Clinical Review

More common skin infections in children

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7501.1194 (Published 19 May 2005) Cite this as: BMJ 2005;330:1194
  1. Michael J Sladden (m.sladden@doctors.org.uk), clinical epidemiologist and specialist registrar in dermatology1,
  2. Graham A Johnston, consultant dermatologist1
  1. 1 Department of Dermatology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, LE1 5WW
  1. Correspondence to:
  • Accepted 22 February 2005

Introduction

Childhood skin infections are commonly seen in both primary care and dermatology practice worldwide. They consume considerable resources and need careful management. However, education and reassurance of patients and parents, combined with simple treatment and self management, play a vital part in successful treatment. We recently reviewed four common childhood skin infections: molluscum contagiosum, cutaneous viral warts, impetigo, and tinea capitis.1 We now review four more skin infections commonly seen in children, describing the epidemiology, clinical features, and treatment of each. For conditions with limited evidence, we provide pragmatic advice and recommendations.

Sources and selection criteria

We searched Medline, Embase, and the Cochrane Library by using the terms “scabies,” “head lice,” “folliculitis,” and “herpes simplex virus.” We included randomised trials, reviews, meta-analyses, and guidelines.

Scabies

Scabies is an intensely itchy dermatosis caused by the mite Sarcoptes scabiei. The infestation can occur at all ages but particularly occurs in children. It is a common public health problem in poor communities and developing countries.

Scabies is highly contagious and is spread from person to person by direct skin contact. Transfer from clothes and bedding occurs rarely and only if contaminated by infectious people immediately beforehand.2 Infestation occurs when pregnant female mites burrow into the skin and lay eggs. After two or three days the larvae emerge and dig new burrows. They mature, mate, and repeat this cycle every two weeks.

The main symptoms of scabies are caused by the host immune reaction to burrowed mites and their products.3 Symptoms appear within two to six weeks of the initial infestation, but reinfestation can provoke symptoms within 48 hours. The most common presenting lesions are papules, vesicles, pustules, and nodules. The pathognomonic sign is the burrow—a short, wavy, grey line that is often missed if the skin is eczematised, excoriated, or impetiginised. In adults, scabies …

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