What is the treatment for skin lesions in children 0-7 years old?

Treatment of Skin Lesions in Children 0-7 Years Old

For children 0-7 years with skin lesions, treatment depends on the specific diagnosis: bacterial infections require topical mupirocin for localized impetigo or systemic antibiotics for cellulitis; inflammatory conditions like atopic dermatitis are managed with frequent emollient application (3-8 times daily) as the foundation plus topical corticosteroids for flares; and emergent conditions like Stevens-Johnson Syndrome or Staphylococcal Scalded Skin Syndrome demand immediate drug discontinuation and intensive supportive care. 1

Bacterial Skin Infections

Impetigo (Localized)

• Apply mupirocin 2% ointment to affected areas 3 times daily for 5-7 days as first-line therapy, achieving 78% clinical efficacy in pediatric patients aged 2 months to 15 years. 1
• Mupirocin should never be used as monotherapy for cellulitis or extensive infections—this is a critical error that can lead to treatment failure. 1

Cellulitis and Extensive Bacterial Infections

• Initiate systemic antibiotics targeting both S. aureus and group A Streptococcus for any cellulitis or infections beyond localized impetigo. 1
• For abscesses, incision and drainage is the primary treatment, with systemic antibiotics added if there are signs of surrounding cellulitis, systemic symptoms, or immunocompromise. 1

Staphylococcal Scalded Skin Syndrome (SSSS)

• Start IV cefazolin immediately if no type 1 penicillin allergy exists. 2
• Add vancomycin 15 mg/kg/dose IV every 6 hours if the patient is critically ill, not improving on beta-lactams within 24-48 hours, in a high MRSA prevalence area, or has confirmed MRSA on culture. 1, 2
• Consider clindamycin 10-13 mg/kg/dose IV every 6-8 hours as adjunctive therapy to stop exotoxin production at the ribosomal level, particularly if the patient has extensive disease or suboptimal initial response. 2
• Treatment duration is typically 7-14 days guided by clinical response. 2

Inflammatory Skin Conditions

Atopic Dermatitis/Eczema

• Apply emollients liberally and frequently (3-8 times daily) as the absolute foundation of therapy, regardless of disease severity—this cannot be overemphasized. 3, 1
• Emollients should be fragrance-free and applied immediately after bathing to restore skin barrier function in patients with chronic itch and xerosis. 3
• For mild-to-moderate flares on trunk and extremities, use topical corticosteroids (class I-II potency). 1
• For facial and genital involvement, use tacrolimus 0.1% ointment as off-label monotherapy to avoid corticosteroid-related skin atrophy in these sensitive areas. 1
• Avoid high-potency topical corticosteroids extensively in children 0-6 years without close dermatology follow-up due to HPA axis suppression risk. 1

Psoriasis (for children ≥12 years in this age range)

• Use combination calcipotriol/betamethasone dipropionate ointment once daily for up to 4 weeks for mild-to-moderate plaque psoriasis. 1

Dermatologic Emergencies

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

• Immediately discontinue the suspected causative drug—this is the single most important intervention. 3, 1
• Assess airway by a pediatric anesthesiologist or intensivist and consider intubation if clinical signs support this, especially if transfer is planned; ensure immediate availability of equipment for difficult intubation. 3
• Establish peripheral IV access through non-lesional skin if possible and commence appropriate IV fluid resuscitation if clinically indicated. 3
• Within 24 hours of diagnosis, arrange examination by an ophthalmologist experienced in ocular surface diseases in children. 3
• Convene a multidisciplinary team led by a specialist in skin failure, including dermatology and/or burns specialists. 3

Congenital Ichthyoses (Collodion Baby/Harlequin Ichthyosis)

• Admit to neonatal intensive care unit immediately. 1
• Apply sterile emollients (white petrolatum or water-in-oil emollients) 3-8 times daily. 1
• Avoid active substances like urea, salicylic acid, or silver sulfadiazine due to risk of percutaneous absorption and systemic toxicity in neonates—this is a critical safety consideration. 1

Parasitic Infections

Scabies

• Topical permethrin is the treatment of choice, with evidence of negative microscopic skin prep required before return to activities. 1

Topical Corticosteroid Use (Over-the-Counter)

For mild itching, inflammation, and rashes in children ≥2 years:

• Apply hydrocortisone to affected area not more than 3 to 4 times daily. 4
• For children under 2 years of age, consult a physician before use. 4

Critical Pitfalls to Avoid

• Never use tetracyclines in children <8 years of age due to risk of permanent tooth discoloration and bone growth effects. 1, 2
• Never use mupirocin as monotherapy for cellulitis or extensive infections—it is only appropriate for localized impetigo. 1
• Never use high-potency topical corticosteroids extensively in children 0-6 years without close dermatology follow-up due to HPA axis suppression risk. 1
• Never apply urea, salicylic acid, or silver sulfadiazine to neonates with ichthyosis due to percutaneous absorption risk and potential systemic toxicity. 1
• For SSSS, avoid using clindamycin empirically if local resistance rates are >10%—verify susceptibility before relying on it as primary therapy. 2