What is the treatment for eroded skin around the nose and mouth in children?

Treatment of Eroded Skin Around the Nose and Mouth in Children

Apply white soft paraffin ointment (petroleum jelly) to the eroded areas every 2 hours during the acute phase, combined with gentle cleansing using warm saline rinses or an oral sponge. 1, 2

Initial Assessment and Diagnosis

Before initiating treatment, determine the underlying cause of the erosions:

• Look for signs of infection: Crusting, weeping, or purulent discharge suggests bacterial infection (commonly Staphylococcus aureus) 3
• Check for grouped, punched-out erosions: These indicate possible herpes simplex infection and require virological screening 3
• Consider perioral dermatitis: Flesh-colored or erythematous papules, micronodules, and rare pustules in periorificial distribution, especially if there's recent topical corticosteroid use 4, 5
• Evaluate for atopic eczema: Look for dry skin, flexural involvement, personal or family history of atopy 3

Primary Treatment Approach

For Simple Erosions Without Infection

• Apply white soft paraffin ointment every 2 hours to prevent drying, cracking, and promote healing 3, 1, 2
• Clean the area daily with warm saline mouthwashes or an oral sponge to remove debris and maintain hygiene 3, 2
• Avoid soaps and detergents as they remove natural lipids and worsen dryness 3

For Erosions With Bacterial Infection

• Apply topical antibiotic such as bacitracin to the affected area 1-3 times daily (for children ≥2 years) 6
• Use aqueous chlorhexidine 0.05% as an antiseptic on erosive lesions 3
• Consider oral antibiotics (erythromycin or cephalosporins) if infection is spreading or severe 7
• Do NOT use prophylactic antibiotics for simple erosions without established infection 1

For Erosions Associated With Inflammation

• Use an anti-inflammatory oral rinse containing benzydamine hydrochloride every 3 hours, particularly before eating 3, 2
• Apply a potent topical corticosteroid mouthwash (betamethasone sodium phosphate) four times daily for severe inflammation 3, 2
• Use antiseptic oral rinse with chlorhexidine twice daily to reduce bacterial colonization 3, 2

Special Considerations

If Perioral Dermatitis is Suspected

• Discontinue any topical fluorinated corticosteroids immediately as these are often the inciting factor 4, 5
• Start topical metronidazole as first-line treatment 4, 5
• Consider oral erythromycin for more extensive or severe cases, depending on the child's age 4, 5
• A low-potency topical steroid may be used briefly to suppress inflammation and wean off stronger steroids 4

If Atopic Eczema is the Cause

• Apply emollients 3-8 times daily to decrease transepidermal water loss 3
• Use topical corticosteroids as the mainstay of treatment for active eczema 3, 8
• Implement regular bathing followed by immediate emollient application 3

Critical Pitfalls to Avoid

• Never use adhesive dressings on or near the lips as they cause additional trauma upon removal 1
• Avoid topical anesthetics for intraoral use in young children due to accidental ingestion risk 1
• Do not use urea, salicylic acid, or silver sulfadiazine in neonates or young children due to percutaneous absorption risks 3
• Avoid occlusive ointments if infection is present as they may increase infection risk and impair sweating 3

Monitoring and Follow-Up

Watch for warning signs requiring urgent reassessment:

• Increasing pain, redness, or swelling beyond 24-48 hours 1
• Purulent discharge or fever indicating systemic infection 1
• Grouped vesicles or erosions suggesting herpes simplex requiring antiviral therapy 3
• Difficulty eating or drinking due to worsening pain 2