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The human body is home to a variety of germs that can cause skin infections. Viruses can cause cold sores and warts. Fungi can cause ringworm, athlete's foot and jock itch. And allergens in the environment, such as those on poison ivy, can cause itchy rashes.
Among the most common childhood skin infections are those caused by bacteria. Dr. Lewis First, chief of pediatrics at the University of Vermont Children's Hospital, explains the best way to treat these infections and how to prevent their reoccurrence.
KIDS VT: What are the primary causes of skin infections?
LEWIS FIRST: There are two major causes of bacterial infections: Staphylococcus aureus, also known as staph, and Group A streptococcus pyogenes, otherwise known as strep. Most, if not all, of us have these bacteria on our skin, and most of the time they live harmlessly in our bodies until the skin is broken through a cut, scratch, bite or puncture wound. When bacteria get under the skin, they can start to grow and multiply.
KVT: What do these infections look like?
LF: They can create rashes, redness, itchiness, sometimes pain and discomfort, and when they become more severe, fever. Different locations of infections result in different types of rashes. A staph infection that occurs in the inside lining of the eye is called a sty. If staph gets under a hair follicle, it can cause little white spots at the base of the hair that ooze pus, called folliculitis. If the pus can't get out, it builds up and can become a furuncle, or boil. And if the boil grows larger and goes deeper into the skin, it can become more painful and become a carbuncle. That, in turn, can develop into an abscess.
KVT: What's the best way to treat bacterial skin infections?
LF: Soaking the area with a wet, warm washcloth is a good way to start. Applying a heating pad or hot water bottle for 20 minutes at a time several times a day will help bring the boil to a head and allow it to drain. Light pressure may also help it to open, but if it doesn't or feels painful, stop! The harder you push, the more you're pressing bacteria deeper into the skin. If the infection is small, your doctor may prescribe an antibiotic ointment, or if it's more severe, an oral antibiotic. Ibuprofen can help reduce some of the inflammation, and that or acetaminophen will reduce the pain. Your health care provider may lance a carbuncle. Only puncture the lesion yourself if your health care professional approves of you doing so, rather than having it done under sterile conditions in a medical office. In those cases, the parent should first sterilize the needle with rubbing alcohol or a lit match, then briefly allow it to cool.
KVT: Are boils contagious?
LF: A boil is not contagious unless it's left open and other people touch it. These infections should be covered with a clean dressing and loose bandage when a child is out and about.
KVT: What is impetigo?
LF: Sometimes children develop little red pimples with blisters that appear around the nose, mouth and, sometimes, on their legs or buttocks. When the blisters pop, they can cause a yellow, scab-like crust and can itch. This is called impetigo. If you touch it, it can spread. Kids who have impetigo are likely shedding staph or strep. For this reason, they shouldn't go to school until they've had at least 24 hours of antibiotics. If the blisters are small, often you can treat them with an antibiotic ointment. If they're more widespread and appear on multiple areas of the body, your doctor may recommend an oral antibiotic. Be sure to wash the skin well with an antibiotic soap, such as one containing chlorhexidine, which will help kill the infection. Cover the area with gauze or a loose bandage and try not to scratch it. The more the blisters are scratched, the more they run the risk of scarring. Because impetigo is contagious, you must thoroughly launder the child's linens, towels and clothing in hot water to prevent spreading the bacteria to others.
KVT: When do bacterial infections become more serious?
LF: When bacteria goes below the upper levels of the skin and into the bloodstream, it can cause cellulitis. The skin becomes warm, red, tender and streaky. The infection can cause fever, chills and swollen glands. This will require an oral antibiotic. Sometimes a child will need intravenous antibiotics to get the infection under control because, on rare occasions, staph can be life-threatening. Infections caused by strep can also cause scarlet fever, which looks like a light red rash over the entire body and feels like sandpaper. Untreated strep can progress to cause rheumatic fever, which in turn can infect the heart and kidneys.
KVT: Are there concerns about the overuse of antibiotics?
LF: Over the years, as people increasingly have used antibiotics, especially for nonbacterial infections, some bacteria have become resistant to antibiotics. That has happened with staph. So if a family discovers that a routine, penicillin-like antibiotic is not working to treat a simple staph infection, then it's possible the child has acquired methicillin-resistant staphylococcus aureus, or MRSA. This type of resistant staph bacteria was once limited to hospitals and nursing homes. But over the last 15 years it has spread into the community and can spread easily within a family. Many people have MRSA on them and don't know it. But once they break the skin and a skin infection occurs, it can be harder to tackle. MRSA is treatable, but it requires a more advanced antibiotic, which can also have side effects.
Whenever antibiotics are ordered, children should take them for the full duration recommended by their health care provider, even if the infection has already disappeared. Conversely, parents should never use old antibiotics if they see redness or rash on the skin because it may not be the appropriate treatment for that rash, or the infection may not be bacterial in nature.
KVT: How can parents prevent bacterial infections?
LF: The best thing you can do is to reduce the amount of bacteria on your skin through thorough handwashing as often as possible, and not just because we're in a pandemic. Taking a daily bath with antibacterial soap, particularly if the child has experienced a staph infection, will reduce the level of bacteria on their skin. Keep wounds clean and covered, and don't share towels, sheets and clothing, especially with someone who's being treated for a bacterial skin infection.