IntroductionSkin diseases are amajor health problem in the paediatric population and account for significantmorbidity.1 Annually, there are morethan 12 million office visits for rashes and other skin concerns in children ofwhich 68% are made to primary care physicians.2 Invarious parts of India, the prevalence of paediatric dermatoses has ranged from8.7-35% in school-based surveys.1       Skin diseases in thepediatric age group can be transitory or chronic and recurrent. The chronicdermatoses are associated with significant morbidity and psychological impact. Incase of pediatric dermatoses, a separate view from adult dermatoses as thereare important differences in clinical presentation, treatment and prognosis.

Factorssuch as socio-economic status, climatic exposure, dietary habits and externalenvironment influence dermatoses in children.1 Proper recognition ofthe many common cutaneous disorders is important as correct diagnosis will helpin prescribing appropriate therapy or determining the need for referral to adermatologic specialist.3 Commonskin problems in paediatric population are discussed below.

Rashes and lesionsRashes come inmany shapes and forms. A symmetric rash distributed equally over the entire body—includingextremities—indicates the possibility of a systemic cause. In contrast, a rashthat appears only on one part of the body such as contact dermatitis, sunburn, orother nonsystemic cause. The cause of a rash can be determined by its shape anddistribution. For example, a rash located under the umbilicus or watchbandsuggests nickel dermatitis.

The other identifying factor is colour of the rash.The majority of rashes seen in the primary care office (approximately 95%) havean inflammatory component and, therefore, will be red. A rash that is not redis unusual and may require referral to a dermatologist for accurateidentification. Scaly rashes involve inflammation in the epidermis, and, if therash is diffuse, the most common diagnosis is a form of atopic dermatitis (eczema).

Nonscaly rashes are a result of injury to blood vessels in the dermis andusually are accompanied by some swelling.3  Molluscum contagiosumMolluscumcontagiosum is a common, benign, self limiting viral infection of the skin thatis caused by poxvirus. The infection typically occurs in the 2-5 year age groupand is rare in children under 1 year of age.

Infection follows autoinoculationor contact with affected people and the incubation period is from two weeks tosix months. The condition is more common in young children and in children whoswim, who bathe together, and who are immunosuppressed. The lesions present asmultiple dome shaped pearly or flesh colouredpapules with a central depression (umbilication), which usually appear on thetrunk and flexural areas. The size of the lesions varies from 1 mm to 10 mm,with growth occurring over several weeks. In immunocompetent patients lesionsmay persist for six to eight weeks. Resolution is often preceded by inflammation.Uncomplicated lesions heal without scarring.

4 Atopic DermatitisAtopic dermatitis is acommon childhood inflammatory skin disease. The disease typically presents in infancy and early childhood and may persist intoadulthood.  Children may present with a varietyof skin changes, including erythematous plaques and papules, excoriations,severely dry skin, scaling, and vesicular lesions. Based on the age of thechild distribution of atopic dermatitis lesions can vary. In infants andchildren lesions are on the extensor surfaces of extremities, cheeks, and scalpwhile older children often present with patches and plaques on the flexorsurfaces. In severe cases thickened plaques with a lichenified appearance maybe seen.

2 ImpetigoImpetigo is a primaryor secondary bacterial infection of the epidermis of the skin. The causativeorganisms are Streptococcus pyogenes and Staphylococcus aureus. Although Streptococcus pyogenes was once consideredto be the most common cause of nonbullous impetigo, Staphylococcus aureus has surpassed it in more recent years. Thereare bullous and nonbullous forms of the infection. Bullousform typically occurs in neonates while nonbullous form is most common inpreschool-and school-aged children. Initially, children may develop vesicles orpustules that form a thick, yellow crust. The face and extremities are most commonlyaffected.

2Viral wartsCutaneous viralwarts are discrete benign epithelial proliferations caused by the humanpapillomavirus. Prevalence of viral warts increases during childhood, peaks inadolescence, and declines thereafter. In healthy children, warts resolvespontaneously and 93% of children with warts at age 11 show resolution by age16. Resolution can be preceded by the appearance of blackened thrombosedcapillary loops. In immunocompromised patients warts may be widespread andpersistent. The clinical appearance of warts depends on their location.

The handsand feet are most commonly affected.4 ConclusionSkin diseases in thepaediatric population are common all over the world including rural and urbanareas. The observation of individual lesions is of greatest significance sinceeach lesion is differently distributed, has specific patterning and morphology.By properly diagnosing the condition appropriate treatment can be initiated.

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