Pediatric dermatologist Bernard Cohen discusses prevention and treatment for an array of summer skin conditions, from insect bites to poison ivy, sunburn and melanoma.
What kinds of issues in children concern you this time of year?
One is insect bite hypersensitivity, when the patient has an acute or toxic reaction to a bee sting or mosquito bite. Children tend to get a lot of swelling and redness, which can be quite itchy and painful but, fortunately, these symptoms are usually localized and short-lived. Typically, they go away within 24 hours.
What should parents do?
I advise parents to use antihistamines and cold compresses, that sort of thing. If the child is having a severe reaction, an anaphylactic reaction with deep-seated hives and swelling in the throat, he or she should get antihistamine and epinephrine immediately. There is a subset of patients, those with a family history of allergy, who will get an acute anaphylactic reaction to a bee sting or insect bite. For children who have this kind of reaction, their parents should carry an EpiPen with them.
Should they go to the emergency room?
In most cases, kids with bad bites and stings should not go to the ER. They arrive with a rash and leave with antibiotics and oral steroids as treatment for a suspected infection that will go away by itself in 12 – 24 hours. Taking antibiotics and steroids is not without risk. If the child still had a rash and swelling from a bite a week ago, then I would be worried about an infection.
Should hypersensitive kids wear repellent?
Yes. The American Academy of Pediatrics suggests using DEET-containing products with a concentration up to 30 percent, which maxes out the length of time it will work. Higher concentrations do not increase their efficacy and may increase the risk of irritation. Wearing light-weight long sleeve shirts and long pants helps too.
Are there areas of the body more vulnerable to bites?
There are certain areas where a child can get a lot of swelling, including ears, eyelids, the top of hands and feet, and genitals. It is important to protect those areas. I tell parents if they are hiking in the woods with their child who is sensitive to bites, take along some Benadryl.
What do you recommend for a bad case of poison ivy?
Cool compresses and Calamine lotion. If it really gets bad, we do use topical steroids, and if it becomes widespread and the kid is incapacitated, we will use oral steroids. But the biggest mistake physicians make is prescribing five-day dose packs for kids, which is a waste of time. It takes a minimum of 24 – 48 hours for oral steroids to kick in. So on day 5, when the child begins the lower dose in the dose pack, the poison ivy flares up again. I treat for a minimum of 10 days and typically 14 days. If you have a severe case of poison ivy and you do not treat it, it can last a month to six weeks.
When should parents have sunburn concerns?
The most important consideration is skin type. If your child has blond hair, blue eyes and no pigment, make sure he or she wears protective clothing and sunscreen. Surfing shirts or long-sleeve sun shirts work well on the beach in the summer.
And skin cancer?
Melanoma is still rare in children but not as rare as it used to be, especially in adolescents. Their risk is now approaching that of adults because of sun and ultraviolet light exposure. I hate it when kids and adults go into tanning salons, which pose a risk of melanoma long term. The cosmetic agents that are used topically to give you a tan look without sun exposure have become much more acceptable. If you can get a tan from a bottle, I’d much rather you do that. Also, I ask moms to do a once-a-month mole check at home. Picking up any changes in their child’s moles early can be very useful from a prevention standpoint.
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