Skin Disorders, Including Pyoderma, Scabies, and Tinea Infections

Common childhood skin disorders

The 3 most common childhood skin disorders are pyoderma, scabies, and tinea. Pyoderma, also commonly called skin sores, is a generic term used to describe a clinical diagnosis of superficial bacterial skin infection, including impetigo, impetigo contagiosa, ecthyma, folliculitis, Bockhart impetigo, furuncle, carbuncle, tropical ulcer, and so forth.³ There are several other diseases that have specific skin features or occasional or accessory skin features (eg, measles, chickenpox, dengue fever

Pyoderma

Pyoderma (Fig. 2) usually manifests as a thick crusted variety or a bullous type.² The skin lesions are contagious but usually heal completely without scarring.¹⁶ Although pyoderma can be caused by group A Streptococcus pyogenes (GAS) and S aureus, boils, furuncles, and carbuncles are usually caused by S aureus infections.

In the United States, S aureus tends to be the predominant causative organism for pyoderma,¹⁷ whereas GAS has predominated in Australian Indigenous populations until recently.

Scabies

Scabies (Fig. 3) is an infestation of the skin by the scabies mite Sarcoptes scabiei. Damage caused through penetration of the skin by the mite, or the host reaction, or damage from scratching, results in visible papules, vesicles, or tiny linear burrows (these contain the mites and their eggs).²⁹ Adult Sarcoptes mites are 0.4 mm long or less; they cannot fly or jump but can crawl on warm skin. Burrows are typically located on the interdigital spaces of the hand, the flexure surface of the

Dermatophytic infection (tinea)

Tinea (Fig. 4) is a fungal infection caused by the dermatophytic fungi, mainly anthropophilic species, such as Trichophyton rubrum, T tonsurans, and T violaceum. In addition, infection can be acquired by contact with dogs and cats (eg, Microsporum spp). A diagnosis of fungal skin infection is most often made on clinical appearance of the skin rash, especially if there is associated nail disease,² but more specific diagnoses are problematic on clinical grounds alone (Table 3).

Definitive

Management of common skin conditions

A practical algorithm for management of common childhood skin conditions has been developed by Steer and colleagues³¹ from work conducted in Fiji. The algorithm was designed to assist nurses and health workers in the clinical diagnosis of common childhood skin conditions and indications for treatment referral, using an Integrated Management of Childhood Illness (IMCI) strategy.³⁴ The first component of the algorithm involved the initial assessment by IMCI-trained nurses (Fig. 5), which was then

Treatment of scabies

Topical permethrin cream is the first-line treatment of choice, except for a few special circumstances,⁴⁵ whereas oral ivermectin is a potentially suitable option in other circumstances (see Table 5). Although clinical scabies can be managed by the implementation of individual treatment with topical permethrin cream in conjunction with appropriate infection control strategies, a broader approach to identify and treat other family or community members is generally appropriate. Indeed, in most

Treatment of tinea

Oral terbinafine results in more rapid mycological cure when compared with oral griseofulvin and, where it is affordable, it has become the treatment of choice for extensive tinea corporis and nail disease (see Table 5). Topical therapy can still be used for localized tinea.

A systematic review of topical treatments for fungal infections of the skin and nails concluded that topical allylamines, such as terbinafine, cure a few more infections than azoles, such as clotrimazole and miconazole.⁵⁸

Summary

Pyoderma, scabies, and tinea affect children globally but are especially common in situations of socioeconomic disadvantage that result in overcrowding and poor access to health care and health hardware for hygiene. In such circumstances, these infections are often under-recognized and certainly undertreated, and the potential morbidity and mortality from their sequelae are underappreciated. There are effective therapies for each of them, but recurrent infections are inevitable without