Professor Yetunde Mercy Olumide is an Emeritus Professor at the University of Lagos and a Consultant Physician Dermatologist and Venereologist. In this interview by TAYO GESINDE, she speaks on causes of skin diseases in children and how to prevent them.

What are the causes of skin diseases in babies and toddlers?

Skin diseases in babies and toddlers can be caused by several different factors: It can be due to some abnormal genes inherited from parents/ancestors, congenital abnormalities which develop for the first time in a fetus due to mutations in the baby’s gene not inherited from parents, birth marks which vary in size from just a spot or may be extensive on the skin, diseases directly passed on from mother to baby through the placenta. These are usually infections e.g. Syphilis, HIV/AIDs, Zika virus etc. Diseases caused by drugs which the mother consumed during pregnancy especially during the early developmental stages of the baby—the first four months, diseases due to environment pollutants with chemicals which the mother absorbed through the skin in pregnancy or in the diet from contaminated fish e.g mercury. Also, a few skin eruptions in the neonate that erupt within 1-2 days are not diseases as such, but are simply due to sudden change in the environment of the baby from the amniotic fluid to an unfamiliar outside environment. These types of eruptions are self-limiting; need no treatment as they simply fade away by 5-7 if not complicated by aggressive treatment. Some of these early eruptions are due to bacterial, yeast or viral infections which the baby acquired in the womb because of early rupture of the protective amniotic membrane and a prolonged labour. Some infections of babies are from bacteria harbored in the nose of health care providers who do not wear nasal masks. The truth is that babies lack immunity to infections as they have not developed the resistance that develop with age. Furthermore, the cultural practices of exposing babies to visitors who carry the babies expose these highly vulnerable babies to a broad spectrum of infections. Any baby/toddler exposed to environmental insect bites e.g mosquitoes and sand flies soon develop a rash. Diaper rash is due to the irritating effect of altered faces & urine when the diaper is not changed promptly, and of course, superimposed Candidal (yeast) infection.

Is it true that the use of body creams and oils causes skin rashes like infantile seborrhea dermatitis (ISD) (eela)?

“Eela” is a generic Yoruba word used for a broad spectrum of chronic childhood skin diseases associated with dry, scaly, white red patches such as infantile seborrheic dermatitis/eczema, atopic dermatitis/ eczema, pityriasis alba or even leprosy. None of these diseases is caused by the use of body creams. Infantile Seborrheic Dermatitis (Cradle Cap) is a greasy, scaly, red/pale white rash that can occur on the scalp, behind the ears, the neck folds, in the armpits, and the diaper area. It is commom at about 6 weeks of age and can resolve spontaneously within a few months. It is not contagious and will not scar. It is not itchy and is generally believed not to bother an infant except there is a superimposed Candidal rash (yeast infection). While several theories have been proposed, the exact cause has not been completely identified. It is not due to poor hygiene.

Pityriasis alba causes mildly scaly pale white patches particularly on the face of older children. This is only of cosmetic significance and often clears on its own. Infantile atopic eczema/dermatitis is a more serious skin rash which erupts usually around age 3-6 months with a bumpy red scaly rash on the cheeks, which progressively involves other parts of the body. This is a very distressing rash for the child because it is very itchy and may disturb the sleep of a child. It often gets secondarily infected by bacteria and even herpes virus from cold sores (fever blisters) on the lips of adults. At times occult scabies (a very itchy parasitic infestation) may be superimposed on atopic eczema. Early leprosy may present simply as 1 or 2 white patches on an older child. The patch of leprosy is not itchy and is painless. Children often acquire leprosy from adults who may not even know that they have leprosy because they do not have the visible signs of late leprosy on the fingers.

How can one prevent skin disease in children?

Neonates and toddlers cannot take care of themselves. Hence skin disease can only be prevented in children if the mothers and other caregivers at home and Day-care centres are knowledgeable as regards basic care of the children which include appropriate nutrition because skin diseases are often not just skin deep. Furthermore, the skin often reflects serious diseases of the internal organs which demand urgent consultation of a pediatrician or skin specialist. Since some infective skin diseases are transmissible from mother/caregivers to child, basic personal skin hygiene and prompt treatment of skin diseases in the mother and other care givers at home and Day-care centres should receive adequate attention. Basic health talks should be given to mothers. This could be done in the clinic waiting rooms/halls for pregnant women in ante-natal clinics, paediatricout patient clinic, skin clinics and health centres, particular those situated near market places patronised by market women. Literate women should avail themselves of the tremendous self-learning resources on the internet which could be googled. As regards direct prevention of skin diseases in children, it is important to study some of the causes already highlighted above and prevent them through appropriate antenatal care of mothers and subsequent care of the babies and toddlers.

Nigeria is a hot and humid country conducive to sweat retention and skin infections. The child should be given a good bath at least once a day preferably at bedtime so that no sweat is left on the skin overnight. Over heating should be avoided. The child should be sparingly clothed with absorbent cotton fabrics. Tight abrasive clothing made from non absorbent fabrics e.g nylon, polyester, crimplene etc should not be used for neonates and toddlers. Abrasive sponge and irritant harsh medicated soaps should not be used on babies and toddlers’ skin. Simple emollients should be used in lubricating the skin after bath. Children should not be left to crawl on dirty grounds riddled with bacteria, fungi and parasites e.g in the market place.

Is it true that the mother’s diet in pregnancy and during lactation may be responsible for skin disease in babies?

It is true that the mother’s diet in pregnancy and lactation generally influences the health of a baby positively or negatively not only on the skin. Growing babies need micronutrients which can only be acquired from the mother particularly in a fully breast fed infant. A healthy well balanced diet of the mother during pregnancy and during breastfeeding often translates into a healthy skin of the baby. Regrettably certain allergies in children are currently being linked to the diet of the mother e.g pea-nut allergy which has gained an alarming attention in the USA. More serious is mercury toxicity in babies acquired from mothers who have consumed fish and other seafood which have accumulated this chemical from contaminated soil.

Many mothers are fond of mixing different creams together to treat skin disease, is this good practice?

It is a very dangerous practice to mix different creams together to treat skin disease. The skin is not just an impervious covering of the body. The skin is capable of absorbing chemicals applied to the skin and these chemicals are absorbed into the blood stream and transmitted to distant organs of the body. This percutaneous absorption is maximally enhanced in hot and humid environment as we have in Nigeria. Because the skin of babies and toddlers have not fully developed the partially protective layer of the skin—the outermost hard keratin layer—a baby’s skin is even more vulnerable to percutaneous absorption of chemicals. All chemicals applied to the skin and even air-borne chemicals have the potential of being absorbed through the skin in varying proportion. Researchers in Nigeria have analyzed many creams commonly used in Nigeria and found that many of them contain hazardous chemicals such as lead, mercury, nickel etc. as trace elements. Lead and mercury are some of the most toxic chemicals known to man. Some of these chemicals particularly mercury accumulate in the body. Mercury accumulates in the testicles and has been known to cause low sperm count and male infertility; mercury has also been found to accumulate in the ovaries and have been known to cause abnormal fetuses and infertility. Mercury is also toxic on the kidneys and nervous system. All these complications can manifest later in life when the babies become adults.

In conclusion, it is very, very dangerous to mix assorted creams and apply on a Baby’s skin. Danger to the baby should not be seen as just a skin rash; but the skin rash should be seen as an indicator of very serious and potentially fatal complications in internal organs. A skin with a rash further amplifies percutaneous absorption of toxic chemicals.

What is the best form of treatment for skin disease?

It is not possible to state the “best treatment” for skin disease because there are hundreds of skin diseases in children and no treatment is universally applicable. For example, there are hundreds of causes of fever e.g. malaria fever, typhoid fever, yellow fever, Ebola fever, Lasser fever, Meningitis and even some cancers of the blood. The “best treatment” is to treat the specific cause of the fever. Therefore, the “best treatment” for skin disease is to make accurate diagnosis of the cause of the skin disease and treat appropriately. Most of the common skin diseases can be treated by the child’s pediatrician who knows when to refer the child to the skin specialist (dermatologist)

Regrettably, in Nigeria there is a general misconception that there is a generic treatment for all these skin diseases and that there is no need to make an accurate diagnosis of each skin disease before treatment is instituted. This pitiable state of affairs has often led to a slap-dash treatment of skin diseases by quacks, herbalists, “old wives tales” prescribed by grandmothers, over-zealous friends and relatives and even some health care providers at the primary and secondary levels. These people just erroneously believe that calamine lotion, a jar of antifungal agent and steroid creams are panacea for all skin diseases whereas steroid creams simply act as fertilizer for skin infections.