Skin Disorders in Young Children II - Discoid Eczema

This is another type of eczema that is common in children and young adults. They present as round, red patches of eczema or skin inflammation located mainly on the arms and legs. The lesions are coin-like, hence the term discoid eczema.

Clinical Features
There are 2 forms of discoid eczema:

• Wet form: with oozing and crusting lesions.
• Dry form: with redness and scaly lesions.

Both forms are persistent, lasting for months if untreated.

​​Discoid eczema is frequently mistaken for ringworm. It does not respond to antifungal creams.

Treatment:
Treatment is with moderate strength steroid creams.
Lesions are slow to resolve and treatment takes considerable time before improvement is seen.

​​What is Diaper Dermatitis?
This is a childhood skin disorder. It affects young children under the age of 2 years. It is an inflammation of the skin resulting from skin irritation of chemicals in urine and faeces.

There are 4 presentations:

• The most common presentation is "chafing dermatitis". This is most frequently observed at 7 to 12 months of age, when the baby's urine volume exceeds the absorbing capacity of the diaper. There is involvement of the convex surface of the thighs, buttocks and waist area (Fig. 6).
• The second is "perianal dermatitis" where the dermatitis is limited to the area around the anus. This is seen in newborns who have experienced diarrhoea (Fig. 7).
• The third presentation is characterized by shallow ulcers scattered throughout the diaper area (Fig. 8).
• The fourth presentation consists of confluent redness with satellite lesions involving the inguinal areas and the genitalia. This is due to a secondary yeast (a fungal) infection (Fig. 9).

​​Diaper dermatitis is the result of prolonged skin contact with urine and faeces. Tight occlusion of faeces and urine by diaper covers increase the penetration of these alkaline substances through the skin.

​​Consult your doctor for advice. Avoid self-medication.

The basis for treatment in diaper dermatitis is to remove the urine and faeces from the skin surface and prevent skin maceration by keeping the diaper area dry.

• Lubrication of diapered skin with a greasy ointment decreases the severity of diaper dermatitis and protects the skin from urine and faeces.
• Very frequent diaper changes followed by application of ointment limits maceration and prevent recurrences.
• Diaper change a few hours after the baby goes to sleep and reducing fluids just before bedtime may help.
• Avoid plastic and rubber pants.
• Yeast infection in the diaper area requires antifungal creams. Your doctor will prescribe the appropriate medication.
• ​In severe dermatitis, your doctor may prescribe hydrocortisone 1 % cream twice daily to help decrease the infant's discomfort.