Things You're Too Embarrassed to Ask a Doctor Season 1, Episode 4: Pediatric Dermatology with Dr. Sarah Stein

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I'm your host Kat Carlton.

I'm sure everyone listening has heard the expression that something is as soft as a baby's bottom, or some iteration of the aforementioned phrase. But what happens when a baby's bottom is:

Red, irritated, sometimes extra moist, sometimes peeling skin, or little breakdown of skin with erosions and cracks.

That's pediatric dermatologist Sarah Stein. On today's show, Dr. Stein gives us a look into the world of warts, moles, diaper rash, acne and a lot more. Stay tuned to this episode of Things You're Too Embarrassed to Ask A Doctor.

Welcome to this episode of Things you're Too Embarrassed to Ask a Doctor. Today, we're joined by pediatric dermatologist Sarah Stein.

Thanks for being on today's show.

Happy to be here.

So Dr. Stein, tell us what do pediatric dermatologists do.

We see children of all ages from birth to about 18 or 20 for any skin, hair, or nails really related concerns that a patient or the family might have.

You see a wide variety of symptoms and types of things that you treat. And unfortunately, today we can only get to a couple because there are so many different things we could talk about. So we're going to talk about warts, diaper rash and acne. So starting out with warts, the lumps and bumps category. One thing a lot of people are searching, are warts and moles the same thing?

So to doctors, they're not the same thing. Certainly people will use lots of different terms to describe things on their skin. But to the doctor, a wart is a generally kind of rough thick bump that can be on any body part. But most commonly, we see them on the hands, particularly on the fingers, or the bottoms of the feet, which people often refer to as plantar warts. But it really has nothing to do with planting things. It just means it's on the bottom of your foot.

And that's as contrasted with moles. Moles are the brown spots that many of us have on our skin. Sometimes they are flat brown spots or raised brown spots. Sometimes they might have hair. And that's what's generally referred to as a mole. The medical term for a mole is a nevus.

And what causes warts?

So warts are actually a skin infection. So it's a germ, specifically a virus, that's very common in our environment. So it's just everywhere that we are. And then we pick up this germ into our skin, usually through a crack in the skin. But it can be a very tiny little crack. So a spot where you had a little rubbing of your skin from a shoe, for example, or a scratch on your skin, that's a place where that word virus can get in. And then it builds basically a house for itself. And so the bump that develops is the wart house. And it's kind of Walling itself off in a protective way. And that's why those bumps become kind of thick and rough and hard.

Great metaphor, a wart house. Can warts cause cancer?

So the common warts that we're generally seeing in the dermatology clinic on people's hands, feet, elsewhere are not the types of warts that have any relationship to cancer. There are warts that people get in the genital regions. And some strains of that virus can be a precursor to the development of certain kinds of cancer, such as cervical cancer. And there's now, luckily, a vaccine against those strains of the wart virus. That's the HPV vaccine. And so that can become a great way to protect from those strains of virus that are found in the genital warts. But for the common warts that we're generally seeing on hands and feet and elsewhere, those are not a risk for cancer.

So as a pediatric dermatologist, do you see occasionally those cancerous warts in adolescence or children? Or are those more typically found in adults?

So the strains of warts that can be related to cancer are usually seen after people become sexually active. And so thankfully, that's not usually what we're seeing in children unless there's been some sort of unfortunate contact.

Recently, I was chatting all things skin care with my co-worker, Jordan. She brought up something I saw echoed in my dermatology related research.

Skin stuff really freaked me out. I was wondering can warts kill you?

So again, most common warts are not going to kill you. They don't cause cancer, and they don't progress to anything that could be at all harmful. But again, the genital warts that can be related to cancer, those cancers can be serious.

Will the warts ever go away on their own?

Yes. In fact, the majority of warts in children do go away on their own. It can take a long time, months to even a few years sometimes. But there is a high chance of them going away on their own because the body's immune system fights off that germ just like it would fight off a cold. And sometimes it just takes a long time for the immune system to wake up and notice the wart.

So if the wart hasn't gone away on its own, how do you remove warts?

Warts don't have to be removed. They're not harmful. And so if they're not causing a problem, or the individuals not concerned by how they look, they can be left alone. But when people don't like having them, they don't like the look of them, or they are causing pain on the bottom of the foot for example, then it's reasonable to try to treat them. There are a lot of treatments for warts because none of them work very well. And that's a pretty good rule of thumb, the more treatments. There are for something, the less well any one of those treatments probably works.

In the dermatology office, our usual first approach to wart treatment is to freeze them. That's called cryotherapy. There are a lot of different agents that can freeze. In fact, there are some products that are sold over the counter in the drugstore that are also used to freeze warts. And the different chemicals will get the skin different degrees of cold. And so that probably impacts how effective any one of those treatments are.

But even with the freezing treatment in the doctor's office, it usually takes more than one time of freezing the wart before it'll go away. So you'll come into the office. You'll have your wart frozen. It'll get maybe red, maybe swollen, maybe blistered, peel some layers. That'll happen over a couple of weeks. And then three or four weeks later, you'll need to come back and treat the spot again because there's probably still some of that wart left at the base.

Those ugly little guys don't want to go away, huh?

Very stubborn.

Next topic we have is diaper rash. Moving on. So tell us what is diaper rash and why does it occur?

So diaper rash is usually what people are referring to when there's a rash in the diaper area in an infant, or child who's still in diapers, or in older patients who for some medical reason may need to also wear diapers. And it's basically an irritation of the skin from being covered by the diaper and from all of the contacts with the contents of the diaper.

So we know it's in the diaper region. The next question we have is where is diaper rash located? So I guess is it localized to a certain part within the diaper?

It's variable. So sometimes it will affect the buttocks and the inner thighs and that frontal part of the groin region. Sometimes it'll be more localized to just a few spots, maybe over the vulva or the scrotum. Sometimes it'll involve the inner thighs. It's variable, but kind of that whole general region.

And what does it look like?

So it's usually red skin that looks irritated. Sometimes it's extra moist. Sometimes there is peeling skin or a little breakdown of skin with erosions and cracks. Sometimes there are bumps. Or even little tiny pus bumps can develop in these areas.

How do you differentiate this from other types of rashes? Are there other common rashes besides diaper rash?

So there are lots of different kinds of rashes. That's generally what we're doing is dermatologist is figuring out what rash is caused by what. But definitely the location, and a person who's wearing a diaper, all of those things will support making that particular diagnosis.

So you mentioned before that there can be bumps. There can be little pustules. One of our questions is can diaper rash look like pimples?

Yes, sometimes it can. Again, because of the moist area there and the occlusion by the diaper, germs can get into the hair follicles, especially on the buttocks. And that can then lead to pimples. That's also sometimes called folliculitis.

Can diaper rash spread?

So it can get sort of more and more severe in the area. So if it's in a limited area in the creases initially, if it's not taking care of, it could get more angry and spread out further on the legs or onto the belly.

That sounds very uncomfortable.

Yes, I think it generally is. The babies tend to be uncomfortable, especially when they have a bowel movement or pass urine. When that hits that sensitive raw skin, that will be very painful. And when they're being cleaned up, if you're trying to wipe away what's on the skin, that also may be more painful.

Can diaper rash bleed?

Yeah, if the breakdown is severe enough then it can lead to a little bit of bleeding.

So how do you treat diaper rash?

Well the number one thing is to try to minimize the contact of that skin with all of the irritants. So changing diapers very frequently, trying to know when the child has wet or stooled in their diaper so that the diaper can be changed quickly. Protecting the skin with a barrier diaper cream is very helpful as well. Those are the diaper creams that generally contain an ingredient like zinc oxide, which goes on very white and sticky. And if you put that paste on the area, I always say like icing on a cake. So thick coats of it, that will be a great barrier for protecting the skin from anything that's in the diaper.

Also important is how you clean the skin. So some of the packaged diaper wipes, which are just so convenient to use, do contain ingredients that can either start a diaper rash or make a diaper rash last longer. Because once the skin is irritated, then there's more chance of becoming sensitive to those ingredients. So it can be important to stop using the packaged diaper wipes for a while and switch to just a soft cloth and water to gently cleanse the area.

Are there certain ingredients people should be looking out for?

Well we always tell people to beware of all the fragrance in products, because the fragrance is often a cause for skin irritation. And then there are other preservatives in diaper wipes that we've learned can contribute to diaper rashes. It's hard to find the preservative free product because they have to be preserved in some way. So that's why switching to just plain water on a soft cloth is sometimes necessary.

Later on in my skin care chat with my co-worker from earlier, Jordan, she mentioned that she gets stress related eczema.

I get eczema. And typically I use a over-the-counter lotion you can get from like Jewels or Walgreen's. But someone told me that you could use diaper rash cream for eczema. Is that true?

Eczema is a pretty general term that describes a lot of just irritated rashes, often as a result of sensitive skin. So there's just so many things that our skin is exposed to in the world. And some people are going to be a little bit more sensitive. And when they get irritated by something on their skin, then their skin gets red, rough, itchy, and can break down.

So diaper rash creams, there are a lot of different kinds of diaper rash creams. So the one I mentioned before that warts best for a diaper rash, which is a white pasty cream will be kind of messy to use for other kinds of rashes. Some products that are marketed as diaper rash cream are more like a clear petrolatum, like a Vaseline ointment type of texture, which I think can be very helpful for treating some types of eczema.

Will diaper rash cream help with thigh chafing?

Yes, it should because chafing is from rubbing on either clothing or one leg against the other. And so putting something kind of greasy on there will help with that.

Last one. Will diaper rash cream wart on jock itch?

So jock itch is actually another type of skin infection with a type of fungus that's also just anywhere in our environment and likes this warm moist area. So if it's just a bland diaper cream, it may not have the anti-fungus fighting ingredients that would be necessary to clear a case of jock itch.

All right. That's all the questions we have for diaper rash. So moving on to our final category, which is acne. Tell us what age does acne start.

So there are forms of acne that can affect children of all different age groups. So there's a type of acne that occurs soon after birth that's called newborn acne. And that generally happens within the first month of life. It's not exactly clear why that happens. For a long time, people thought it was the result of the mother's hormones that get passed to the baby, making the baby almost like a mini teenager. Nowadays, we wonder if it's maybe just the baby's skin getting used to other kinds of germs in our environment. But that generally starts to go away on its own after about a month of age.

There is another type of acne that affects infants. We call infantile acne from about one month to one year of age. That's more common in boys. And it usually is just that these individuals have more sensitivity to the normal levels of hormones. And so their skin structures that are the root cause of acne are just overly sensitive to those hormonal levels. And so they'll get some pimples during the first year of life. That also generally gets better after about a year of age.

And then the typical teenage acne can start as early as about seven years of age these days. So between 7 and 12, we call it pre-adolescent acne, but it's completely normal. And then after 12 is generally the adolescent acne that's so common in teenagers. So acne that might start between the ages of one or two and six or seven years old, that may be the sign of abnormal hormone levels. And that may require further evaluation.

Which leads me to my next question. Is baby acne normal?

Yes, so that type of acne I was describing in the first month of life is very normal and generally just goes away on its own. Can look pretty messy during that first month of life, which can be a bummer if people are wanting to take newborn pictures. But it generally does get better on its own. It doesn't need or really shouldn't be too aggressively treated.

So a couple of questions we have. Will baby acne scar? And can baby acne turn into eczema?

So baby acne usually does not turn into eczema. Lots of babies will develop eczema. So it can sort of feel like one thing is turning into the other, but it's probably just the next stage that's happening. The newborn acne generally does not cause any kind of scarring. Very, very rarely can infantile acne be composed of larger bumps or cysts, which could leave a scar. And in those cases, that definitely would be important to see a doctor to discuss management.

Can baby acne spread or get infected?

That would be a very, very rare complication.

Do we know if baby acne itches or hurts these babies?

We think it probably doesn't. Most of the time, the babies don't seem bothered by it. So I think it bothers parents much more than the baby.

So moving on, you mentioned now acne can start as early as age 7. And then we know, typically a lot of teenagers are getting acne. Adolescent acne is pretty common. So what causes that and how do you treat it?

So acne is almost a normal developmental stage. It's the result of the change in the hormone levels that happen as we mature. And those hormones work on the structure in our skin called a pilosebaceous unit. So that's a hair follicle with a special type of sweat gland attached to it. And mostly, those structures are over our face, but also are upper chest and upper back. So these are the areas that are very prone to acne. And as the hormone levels change, the secretions in that structure get stickier and stickier and that forms almost like a glue that plugs up that pore. And that's what leads to the bumps that we call pimples.

When people are coming to you with acne issues, is it mostly cosmetic or can it lead to any other issues that people would need to get treated for?

So we think that acne is definitely more than just a cosmetic problem. It can lead to permanent marks and scars. And it's a very significant component of an adolescent's quality of life. It affects their self-esteem, their self-confidence, and how they project themselves to the world. So it then plays into a lot of psychiatric conditions and emotional problems. So we don't like to think of it as a cosmetic problem. We think it's a significant medical problem. And we think that we have really great treatments for it at this time. And so we're anxious to try to help patients to get through it.

Do you wart with psychiatrists or psychologist to deal with these emotional mental issues?

Sometimes that's necessary if a patient is bothered to that degree and our medical management isn't enough.

That's good to know. Anything else you want to add about this topic?

A lot of patients will want to know what they can do in terms of skin care since most everyone is susceptible to acne. So I like to just instruct people that it's helpful to be cleansing your face gently twice a day. None of the acne is the result of being dirty, but it does help to cleanse off the normal oils from the skin to keep the pores clear. So gently cleansing without scrubbing is helpful. And then avoiding products that might additionally clog the pore. So avoiding thick greasy products on the skin where acne tends to occur.

All right. Thanks so much, Dr. Stein, for being on our show today.

Thank you.

Until next time, this has been Things You're Too Embarrassed to Ask A Doctor.

Once again, I'm Kat Carlton. And you've been listening to Things You're Too Embarrassed to Ask a Doctor. Music from today's episode is by Blue Dot Sessions. For more information on our show or to submit a question visit us at www.UChicagoMedicine.org/podcast or tweet us @tytepodcast, that's tytepodcast.

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