02 March 2009

Ouches and itches

More skin on show in summer means more skin irritation. It also opens the door for a host of nasties that could get under your skin.

More skin on show in summer means more skin irritation. It also opens the door for a host of nasties that could get under your skin. Keep your family itch and scratch-free with this summer skin survival guide. By PROFESSOR MAURICE KIBEL

Insect bites

Bites are a nuisance but serious only if they become infected from scratching. Some children develop a sensitivity to bites, a condition known as papular urticaria.

This is common in the warmer months. Repeated bites from fleas or sometimes bedbugs result in hypersensitivity and severe itching at the site of both fresh and old bites. Secondary infection, particularly by bacteria, is frequent.

A blitz on fleas in your home is essential. Spray mattresses and cracks in the floor with a good insecticide. However, outdoor sand fleas are often to blame. Apply calamine lotion, or bicarbonate of soda mixed with a little water, to relieve the itching. If it becomes unbearable, use crotamiton cream (Eurax).

Bee stings

Red alert! Some people are allergic to stings and can develop hives (also known as an urticarial rash) or even severe shock, with swelling of the face and mouth, difficulty with breathing and drowsiness.

If any of these symptoms appear after a sting, get the child to a doctor immediately. Adrenaline preparations, either by injection or inhaled, can ease the problem instantly.

In future, the child should wear a bracelet indicating an allergy to bees and a kit containing adrenaline in a syringe should always be on hand.

A sting is painful and the site stays red and swollen for about two days.

If the sting is still visible in the skin it should be carefully scraped out with the blunt edge of a knife or a credit card. Don't use tweezers – they could squeeze out the last bit of venom.

You can apply a cool, wet cloth or ice cube to help relieve the pain and swelling but don't rub as this will spread the venom. Antihistamine cream or calamine lotion may help.

Tick bite

If your child develops a fever after being bitten by a tick, see a doctor to make sure it isn’t tick-bite fever.

Carefully remove the tick so the head doesn’t stay behind. Putting Vaseline or oil on beforehand will make it easier to remove. Apply Betadine to the site.

Ringworm of the body (Tinea corporis)

A fungal infection of non-hairy skin, in children this rash particularly affects the face. The patches tend to be oval with a well-defined border and they spread outwards as they clear in the centre. Ringworm can be spread through direct contact, contaminated brushes or dogs and cats.

Antifungal creams will have a rapid effect but must be continued for two to four weeks. You can use the older (and cheaper) ointment Whitfield's, if newer ones are not available.

Ringworm of the scalp (Tinea capitis)

This is the most common fungal skin infection in children. It may take the form of a single round scaly bald patch on the head but more often there are several small scabbed patches.

Hypersensitivity to the fungus often develops, leading to a marked inflammatory reaction and enlarged nodes on the back of the head. This is often mistaken for impetigo of the scalp. There may well be bacterial infection too.

The condition will not clear up without antifungal treatment. Give oral griseofulvin – local treatment is ineffective.

Head lice

This common infestation of the scalp in children is not a sign of poor personal hygiene. Lice spread easily when children share combs and hats. Lice can't jump or fly but crawl from head to head.

The eggs of head lice (nits) can be seen as little white specks glued to the scalp hairs. It's easiest to spot them at the neckline and behind the ears.

Adult lice feed on blood by biting the scalp. It can take up to two months after infestation before you notice the signs. Itchy bumps develop and these often become infected from scratching, resulting in infection of the scalp.

The lymph nodes at the back of the head and in the neck are often enlarged. The eyelids can also be affected. In teenagers, pubic and under-arm hair may be infested.

Malathion with 0,4% alcohol is a cheap, safe and effective treatment. It kills lice and nits so the hair need not be combed to remove nits.

Permethrin is also an extremely effective, safe and cosmetically acceptable treatment for both scabies (see next page) and head lice.

Treat the whole family, not only the infected person, as head lice spread very easily. If your child has lice, you’ll have to notify the school.


Impetigo is a common and highly contagious bacterial infection of the skin. It appears in patches (about the size of a R1 coin) with blisters that rapidly become crusted. Sores often look as if they've been coated with honey or brown sugar.

Children tend to get it on the face, especially around the nose and mouth. It's caused by the Staphylococcus aureus bacterium or by certain strains of streptococcus which are often found together.

Most children get impetigo through physical contact with an infected person or by sharing towels, clothes, bed linen or toys.

Betadine or Bactroban ointments are effective, but all cases should be treated with an oral antibiotic or, where necessary, by injection.

Local treatment is less important. These ointments also work against residual germs in the nose that continue to cause abscesses and sores in children.

Heat rash (prickly heat)

Heat rash, also known as sweat rash, is caused when the tiny sweat gland openings become blocked.

What you see is a multitude of tiny clear blisters, often on the face and forehead or, in more serious cases, small red spots on the upper body. Humid, hot weather and being dressed too warmly may cause heat rash.

Dress in lighter clothing. Avoid greasy ointments that can make matters worse.

Molluscum (Molluscum contagiosum)

This viral infection of the skin causes well-defined, raised pearly grey pimples that measure 1 to 5 mm and may be found on any part of the skin. The pimples vary in number from only one or two to several hundred.

Molluscum is easily spread to other children. It is quite painless but disfiguring. The only real danger is when spots around the eye affect the eye itself. HIV-positive children or those with other immune deficiencies are prone to severe molluscum.

Molluscum generally disappears over time but if troublesome, or if there are lots of pimples, you should consult a doctor. Salicylic acid can be applied directly to the lesions.


Tiny insects (mites) burrow into the top layer of skin on warmer areas of the body such as the skin folds of the wrist and between the fingers or where clothing is tight, especially on the lower body.

An allergic reaction to scabies mites, their eggs and droppings causes small, intensely itchy spots. The itchiness is so severe it can keep the child awake at night. When these are scratched they become infected quite easily. Scabies is spread by skin contact and not as much by clothing and bed linen as was previously thought.

Various ointments can be bought over the counter; ask your pharmacist for one that's safe for babies and children. The rest of the family should wash with a special medicated soap (Tetmosol) against mites.


Warts are growths on the skin caused by a virus. There are several types but the common variety found on the face, hands, feet and elsewhere has a raised, rough surface.

Plane warts (verruca plana) are smooth and only slightly raised. The most troublesome are plantar warts on the soles of the feet. They may be painful as they are pushed in by the body’s weight.

Warts usually disappear in time if left untreated because the body's defences destroy the virus. If they're troublesome on the hands or feet, you can deal with them yourself but don't try to do so with facial warts.

The simplest is to apply an ordinary plaster which should be changed daily (it may take three weeks to see the wart diminish and disappear). If this doesn't work, apply wart paint (available from a pharmacy) but follow the instructions carefully.

A plantar wart can be treated by first rubbing off the rough skin with a pumice stone, then applying a salicylic acid plaster, known as a wart plaster. Change the plaster every day.

[This is an extract of an article that originally appeared in the Summer 2008/2009 edition of YOU Pulse / Huisgenoot-POLS. The current edition is on sale now.]

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