of complications such as high persistent fever, vomiting, severe headache, or drowsiness.

You treat scabies with specific scabies mite remedies. Apply this cream to the entire body from neck to toes and let it work for a certain amount of time before rinsing it off. Treat all family members at the same time, even if they have no symptoms. Wash all clothes, linens and towels at a high temperature. Treat lice with lice shampoo or lotion. Follow the instructions carefully and repeat the treatment after seven to ten days to kill newly hatched lice. Comb the hair thoroughly with a fine lice comb to remove nits.

Warts often disappear spontaneously after months to years. If you want to treat, freeze treatments or special fluids are available. Patience is important because treatment takes time. Molluscum contagiosum also usually disappears on its own within one to two years without treatment. In case of annoying injuries, the doctor can remove them. You treat ringworm with antifungal cream for a few weeks. In case of extensive ringworm or scalp involvement, antifungal drugs in tablet form are necessary.

Hives are treated with antihistamines to reduce itching and swelling. Try to identify and avoid the trigger. In case of severe reactions with throat swelling or breathing problems, you should seek medical attention immediately.

There are several misconceptions and ineffective approaches to skin problems in children. Excessive washing and scrubbing of the skin does not help and often makes it worse. In eczema, too much washing disrupts the already fragile skin barrier. Always use mild, fragrance-free products and limit bathing to a maximum of three times a week, briefly and in lukewarm water.

The idea that skin should “breathe” and therefore does not need a cream is wrong for dry skin and eczema. Intensively applying emollient cream helps to restore the skin barrier. Don't be sparing with cream; use generous amounts. Home remedies with no proven effectiveness, such as certain oils, vinegars, or other products, can cause irritation without helping. Stick to medically proven treatments.

Ignoring infections in the hope that they will go away on their own is not wise in the case of bacterial infections such as impetigo. Untreated impetigo can spread and infect other children. The idea that lice are a sign of poor hygiene is completely false. Lice do not prefer dirty or clean hair; they can affect anyone. Shame should not stand in the way of treatment.

Self-medication with strong anti-inflammatory creams without medical advice is risky, especially in children. These creams come in various strengths and improper use can damage children's thin skin. Use only as prescribed and instructed.

When should I take my child to the doctor?

Consult a doctor if the rash is accompanied by a fever and your child looks ill, if there are blue or purple spots that don't press away, if the skin problems don't respond to home care after a few days, or if there are signs of infection such as increasing redness, swelling, pus, or red stripes. Trust your parental instincts; you know your child best.

Are skin problems in children contagious?

That depends on the cause. Infections such as impetigo, ringworm, scabies, lice, chickenpox and other viral diseases are contagious. Eczema, allergic reactions, and non-infectious conditions are not contagious. If in doubt whether your child can go to school or daycare, consult with the doctor.

Can I prevent my child's skin problems?

Some skin problems are difficult to prevent, such as atopic eczema with an inherited component. But you can reduce the risk of other problems. Good hygiene helps prevent infections. Frequent diaper replacement prevents diaper eczema. Gentle, fragrance-free care products reduce the risk of irritation.

Do children grow from eczema?

Many children with atopic eczema see their symptoms decrease as they get older. About half of the eczema disappeared by school age, and in even more children around puberty. However, some people suffer all their lives, although often in milder forms. Good skin care and avoiding triggers help to minimize complaints.

Is duct tape effective against warts?

There is limited scientific evidence of the effectiveness of duct tape against warts, but some parents report success. The theory is that covering the wart irritates the skin and activates the immune system. It's a safe method to try: stick a piece of duct tape to the wart, replace it every few days, and lightly sand the wart. It does take patience, weeks to months.

Does my child with a skin problem have to stay home from school?

This depends on the condition. For infectious infections such as impetigo in the first 24 hours of antibiotic treatment, scabies until after treatment, lice until the first treatment is done, and some viral diseases, your child should stay home. In case of non-contagious conditions such as eczema or allergic reactions, your child can simply go to school.

1. Skindr dermatologists
2. Gezondheidenwetenschap.be - Skin problems in children
3. EBPNet - Evidence-Based Practice Network