Everyone has heard the phrase ‘soft as a baby’s bottom’.  As a society, we cherish the belief that babies have the most perfect skin.  In fact, as we age, it becomes the ideal touted by anti-aging products and the media.  It is certainly a romantic notion, but infant skin is not completely resilient and fully developed so we have to learn how to protect and nourish it.  Even for the smoothest of bottoms, there are dangers lurking in common skin care products in the form of toxins, preservatives, and chemicals.

Let me explain what medical science has taught us about baby’s delicate skin:

Human skin maintains some of the same functions from birth throughout all stages of life.  It serves as a physical barrier between the environment and us, helps regulate body temperature, prevents insensible fluid loss from our bodies, and plays a great role in immune function.  However, there are some fundamental differences between infant and adult skin.  For instance, the barrier function of infant skin is not completely developed.  Babies lose more water through the skin and absorb environmental toxins and chemicals more easily than adults [1].  They are also more prone to developing bacterial infections than adults [2].  It is remarkable to note that the application of safe, natural moisturizers to baby’s skin can enhance its barrier function and prevent some of these issues.  In a recent randomized, controlled trial, when premature infants were massaged with sunflower seed oil three times a day, they had a 41% decrease in serious life threatening infections and a 26% reduction in mortality [3].  Recent evidence suggests that barrier development continues to occur throughout the first year of life and that baby’s skin is notably thinner structurally than ours.  Its fragile nature, high surface area to volume ratio and baby’s decreased subcutaneous fat volume all make infant skin more prone to easily absorbing any chemicals or toxins applied to it.  This is all worsened by the fact that babies still have immature drug metabolism and detoxification systems.  Basically, their little bodies cannot eliminate any toxins they absorb in the same manner that adults can.  These compelling findings highlight the importance of only essential, safe, and gentle skincare for developing infants.

When it comes to bathing, oddly enough, there is increased evidence to suggest that washing with a washcloth during the first month of life actually causes dehydration of the skin when compared with simply soaking in water.  Another study found that bathing an infant in a tub was associated with higher risk of cord infection versus no washing at all.   And when it comes to cleansers, the consensus among dermatologists appears to be that a mild liquid cleanser may actually be less drying and less irritating than water alone after the first month of life. Additionally, bathing should be brief (10 minutes or less) and should occur no more than every other day.

What about sunscreen? Photoprotection or sun protection is incredibly important for babies and children as it is for adults because UV damage is cumulative.   We also have to take into account that children spend more time outdoors in the sun and that their skin is more vulnerable to damage.  In fact, in the case of infants, they are entirely at the mercy of their caregivers to practice sun protection because they cannot communicate when they have a sunburn.  However, when it comes to the application of sunscreen, over the years, many have expressed concern about the possible hormone disrupting chemicals found in many formulations.   And, as mentioned earlier, this is especially worrisome in infants and children because their skin absorbs chemicals more easily and their bodies cannot metabolize them as quickly and efficiently.  Therefore, this remains to be a very contentious topic where the jury is still out.  My personal suggestion would be to follow the recommendation made by the American Association of Pediatrics: to minimize the reliance on topical products in infancy by avoiding sun exposure and using sun-protective clothing whenever possible [4].

Even if you do not subscribe to the philosophy of using natural and organic skin care products for your own adult skin, there are significant and worthwhile benefits of going natural for your developing baby and child.  As parents, we all want what is best for our children, and the evidence points strongly towards special care for fragile infant skin.

As an expectant mom and physician-scientist with a keen interest in immunity, inflammation and autoimmune disorders of the skin, I am passionate about advocating for parents by educating them about the risks associated with the use of chemicals and toxins in common skincare products. However, chemicals are only part of the problem, the other important piece is education about healthy skincare practices and avoidance of unnecessary products applied to the skin.  Our babies deserve the best shot at optimum skin health and development.  And, we deserve to know that what we put on baby’s skin is safe from harsh chemicals, toxins and preservatives.

How many of you use natural or organic skin care products for your infants and children? Do you feel that they are worth the price? Do you wish that they were more readily accessible in mainstream stores?

References:

1. Shwayder T, Akland T. Neonatal skin barrier: structure, function, and disorders. Dermatol Ther. 2005;18(2):87-103.
2. Darmstadt GL, Dinulos JG. Neonatal skin care. Pediatr Clin North Am. 2000;47(4):757-782.
3. LeFevre A, Shillcutt SD, Saha SK, et al. Cost-effectiveness of skin-barrier-enhancing emollients among preterm infants in Bangladesh. Bull World Health Organ. 2010;88(2):104-112.
4. American Academy of Pediatrics. Recommendations on limiting sun exposure. Accessed January 9, 2013.

is more than a protective cover, its healthy condition is vital to the functions of our whole immune system. In addition to creating a barrier against the elements, the skin houses immune cells and produces antibodies.  It is also one of the body’s 3 main systems for eliminating toxins, along with the lungs and digestive system. Therefore, naturally healthy skincare is essential to supporting your baby’s immune system.

Supporting skin immunity is a tool in your arsenal to battle all kinds of illness, even colds and flu. Many don’t know the skin plays a vital role in immunity, or that proper skin care can indeed contribute to overall health.

Dry, cracked skin is typical in winter months.  More than annoying, these conditions leave the body more susceptible to viruses and bacteria that circulate from contact and through the air. When developing skin is dehydrated, under-nourished, cracked, irritated or disrupted, whole body immunity can be compromised.

Keep the skin well supported with 3 simple steps. For best protection, the first step is to start with a moisturizing cleanser, then second, nourish the skin (ideally in two phases) with a water and then an oil infused moisturizer – like an aloe vera based cream, followed by an essential fatty acid rich lotion. Then third, defend the skin with protective balms with a mild SPF factor – especially the facial area where skin is most exposed to the ravages of dry air and temperature changes.

Keeping skin healthy and hydrated is an important step in supporting the whole body’s immunity!

It’s taken a long time for science to quantify what mothers have always known: the skin of babies and toddlers is very different from the skin of older children and adults. Babies’ skin is softer because the outermost protective layer, the stratum corneum, isn’t mature until at least age two. In babies and toddlers the total epidermis is also thinner, with increased absorption:

Ultraviolet radiation can penetrate more deeply.

This can damage skin DNA, trigger inflammation, accelerate aging, and suppress the immune system in the skin. (Our skin is a key, active part of our immune system – not just the physical barrier we’ve long assumed.) Radiation-induced skin changes can start accumulating during a baby’s first summer.

Sunscreen chemicals penetrate more easily as well.

Many of the chemicals used in sunscreens to absorb radiation act like estrogen hormones. These could end up throughout a baby’s body in the blood, and later be detected in the urine. This hasn’t been proven to cause a problem. Or proven safe.

How do you balance the health of young skin, where just a few sunburns can double the melanoma risk later in life? I recommend a few simple steps:

1. Avoid midday sun, when practical.
2. Choose sun-protective clothing for everyday wear when babies or toddlers will be outside. K&J clothing has a UPF of 50+, using no chemicals. And it’s adorable! In contrast, a typical tee has a UPF of only 5 or 10.
3. Seek shade with your little one.
4. Use a mineral sunscreen to physically block UV radiation. Zinc and titanium are the two common mineral active ingredients. Micron-particle-size minerals are small enough to go on clear and large enough not to be absorbed through the skin.

And don’t forget a pair of stylin’ baby sunglasses!

Paller AS, Hawk JLM, Honig P, Giam YC, Hoath S, Mack MC, and Stamatas GN. “New Insights about Infant and Toddler Skin: Implications for Sun Protection.” Pediatrics. 2011; 128(1):1-11.

Dr. Greene’s Answer:

Getting a rash under the neck is very common at 4 months because the skin of the neck’s folds rubs against itself. The heat, friction, and moisture combine to irritate the skin and interrupt the normal outside, protective layer. This rash will often stay there until kids are sitting up most of the day, no matter how it is treated.

Sometimes yeast can get into this irritated skin. When that happens, a yeast cream should reliably get rid of the infection within two weeks, but the rash will usually stay. If the rash is spreading to other spots of high friction or moisture, that would be expected, but if the rash is spreading to normal, exposed skin that doesn’t get this kind of stress, it should be checked again.

As for cleansing the area, soap can be irritating. I prefer just using warm water and a very soft washcloth, and then drying it very carefully. Air to the area is very healing, and sometimes a very thin layer of something like A&D ointment can protect the skin.

Dr. Greene’s Answer:

Any diaper rash that’s been going on for more than a week has most likely become complicated by a yeast infection. This is especially common when the rash is exacerbated by loose stools.

The best course of treatment is to keep the area as clean as possible. You might want to consider bathing your baby’s bottom with warm water after each diaper change rather than wiping already tender tissue with a wipe. After cleansing, apply a moisture barrier ointment such as A+D to aid in healing the damaged skin, along with an over-the-counter yeast treatment such as Lotrimin to combat the yeast. If the rash worsens or doesn’t show improvement after a few days, you’ll want to check with your baby’s doctor.

Related concepts:

varicella-zoster virus, chickenpox, shingles

Introduction to chickenpox:

Chickenpox is one of the classic childhood diseases. A young child covered in pox and out of school for a week is a typical scene. The first half of the week feels miserable from itching; the second half miserable from boredom. Since the introduction of the chickenpox vaccine, classic chickenpox is becoming less and less common.

What is chickenpox?

Chickenpox is caused by the varicella-zoster virus, a member of the herpesvirus family.
Chickenpox is one of the most contagious childhood illnesses. The disease is usually mild, although serious complications sometimes occur.
Some of the complications include impetigo (especially when the pox are scratched), hepatitis, pneumonia, encephalitis, meningitis, Reye syndrome, and severe invasive streptococcal infections.

Who gets chickenpox?

Before the vaccine, chickenpox was a standard feature of childhood. Still, most cases occur in children younger than ten. The illness is most common in the late winter and early spring.
Adults and older adolescents usually get sicker with chickenpox than younger children do. Years after having chickenpox, some adults and older adolescents may then get shingles, a painful second outbreak of a varicella-zoster virus rash.
Children under one year of age whose mothers have had chickenpox are not very likely to catch it. If they do, they often have mild cases because they retain partial immunity from their mothers’ blood. Children under one year of age whose mothers have not had chickenpox, or whose inborn immunity has already waned, can get severe chickenpox.
Complications are more common in those who are immunocompromised either from an illness (e.g. AIDS) or from a type of medicine (e.g. chemotherapy). Some of the worst cases of chickenpox have been seen in children who have taken steroids during the incubation period, before they have any symptoms. These children are usually being treated for asthma.

What are the symptoms of chickenpox?

Most children with chickenpox act sick with vague symptoms, such as a fever, headache, tummy ache, or loss of appetite, for a day or two before (and 2-4 days after) breaking out in the classic pox rash.
The average child develops 250-500 small, fluid-filled blisters over red spots on the skin (“dew drops on a rose petal”). The blisters often appear first on the face, trunk, or scalp and spread from there. After a day or two, the blisters become cloudy and then scab. Meanwhile, new crops of blisters are springing up in groups. The pox often appear in the mouth, in the vagina, and on the eyelid.
The pox itch intensely.
The pox are worse in children who have other skin problems, such as eczema or a recent sunburn. Some children get more than 1500 pox.
Some children who have had the vaccine will still develop a mild case of chickenpox. They usually recover much quicker and only have a few pox. These often do not follow the classic descriptions of the disease.

Is chickenpox contagious?

People who have chickenpox become contagious 24 hours (and sometimes as long as 48 hours) before breaking out. They remain contagious while uncrusted blisters are present, usually one week or less after breaking out.
Chickenpox is extremely contagious, and can be spread by direct contact, droplet transmission, and airborne transmission.
Even those with mild illness after the vaccine may be contagious.

How long does chickenpox last?

Most children feel better, have scabs on all of the pox, and are safe to return to school or other activities within one week of the beginning of the rash. The pox may remain visible for days or weeks after that, but most of them will not scar unless bacteria are introduced during scratching.
Once someone catches chickenpox, the viral infection usually lasts for a lifetime, with the virus kept in check by the immune system. About 1 in 10 adults will experience shingles, a very painful rash, when the virus re-emerges during a period of stress for the body.

How is chickenpox diagnosed?

Chickenpox is usually diagnosed from the history and the classic rash. Blood tests and tests of the pox themselves can make the diagnosis if there is a question.

How is chickenpox treated?

Historically, treatment has been aimed at keeping children comfortable while their own bodies fight the illness. Aveeno Bath (or other oatmeal baths) in lukewarm water provides a crusty, comforting coating on the skin. An oral antihistamine will help to ease the itching, as will topical lotions such as Calamine or Sarna. Remember to trim the fingernails short to reduce secondary infections and scarring.
Safe antiviral medicines have been developed. To be effective, they usually must be started within the first 24 hours of the rash. For most otherwise healthy children, the benefits of these medicines may not outweigh the costs.
However, for those with skin conditions (such as eczema or recent sunburn), lung conditions (such as asthma) or those who have recently taken steroids, the antiviral medicines may be very important. The same is true for adolescents and for children who must take aspirin on an ongoing basis.
Some doctors also give antiviral medicines to people in the same household who subsequently come down with chickenpox. Because of their increased exposure, they would normally experience a more severe case of chickenpox.

How can chickenpox be prevented?

Because chickenpox is airborne and is so contagious before the rash appears, it is difficult to avoid. It is even possible to catch chickenpox from someone on a different aisle in the supermarket, who doesn’t even know they have chickenpox!
A chickenpox vaccine has been available since 1995. It is about 100 percent effective against moderate or severe illness, and 85 or 90 percent effective against mild chickenpox. The Advisory Committee on Immunization Practices (ACIP) has recently recommended a two-dose vaccination series for varicella. They recommend a first dose administered at age 12-15 months and a second dose at age 4-6 years. Therefore, many children, adolescents, and adults who received only one dose based on previous recommendations are now receiving a “catch up” vaccine.
Why the change? A randomized clinical trial of 1 dose versus 2 doses of varicella vaccination showed that the estimated vaccine efficacy of 2 doses for a 10-year observation period was 98.3%, significantly higher than the efficacy of 1-dose vaccination.

Related A-to-Z Information:

Asthma,

Conjunctivitis (Pink eye), Contact Transmission, Droplet Transmission, Eczema, Encephalitis, Exanthems (Childhood rash), Febrile seizures, Headache, HIV, Human Herpesvirus, Impetigo, Pinworms, Pneumonia, Poison Ivy, Oak, and Sumac, Reye Syndrome, Smallpox, Streptococcus (Strep), Sunburn

Related concepts:

HPV, Verrucae, Common warts, Genital warts, Condylomata accuminata

Introduction to warts:

Contrary to well-established belief, the underside of a wart is smooth and round, and the entire wart is confined to the epidermis — the outermost layer of the skin. There are no ‘roots’!
Even without roots, warts can be difficult to destroy.
Warts will not leaves scars, though some of the more aggressive wart therapies might.

What are warts?

Warts are infections caused by viruses that are present everywhere, making them among the most common of all childhood skin conditions. The culprit will be one of more than 70 types of human papillomaviruses (HPV). They are spread when the virus touches a part of the skin where the outer protective layer is broken, either by minor trauma or by moisture. This happens most commonly on the fingers, elbows, knees, and the bottoms of the feet. Warts on the bottom of the feet are called plantar warts – named for the plantar surface (sole) of the foot.
Genital warts (condylomata accuminata) should be addressed carefully in children in order to be sure there has been no sexual abuse.

Who gets warts?

Anyone can get warts.
Some people get warts more easily than others. Warts are more common in children than in adults, partly because of their less mature immune systems and partly because they spend more time in wet-floored locker rooms and in active, close play.
Common warts occur in about 1 in 10 children. Genital warts occur in about 1 in 3 sexually active teens.

What are the symptoms of warts?

Warts are firm or fleshy bumps that might become yellowish tan, grayish black, brown, or remain flesh-colored.
Under a magnifying glass, the roughened surface of a wart often looks like a tiny cauliflower. The little black dots sometimes seen are the ends of blood vessels that the wart has recruited to bring it food.
Plantar warts often make running, jumping, and even walking, uncomfortable. The tenderness can change posture and cause strain elsewhere in the body. A little wart can be a big problem. Sometimes filing with an emery board and/or wearing a doughnut bandage can alleviate the discomfort. The warts are usually most tender when they are growing most rapidly. Often, the pain will disappear within a few days even if nothing is done.

Are warts contagious?

Yes. They are spread when the virus touches a part of the skin where the outer protective layer is broken. Warts can spread by direct contact (from yourself or someone else) and by means of fomites.
Genital warts can spread through the birth experience, through innocent contact, or through sexual contact.

How long does it last?

Warts generally appear 1 to 6 months after the person has become infected. Most warts will eventually go away on their own, expelled by the body’s immune system. About 25 percent are gone within 3 to 6 months and 65 percent disappear within 2 years.

How are warts diagnosed?

Warts are usually diagnosed by careful examination. Sometimes lab confirmation is needed. Genital warts should be evaluated carefully in children in order to be sure there has been no sexual abuse.

How are warts treated?

Warts should be treated if they are spreading, unsightly, or continue to be painful.
Treatments abound, varying from as gentle and simple as taping a patch of banana peel on before bed, to as high-tech and powerful as superpulsed carbon-dioxide-laser vaporization.
The active ingredient in most over-the-counter wart remedies is salicylic acid, a natural substance found in many plants (willow bark) and most fruits. It can be applied either as a liquid or a patch (I prefer the patch). With regular application, many warts will disappear within 12 weeks. These topical treatments often work best if the surface of the wart is disrupted with warm soaks and/or an emery board before application.
Physicians use many options to treat warts (surgery, lasers, chemical cautery, electrodesiccation, lasers, and even chemotherapy), but freezing is the most common. Gentle freezing repeated every week or two — usually at least 4 times — is more effective than a single aggressive attempt to freeze. This approach is less painful and much less likely to scar. Physicians often use different chemical methods on genital warts.
Even though these techniques destroy the bulk of the wart viruses, direct destruction is only a part of the story. This can be seen by how poorly they work in people who have immune deficiencies. In the final analysis, it’s our own immune systems that are activated and engaged to eliminate the warts. Squaric acid applications are aimed specifically at triggering this immune response.
Sometimes oral medicines such as cimetidine are used.
Hypnosis has also been tried as a means of activating the immune system. When studied scientifically, hypnotic suggestion has proven to be as powerful as many conventional medical treatments at getting rid of warts. ‘Charming warts’ is particularly effective with children, and is discussed in leading medical textbooks. I’ve had success with dabbing warts with paint and letting children watch them glow under a black light! For added impact, I’ve sometimes pressed a painted wart onto a piece of filter paper to make a spot, and then burned the paper. I tell the child it will fall off in two weeks – and it does!

Mark Twain’s quaint solution, then, is consistent with the latest medical science:
Why, you take your cat and go and get in the graveyard ‘long about midnight when somebody that was wicked has been buried; and when it’s midnight a devil will come, or maybe two or three, but you can’t see ‘em, you can only hear something like the wind, or maybe hear ‘em talk; and when they’re taking that feller away, you heave your cat after ‘em and say, ‘Devil follow corpse, cat follow devil, warts follow cat, I’m done with ye!’ That’ll fetch ANY wart.

How can warts be prevented?

Avoiding contact with warts is the best way to prevent them – particularly when there is a break in the skin.
Avoiding sucking or chewing on fingertips can prevent some warts on the hands. Wearing something on the feet in locker rooms and at the pool can prevent many plantar warts.

Related A-to-Z Information:

Chickenpox (Varicella), Cold Sores (Herpes simplex), Contact Transmission, Coxsackievirus, Eczema, Fomites, Hand-Foot-Mouth Disease, Hemangioma, Impetigo, Milia, Miliaria, Mongolian Spots, Moles (Nevi), Poison Ivy, Oak, and Sumac, Pustular Melanosis, Ringworm (Tinea corporis), Salmon Patches (Stork bites), Sexual Abuse, Stye, Thumb-sucking

Related concepts:

Staphylococcus aureus, Staphylococcal infections

Introduction to staph:

Staph infections are very common. The bacteria look like innocent clusters of grapes under the microscope.

What is staph?

Staph bacteria surround us! They are often found on the surface of healthy people’s skin. Infection occurs if they enter the skin, or enter the body through another route.
There are many species of Staph bacteria. They cause a wide variety of illnesses in children, ranging from very mild skin infections to devastating toxic shock syndrome.
Skin infections are especially common and include impetigo, conjunctivitis, cellulitis, acne, boils, styes, and infected wounds or hangnails. Staph can be associated with mild blocked tear ducts in newborns. Staph scalded skin syndrome, though, is a severe skin disease caused by Staph.
Staph can cause infections in the ears, nose, and throat. And it can cause swimmer’s ear, an infection in the ear canal.
Staph infections also occur in lymph nodes. Staph blood infections can lead to many other areas of infection including pneumonia, infective arthritis, bone infections, and even meningitis.
Staph food poisoning is one of the most common types of food poisoning.

Who gets staph?

Most or all children get some form of Staph infection. Those with an underlying chronic disease, such as diabetes, or those with indwelling foreign bodies, such as shunts, catheters, or artificial joints, are at the highest risk.
Staph food poisoning comes from eating foods contaminated by Staph. Staph usually gets into the food from food handlers with infected eyes, fingers, pimples, boils, rashes, or nasal secretions. When Staph is introduced into prepared foods and not followed immediately by cooking or refrigeration, the bacteria multiply and produce a toxin that will not be destroyed by cooking. The ideal temperature for Staph to grow is about body temperature.
The most commonly affected foods are sandwiches, sliced ham, poultry, or other meats, potato salads, egg salads, salad dressings, cream-filled pastries, and custards.

What are the symptoms of staph?

The symptoms of a Staph infection vary depending on the location and severity of the infection. (See individual conditions such as conjunctivitis or impetigo for possible symptoms. Staph may produce pus wherever it appears.
Staph food poisoning is dramatic in that it begins quickly after eating the offending food — within 8 hours, usually within 4 hours, often within 30 minutes. Children with Staph will have sudden severe nausea, vomiting, and cramps, often accompanied by diarrhea. There is usually no significant fever, in fact the temperature often drops. And the person feels miserable!
If you’ve ever lain on the floor for several hours wishing you were dead, suddenly sick after eating a meal, Staph was a likely cause.
The rapid onset, presence of vomiting, and absence of significant fever make it possible to distinguish Staph from other sources of food poisoning. (Clostridium, for example, takes longer to make you sick and rarely includes vomiting; Salmonella also takes longer and usually includes a fever).

Is staph contagious?

Staph infections can be spread from person to person by direct contact.

How long does staph last?

Staph food poisoning usually lasts for a day or two. Other Staph infections have widely varying lengths.

How is staph diagnosed?

Staph can be identified with cultures or other diagnostic tests of the part of the body infected. Sometimes the diagnosis is clear from the history and physical exam.

How is staph treated?

Treatment depends on the location and severity of the infection. Most Staph infections require some sort of antibiotics. These might be antibiotic creams, eye drops, or oral or IV antibiotics depending on the location. These must be chosen carefully, as many Staph are resistant to many antibiotics.
For Staph food poisoning, antibiotics are not helpful.

How can staph be prevented?

Staph bacteria are so widespread, that infection can be difficult to prevent. Some infections can sometimes be prevented by observing “contact” precautions, including excellent hand washing.
Staph food poisoning can be prevented by not allowing cooked or prepared foods to sit at room temperature for longer than 2 to 4 hours. As far as possible, reduce the time from food preparation to either refrigerating or eating the food.
People with open sores on the hands or face, or with a thick creamy discharge from the nose, should not be involved in preparing food.

Related A-to-Z Information:

Adenovirus, Arthritis (Juvenile rheumatoid arthritis, JRA), Baby Acne, Blocked Tear Duct, Campylobacter, Celiac Disease, Clostridium Perfringens, CMV (Cytomegalovirus), Cold Sores (Herpes simplex), Conjunctivitis (Pink eye), Contact Transmission, Dehydration, Diaper Rash, Diarrhea, E. Coli, Enteroviruses, Fomites, Food Allergies, Gastroenteritis, Giardia Lamblia, Headache, Impetigo, Infant Botulism, Influenza (Flu), Lead Poisoning, Meningitis, Norwalk Virus, Pneumonia, Rotavirus, Salmonella, Sinusitis, Swimmer’s Ear (External otitis), Type I Diabetes, Vomiting

Related concepts:

Tinea Corporis

Introduction to ringworm:

The name ringworm survives from antiquity, when doctors thought that this round rash was indeed caused by a worm. Now we know that this common skin infection has nothing at all to do with worms, but it can have something to do with pets!

What is ringworm?

Ringworm is a fungal infection of the skin. Fungi survive by eating plant or animal material. The ringworm fungi feed on keratin, the material found in the outer layer of skin, hair, and nails. These fungi thrive best on skin that is moist, hot, and hidden from the light. When this infection is found on the feet, it is commonly called athlete’s foot; when it is found in the groin, it is commonly called jock itch; and when it is found on the body, it is still called ringworm.

Who gets ringworm?

Up to 20 percent of the population has one of these infections at any given moment. To catch ringworm, you have to be exposed to it and you have to be susceptible. Some people are much more susceptible than others. Those with eczema or other skin problems get ringworm more easily because the protective barrier of the skin’s outer layer is less intact. Children are more susceptible before puberty. Boys get it more easily than girls. Some people are genetically predisposed and can get it easily throughout life.

What are the symptoms of ringworm?

The classic ringworm rash begins as a dry, raised, round patch, which may be slightly red. The patch may also be somewhat itchy. As it grows, the center of the patch clears, leaving a ring-like appearance. Not all children display this central clearing. In fact, there is wide variability in the way ringworm can appear from person to person.

Is ringworm contagious?

Ringworm is moderately contagious. Ringworm can be caught from other humans, both by direct contact and by prolonged contact with flakes of shed skin (from sharing clothes or from house dust, for instance). Wrestlers commonly spread it back and forth with their sweaty contact (tinea gladiatorum!).
It can be caught from domestic animals (especially dogs and cats), as well as most farm animals. The infection can be caught from the animal directly, or from anything the animal rubs against.

How long does ringworm last?

Without treatment, most cases of ringworm would disappear on their own within several months, but they can become chronic.
Ringworm symptoms usually disappear quickly with treatment, but the treatment should be continued for two to four weeks to eliminate all of the fungus.

How is ringworm diagnosed?

Ringworm is often diagnosed by the history and physical examination (and rapid response to treatment). The diagnosis can be confirmed by looking at skin scrapings under the microscope, where the fungus is visible. Also, ringworm lesions usually do not glow under ultraviolet light.
When apparent ringworm does not respond to treatment as expected, it is important to reconsider the diagnosis.

How is ringworm treated?

The treatment for ringworm is one of the many effective topical antifungal creams, such as miconazole or clotrimazole. Several of these antifungal creams are now available without a prescription. Treatment may require several weeks. Only by treating for at least one week after the resolution of symptoms can one guarantee eradication. As soon as treatment has begun it’s fine for your child to play with others, but it’s best not to share clothing or to let other children rub the patch of ringworm.
When fungus is found in the nails or on the scalp, the infection is much more difficult to eliminate. Prolonged treatment with a prescription oral anti-fungal medicine, as well as other topical medicines, is usually necessary. Scalp ringworm is a major cause of hair loss, and should be treated aggressively.
If you think your pet may be involved, contact your veterinarian to get up-to-date information on the best treatment for animals.

How can ringworm be prevented?

Avoiding exposure is the best way to prevent ringworm. Because these fungi thrive best on skin that is moist, hot, and hidden from the light, dressing to keep the skin cool, dry, and light can also help prevent this infection.

Related A-to-Z Information:

Contact Transmission, Eczema, Exanthems (Childhood rash), Fomites, Impetigo, Lice, Lyme Disease, Pinworms, Poison Ivy, Oak, and Sumac, Scabies, Seborrhea (Seborrheic dermatitits)

Related concepts:

Dermatitis – seborrheic, Dandruff

Introduction to seborrhea:

What do babies and teens have in common? Seborrhea!

What is seborrhea?

Seborrhea is a chronic skin condition that shows up where and when the sebaceous glands in the skin are most active.

Who gets seborrhea?

Anyone can get seborrhea. Seborrhea is more common in children than in adults, especially during the first year of life and during the teenage years.
Most people with seborrhea are otherwise healthy, but people with HIV often develop severe seborrhea.

What are the symptoms of seborrhea?

The main feature of seborrhea during childhood is red skin covered with greasy, crusty scales. It’s most common behind the ears, under the arms, in the diaper area, and on the face and neck. In the first month of life it is most common on the scalp, where it is called cradle cap. In teens, the seborrhea may only appear as the dry flakes of dandruff. It may also appear on the eyelids or concentrated in the beard area. Occasionally it shows up in ear canals or in the belly button.
If seborrhea itches at all, the itching is typically mild.

Is seborrhea contagious?

No

How long does seborrhea last?

Most seborrhea in babies disappears by the first birthday. In teens, it may only be present during puberty, or it may become a lifelong condition.

How is seborrhea diagnosed?

Seborrhea is usually diagnosed based on the physical exam.

How is seborrhea treated?

Seborrhea is often treated with an anti-seborrhea shampoo containing sulfur, salicylic acid, selenium, zinc, or tar. Stronger treatments are available if needed.
Some children have eczema or fungal infections in the same areas. This needs to be treated at the same time. (J Am Acad Dermatol 1993 Dec;29(6):1008-12).

How can seborrhea be prevented?

Often seborrhea cannot be prevented. Sometimes gentle skin cleansing and avoiding excess perspiration can reduce or prevent seborrhea.

Related A-to-Z Information:

Baby Acne, Cold Sores (Herpes simplex), Conjunctivitis (Pink eye), Cradle Cap, Diaper Rash, Eczema, Erythema Toxicum (Baby rash), Exanthems (Childhood rash), Hemangioma, HIV, Impetigo, Milia, Miliaria, Poison Ivy, Oak, and Sumac, Pustular Melanosis, Scabies, Stye, Swimmer’s Ear (External otitis)