HealthLeader

An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Comfort In Their Own Skin

Advances in pediatric dermatology are bringing back joy in children

Every parent wants their child to feel comfortable in their own skin, but this can seem impossible if that child is afflicted with bad acne or constantly itching from eczema. Such conditions take a terrible toll, as Adelaide Hebert, M.D., professor and director of pediatric dermatology at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), knows only too well.

“Children suffer a lot due to skin disorders whether at home or at school. Skin disorders often result in teasing, bullying and being excluded from activities,” says Hebert, a pediatric dermatologist with UT Physicians. “The physical and emotional discomfort affects sleeping patterns, which in turn impacts mood and academic performance. Troublesome skin conditions can have devastating consequences not just on children, but their whole family.”

The good news is that, armed with the right expertise and treatment, results can be truly transformational. Flashing a gorgeous smile and beautiful blue eyes, 6-year-old Audrey bears testimony to Hebert’s healing hands. They have brought her parents, Leslie and Todd Bazin, a renewed sense of hope and happiness in sharp contrast to their previous life, which was devastated by Audrey’s severe eczema.

“It strained her ability to make friends. I got so tired of people asking me what’s wrong with her skin and having to explain why her skin looks the way it does or why she had to keep going to the school nurse. This was a quality of life issue,” Leslie says.

Audrey’s eczema became so all consuming, it even stunted her growth. This ultimately led her parents to Hebert, who has more than three decades of experience and countless patient success stories.

“Our pediatric dermatologist just looked at me and said, ‘I’m totally tapped out, I can’t help you anymore. You need to see Dr. Hebert,’ ” Leslie recalls.

With the benefit of Hebert’s therapy, Audrey’s sleeping and eating returned to normal and she started to grow beyond expectations. Through calculated trial and error with various treatments, her once red and inflamed skin showed considerable improvement. Three years since Audrey’s first appointment, she is now unrecognizable in body and spirit.

“She gave Audrey a sense of control over the situation and always had another option, which left us feeling so confident. Thanks to her tireless dedication, we all got our lives back and are so relieved that our little girl is no longer enduring such torment.”

Early intervention is the key to successfully tackling any skin complaint, according to Hebert, who also speaks from personal experience having suffered eczema as a child.

“Do not suffer in silence or wait for your skin condition to worsen. Although only mild, my childhood eczema really bothered me because it was so visibly evident. I went to see a dermatologist and remember thinking it would be great if I could ever have the opportunity to someday help kids who also suffered so intensely with their own eczema,” Hebert recalls. “During my childhood there were limited numbers of topical steroid creams and tar lotions which were satisfactory but nothing in comparison to what we can currently offer for treatment. To help most patients with atopic dermatitis, the physician needs to ‘grab the bull by the horns’ and gain control of the skin disorder,” she says.

“So many teenagers with acne go from scarcely being able to look me in the eye to exuding confidence and telling me I have totally changed their life. That is what motivates me every day — helping people to be happy again,” Hebert says.

Eczema

Although the severity of Audrey’s eczema, also known as atopic dermatitis, is rare — the condition affects one in five schoolchildren in the U.S. to varying degrees. Symptoms include dry, itchy, red skin, which may be more prone to infection and sensitive to heat and allergens, such as dust or wool. The dermatitis tends to appear in patches on the elbow and knee creases, and those affected also often suffer from asthma and hay fever.

Hebert believes the condition is widely undertreated, despite the extensive range of treatment options.

“Some creams, such as ceramide formulations, are available over the counter and can be applied two to three times a day. Topical steroids, from age 3 months upward, can provide effective relief although there are rare potential side effects from long-term use, such as skin thinning and discoloration,” Hebert says. “But there are also now nonsteroidal medications which work as immune modulators, effectively turning off the irritation and inflammation. Better medicines are becoming available all the time, so the key is not to stop looking for new options.”

Hebert recalls the case of a 3-year-old boy who felt so trapped by his eczema he became withdrawn and stopped talking. Bloodstained sheets from scratching through the night uncover the agonizing daily reality for children badly affected. 

“Children respond with all kinds of coping mechanisms and the effects of atopic dermatitis are just as upsetting for the parents. The whole family dynamic is disrupted, which is why it is vital to seek help from a dermatologist.”

Birthmarks

Red birthmarks, called hemangiomas, can be a source of considerable distress, especially as children grow older and become more self-conscious. With 70 percent of hemangiomas appearing on the head and neck, it is easy to see why this is the case.

“It can be really upsetting for a 4 or 5-year-old to have someone ask, ‘What is that on your face?’ Parents can also take offense when a stranger approaches them and says, ‘What is wrong with your child?’ ” Hebert says.

Fortunately, children can be spared such an ordeal.

“It is possible to start therapy for hemangiomas of infancy at 3 to 8 weeks. Treatment can be topical in certain cases or involve oral medication for the more severe or potentially larger hemangiomas or hemangiomas in certain anatomic locations,” Hebert says. “Helping the child to look more normal can remove the psycho-social burden and give them have a more positive first experience of school when they are most vulnerable in their early years.”

Psoriasis

Every year approximately 20,000 children in the U.S. under the age of 10 are diagnosed with psoriasis. This papulosquamous skin disorder is commonly found on the elbows, knees and scalp, with the symptoms being red, scaly patches occurring in well-defined plaques.

“Treatments include tar-based products which can be left on overnight. Common therapeutic interventions use combinations of vitamin D analogues with or without steroid creams,” Hebert says. More severe cases or patients with psoriasis in occurrence with joint disease may require systemic medications.

The cause of psoriasis is unknown, although genetics are thought to play a role. If both parents have psoriasis, the chance of the child developing this skin disorder increases by 50 percent.

Some young people report the onset of psoriasis following an infection, particularly strep throat. Many young people affected experience a flare-up shortly after an earache, strep throat, bronchitis, tonsillitis or a respiratory infection.

Children are more likely to experience the onset of psoriasis and psoriatic arthritis together.

According to the American Academy of Dermatology, a peak period of pediatric psoriasis onset is age 11 to 12. As with atopic dermatitis, genes, the immune system and environmental factors are all believed to play a role in the onset of the disease. Early recognition, diagnosis and treatment are critical to relieve pain and inflammation and help prevent progressive joint damage.

Acne

Few teenagers are lucky enough to escape the scourge of acne. While acne is for some an occasional annoyance, for others it can be a huge issue causing untold physical and psychological pain.

That is why Hebert recommends taking good care of your skin and acting fast if acne becomes a problem, particularly if scarring is noted.

“The dentist does not wait until cavities appear — there exists a whole dental program of maintenance and prevention. The same applies with acne care,” Hebert says. “Carrying out a regular skincare routine is really important and the sooner the patient gets into these good habits, the more their skin will improve.”

Over the last 20 years, teenagers have started to hit puberty earlier, which has led to Hebert seeing acne in an increasingly younger age group.

“I have seen acne in children as young as 7 years of age and acne is becoming more common among 9 to 12-year-olds. As one in every six pimples carries risk of scarring, this represents a big issue and one that needs tackling with advice and treatment,” Hebert says.

Like all parents, Hebert warns against the perils of squeezing or picking acne lesions and suggests steering clear of using grainy scrubs, which can increase inflammation.

“Swimming may be helpful, because of the drying effect of the chlorine. I recommend a well-balanced diet without junk food or too many carbohydrates. Switching soda for water and getting plenty of fruit and vegetables, along with the proper skin regimen and treatment, can really improve a teenager’s overall skin condition,” Hebert adds.

Diet alone is unlikely to be enough to keep the zits at bay. Over-the-counter washes or creams containing salicylic acid and benzoyl peroxide can be effective. For more serious cystic acne, there are both topical and oral antibiotics, which should be combined with topical benzoyl peroxide to enhance effectiveness and reduce antibiotic resistance. If these treatment measures do not adequately control the acne, oral retinoids may be offered.

Hebert advocates seeing a dermatologist for acne if the disorder is not getting any better and if it is causing scarring and/or distress to the patient.

A six-month course of oral retinoids for moderate to severe acne can work wonders.

“Even after just two months of oral retinoid therapy, the results typically are dramatic. Patients’ friends and family notice a huge difference, not just in their appearance but their whole sense of self and well-being,” Hebert says.

“The damaging impact of this disease on both girls and boys is not to be underestimated. I care for acne patients every day but continue to find the stories of suffering I hear so compelling,” Hebert says. “First step treatments are available from the pharmacy. But if those products are not producing clearance of your acne, it is probably time to step up and see a specialist for a personalized plan.”

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