From the Guidelines
The child should be evaluated by a pediatrician or dermatologist to determine the underlying cause of the neck discoloration and prescribe appropriate treatment. The neck discoloration in a 12-year-old could be acanthosis nigricans (a velvety darkening of skin folds), tinea versicolor (a fungal infection), or another dermatological condition that requires proper medical diagnosis. When considering treatment options, it's essential to note that the use of topical corticosteroids should take into account the age of the patient, the site to be treated, and the extent of the disease, as highlighted in a study by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1. Some key considerations for managing skin conditions include:
- Time for explanation and education is essential
- Adequate amounts of emollients should be prescribed, and these should be used liberally
- Deterioration in previously stable eczema may be due to secondary bacterial infection or to development of a contact dermatitis, as noted in the study 1. If the discoloration is acanthosis nigricans, it may be related to insulin resistance, and addressing underlying metabolic issues would be important rather than just treating the skin. If it's tinea versicolor, an antifungal medication might be needed. Self-diagnosis and treatment without proper medical evaluation could delay appropriate care or potentially cause harm. Given the potential complexity of the condition, it's crucial to prioritize a thorough medical evaluation to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
For dermatologic use only. Active Ingredient Hydrocortisone 1% Purpose Anti-itch
The most suitable ointment for a 12-year-old with neck discoloration is hydrocortisone ointment, as it is for dermatologic use and serves as an anti-itch medication 2 2. Mupirocin ointment is also for dermatologic use, but its use is not explicitly indicated for neck discoloration or anti-itch purposes in the provided label 3. However, hydrocortisone is a more suitable option given its explicit anti-itch purpose.
From the Research
Treatment Options for Neck Discoloration
- The treatment for neck discoloration depends on the underlying cause, which could be a fungal infection 4, 5, 6.
- Topical antifungal agents such as azoles (e.g., clotrimazole, miconazole), allylamines (e.g., terbinafine, naftifine), and benzylamines (e.g., butenafine) can be effective in treating fungal infections 4, 6.
- Clotrimazole has been shown to be effective in treating skin infections caused by Candida or dermatophytes, with clinical cure rates comparable to other antifungal agents 5.
- Terbinafine and naftifine have been found to be effective in achieving clinical and mycological cure in patients with tinea corporis and tinea cruris, with minimal adverse effects 6.
- Combination antifungal/corticosteroid creams, such as Lotrisone and Mycolog-II, are also available, but evidence suggests they are more expensive and less effective than single-agent antifungals 7.
Specific Treatment Recommendations
- For a 12-year-old patient with neck discoloration, a topical antifungal agent such as clotrimazole or terbinafine could be prescribed 4, 5, 6.
- Naftifine has also been shown to have anti-inflammatory properties, making it a potential option for patients with inflammatory disease of unknown aetiology 8.
- However, it is essential to note that the effectiveness of these treatments may vary depending on the specific cause of the neck discoloration and the individual patient's response to treatment.
Considerations for Treatment
- The choice of treatment should be based on the severity of the infection, the patient's medical history, and the potential for adverse effects 4, 6.
- Topical treatments are generally preferred over systemic treatments for superficial fungal infections, as they have fewer side effects and are less likely to interact with other medications 4, 6.