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Dermatitis in Young Children
Q: My 4-1/2-year-old daughter has had some type of dermatitis since she was about 8 months old. This appears in between her toes (like athlete's foot at first), behind her ears, in the folds and curves of her ears, under her arms, and in the folds of skin at the leg and groin area. It gets so raw and cracked that it bleeds. I took her to see a dermatologist when she was about one. He said that she would outgrow this by the time she was two. He recommended triple antibiotic cream for the times when it gets extremely rough.
However this only helps for a short time. If I miss even one day, it starts the cycle of becoming raw and oozing. When the areas are not raw and oozing, they appear like very dry, chapped skin. Do you have any other suggestions?
A: It is very hard to make a diagnosis involving a skin rash without actually seeing it. There are many different types of skin conditions that could be present in your child that are all treatable. Skin conditions such as eczema, psoriasis, and seborrhea are very common in young children. My major recommendation would be to go back to your primary physician or dermatologist to have it re-evaluated.
When a physician makes a diagnosis, she is not saying that another diagnosis is impossible, just that this is the most likely cause of a particular problem. But if the child is not responding to the recommended treatment then she needs to be seen again.
Probably one of the great miscommunication problems we have in terms of patient/doctor interactions these days is not making it clear that patients should come back if they are not improving. I think some patients have the idea that they are bothering their doctors or that they are causing a problem if they return for treatment of the same complaint again. It is very helpful for a physician to find out if the first recommended therapy didn't work; he can re-evaluate the problem and see if a different treatment or evaluation is needed.
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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.