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Date Posted: 06:54:41 06/10/03 Tue
Author: Dr.Sara Black
Subject: Disease and Infection Information

Psoriasis
This skin disease occurs when new skin cells are produced too quickly, resulting in a rash and other symptoms. About two out of every 100 Americans have psoriasis; only about ten percent of cases occur in the first decade of life, and the condition is quite rare in infants.
Red areas of raised, scaly skin�most commonly on the elbows, knees, fronts of the legs, backs of the arms, genitalia, back and scalp� are hallmarks of the disease. The condition may cause no apparent discomfort, or the skin may be itchy and sore. While psoriasis is usually a persistent, chronic disease, its symptoms come and go over time. There is no cure for psoriasis, but there are a variety of treatments that can alleviate its sometimes severe discomfort.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS PSORIASIS?
Psoriasis begins as red and sometimes itchy areas of raised skin (plaques) on the elbows, knees, backs of arms or any area of the body mentioned before. The raised patches may become dry, white and flaky, or they may become silver and scaly, although the moist environment of the diaper area sometimes keeps the scale from becoming prominent. About one-quarter to one-half of children who develop psoriasis also develop pitting and other changes of their fingernails. If psoriasis begins in infancy, it usually appears first in the diaper area.
WHAT CAUSES PSORIASIS?
The precise cause of psoriasis is unknown. However, it often runs in families, indicating a possible inherited predisposition. For example, children whose parents have psoriasis are three times more likely to develop psoriasis than the rest of the population. The disease is uncommon in people of African and Japanese descent, as well as among Native Americans.
Psoriasis in babies may be worsened by direct contact with an irritating physical, chemical or biological substance. Psoriasis also may appear at a site of injury or surgical incision, and even in areas commonly bound by tight clothing.
WHAT TREATMENTS ARE AVAILABLE FOR PSORIASIS?
The type of psoriasis and its severity determine how aggressively a pediatrician or dermatologist treats the disease. If an irritating substance is causing the psoriasis, its removal may clear up the problem.
Initially, the doctor may recommend application of an over-the-counter moisturizing agent or emollient. Psoriasis makes the skin dry and flaky, and emollients such as petroleum jelly help the skin retain water.
Other possible treatments, such as exposure to sunlight or ultraviolet light and the use of over-the-counter topical cortisone creams, should be carried out only under close medical supervision. In some cases, psoriasis is treated with creams containing strong substances such as dithranol or tar; however, these creams should not be applied in the genital area, as they may burn or further irritate the delicate skin there.
COPING WITH PSORIASIS
While there is no certain way to prevent or treat psoriasis, good hygiene plays an important role in controlling the disease.
� Keep the child's skin, clothing and bed linen clean.
� Change wet or soiled diapers frequently.
� Follow the doctor's instructions in applying any ointment or other treatments for psoriasis.
� Keep the child's fingernails clean and clipped short to minimize risk of a skin infection caused by scratching.
� Bathe the child frequently in lukewarm or cool water to alleviate itching and discomfort.
GETTING HELP
Call your pediatrician if:
� Your child develops symptoms characteristic of psoriasis
Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, � 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.
Birthmakrs
Skin discolorations that are present at birth or appear shortly thereafter are known as birthmarks. They can develop anywhere on the skin, although some types tend to appear most frequently in particular areas. (Flat vascular malformations or port wine stains, for instance, commonly appear on the face.)
Most birthmarks are harmless, and only a small proportion pose significant cosmetic problems. Furthermore, the most common types of birthmarks are temporary, disappearing before the child reaches school age.
In a few rare cases, a birthmark may suggest the presence of a serious underlying disorder or pose an increased risk of skin cancer. Pediatricians examine babies carefully to identify such birthmarks, many of which can be safely removed.
HOW DO BIRTHMARKS DEVELOP?
Different types develop in different ways. Some are the result of excess pigment cells in a small area, while others develop when tiny blood vessels overgrow or expand in the skin.
TYPES OF BIRTHMARKS
�Cafe au lait Spots
. These are small, sharply defined areas of light to dark brown color. They are more common in dark-skinned infants, occuring in 12 percent of black newborns. Numerous cafe au lait spots may indicate the presence of a rare inherited disease called neurofibromatosis.
�Moles
. Moles, also known as Pigmented Nevi
, are rarely present at birth, developing instead throughout childhood and adolescence. Moles in newborns are typically somewhat larger than in adults, and they have the potential to become cancerous, so removal is usually recommended.
Some infants are born with extremely large moles that may cover large segments of the body. Besides being disfiguring, these moles have a high potential to become cancerous, and they should always be removed.
�Mongolian Spots
. These are large, flat, bluish or black patches that as many as 90 percent of black and other dark-skinned infants are born with. They usually are located at the base of the spine or on the buttocks. They are entirely benign and usually disappear without treatment by late childhood.
�Port Wine Stains
. Port wine stains are flat, red or purple discolorations caused by overgrowth of tiny blood vessels in the skin. They are present at birth, usually appearing on the face or limbs, and they grow along with the child rather than fading. Prominent or disfiguring port wine stains can be removed with laser treatment.
�Salmon Patches
. Also known as Stork Bites
and Angel Kisses
, these deep pink patches are the most common birthmarks, appearing in about 40 percent of all newborns. Salmon patches are most often found on the nape of the neck, the middle of the forehead and the eyelids. They usually fade and disappear before the first birthday.
�Strawberry Hemangiomas
. These raised, bumpy spots appear on a baby's skin in the first two to five weeks of life. They may start out pale, then turn red or purple and grow larger, especially in the first six months. Strawberry hemangiomas are most commonly found on the head, neck or shoulders. In contrast to port wine stains (flat hemangiomas), almost all shrink over the first two or three years and disappear by late childhood.
WHAT TREATMENTS ARE AVAILABLE?
The rare birthmarks that require treatment can sometimes simply be cut out of the skin in a minor surgical procedure. Lasers have been developed that can remove certain red and brown birthmarks.
IS MEDICAL ATTENTION NECESSARY?
A birthmark that is quite large, ulcerated, or located in an area where it interferes with functions such as eating does require medical attention. The rare types of birth marks associated with skin cancer should also be evaluated with special care.
At or soon after birth, the pediatrician will take note of ordinary types of birthmarks, and, if they are large, measure them. In later visits, he will check the birthmarks to see if they are regressing naturally or changing in any unusual ways. If a birthmark is disfiguring or potentially dangerous, the pediatrician may refer you to a dermatologist or plastic surgeon to have it treated or removed.
GETTING HELP
Call your doctor if:
� A birthmark changes in size, color or shape
� A birthmark bleeds or itches
� A birthmark becomes sore or tender
� Any new molelike growths appear, especially if they are irregularly shaped, discolored or large
Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, � 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.
Stytes
These pimplelike lesions that form at the edge of the eyelid are extremely common in children. They usually appear in the inner corner of the lower lid. Most styes look like small, red bumps with white centers. There is often a mild swelling and irritation of the entire eyelid.
HOW DO STYES DEVELOP?
A stye develops when a hair follicle or sweat gland at the base of an eyelash gets infected with bacteria�usually of the Staphylococcus family. The bacteria may be present in the eyelash follicle (the tiny passage where the lash is anchored in the skin) and multiply when the follicle is blocked. Bacteria may be introduced when the child rubs her eyes with dirty hands.
Before the stye appears, the child may complain of eye soreness that feels like a foreign object is caught beneath the eyelid. Swelling of the eyelid follows, accompanied by tearing and redness. Soon afterward, the stye itself forms.
IS MEDICAL ATTENTION NECESSARY?
Only if a stye lasts more than a few days, gets extremely irritated or enlarges significantly. Persistent styes may be treated with antibiotic eye ointment, but this method is rarely necessary.
WHAT TREATMENTS ARE AVAILABLE?
Home remedies are usually effective. Every three or four hours, apply a warm, wet compress to the eye and hold it there for 10 to 20 minutes. Use a clean cloth soaked in fairly warm (but not uncomfortably hot) tap water; a mild saltwater solution may be particularly effective. It is probably not a good idea to use an eye cup (a round container made expressly for soaking the eyes), because they can harbor bacteria and prolong the infection.
Never squeeze a stye. Even if you succeed in pushing out any pus that has accumulated, you risk spreading the infection to other parts of the eye.
PREVENTING STYES
� Discourage eye rubbing.
� Make sure all children have separate wash cloths and towels.
Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, � 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.
Scabies
This intensely itchy skin condition is caused by infestation with tiny, burrowing mites that lay their eggs within the outermost layer of the skin. Scabies infestations often look like brownish-gray, threadlike lines ending in black dots. These lines mark the path of the mite as it burrows under the skin. Itching usually develops a month or longer after the mite enters the skin. Small, red bumps erupt. Continued scratching can lead to a severe rash resembling eczema.
HOW DOES SCABIES DEVELOP?
Children can get scabies from skin-to-skin contact with someone who is already infested. Once the mite enters the skin, it deposits eggs and fecal material. As the eggs hatch and the mite population increases, itching develops gradually. This process may take four to six weeks. The picture may be complicated by a secondary infection, which occurs when bacteria enter skin broken by excessive scratching.
The symptoms of scabies infestation are often prompted by an allergic reaction, which develops when the immune system directs antibodies at the mites or their by-products. The fact that symptoms develop more quickly in second than in first infestations suggests that an allergic reaction is at work.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS SCABIES?
Before age two, scabies infestation is most likely to affect the armpits, feet and ankles. Older children more often develop lesions around the hands and wrists. Any time a child has an extremely itchy rash in these areas, scabies is a possible explanation, particularly in a child who rarely develops skin irritations. If several members of a household develop similar symptoms, scabies or some similar skin infestation is a likely explanation.
IS MEDICAL ATTENTION NECESSARY?
Yes. Scabies mimics many other skin irritations, particularly after being scratched for a few days, so the doctor should examine the rash and make a definite diagnosis. The doctor also will recognize the signs of a secondary bacterial infection, a common complication of scabies.
HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS SCABIES?
Scabies is diagnosed by microscopic examination of cells from a suspicious-looking lesion. If a scabies infestation is present, mites, eggs or feces will be visible.
WHAT TREATMENTS ARE AVAILABLE?
Several creams and lotions are available to eliminate scabies mites. These preparations are typically applied to the entire skin surface from the neck down and left on for six to eight hours. In most cases, one treatment is sufficient to get rid of the infestation, but a second treatment is sometimes needed about two weeks after the first.
PREVENTING SCABIES
� Avoid close physical contact with anyone known to have scabies.
� Discourage children from sharing towels and clothing.
� Consider treatment for the whole household if one member has scabies.
� Use hot water to wash all clothes, towels and bedding used by a child or adult with scabies.
Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, � 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, I,Death comes swiftly by moonlight,sneak Stone Lightning from Frozen Lake is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.
Boils
Also known as furuncles, boils are bacterial skin infections that arise when a sebaceous (oil) gland is blocked or a hair becomes ingrown in its follicle�the channel along which it grows from its root to the surface of the skin. The boil may feel itchy or painful, and the child may be tired and feverish.
Boils begin as hard, painful red lumps; they grow bigger and more painful as white blood cells are drawn to the site to fight the infection. The white blood cells form a capsule or "head" around the infection, resulting in an abscess. This pus-filled head usually takes two to three days to burst or drain. By that time, the pain should be alleviated, and the boil should completely heal within another week.
Because infections spread easily from one hair follicle to another, boils sometimes appear in clusters called carbuncles. These clusters are more painful than single boils, and they tend to heal more slowly. If a child has been ill or has lowered resistance to infection for some other reason, boils are more likely to develop into carbuncles.
WHAT CAUSES BOILS?
Boils and carbuncles are caused by bacteria, many of which normally colonize on the surface of the skin. The strain of bacteria most commonly responsible is Staphylococcus. Because bacteria are everywhere in the environment, almost everyone may develop a boil at some point. However, boils and carbuncles are more likely to occur in conditions of poor hygiene or when illness lowers resistance to infection.
The bacteria in boils can sometimes spread from one child to another through ordinary rough-and-tumble play
COPING WITH BOILS
Clean the skin around a boil with alcohol to help prevent the infection from spreading. To reduce the chance of irritating a boil, cover it with an adhesive dressing made of clean, dry gauze.
Never squeeze a boil; you may spread the infection by pushing the pus downward. Apply warm, moist compresses to the boil to encourage early draining. Antiseptics and ointments are of little value. Follow the pediatrician's directions for home care.
IS MEDICAL ATTENTION NECESSARY?
Yes, usually. Since boils will make children very uncomfortable, and since effective therapy is available, a doctor should be consulted.
WHAT TREATMENTS ARE AVAILABLE?
The pediatrician may prescribe a course of antibiotics to eliminate the boil or carbuncle. Follow her orders about the timing and size of antibiotic doses, and continue the medication for as many days as the doctor has prescribed, even if the symptoms have disappeared.
A pediatrician may also lance a boil (cut it open to drain the pus). Incision and drainage usually bring complete healing. If a child suffers from recurrent boils, a sample of the pus may be taken to determine the underlying cause of the infection. It may also be appropriate to do tests for some underlying cause, such as diabetes or an immune deficiency.
PREVENTING BOILS
The bacteria that cause boils are present throughout the environment, so prevention is often difficult. Helpful measures include:
� Encouraging frequent hand washing
� Making sure a child bathes regularly
� Cautioning a child not to touch another child's boil
� Covering a boil with an adhesive dressing to prevent spreading the causative bacteria
GETTING HELP
Call your doctor if your child:
� Has swollen and tender glands in the same area as the boil
� Has red streaks under the skin radiating out from the boil
� Has a boil in an awkward place�near the eyes, mouth, ear, under the armpit or in the diaper area of a baby
� Has a boil that has not come to a head in five days
Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, � 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.

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This sneak for Stone Lightning is stopped by his mate and lead mare Calamity. (NT) -- Calamity, 12:48:02 06/10/03 Tue