You have to be attentive to every purulent “sore” in your child and start treatment as early as possible
Hydradenitis
In adolescents and adults, boil-like boils sometimes develop in the groin and armpit in areas covered with hair and sweating profusely. This is the so-called hydradenitis – a purulent inflammation of special sweat glands located in these places. In humans, these glands do not have any important function, the secretion they release under the influence of skin bacteria (with a lack of hygiene), in fact, causes an unpleasant smell of sweat. And in animals, the secret of these glands has a sex-specific odor that attracts an animal of the opposite sex. That is why the main problems with inflammation of these glands occur in adolescents who have reached puberty.
With boils, hydradenitis is related by the considerable depth of the process and the large size of the abscess – sometimes the size of a hazelnut. The inflammatory process usually develops when the excretory duct of the gland is blocked, it is also caused by staphylococcus aureus. The accumulation of sweat in these folds of the body contributes to the development of infection – for example, after high physical activity, sports exercises in the absence of conditions for taking a shower. I must say that hydradenitis can also be caused by fungi that “specialize” in superficial skin lesions; when the sweat gland duct is blocked, fungi in it multiply intensively, causing suppuration.
Treatment of hydradenitis consists in opening a mature abscess. The use of antimicrobial and antifungal ointments usually does not work. But for the prevention of recurrence, the treatment of superficial fungal skin lesions in the folds and careful hygiene of these places play a primary role.
Vesiculopustulosis and pseudofurunculosis
In infants, recurrent purulent skin lesions – vesiculopustulosis – are also often observed . With it, superficial vesicles with cloudy or purulent contents ranging in size from 2-3 mm to 1 cm or more appear on apparently intact skin, this rash does not cause temperature and general disturbances. A similar picture is given by pseudofurunculosis – it is so called to emphasize its dissimilarity with furunculosis: with pseudofurunculosis, it is not the hair bags that become inflamed, but the ducts of the sweat glands.
With pseudofurunculosis, pustules are superficial, unlike a boil, they are flabby, the thin layer of the epidermis (surface layer of the skin) covering them does not have a purulent plug and is easily removed, underneath it is visible liquid pus in a small amount and young red skin. The general condition of the child with this disease practically does not suffer, which indicates the superficial nature of the inflammatory process. However, abscesses occur again and again, often in large numbers, which, naturally, frightens the parents and requires intervention.
What is the reason for this skin lesion in infants? These are diaper rash, increased sweating due to an excessively high temperature of the child’s environment or excessively warm clothing, and poor hygiene. I constantly have to deal with parents who stop bathing their child at the slightest sign of ill health, who consider the bath to be almost the main source of colds. The fact is that babies generally develop poor immunity to staphylococci, so that the infection, once it gets on the skin, lasts a long time. With age (already in the second half of the year), the immune response becomes more mature, so that pustular diseases are much less common.
Of course, this does not mean that it is necessary to wait for the “maturation” of the immune system – the presence of a pustular infection requires vigorous therapeutic measures. But energetic does not mean an abundance of medicines, the child does not need them. You just need to empty all the pustules, removing a thin film from them by simple rubbing with a sponge or terry cloth, wash all skin with soap, and stop wrapping the child. Antiseptics can be applied locally : 0.1% solution (pink) of potassium permanganate or 0.02% furacilin solution. With an abundance of pustules, the use of antibacterial ointment is also justified (see table). After carrying out such treatment for several days, you will reliably get rid of pustules, without resorting to either antibiotics inside or to drugs acting on the immune system – it will “mature” without outside interference.
Unlike these generally benign, albeit not very pleasant diseases, pemphigus of newborns – an extensive staphylococcal skin lesion – is an extremely dangerous disease. Usually, we are talking about the infection of the baby during childbirth (for example, if the mother has an infection) or shortly afterwards (if infected in the hospital). This disease is treated intensively with antibacterial agents (see table).
Acne – youthful acne
With furunculosis, one should not confuse youthful acne – acne; they are somewhat similar to a small boil, but unlike a boil, they represent a violation of the secretion of sebum with subsequent infection of the resulting sebaceous cyst. Acne most often occurs on the face and upper body, especially in adolescents. This is due to the increased production of sebum during puberty. At the same time, small and larger (up to a pea) elevations, usually with a visible whitish “head”, appear on the skin of the face, the upper part of the body. Such elements are called comedones , when squeezed, sebum is released. Comedones do not show signs of inflammation – redness, their color does not differ from skin color. But when they fester and turn into acne – acne, they turn red, and if there are a lot of them, then the redness merges. And if comedones are distinguishable mainly close and practically do not spoil the appearance of a teenager, then the presence of acne is a serious cosmetic defect that painfully affects the self-awareness of a young man.
The inflammatory process in acne is usually caused by special propionobacteria , which prefer fat as a nutrient medium. Less commonly, acne is infected with staphylococcus and other pathogens. When acne ripens, the abscess opens; if it was large, then in its place scars can form, ultimately severely spoiling the appearance.
In addition to puberty (a normal increase in the level of male sex hormones), factors contributing to the appearance of acne are hormonal changes in women before menstruation or during pregnancy, the use of certain cosmetics (moisturizing lotions, fatty creams), and emotional stress. Excessive consumption of fats and iodine (with food additives, food), the use of certain drugs (contraceptives, steroids, anticonvulsants, lithium-containing drugs) are of some importance.
Acne, in general, elements are harmless, but you should still be aware of the alarming symptoms that require a doctor’s examination. This is when large areas of the skin are affected by acne, their occurrence is accompanied by fever, acne is large (with cherries or more) and painful. Soreness in the area of the lymph nodes in the neck, under the jaw, in front of the auricle (reaction of the lymph nodes, indicating the severity of inflammation) should also be alarming.
Modern approaches to the treatment of acne include a properly formulated diet (a sufficient amount of vitamins A and B – a complex, zinc salts) and a decrease in the consumption of iodine-containing products, primarily seafood, and replacement of iodized salt with regular salt. Any other restrictions – diets, which can often be found in popular literature and in the advice of well-wishers, are not justified.
Parents should make sure that their teenager with acne keeps their skin clean, but this should not be excessive. You should not squeeze and pick pimples, as this leads to suppuration of deeper tissues and the formation of more extensive disfiguring scars. A teenager with acne shouldn’t spend too much time in the sun, although of course it’s not worth avoiding the sun at all. Since comedones are formed due to excess sebum, you should not use fatty creams, lotions, and decorative cosmetics based on fat. For washing acne-covered areas of the skin, many recommend using a rough washcloth (terry cloth mitt); and this does not require undue zeal: 2-3 passes with a hard tissue are enough to remove the “extra” layer of dead cells and fat from the skin, especially since the effectiveness of this method is disputed by serious researchers.
Both local and general remedies are used to treat acne, it is carried out for a long time, so the teenager should immediately be set up to need regular treatment for at least a few weeks. Local treatment consists in cleansing the skin, softening and removing the dying layer of skin, sebum and facilitating its release from the sebaceous glands. For this purpose, salicylic acid preparations have been used for a long time, which can dissolve the stratum corneum of the skin. This is an alcoholic solution of salicylic acid, as well as Clearazil , which at one time was obtrusively advertised on TV. Modern cleansers are more effective, especially lotions containing benzoyl peroxide. These are drugs Benzacne , Desquam , Eklaran , Oxy 5, 10, they are used 1–2 times a day. Airol lotion also gives a good effect when applied topically, it is used once a day for 4–6 weeks. Azelaic acid preparations ( Skinoren ) are also used topically 2 times a day.
In more complex cases that do not respond to local treatment, general remedies are used. This is primarily treninoin (Retin-A) or isotretinone ( Roaccutane ), they are taken orally. Treatment with these drugs should be carried out under the supervision of a physician, since in the course of treatment, laboratory tests of liver function are necessary.
Doctors prescribe antibiotics only for severe suppuration of acne. Erythromycin ointments are effective, which inhibits the growth of propionobacteria . In addition to the “usual” erythromycin ointment, a solution for topical application of Erifluid , which does not contain fat, is used. In addition to erythromycin, the drug Zinerit contains zinc salt in solution, which reduces the production of sebaceous glands. These drugs are taken 1-2 times a day.
Parents should understand that having acne in a teenager causes a number of psychological problems associated with a decrease in his self-esteem. Parents should reassure the child, try to correct defects in the diet and lifestyle. A teenager should know that acne is a temporary matter, it is important to set him up for persistent and patient implementation of the above therapeutic measures for a sufficiently long time – 2-4 months.
Impetigo
Impetigo (often with the epithet “contagious”) is the most common skin disease in children, it is characterized by purulent elements on the skin, which quickly become covered with layered thick crusts. When the crust is removed, an erosive surface is found, on which a layered crust forms again. Such elements often increase in area, sometimes smaller children appear around the “parent” element. Often, the infection is carried to distant parts of the body, so that in severe cases, the entire skin of the child is affected to one degree or another.
An unpleasant disease in itself can also cause a serious complication – acute glomerulonephritis – inflammation of the kidneys. The fact is that impetigo causes group A beta-hemolytic streptococcus – those of its varieties, among the antigens of which there is an M-antigen, which has common features with antigens of some renal structures (membranes of the renal glomeruli). The resulting M-antigen antibodies bind to the kidney tissue, damaging them, causing glomerulonephritis.
I must say that strep in the beginning of impetigo is easy to become infected by staphylococci and so it should be considered when selecting antibiotic. Impetigo is a very contagious disease, so sick children, despite their good general condition, are not admitted to children’s institutions.
In fact, impetigo, subject to the rules of personal hygiene, using bactericidal soap and removing the crusts after softening them (with lotions or smearing with cream), is cured without antibiotics, but the use of antibacterial ointments accelerates recovery and reduces the period during which the child is contagious. To suppress streptococcus, ointments with all antibiotics, except for gentamicin and neomycin , which are active against staphylococci, are suitable . If in doubt about the nature of the pathogen, it is appropriate to use Bactroban , which is equally active against both possible pathogens.
I must say that antibodies to streptococcus are usually formed in the early stages of the disease, so it is not worth waiting for the process to reach the stage at which treatment seems logical to you. After all, such treatment may not prevent the development of glomerulonephritis. That is why you need to be attentive to every purulent “sore” in your child and start treatment as early as possible.
Erysipelas
This not very euphonious term (the term “erysipelas” sounds nobler) denotes streptococcal skin infection. Redness and swelling spreads over the skin; in severe cases of erysipelas, the skin of almost the entire arm or leg may be affected. This disease is characterized by a clear raised border between the affected and healthy skin, as well as a significant disorder of the general condition, high fever, toxicosis. Erysipelas most often develops in children with certain chronic diseases – kidney disease, diabetes.
Erysipelas is a serious illness that requires the immediate administration of antibiotics (penicillins). It is fraught with numerous complications, up to and including sepsis. In recent years, cases of a fulminant course of streptococcal infection have been described, in which erysipelas is combined with the melting of all the soft tissues of the arms and legs. Fortunately, no such cases were observed in children.
We have seen the most common bacterial skin infections. In the following articles, we will talk about viral and fungal skin diseases, which are also common in children.