Tag: dermatology

Treating Hard to Control Warts

Unfortunately, there are no quick and easy ways to treat warts.

In fact, because there are no quick and easy ways to treat warts, many pediatricians suggest that parents simply wait it out, and let the warts go away on their own.

Common Wart Treatments

If you don’t have the patience to wait for a wart to go away on its own, which can take months to years, you can try:

  • OTC topical liquid or gel wart remover treatments with salicylic acid
  • OTC wart remover treatments with salicylic acid on a pad
  • OTC wart remover treatments that freeze warts
  • duct tape

Your pediatrician might also try:

  • cryotherapy – “prescription strength” wart freezing, which may have to be repeated multiple times
  • cantharidin – not FDA approved in the US, but this blistering agent is often applied to warts to induce them to go away

And of course, your pediatrician might also simply recommend that you wait it out for a few more months or years, as the warts should eventually just go away.

But why not treat the warts if treatments are available? Many experts say that at best, standard wart treatments only work half of the time. And they can be painful or leave scars.

Treating Hard to Control Warts

Again, treating warts is often hard, even in the best of circumstances. Warts can be even harder to treat if they are around your child’s nails (periungal warts) or on the bottom of their feet (plantar warts).

Plantar warts can be hard to treat.
Plantar warts can be hard to treat. Photo by happyfeet34 (CC BY 2.0)

Still, if you are not getting anywhere, you should ask yourself these questions and share the answers with your pediatrician:

  • Does your child really have warts?
  • Did you follow the directions on the label carefully?
  • Are you gently rubbing away hard skin from the surface of the wart with a pumice stone or emery board each week?
  • Are you softening the skin on and around the wart by soaking the area in warm water for at least 5 minutes before your wart treatments?
  • Did your child’s wart mostly go away and then come right back in the same spot?
  • Did your child’s wart completely go away, but new warts came up in different places?
  • Did your child get a much bigger wart around the site of a previously treated wart (a ring wart)?

A dermatologist can treat your child’s truly resistant warts with cryotherapy, cantharidin, higher strength salicylic acid paste than is available OTC, yeast injections, electrosurgery, or pulsed dye laser therapy, etc.

What To Know About Treating Hard to Control Warts

Although multiple wart treatments are available, warts are not easy to treat and so it is not unreasonable to just leave them alone if they aren’t bothering your child.

More Information About Treating Hard to Control Warts

Treating Hard To Control Eczema

Eczema or atopic dermatitis very commonly affects kids.

Few conditions are as frustrating for parents and pediatricians, because even when properly treated, you can expect eczema to flare up from time to time after it gets better. Eczema is even worse when it isn’t properly treated though.

What Triggers Your Child’s Eczema?

Like other things that are supposed to have triggers, like asthma and migraines, it is often hard to figure out what triggers a child’s eczema.

Dress in soft, breathable clothing and avoid itchy fabrics like wool, that can further irritate your eczema.

National Eczema Association

Common eczema triggers to avoid might include:

  • harsh soaps and cleansers, shampoos, and body washes, including those with fragrances
  • food allergy triggers – milk and eggs
  • environmental allergy triggers – dust mites and animal dander
  • low humidity
  • temperature extremes – either getting too hot or too cold
  • skin infections

And anything else that might make your child’s skin dry and itchy.

Eczema Treatments for Kids

Although there is no cure for eczema, it is usually possible to control your child’s eczema, including getting rid of all or most of her eczema rash and decreasing how often your child has eczema flares.

These basic treatments include:

  • using lukewarm water for daily baths and showers
  • using a soap substitute or cleanser that is unscented, fragrance-free, and dye-free – Cetaphil, Dove, Aveeno
  • using a tar-based shampoo if your child’s scalp is red and itchy – T-Gel
  • daily use of moisturizers, especially within a few minutes of taking a bath or shower (soak and seal therapy)
  • prompt use of a moderate strength prescription topical steroid (like traimcinolone acetonide 0.1% cream) as soon as your child has a flare, with red, rough itchy skin
  • as needed use of oral antihistamines to help control itching during flares – Benadryl
  • keeping your child’s finger nails short to minimize damage from scratching

A written eczema action plan can make sure that you understand how and when to do each of these treatments.

Best Moisturizers for Eczema

Everyone seems to have their favorite eczema moisturizer.

Which is best?

The best moisturizer is probably the one that your child will use and which works to keep his skin from getting dry. In general though, ointments are better than creams, which are better than lotions.

Some favorites include Aquaphor (too thick and greasy for some people), Vanicream Moisturizing Skin Cream, CeraVe Moisturizing Cream, Eucerin Original, and Cetaphil Moisturizing Cream.

Whichever moisturizer you use, be sure to apply it to your child’s skin within three minutes of his soaking in a bath or shower so that you can seal in the moisture (soak and seal therapy).

Treating Hard To Control Eczema

What to do you do when basic treatments aren’t working?

Although a pediatric dermatologist can evaluate your child to see if she needs a systemic medication, phototherapy, or other treatment, most kids with hard to control eczema simply need more education to make sure they are using standard treatments correctly.

  • Is your child bathing correctly?
  • Are you putting on the right moisturizer, using enough moisturizer, and using it often enough?
  • Is your soap too harsh?
  • Are you afraid to use a topical steroid?
  • Are you applying a steroid over a moisturizer, which can make it less effective?
  • Could you be doing more to avoid triggers?
  • Could stress be triggering your child’s eczema?

What’s next?

A Staph skin infection might be a problem. In addition to oral antibiotics, weekly dilute bleach baths might help if this is an issue for your child.

Your child with hard to control eczema might also benefit from:

  • using more moisturizer over his entire body – don’t spot treat the areas that you think are a problem
  • using a thicker moisturizer – put your jar of Aquaphor in the freezer or refrigerator if your child doesn’t typically like using a moisturizer or complains that it stings or burns
  • a prescription barrier cream to control itching – Atopiclair, MimyX
  • a prescription topical Clacineurin Inhibitors – Elidel, Protopic
  • a 504 school plan
  • changing your laundry routine – wash new clothes, use mild, dye free laundry detergent and rinse twice after washing
  • using sunscreen and rinsing after swimming in a pool or excessive sweating, applying a moisturizing quickly afterwards
  • allergy testing to better identify triggers

You might also talk to your pediatrician about wet wrap therapy. With this treatment, you have your child take a bath or shower, applying a topical steroid to the affected areas and a generous amount of moisturizer to the rest of your child’s skin. Next, cover the area in wet cotton clothing or a wet dressing, and lastly, dress your child in dry cotton clothing, removing them all once the clothing dries out. You can then repeat the whole process or start again the next night, continuing until your child’s eczema is under better control.

Wrap therapy can be done with wet pajamas if you have to cover a big area, tube socks with the end cut off if you just have to do his arms, or cotton gloves for hard to control hand eczema. Some experts even recommend using a chilled wet dressing, putting the wet clothes in the refrigerator for a short time before using them on your child.

If you are at the point of considering wet wrap therapy, seeing a pediatric dermatologist might also be a good idea.

What To Know About Treating Hard To Control Eczema

While eczema can usually be controlled and most kids eventually outgrow having eczema, you may need some help to really understand how to really manage your child’s eczema effectively.

More Information About Treating Hard To Control Eczema

Treating Hard to Control Acne

Does your teen or pre-teen have acne?

Does he want to get it under control? Will he actually follow a daily regimen your pediatrician prescribes?

Acne Treatments for Kids

While treating your child’s acne on you own with an over-the-counter product can be a good way to start, there are so many products, you do want to make sure you are using the right ones. In general, you should likely start with:

  • products with benzoyl peroxide (BP), which might include OTC 5-10% BP wash for your child’s back or chest
  • a gentle, soap free, pH-balanced cleanser to wash your child’s face twice a day or a salicylic acid cleanser
  • a facial toner, only if necessary to remove excess oil or makeup

When those regimens aren’t working, your pediatrician can prescribe stronger acne medicines, usually in a step-wise fashion, including:

  • a topical retinoid –  Tretinoin (Retin A), Adapalene (Differin), or Tazarotene (Tazorac)
  • a combination topical product – BP/clindamycin (BenzaClin), BP/adapalene (Epiduo), BP/erythromycin (Benzamycin),  tretinoin/clindamycin (Ziana)
  • oral antibiotics – doxycycline, monocycline, tetracycline

If your child isn’t tolerating these medicines, like if it is causing his skin to become dry, make sure he is also using a moisturizer and washing with a mild soap substitute, like Dove. Starting with the lowest strength medicine can also be helpful, perhaps even just using topical medicines every other day until your child gets used to them.

Treating Hard to Control Acne

What do you do if your child’s acne isn’t getting better?

Ask yourself these questions and discuss the answers with your pediatrician:

  • Has your child started puberty yet? If not, talk to your pediatrician or a pediatric endocrinologist to see why he or she has such bad acne.
  • Are you avoiding picking up an acne prescription because of the cost? Ask your pediatrician about lower cost alternatives.
  • Is your child really using his acne medicines each day?
  • Is your child correctly using his acne medicines each day, avoiding spot treating problem spots and using a pea-size amount of cream or ointment to cover his whole face? Teach her to use the 5-dot method of applying acne cream – with a small pea-size amount of cream, place dots of the cream on their forehead (1), cheeks (2, 3), nose (4), and chin (5). Rub the cream in until, keeping in mind that they are using too much if you can see or feel any left over cream.
  • What kind of acne does your child have? Comedonal (whiteheads and blackheads) and inflammatory acne (classic zits or pimples) are treated differently.
  • Does your child frequently touch or rub his face, which can make acne worse?
  • If using makeup, is it oil-free and noncomedogenic?
  • Is your child overdoing washing, using a harsh soap or astringent, thinking that dirt is making her acne worse?
  • Does your child use a non-comedogenic sunscreen, remembering that a sunburn will make her acne worse in the long run?
  • Does your child have severe acne, which should probably be treated with a combination of oral antibiotics plus topical retinoids with BP, with or without topical antibiotics?
  • Did you give the medicines enough time to work or have a relapse because you stopped them too soon? Acne often worsens before it gets better and oral antibiotics are often continued for months and months,  with a goal of being tapered and stopped after about three to six months.
  • Does your child need a step-up in therapy? Ask your pediatrician if you need to add on a new medicine, switch to a combination product, or move to a higher strength product.
  • Have you considered adding hormonal therapy (combination oral contraceptives) for your pubertal daughter with severe acne, such as Ortho-Tri-Cyclen, Estrostep, or Yaz?

Lastly, even with worry about possible side effects, oral isotretinoin (Accutane, Amnesteem, Sotret, and Claravis) is still a good option for teens with severe, refractory, and scarring acne. At this point, and perhaps even before, an evaluation by a dermatologist would be a good idea.

What To Know About Treating Hard to Control Acne

There are no quick fixes for acne, but your pediatrician can offer you a step-by-step regimen of topical and oral acne treatments.

More Information On Treating Hard to Control Acne