Services for Children

Childhood is a time of tremendous physical, intellectual, social, and emotional change. The skin is also changing, and your pediatric dermatologist is uniquely trained to diagnose and treat children’s skin.

Acne

Acne is the term for plugged pores, pimples, and deeper lumps that occur on the face, neck, chest, back, and shoulders. Common signs of acne are blackheads, whiteheads, pus-filled lesions, and nodules (large raised bumps). Treatment plans depend on your child’s symptoms, age, and general health.

Birthmarks

Birthmarks appear in a variety of shapes and colors in the first year of life. Most birthmarks are harmless and may fade or disappear over time without treatment. However, some types of birthmarks may be signs of a more serious medical condition. A pediatric dermatologist can help determine the type of birthmark based on a visual examination of your child’s skin.

Bug bites

A variety of insects can cause itchy bumps. These may include mosquitoes, chiggers (harvest mites), fleas, biting midges (no-see-ums), or bedbugs. Some children develop an increased sensitivity (almost like an allergic reaction) to bug bites called papular urticaria. This reaction leads to itchy bumps or blisters all over the body that may leave dark spots behind and may last several months. Topical steroids and antihistamines can sometimes help the bumps and marks fade faster.

Biopsies

Biopsies involve removing a small piece of skin to help diagnose the cause of skin changes. The most common types are punch biopsies, excisional biopsies, and shave biopsies.

Cysts

A cyst is a pocket-like area in the skin that can be filled with a variety of substances including fluid, blood, tissue, hair, or a foreign body. Most of the time, a diagnosis can be made based on the look and feel of the cyst. Sometimes specific tests are needed to make a diagnosis. The most common cysts in children include dermoid cysts, lipomas, pilomatrixomas, pyogenic granulomas, and sebaceous cysts. Often, surgery is required to remove cysts.

Dry skin

Dry, cracked, or rough skin may affect the entire body surface or be localized to certain areas such as the hands, feet, or lips. There are many causes for dry skin including irritating soaps, climate changes (i.e. winter itch), genetics, eczema, yeast infections, and allergies. Treatment plans depend on the underlying cause and your child’s age.

Eczema (Atopic Dermatitis)

Children with eczema (also called atopic dermatitis) have an ongoing problem with sensitive, dry, red, and itchy skin. In school-aged children, the rash of eczema is often in the elbow creases, on the backs of the knees, on the neck, and around the eyes. Eczema can be a frustrating disease for children and adults, especially when the itching makes it difficult for children to sleep. A pediatric dermatologist can help confirm the diagnosis, control symptoms with a good treatment plan, and sometimes find triggers through patch testing (a specific kind of allergy test).

Hair loss (Alopecia)

Alopecia means hair loss. In children, alopecia can be due to a variety of conditions including tinea capitis (ringworm), alopecia areata, trichotillomania, telogen effluvium, nutritional deficiency, or endocrine problems. To diagnose the cause of alopecia your pediatric dermatologist will often complete a history and physical examination with special attention to the scalp and hair. Sometimes blood tests, hair pull tests, a trichogram, or a biopsy are needed to make a diagnosis.

Head lice

Head lice are tiny parasitic insects that can live on children’s heads and cause intense itching. They are highly contagious and often spread between family members and classmates. Prescription creams are often needed to clear an infestation.

Laser treatments

Laser skin therapy is a low-risk, noninvasive therapy used by pediatric dermatologists to treat many skin conditions. The most commonly used lasers in pediatric dermatology are the pulsed dye laser and CO2 laser, however, many other types of lasers may be used depending on your child’s needs. Lasers are commonly used to treat birthmarks, vascular lesions (blood vessel anomalies), hemangiomas, port wine stains, lymphatic malformations, acne scarring, surgical scars, traumatic scars, burn scars, some skin cancers, tattoo art, traumatic tattoos (road rash), hidradenitis, some inflammatory skin diseases, viral warts, and tumors resulting from syndromes (e.g. angiofibromas in tuberous sclerosis). Laser treatments may be performed in the office or with sedation (under anesthesia).

Moles

Moles are common flat or raised brown spots on the skin composed of a skin cell called the melanocyte. Melanocytes are the cells in our skin that make pigment. Moles may be present at birth or develop any time between childhood to early adulthood. Children often have an average of 20 moles. Moles that are irregular shaped or contain multiple different colors of black, blue, white, or red should be evaluated by your medical provider.

Molluscum

Molluscum contagiosum is a viral skin infection that creates small bumps on the skin and is very common in children. The bumps usually heal without treatment within 1 to 2 years. Cantherdin (“beetle juice”) is often used to help the bumps go away faster.

Poison Ivy

Contact with oil from poison ivy, poison oak, and poison sumac plants can cause a very itchy rash with blisters. The rash usually appears 1 to 2 days after a child was in a forest or field and may last up to 3 weeks. In addition to gentle skin care, steroid creams or pills are sometimes needed to clear the rash.

Psoriasis

Psoriasis is a common skin condition that sometimes looks similar to eczema. It often appears as dry, red, scaly patches on the skin that can be very itchy and sometimes burn. The rash may come and go in an unpredictable way. Treatment options depend on the type and severity of the psoriasis as well as the area of skin that is affected. Typical therapies include creams, ultraviolet (UV) phototherapy, oral medications, or biologics (certain medicines that are injected under the skin).

Ringworm

Other names for ringworm include tinea, jock itch, athlete’s foot, and nail fungus. The appearance and symptoms may be different depending on the part of the body that is affected. In the scalp, there may be flakes resembling dandruff, pus bumps, or hair loss. On the body, there may be scaly, red rings with clearing in the center. On the feet, the skin is usually moist and flaky between the toes and there may be blisters on the foot. Nail fungus often shows up as a buildup of flaky skin and fungus under the nails.

Skin cancer checks in children

Skin cancer is rare in children, even so, there are times when a mole should be checked by a pediatric dermatologist just to be sure. Some signs that a child should be examined by a dermatologist include (1) having any mole that is changing or looks different from the rest; (2) a mole with multiple different colors such as red, blue, black, or white; (3) moles that bleed or look like an open sore; (4) having over 50 moles on the body; or (5) moles larger than a dime (over 1 cm diameter).

Skin allergies

Allergic contact dermatitis is a type of skin allergy in which children develop a rash after touching things they are allergic to. Children are not born with this type of allergy, but develop it over time after days, months, or even years of exposure to the substance. Common causes of allergic contact dermatitis include homemade slime, plants, metals, antibiotic ointments, fragrances and flavorings, preservatives, rubber, lanolin in creams, dyes, and essential oils. Often, allergic contact dermatitis can be diagnosed by history and physical examination. Sometimes skin biopsies, blood tests, and patch testing (a specific type of allergy test) are required to diagnose this type of skin allergy.

Skin infections

Staphylococcus aureus (“Staph”) and Streptococcus pyogenes (“Strep”) are the most common bacterial causes of skin infection. Bacteria may cause red painful skin, pus or fluid leaking out of the skin, painful bumps, or crusts and blisters. Healthcare professionals often diagnose bacterial infections based on how they look. Often, a culture is taken as well by rubbing a swab over the infected area. Bacterial infections are treated with antibiotic pills and creams. In some cases, viruses, fungi, or parasites may infect the skin necessitating other treatments based on the type and severity of your child’s infection.

Sun protection

Invisible parts of the sun’s energy that reach the earth, called ultraviolet (UV) light, can damage skin cells causing increased numbers of moles, freckles, wrinkles, and skin cancers. Children should try to avoid the sun between 10 a.m. and 2 p.m., cover the skin with sun protective clothing and hats when outdoors, and regularly use broad-spectrum UVA and UVB sunscreens with an SPF of 30 or higher.

Surgery*

If a surgical procedure is necessary, Dr. Burkhart will determine whether the procedure can take place the same day or if it needs to be scheduled at a later date. We will work with your child and family to discuss whether a local anesthetic or general anesthetic is the best option. Children who undergo surgeries in the office will have the options of having their parents stay in the room with them and watching or listening to videos or music to help make them feel as comfortable as possible.

Vitiligo

Vitiligo is an autoimmune disease where individuals develop areas of white or lighter-colored skin due to the destruction of pigment producing cells (melanocytes) in the skin. Sometimes, vitiligo is associated with other autoimmune conditions that may develop over time. Thyroid disease is the most commonly associated autoimmune disease, so a vitiligo work-up may include checking labs related to thyroid function and other specific antibodies. Typical treatments for vitiligo include creams and light therapy.

Warts

Warts are caused by a very common viral infection of the skin caused by the human papilloma virus (HPV). Most warts will go away completely within 2 years without any treatment. However, when the warts are painful or extensive many children undergo treatment to help clear the warts more quickly. Common treatments include freezing (cryotherapy), injections, immunotherapy (squaric acid or DPCP), lasers, prescription treatments, and over-the-counter salicylic acid liquids, pads or tape (Dr. Scholl’s, Compound W, Duofilm, or Mediplast).

*Dr. Burkhart has operating room privileges at Wake Med for conditions requiring surgery