Common Skin Diseases Of Childhood
( Originally Published 1927 )
The desire to allay the fear and undue alarm of parents has prompted the author to write this chapter. The normal changes in the skin of the infant will first be discussed, followed by a brief recital of commonly met diseased conditions.
Before birth, the infant floats in the so-called "bag of waters." Nature has purposely provided this habitation, for while the infant resides there, danger of any physical injury is greatly lessened as it is a physical law that watery solutions break the force of blows or other forms of injury. The constant immersion of the body in this watery medium would prove harmful to the skin, as well as to some of the deeper structures, were it not that Nature has provided an oily covering for the outside body surface. Covered with this whitish, greasy substance, the infant's body emerges into the outside world. When this lubricating material is removed, the infant's skin is of a deep purplish color be-cause the mechanism for the purification of the blood has not been definitely established. As soon as this function is perfected, the color of the skin turns to a bright red. This change appears first on the face, then on the trunk and finally over the rest of the body. This bright red color fades slowly during the first month and the skin takes on a pale pink color which it retains during infancy. Between the third and fourth day after birth, the color of the baby's skin may turn yellow. This change should not cause alarm for it usually disappears in about ten days or two weeks.
In addition to those changes in the infant's skin which principally concern the establishment of the normal color, there are others of greater and more vital importance. It is Nature's desire to start the infant in life without any handicaps. She, there-fore, sees to it that a new skin surface is provided and this is done by a barely perceptible peeling of the old skin. In the normal baby, this change be-gins about the fourth or fifth day after birth and is usually completed in about ten days or two weeks. However, there are certain exceptions. When the infant is weak and delicate, the peeling of the skin may be quite marked. Shedding of the skin which begins two or three weeks after birth usually means a disease.
The healthy infant rarely sweats before the end of the fourth month and then only on the forehead. Marked sweating during the first year of life is a sign of disease, especially rickets.
SKIN DISEASES OF INFANCY
Having considered those changes in the skin which may take place in healthy infant at and shortly after birth, let us turn our attention to those diseased conditions which may attack the baby and in which heredity plays a greater or lesser role. Fortunately, these afflictions are comparatively few in number and seldom seen.
"Fishskin" Disease.—Description.—Probably the most common disease of this group is the so-called "fishskin" disease (technically termed ichthyosis). This condition is the result of the failure of the oil and sweat glands to pour out their oily and watery lubricating substances. As a result, the skin becomes dry, loses its natural elastic character, becomes thickened and resembles a piece of dried-out leather. In addition, scales finally make their appearance on the skin surface. These are dry, thin or thick, small or large, and resemble fish scales. The skin situated over joints where frequent movement is necessary feels greatly this loss of elasticity and finally the skin gives way, splitting and cracking as a result. The above description holds good for the milder forms of this disease which are fairly common and appear, as a rule, shortly after birth.
While the appearance of the skin often causes considerable worry to the parents, the patient usually experiences little or no itching or discomfort, and the general health does not suffer. This disease may spread practically over the entire body or may be seen only on the outside surface of the limbs. The seriousness of this condition lies in the ease with which such a skin may suffer from eczema (tetter) and other skin conditions, as a result of apparently trivial irritations. "Fishskin" disease is always worse in the winter and milder in the summer. Indeed, mild cases may disappear entirely during the warm weather.
Cause.—Unfortunately, the exact cause of this condition is unknown, but it is suspected to be the result of faulty action of certain glands. It is possible for this defect to be passed along from one generation to another.
Suggestions for Treatment.—The management of this disease requires the services of a specialist. However, there are a few measures which may be employed by the patient with benefit. Neither soap nor ordinary water should be used for bathing, but a warm bath with bran or starch followed by the application of an oil such as cocoa butter, olive oil, oil of sweet almonds, or vaseline, is often helpful. It is the writer's belief that exposure of such a skin to the sun's rays for a short time is very advantageous.
"Parchment-Skin" Disease (Xeroderma pigmentosum).—Description.—Sunlight is ordinarily a most valuable tonic and everybody recognizes the benefit of sun baths in health and in disease. However, there are certain individuals, particularly children, who suffer from a peculiar inherited weakness whereby exposure to the sun's rays causes not only harm, but even serious disease. To this peculiar affliction the name "parchment-skin" disease has been applied.
This disease first appears during the summer months in a most innocent fashion. The child, one year old or more, after being exposed to the sun's rays, usually develops a sort of sunburn with marked redness, slight swelling, and some roughness of the skin. This condition persists during the summer months, disappearing almost entirely during the winter. However, with the oncoming summer, the same condition returns. The irritating rays of the sun continue to damage the skin so that when the child reaches the age of three or four, freckle-like spots, scaliness, and flat warts appear. The freckles represent Nature's effort to stop the harmful rays from entering the depths by inter-posing a sort of screen, and the warts and scaliness indicate that the effort has been met with defeat and that a diseased condition has begun in the deeper parts of the skin. The fact that the sun's rays are harmful is further emphasized by a reddening of the eyes when in sunlight and by a some-what blurred vision. Finally, cancerous growths develop on various parts of the skin surface and death results, very often, before the fourteenth year. The above described changes are most apt to be seen on the scalp, face, and arms. This is a very rare disease.
Suggestions for Treatment. — Unfortunately, treatment is of little benefit in most cases. Keeping the child indoors in a room equipped with colored glass, to filter out certain of the sun's rays, may be tried. When the cancers develop, they are to be removed by a surgeon.
Epidermolysis bullosa hereditaria.—Description.—Another very rare skin disease in which heredity plays a part is known technically as epidermolysis bullosa hereditaria. It usually begins in infancy or early childhood, is not fatal as a rule, but persists throughout life. In some in-stances, this affection has passed on through several generations.
The first unusual feature is the appearance of blisters from such slight injuries as may be caused by the pressure of a shoe, weight of the elbow on the table, grasping of an object firmly, etc. These blisters are of different size and usually heal with a certain amount of thinning of the skin. Science has not discovered any remedy which can correct this condition.
Syphilis.—Finally, mention must be made of the various ways in which syphilis may affect an infant. Syphilis is a transmissible disease, that is, the germs which cause this affliction may be car-. ried by the blood of the mother to the infant. In some cases the infant dies before birth, indeed, many medical men regard syphilis as the most common cause of persistent miscarriages. When the syphilis-infected infant is born alive, the signs of this disease may or may not be present. Indeed, they may not appear for about four months after-wards. Between the time of birth and the fourth month of life, the skin of such infants may show copper-colored spots, flat and covered by a wrinkled skin, or small elevations of copper color, particularly in areas where the skin surfaces rub. Probably the most common eruption is one composed of blisters principally seen on the palms and soles. 'When these blisters break, they leave a raw, ulcer-like surface. In addition to these skin changes, the infant looks like a little old man with an emaciated face, suffers from a constant cold, and shows splits at the corners of the mouth. The bones of the skull, particularly at the front and sides of the head, stand out as swellings, and the hair is scanty especially over the temples. The infant may escape all these changes and the syphilitic infection may not become apparent until the age of six years or thereabouts. At this time, the changes include eye troubles, ear troubles, and changes in the second or permanent set of teeth. The syphilis-affected teeth are most strikingly seen in the middle upper incisors. They appear shaped like pegs, with the cutting edge smaller and hollowed out, and with spaces between the teeth wider than normal. The growing child may even escape these manifestations of syphilis and no abnormalities may present themselves until early manhood.
Suggestions for Treatment.—The most expert medical care is the only sure way of combating this affliction.
Birthmarks. — Description. — Birthmarks are either present at birth or appear during the first months of life. They are not of a serious nature, but are most disfiguring and annoying especially when on the face. No one knows just why these occur, but it is known that they are due to an in-crease either in the number or in the size of the blood vessels of the skin.
Some birthmarks are flat, of deep red or purplish color and of the size of a palm or larger. Their surface may be smooth or a number of growths may be superimposed. Crying or other actions requiring an effort, always make the redness temporarily worse. This particular form of birthmark is known as "port-wine stain." Other forms of birthmarks appear as raised growths, separated from the normal skin. They have a purplish color and either a smooth or wartlike surface. It is possible to feel the pulse beat by placing the hand on them.
Suggestions for Treatment.—Proper treatment of birthmarks requires the services of a skin specialist.
Moles with Excessive Coloring Matter
(Pigmentary Moles).—Moles with excessive coloring matter may appear at birth, shortly after-wards, or after a lapse of many years. Hairy moles are apt to appear in infancy, while the non-hairy variety is usually seen during youth.
Suggestions for Treatment.—The skin specialist is best capable of handling this condition with success.
Attention will now be given to a description of the more common skin conditions of infancy and childhood, in which heredity plays no role.
Prickly Heat (Miliaria). — Description.
This condition is very common during the summer. It either results from a swelling of part of the sweat gland or from an inflammation in its immediate vicinity. As a result, either pearly blisters appear on the skin surface, or small, reddish, solid elevations, many of which are topped by tiny blisters. In the more severe cases, the skin about these elevations may be more or less reddened. Some-times a feeling of heat or itching may be felt be-fore the eruptions appear. This condition does not last more than a week, as a rule, but where the cause is not removed, new spots may appear more or less constantly and the disease may last during the entire summer.
Causes.—Prickly heat is especially frequent in the very fat, in infants, in those who sweat very freely, in those who overbundle themselves, and in those weakened by some previous disease. Infants and children who develop prickly heat may, at the same time, also suffer from boils.
Suggestions for Prevention.—Those who are subject to prickly heat may prevent such attacks by giving heed to the following suggestions. Excessive physical exertion and hot drinks should be avoided during the hot season and light clothing should be worn. Baths should be taken frequently, followed by liberal powdering of the body with any good powder, such as boric acid powder, or similar preparations. Children should be lightly clad in thin woolens during the summer and should be kept in a cool place sheltered from the intense heat. Measures should be taken to avoid constipation and other disturbances of the digestion. Foods which stimulate the circulation, such as meat, especially fried, should be avoided. Drinking of large quantities of cool water is beneficial.
With the appearance of the eruption, starch, bran, or borax baths and the application of boric acid solution should be tried. When these measures fail, a physician should be consulted.
Chafing (Erythema intertrigo).—Description.—Chafing occurs, as a rule, among children and stout persons. The parts usually affected are the groin, the neck, and the areas about the bends of the joints. This trouble may begin as a redness of the skin surface, or as redness with breaks in the skin due to scratching. A sticky watery discharge may be present. This condition may remain as such or may develop into another type of rash (eczema). A feeling of heat and soreness is usually experienced. Contact with moist diapers and with discharges from the bowels are the usual causes.
Suggestions for Treatment.—The same measures recommended for prickly heat can here be used with benefit. When satisfactory progress does not result, a physician should be consulted.
Eczema (Tetter, Salt Rheum).—Introduction.—When eczema appears on a child's skin, the naturally anxious parents usually ask a number of questions: Does this rash come from the blood? Could I have given this disease to my child? Is this skin condition contagious?
In the writer's opinion, parents should have definite information concerning these most reason-able and sensible questions. Eczema is not a blood disease and cannot be transmitted from parents to their offspring. It is not contagious, for only those conditions caused by germs or parasites possess these qualities and as eczema is not caused by germs, it is therefore not contagious.
Description.—Like many diseases, tetter presents a number of forms, some mild and others severe. The mildest expression of this skin condition is one of redness of the part, together with some swelling and more or less itching. This redness and swelling are brought about by an increased amount of blood, which Nature sends to the affected part. This phenomenon is common to all inflammation and as eczema belongs to this great group of skin diseases, naturally the same condition holds true. The redness of eczema is characteristic in that it does not stop abruptly but gradually fades into the healthy skin. .
As the eczema-affected skin improves, the redness and swelling diminish, the itching ceases, and the skin peels. The peeling is Nature's way of throwing off that portion of the skin diseased and injured by the inflammation. This type is, as a rule, of short duration (several weeks) when properly treated.
The mild form just described appears fairly often, but commonly a more severe form of eczema is encountered. In the latter, in addition to the redness and swelling, small blister-like elevations are also present. They are usually quite close together and, when broken open, a sticky fluid es-capes which dries on the skin, resulting in yellowish gummy crusts (scabs). The itching is usually very severe and the child scratches until blood appears; under such circumstances the crusts appear brownish. When these scabs occur on the face, they constitute the so-called "milk crusts."
One's curiosity is naturally aroused as to how these small blisters form. We know that eczema is an inflammation and, as such, the part affected receives more blood than under normal conditions. A certain part of the blood, called the serum, accumulates in spaces in the epidermis (the upper-most layer of the skin). As that part of the epidermis is pushed upwards, the spaces filled with this fluid also ascend and when they reach the surface of the skin they appear as little blisters.
As this skin condition improves, the oozing ceases, the redness lessens, the crusts drop off, and a newly formed skin appears. At first it is red and thin. Later on, the skin thickens and assumes its normal color.
Since the changes are here so tremendous, the skin naturally becomes weakened and is liable to infection by pus germs. Children who suffer for a long while from eczema may develop enlarged glands in the neck. This complication is not serious and is most apt to appear when the itching has been most intense or when infection by pus germs has taken place. While, at times, these .glands may turn into abscesses, they usually disappear when the eczema is cured. This form most frequently affects the face, scalp, and diaper regions.
Course.—Eczema of infants usually appears within the first six weeks or two months of life. It is supposed that the tendency for this disease lessens by the second year. It returns rather easily, and its duration depends upon the mildness or severity of the disease, the cause, and how quickly competent medical attention is procured. At times, tetter may last for months, despite the most skillful handling. The belief held that it is dangerous to cure an eczema is to be greatly regretted. In order to obtain the best and quickest results, to prevent suffering and harm to the general health through loss of sleep, it is urged that the treatment of eczema should not be delayed, but be started at the earliest possible moment. The above statements cannot be too strongly emphasized.
Causes of Eczema in Infants.—The causes of eczema are here given, not with any idea that they should serve as a means of self-treatment, but only as a help to avoid this most trying disease of in-fancy and childhood. Probably the most frequent cause for infantile eczema lies in improper feeding and faulty digestion, and their correction will very often ward off this disease. It is unwise for mothers to give their infants laxatives, unless they are prescribed by a physician, for very often their use can be avoided through judicious feeding. Teething rarely causes an eczema although it may aggravate it. It is important to know that eczema is not always caused by internal conditions, for long contact of the skin with urine or with stools, the use of irritating soaps and exposure to cold winds without protection may also be responsible.
Suggestions for Prevention.—Once an eczema has developed, the best that can be done is to seek the services of a physician, or better, a skin specialist. There are, however, certain things that the parents should do with the thought in mind that "an ounce of prevention is worth a pound of cure." If the child is breast-fed and appears to suffer from indigestion, it is wise to consult a physician to determine whether the mother's milk is suited for the child and also for instructions. as to the intervals between feeding, etc. A usual and regrettable fault of many mothers is nursing the infant too' often during the night. While a feeding or two is permissible in the case of a very young infant, this practice ought to be discontinued after the third or fourth month. When the child is bottle fed, such formulas should always be prescribed and regulated by a competent doctor who can very early detect whether the formula is a proper one by the increase in weight, the character of the stools, etc. The frequent drinking of plain or alkaline water between the feedings is to be encouraged, as it is a most excellent practice.
The diet of older children, particularly if they have suffered from an eczema during infancy, should be carefully watched. Such children should not be permitted to partake of ice cream, candy, cake, potatoes, and oatmeal, while other starchy foods should he taken only in very small amounts.
Strict attention should be paid to the condition of the bowels, for their role in the causation of an eczema is very important. It is not amiss to again emphasize that very often constipation in the infant or young child may be overcome by regulation of diet. It is unwise to give physics indiscriminately. t- The baby should be kept scrupulously clean and dry. The napkins are not to be washed in strong soda solutions and should not be used a second time after simply being dried. Infants and children suffering from eczema should not be exposed to cold winds unless protected. It is preferable that such children take their airings indoors. The eczema-affected skin should not be cleansed with soap and plain water, but with sweet oil, olive oil, vaseline or cold cream. When water must be used, starch, bran, or borax may be added so as to render the water nonirritating. Ointments used as applications to the skin may be removed by the same substances recommended for cleansing the skin.
When it appears impossible to control the itching of the eczema-affected face by medicinal applications, physical restraint must be used. One of the best plans is to surround the arm at the elbows with pasteboard splints, and hold them in place with bandages. This allows free use of the hands and makes it impossible for the child to reach the face.
The Hives of Infants and Young Children (Papular Urticaria). Description. This eruption of infancy furnishes another illustration of the damage the skin may suffer from improper feeding and disturbed digestion. The condition is peculiar in that it is apt to appear each summer for a number of years, usually disappearing, either in part or completely, with the oncoming of the cold weather.
The eruptions of this disease are rather striking. They usually are present on the arms and legs, hands and feet. They consist of solid elevations, firm, hard, of the natural skin color and distinctly separated from the unaffected skin, but the skin surrounding each elevation is apt to be red and somewhat swollen. The itching of this affliction is so very intense that scratching is usually continued until blood appears. Indeed, crusts of blood are so constantly seen on the tops of the elevations that this feature constitutes a characteristic of the disease. The constant itching with the attendant disturbance of sleep may undermine the health of the child.
Suggestions for Treatment.—Since the usual causes of this condition are indiscretions in diet and indigestion, it is to be expected that the cure rests upon the correction of these faults. It is therefore urged that a competent medical man be consulted as soon as possible after the appearance of this condition. A daily warm starch bath will often soothe the skin temporarily. It is urged upon parents that those measures which have caused the disappearance of the hives he continued for some time afterwards, so as to lessen the chances of any return.