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Suggest Treatment For Scars On Skin After Treating Impetigo
Question: My Son, 3.5 years old now was diagnosed and treated for impetigo last summer (2014) by his pediatrician using mupirocin (bactoban) prescription ointment for several months. It worked to some extent but the skin condition kept on expanding and so the scars (you can see the pics with old scars). It was very itchy for him as at night he will scratch unknowingly and in the morning i will see yellow pus and blood on his underwear as a result of that. I tried covering it up as much as possible with band aid but with limited success as the area was very large. From one side of his buttock it expanded to the other when we had visited Florida where in we had spent considerable time in the pool. Finally after 4-5 months we visited a Dermatologist after his Pediatrician asked us to do so. The Dermatologist said its not impetigo but eczema and prescribed Triamcinole Acetonide 0.1% to be applied twice for two weeks. It worked initially and we were happy that it has been diagnosed correctly but after four weeks it started reappearing again. We stopped the Triamcinole as it was a steroid based ointment. Friends suggested to use cold pressed coconut oil and other fragrance free lotion thoroughly. We also got some homeopathic lotion from WholeFoods market and natural aloe vera. Looks like nothing is helping. We are confused what to do. More importantly we don't know if its impetigo or a form of eczema. In the last two weeks it has not aggravated and is stable. Please advise.
Just to add to above- he goes to day care 5 days a week. Last summer he was also given an antibiotic once. The last picture attached is from last year when it was expanding rapidly.
Just to add to above- he goes to day care 5 days a week. Last summer he was also given an antibiotic once. The last picture attached is from last year when it was expanding rapidly.
Brief Answer:
Kindly send good resolution pictures of the area.
Detailed Answer:
Hello,
Welcome and thanks for posting your query to the forum.
I can understand your concern for the skin issue of your son. In view to help you best I request you to kindly upload few good resolution pictures of the affected area. For that you have a feature on the right side of the page. Or else you can send the pictures at
YYYY@YYYY
With attention " Dr Sanjay Kanodia "
Hope to hear soon from your side.
With regards,
Dr Sanjay Kanodia
MD-DERMATOLOGY
Kindly send good resolution pictures of the area.
Detailed Answer:
Hello,
Welcome and thanks for posting your query to the forum.
I can understand your concern for the skin issue of your son. In view to help you best I request you to kindly upload few good resolution pictures of the affected area. For that you have a feature on the right side of the page. Or else you can send the pictures at
YYYY@YYYY
With attention " Dr Sanjay Kanodia "
Hope to hear soon from your side.
With regards,
Dr Sanjay Kanodia
MD-DERMATOLOGY
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Kanodia, I have uploaded 4 pictures taken with my phone. In case you want much better pictures, i can upload it tomorrow. The last picture (2014 Picture.jpg) is from last year when it was growing rapidly.
Brief Answer:
Skin changes not related to impetigo.
Detailed Answer:
Hello XXXXXXX
Welcome to the forum again and thanks for posting the pictures.
I do understand your concern and appreciate your efforts to get early resolution of your son's condition.
The pictures are though helpful but not of the best resolution to reach to a conclusive point. Even then I can make out that the condition was not related to impetigo previously as well as in present situation too.
These are basically eczematous changes and are not changes due primary skin infection. Do let me know if his genital area has some eruptions or any other area such as upper body or on hands or Web spaces of fingers have any eruptions.
I humbly request you to kindly upload few good resolution pictures of the affected area. Do take the pictures from front as well as back area so that any involvement of genital area can be examined.
Hope to hear soon from your side.
With regards,
Dr Sanjay Kanodia
MD-DERMATOLOGY
Skin changes not related to impetigo.
Detailed Answer:
Hello XXXXXXX
Welcome to the forum again and thanks for posting the pictures.
I do understand your concern and appreciate your efforts to get early resolution of your son's condition.
The pictures are though helpful but not of the best resolution to reach to a conclusive point. Even then I can make out that the condition was not related to impetigo previously as well as in present situation too.
These are basically eczematous changes and are not changes due primary skin infection. Do let me know if his genital area has some eruptions or any other area such as upper body or on hands or Web spaces of fingers have any eruptions.
I humbly request you to kindly upload few good resolution pictures of the affected area. Do take the pictures from front as well as back area so that any involvement of genital area can be examined.
Hope to hear soon from your side.
With regards,
Dr Sanjay Kanodia
MD-DERMATOLOGY
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Doctor. I will click some high resolution picture tomorrow morning in day light conditions and upload. As suggested will click both frontal and back pictures. I have not seen any eruptions anywhere else but will have a look again to make sure.
Brief Answer:
I will wait for the same.
Detailed Answer:
Dear young lady,
Thanks a lot for your swift response. I will wait for the pictures to get uploaded and respond accordingly.
With regards,
Dr Sanjay Kanodia
I will wait for the same.
Detailed Answer:
Dear young lady,
Thanks a lot for your swift response. I will wait for the pictures to get uploaded and respond accordingly.
With regards,
Dr Sanjay Kanodia
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor, I am uploading some more pictures taken this morning. I did check his other parts and did not see any other appearance anywhere other than his bump. All new pictures uploaded has the series "New 2105 Jan". Regards,
Brief Answer:
Related to eczema like condition and not at all impetigo.
Detailed Answer:
Hello XXXXXXX
Welcome back and thanks a lot for sending all the important good resolution pictures along with further details of the condition.
I have analyzed all the pictures and interpreted the complete sequence of events of your son's condition. After analyzing the complete query with best diligence let me first reassure you that your son's condition is quite very commonly seen condition and there is nothing serious regarding this condition.
To tell you regarding the condition- Our skin is basically multilayered structure and the sensitivity of the skin varies form person to person with different age.
In children it is even more sensitive and in some kids it can be over sensitive. In your son's case there is an excessive tendency to scratch at particular area. Once your son's scratches at a particular site then it induce more itching and then it becomes a vicious cycle. Itching at one place induces more itching at nearby places and therefore causes further aggravation of the condition.
This can cause superficial damage to the skin which causes oozing of fluid and more provocation of the problem. These areas can secondarily get infected and later on as these heal then can leave the marks which we can see in your son’s case as eczema like condiiton.
You can see in the picture of 2014 that the area is basically eroded and have lot of excoriation marks. Present pictures also have marks remaining form the previous episode of 2014. In the present pictures you can see that there are basically superficial excoriations. So I first and foremost reassure you that it is not related to Impetigo or any infective condition. Had it been an infective condition then we would have seen it all over body spreading to rest of the sites too, which according to yourself is not present.
For the betterment kindly follow the suggestions below:
1. Let you take all measure that your son is not scratching his skin. Trim his nails and use a filer to make his nail blunt so that the sharp edges of nails can be avoided.
2. Let him wear cotton clothes and avoid synthetic clothes totally. Make sure that your son’s clothes are lose enough and are not at all any synthetic garments in the same.
3. Let him stay in cool environment (preferably AC) and avoid sweating.
4. Let him take daily bath once in morning.
5. Let him not pinch pop or squeeze or rub any area.
6. Do not use any home remedies near the affected area.
7. Do warm compression over the affected area. Take a wet towel soaked in warm water and apply it for 5-10 minutes for 3-4 times a day.
For the part of treatment I suggest my patients to follow the suggestions below:
1. Apply plane cortisone cream in a thin layer in morning and at night time. Apply in a very thin layer so that it should not be visible to naked eye. You can apply it for 7 days and then stop it after that.
2. For itching tablet “Loratadine” or "Deslotatadine" tablet by mouth can be given half tablet for two times or up to three to four times also if the itching is more.
Last but not the least an important cause is using nappies in the day care centres or related soiling of the buttock and lower areas by faeces or urine. I suggest you to check how best this part is taken care of by the day care centre staff.
I reassure you again that if you take care of above points then the condition will definitely become better and can be cured.
I hope above information will help you. If you have further queries I will be happy to help.
"Wish you good health"
Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
Related to eczema like condition and not at all impetigo.
Detailed Answer:
Hello XXXXXXX
Welcome back and thanks a lot for sending all the important good resolution pictures along with further details of the condition.
I have analyzed all the pictures and interpreted the complete sequence of events of your son's condition. After analyzing the complete query with best diligence let me first reassure you that your son's condition is quite very commonly seen condition and there is nothing serious regarding this condition.
To tell you regarding the condition- Our skin is basically multilayered structure and the sensitivity of the skin varies form person to person with different age.
In children it is even more sensitive and in some kids it can be over sensitive. In your son's case there is an excessive tendency to scratch at particular area. Once your son's scratches at a particular site then it induce more itching and then it becomes a vicious cycle. Itching at one place induces more itching at nearby places and therefore causes further aggravation of the condition.
This can cause superficial damage to the skin which causes oozing of fluid and more provocation of the problem. These areas can secondarily get infected and later on as these heal then can leave the marks which we can see in your son’s case as eczema like condiiton.
You can see in the picture of 2014 that the area is basically eroded and have lot of excoriation marks. Present pictures also have marks remaining form the previous episode of 2014. In the present pictures you can see that there are basically superficial excoriations. So I first and foremost reassure you that it is not related to Impetigo or any infective condition. Had it been an infective condition then we would have seen it all over body spreading to rest of the sites too, which according to yourself is not present.
For the betterment kindly follow the suggestions below:
1. Let you take all measure that your son is not scratching his skin. Trim his nails and use a filer to make his nail blunt so that the sharp edges of nails can be avoided.
2. Let him wear cotton clothes and avoid synthetic clothes totally. Make sure that your son’s clothes are lose enough and are not at all any synthetic garments in the same.
3. Let him stay in cool environment (preferably AC) and avoid sweating.
4. Let him take daily bath once in morning.
5. Let him not pinch pop or squeeze or rub any area.
6. Do not use any home remedies near the affected area.
7. Do warm compression over the affected area. Take a wet towel soaked in warm water and apply it for 5-10 minutes for 3-4 times a day.
For the part of treatment I suggest my patients to follow the suggestions below:
1. Apply plane cortisone cream in a thin layer in morning and at night time. Apply in a very thin layer so that it should not be visible to naked eye. You can apply it for 7 days and then stop it after that.
2. For itching tablet “Loratadine” or "Deslotatadine" tablet by mouth can be given half tablet for two times or up to three to four times also if the itching is more.
Last but not the least an important cause is using nappies in the day care centres or related soiling of the buttock and lower areas by faeces or urine. I suggest you to check how best this part is taken care of by the day care centre staff.
I reassure you again that if you take care of above points then the condition will definitely become better and can be cured.
I hope above information will help you. If you have further queries I will be happy to help.
"Wish you good health"
Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks you very much. It is a relief. One of the doctors at this forum had asked me to treat him for scabies using 5% Permethrin ointment (one application neck to toe) after the eczema symptoms ease. I assume i don't have to do such? He does not wear nappies or diapers anymore. We make sure to change his underwear as soon as he comes back from his pre-school.
Brief Answer:
Further suggestions and guidance regarding the mild eczema like condition.
Detailed Answer:
Dear XXXXXXX
Welcome back and thanks a lot for your further follow up.
I am really happy to know that you are relaxed after getting all the simple facts regarding your son's condition. As a parent I can very well understand your part of concern and anxiety related to our kids.
But as I reassured you this is very simple and commonly seen condition especially in kids. It is not unusual to find such kind lesions, so do not worry and make every effort possible to stop your little kid from scratching as well as good maintenance of hygiene.
As your son is around 3.5 years so he will understand the hazards and untoward side effects of scratching. Explain your son regarding the condition in playful manner so that he understands that he has not to scratch. Trim his nails and file his nails frequently and just check with your skin if the nails are sharp or blunt. Follow all the simple suggestions as explained before and you will find remarkable improvement in his condition.
For the part of scabies: I would have kept that possibility in case if we have had found lesions at other sites of body as well as in other family members (especially yourself as you spend most of time with him). Scabies is very infective condition and spreads rapidly to all the body sites as well as in other family members.
If you review our discussion I had asked you to check other body sites and send pictures of any lesions if present on front of body, which are actually not!!!
As the condition is present since more than 6 months which is enough of time for the scabies mite to get spread to so many other sites as well as to yourself. As it is infective condition so requires proper treatment and never heals by itself.
As you gave a history of remission for more than few months, which is quite impossible in scabies. A specific point of itching at night is bit indicative but I consider it as your observation at night time. The kid spends most of his time at day care, so you see him only after evening. He might be scratching at day care which you can ask the day care people. Also guide the day care people to take extra care of your lovely kid to not scratch their and to help him out of this condition.
Based on all these points I do not give scabies as an important diagnosis. Even then with due professional regards, there is no harm if you want to apply an antiscabicidal cream.
I hope above information will help you relax you completely. If you have further queries I will be happy to help.
"Wish you good health"
Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
Further suggestions and guidance regarding the mild eczema like condition.
Detailed Answer:
Dear XXXXXXX
Welcome back and thanks a lot for your further follow up.
I am really happy to know that you are relaxed after getting all the simple facts regarding your son's condition. As a parent I can very well understand your part of concern and anxiety related to our kids.
But as I reassured you this is very simple and commonly seen condition especially in kids. It is not unusual to find such kind lesions, so do not worry and make every effort possible to stop your little kid from scratching as well as good maintenance of hygiene.
As your son is around 3.5 years so he will understand the hazards and untoward side effects of scratching. Explain your son regarding the condition in playful manner so that he understands that he has not to scratch. Trim his nails and file his nails frequently and just check with your skin if the nails are sharp or blunt. Follow all the simple suggestions as explained before and you will find remarkable improvement in his condition.
For the part of scabies: I would have kept that possibility in case if we have had found lesions at other sites of body as well as in other family members (especially yourself as you spend most of time with him). Scabies is very infective condition and spreads rapidly to all the body sites as well as in other family members.
If you review our discussion I had asked you to check other body sites and send pictures of any lesions if present on front of body, which are actually not!!!
As the condition is present since more than 6 months which is enough of time for the scabies mite to get spread to so many other sites as well as to yourself. As it is infective condition so requires proper treatment and never heals by itself.
As you gave a history of remission for more than few months, which is quite impossible in scabies. A specific point of itching at night is bit indicative but I consider it as your observation at night time. The kid spends most of his time at day care, so you see him only after evening. He might be scratching at day care which you can ask the day care people. Also guide the day care people to take extra care of your lovely kid to not scratch their and to help him out of this condition.
Based on all these points I do not give scabies as an important diagnosis. Even then with due professional regards, there is no harm if you want to apply an antiscabicidal cream.
I hope above information will help you relax you completely. If you have further queries I will be happy to help.
"Wish you good health"
Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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