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• Acne
• Athlete's Foot ( Tinea Pedis )
• Boils ( Abscesses )
• Eczema ( Atopic Dermatitis )
• Fingernail Infection ( Paronychia )
• Hand, Foot, and Mouth Disease
• Heat Rash ( Miliaria )
• Hives ( Urticaria )
• Impetigo ( Infected Sores )
• Insect Bites
• Jock Itch
• Lice ( Pediculosis ), Head
• Pityriasis Rosea
• Poison Ivy
• Ringworm of the Body ( Tinea Corporis )
• Ringworm of the Scalp ( Tinea Capitis )
• Scabies
• Scarlet Fever
• Shingles ( Zoster )
• Skin Trauma

1. cuts and scratches
2. scrapes ( abrasions )
3. puncture wounds
4. bruises

• Sutured Wound Care
• Sunburn
• Tinea Versicolor
• Toenail, Ingrown
• Warts
• Wound Infection ( Skin Infection )

• Blackheads, whiteheads ( pimples ), or red bumps
• Face, neck and shoulders involved
• Adolescent and young adult years
• Larger red lumps quite painful

Acne is due to plugging of the oil glands. More than 90% of teenagers have some acne. The main cause of acne is increased levels of hormones during adolescence. It is not caused by diet, and it is unnecessary to restrict fried foods, chocolate, or any other food. Acne is not caused by sexual activity of any kind, nor by diet or not washing the face often enough. The tops of blackheads are black because of the chemical reaction of the oil plug with the air.

Acne usually lasts until20 or 25 years of age. It is rare for acne to leave any scars, and people worry needlessly about this.

There is no magic medicine at this time that will cure acne. However, good skin care can keep acne under control and at a mild level.

Basic Treatment for All Acne

• Soap: The skin should be washed twice each day and after exercise. The most important time is before bedtime. A mild soap such as Dove should be used.
• Hail: The hair should be shampooed daily. Hair can make acne worst by friction if it is too long.
• Avoid picking. Picking keeps acne from healing.

Treatment for Pimples
Pimples are infected oil glands. They should be treated with the following:

• Benzoyl peroxide 5% lotion or gel. This lotion helps to open pimples and unplug blackheads, and it also kills bacteria. It is available without a prescription. Ask your pharmacist to recommend a brand. The lotion should be applied daily at bedtime. In redheads and blonds it should be applied every other day initially. An amount the size of a pea should cover most of the face. If the skin becomes red or peels, you are using too much of the medicine or applying it too often, so slow down. This lotion may be needed for several years.
• Pimple opening: In general, it is better not to " pop " pimples, but teenagers do it anyway. Therefore do it safely. Never open a pimple before it has come to a head. Wash your hands and face first.
  Use a sterile needle ( sterilized by alcohol or a flame ). Nick the surface of the yellow pimple with the tip of a needle. The pus should run out without squeezing. Wipe away the pus and wash the area with soap and water. Scarring will not result from opening small pimples, but it can result from squeezing boils or other large, red, tender lumps.

Treatment for Blackheads ( Comedones )
Blackheads are the plugs found in blocked-off oil glands.
They should be treated with the following:

• Benzoyl peroxide: This agent is also excellent for removing thickened skin that blocks the openings to oil glands. It should be used as described above for treating pimples.
• Blackhead extractor: Blackheads that are a cosmetic problem can sometimes be removed with a blackhead extractor.

The use of an antifungal shampoo makes your child less contagious and allows him or her to return to day care or school. Purchase a nonprescription shampoo containing selenium sulfide ( e.g., Selsun ). Lather up and leave it on for 10 minutes before rinsing. Use the antifungus shampoo twice a week for the next 8 weeks. On other days, use a regular shampoo.

Ringworm is mildly contagious. In the days before antifungal medications, about 5% of school contacts usually became infected. However, 25% of siblings ( close contacts ) developed ringworm. Once your child has been started on griseofulvin and received one washing with the special shampoo, he or she can return to school. Caution your child not to share combs or cups with other children. Check the scalps of your child's siblings and close friends. If you see any scaling or patches of hair loss, refer that child to their doctor's office.

It is psychologically harmful and unnecessary to shave the hair, give a close haircut, or to force your child to wear a protective skull cap.

Follow-up Visits

Return to office if ringworm does not clear up after 6 to 8 weeks of taking griseofulvin.

CALL OUR OFFICE

During regular hours if

• The ringworm looks infected with pus or a yellow crust
• The scalp becomes swollen or boggy
• The ringworm continues to spread after 2 weeks of treatment
• You have questions or concerns

• Red, scaly, cracked rash between the toes
• Itchy, burning rash
• Rash raw and weepy with scratching
• Often spreads to instep
• Unpleasant foot odor
• Mainly occurs in adolescents

Athlete's foot is caused by a fungus infection that grows best on warm, damp skin.

With proper treatment, it usually clears in 2 to 3 weeks.

Antifungal Cream
Buy Tinqactin, Micatin, or Lotrimin cream at your drugstore. You will not need a prescription. First rinse the feet in plain water or water with a little white vinegar added.
Dry the feet carefully, especially between the toes. Then apply the cream to the rash area and well beyond its borders twice a day. Continue the cream for several weeks or for at least 7 days after the rash seems to have cleared.
Successful treatment often takes 3 to 4 weeks

Dryness
Athlete's foot improves dramatically if the feet are kept dry. It helps to go barefoot or wear sandals or thongs as much as possible. Wear shoes that allow the feet to breath. Cotton socks should be worn because they absorb sweat and keep the feet dry. Change the socks twice daily. Dry the feet thoroughly after baths and showers.

Foot Odor
Foot odor will often clear as the athlete's foot improves. Rinsing the feet and changing the socks twice daily are essential. If that does not work, rinse the feet in a basin of warm water containing 1 ounce of vinegar. If you can still smell your child coming, take off their tennis shoes and wash them in your washing machine with some soap and bleach.

Discourage Scratching
scratching infected feet will delay a cure.

Contagiousness
The condition is not very contagious. The fungus will not grow on dry, normal skin. Your child may take physical education and continue with sports.

IMMEDIATELY if

• It look infected ( yellow pus, spreading redness, red streaks ).

During regular hours if

• The athlete's foot is not improved in 1 week.
• It is not completely cured after using treatment for 4 weeks.
• You have questions or concerns

• Tender, red lump in the skin
• Causes pain even when not being touched
• Usually 1/2 to 1 inch across

A bacterial infection of a hair root or skin pore caused by Staphylococcus
(also called staph bacteria).

Without treatment, the body will fight off the infection. After about a week, the center of the boil becomes soft and mushy (filled with pus). The overlying skin then develops a pimple or becomes thin and pale. The boil is now ready for draining. Without lancing, it will drain by itself in 3 or 4 days. Until it drains, a boil is extremely painful.

Antibiotics
Boils heal faster and are less likely to recur if your child receives an antibiotic that kills staph bacteria.

Lancing or draining the boil
In general, it's better not to open a boil on your own child because it's a very painful procedure. Until the boil comes to a head or becomes soft, apply warm compresses 3 times a day for 20 minutes. When the boil is ready, contact your child's health care provider. If you must open it yourself, use a sterile needle (sterilized with alcohol or a flame), make a large opening, and squeeze very gently or not at all.

Once opened, the boil will drain pus for 2 or 3 days and then heal. Since the pus is contagious, the boil must be covered by a large 4 x 4 inch gauze bandage and microporous tape. This bandage should be changed and the area washed with an antiseptic soap 3 times a day.

Prevention of more boils
Boils can easily become a recurrent problem. The staph bacteria on the skin can be decreased by showering and washing the hair daily with an antibacterial soap. Showers are preferred because during a bath bacteria are just moved to other parts of the skin.

Common mistakes in the treatment of boils

Sometimes friends or relatives may advise you to squeeze a boil until you get the core out. The pus in a boil will come out easily if the opening is large enough. Vigorous squeezing is not only very painful but also carries the risk that bacteria will be forced into the bloodstream. Squeezing can also cause other boils in the same area. Again, squeezing should be done very gently or not at all (as on the face).

IMMEDIATELY if :

• The boil is not better within 48 hours after starting the antibiotic.
• Your child starts acting very sick.

Call during office hours if :

• The boil has come to a head and needs to be opened.
• You have other concerns or questions.

• Red, extremely itchy rash.
• Often starts on the cheeks at 2 to 6 months of age.
• Most common on flexor surfaces (creases) of elbows, wrists and knees.
• Occasionally, neck, ankles, and feet involved.
• Rash raw and weepy if scratched.
• Constant dry skin.
• Diagnosis must be confirmed by a physician.

Eczema is an inherited type of sensitive skin. A personal history of asthma or hay fever or a family history of eczema makes it more likely that your child has eczema. Flare-ups occur when there is contact with irritating substances (e.g., soap or chlorine). In 30% of infants with eczema, certain foods cause the eczema to flare up. If you suspect a particular food item (e.g., cow's milk, eggs, or peanut butter) is causing your child's flare-ups, feed that food to your child one time (a "challenge") after avoiding it for 2 weeks. If it does cause flare-ups, the eczema should become itchy or develop hives within 2 hours of ingestion. If this occurs, avoid ever giving this food to your child and talk to us about food substitutions.

This is a chronic condition and will usually not go away before adolescence. Therefore early treatment of anal itching is the key to preventing a severe rash.

Steroid Creams
Steroid creams are the main treatment for itchy eczema. When a rash quiets down, use it at least once daily for an additional 2 weeks. After that, use it immediately on any spot that itches. When you travel with your child, always take the steroid cream with you. If your supply starts to run out, get the prescription renewed.

Bathing and Hydrating the Skin
Hydration of the skin followed by lubricating cream, is the main way to prevent flare-ups of eczema. Your child should have one bath each day for 10 minutes. Water-soaked skin is far less itchy. Eczema is very sensitive to soaps. Young children can usually be cleaned without any soap. Teenagers need a soap to wash under the arms, the genital area, and the feet. They can use a nondrying soap such as Dove for these areas. Keep shampoo off the eczema.

Lubricating Cream
Children with eczema always have dry skin. After a 10-minute bath, the skin is hydrated and feels good. Help trap the moisture in the skin by applying an outer layer of lubricating cream to the entire skin surface while it is damp. Apply it after steroid cream has been applied to any itchy areas. Apply the lubricating cream once daily (twice daily during the winter). Some lubricating creams are Keri, Lubriderm, Nivea and Nutraderm. Avoid applying any ointments, petroleum jelly, or vegetable shortening because they can block the sweat glands, increase itching and worsen the rash (especially in warm weather). Also, soap is needed to wash them off. For severe eczema, ointments may be needed temporarily to heal the skin.

Itching
At first sign of any itching, apply the steroid cream to the area that itches. Keep your child's fingernails cut short. Also, wash your child's hands frequently to avoid infecting the eczema.

Wool fibers and clothes made of other scratchy, rough materials make eczema worse. Cotton clothes should be worn as much as possible. Avoid triggers that cause eczema to flare up, such as excessive heat, sweating, excessive cold, dry air (use a humidifier), chlorine, harsh chemicals and soaps. Never use bubble bath. Also, keep your child off the grass during grass pollen season (May and June). Keep your child away from anyone with fever blisters since the herpes virus can cause a serious skin infection in infants. Otherwise, use a soy formula. Also try to avoid cow's milk products, eggs, peanut butter, wheat, and fish during the first year of life.

IMMEDIATELY if :

• The rash looks infected (yellow pus or scabs, spreading redness, red streaks).
• The rash flares up after contact with someone who has fever blisters (herpes).
• Your child starts acting very sick.

During regular office hours:

• The rash becomes raw and open in several places.
• The rash hasn't greatly improved after 7 days of using this treatment.
• You have other questions or concerns.

• A large pimple at the junction of the cuticle and the fingernail
• Redness and tenderness of this area
• Occasionally, pus draining from this area

Those with a large pimple or is draining pus are usually infected with the Staphylococcus bacteria. The bacteria usually enters the skin through a break in the skin caused by pulling on or chewing on the cuticle. If the cuticle area is only red and swollen, it is due to Candida (yeast). Yeast infections usually occur in children that suck their thumb or finger, swim a lot, or have waterlogged cuticles from other activities.

With proper treatment, this infection should clear up in 7 days. If not, your physician will probably prescribe an oral antibiotic.

Antiseptic soaks
If the cause is bacteria, soak the infected finger three times a day for 10 minutes in warm water and liquid antibacterial soap. Do this for 4 days, or longer if the wound has not healed.

Antibiotic ointments
For bacterial infection apply an antibiotic ointment 6 times a day. Cover it with an adhesive bandage. Continue to apply the antibiotic ointment until no signs of infection remain.

Open any large pimple
Open and drain any visible pus pocket using a needle sterilized with rubbing alcohol or a flame. Make a large opening where the pus pocket joins with the nail. If the pus doesn't run out, gently squeeze the pus pocket.

Yeast (Candida) infections
For yeast infections apply the medicine prescribed by your physician three times daily. Also, try to keep the area dry. Do not cover it with a Band-Aid.

Discourage any picking or chewing of hangnails (loose pieces of cuticle). Instead, cut these off with nail clippers.

IMMEDIATELY if:

• Fever develops.
• A red streak spreads beyond the cuticle.

During office hours if:

• The infection has not improved after 48 hours on home treatment.
• The infection is not totally cleared up by 7 days.
• You have other concerns or questions.

• Small ulcers in the mouth
• A mildly painful mouth
• Small water blisters or red spots located on the palms and soles and on the webs between the fingers and toes
• Five or fewer blisters per limb
• Sometimes, small blisters or red spots on the buttocks
• Low-grade fever between 100o and 102oF (37.8o and 38.9oC)
• Mainly occurs in children 6 months to 4 years of age

Hand, foot, and mouth disease is always caused by a Coxsackie A-16 virus. It has no relationship to hoof and mouth disease of cattle.

The fever and discomfort are usually gone by day 3 or 4. The mouth ulcers resolve in 7 days, but the rash on the hands and feet can last 10 days. The only complication seen with any frequency is dehydration from refusing fluids.

Antacid Solution
Use an antacid solution for pain relief. For younger children, put 1/2 teaspoon antacid solution in the front of their mouth 4 times a day after meals. Children over age 4 can use 1 teaspoon of an antacid solution as a mouthwash after meals.

Diet
Change to a soft diet for a few days and encourage plenty of clear fluids. Cold drinks, popsicles, and sherbet are often well received. For a younger child, give fluids by cup rather than from a bottle. Avoid giving your child citrus, salty, or spicy foods. Also avoid foods that need much chewing.

Fever
Acetaminophen or ibuprofen may be given for a few days for severe mouth pain or a fever above 102°F (38.9°C).

IMMEDIATELY if:

• Your child has not urinated for more than 8 hours.
• Your child starts acting very sick.

During regular hours if :

• The fever lasts more than 3 days.
• The mouth pain becomes severe.
• You have other concerns or questions.

• Tiny, pink bumps
• Occasionally, some are pinpoint-size water blisters
• Mainly on neck and upper back or chest
• Occurs during hot, humid weather
• Heat rash can be itchy
• Older children report a "prickly" pins and needles sensation
• No fever or sickness
• Also called "prickly heat"

Heat rash is caused by blocked-off sweat glands. Lots of children get it during hot, humid weather when sweat glands are overworked. Infants can also get it in the wintertime with fever, overdressing, or ointments applied to the chest for coughs (ointments block off the sweat glands). Older children can get it with exercise.

With treatment, heat rash usually clears up completely in 2 to 3 days.

Cooling

Use techniques that cool off the skin:

• Give cool baths every 2 to 3 hours, without soap. Let the skin air-dry.
• For localized rashes, apply a cool, wet washcloth to the area for 5 to 10 minutes.
• Dress your child in as few layers of clothing as possible.
• Lower the temperature in your home or use a fan when your child is asleep.
• Have the child lie on a cotton towel to absorb perspiration.

Hydrocortisone cream
Apply 1% hydrocortisone cream (no prescription necessary) 3 times a day to itchy spots. Avoid hydrocortisone ointments. Calamine lotion is another option.

Avoid ointments
Avoid all ointments or oils because they can block off sweat glands. Be sure the rash isn't caused by a mentholated ointment being used for a cough.

During regular hours if:

• The rash lasts more than 3 days on this treatment.
• You have other concerns or questions.

• Very itchy rash.
• Raised pink spots with pale centers (hives look like mosquito bites.).
• Size range of 1/2 inch to several inches across.
• Shapes quite variable.
• Rapid and repeated changes of location, size, and shape.

Widespread hives are an allergic reaction to a food, drug, viral infection, insect bite, or a host of other substances. Often the cause is not found. Localized hives are usually due to skin contact with plants, pollen, food or pet saliva. Localized hives are not caused by drugs, infections or swallowed food. Hives are not contagious.

More than 10% of children get hives. Most children who develop hives have it only once. The hives come and go for 3 or 4 days and then mysteriously disappear. Large swellings are common around the eyes, lips, and genitals if hives occur there. Some young children become sensitized to mosquito or flea bites. They develop big hives (called papular urticaria) at the sites of old and new bites that can last for months.

Antihistamine Medicine
The best drug hives is an antihistamine. An antihistamine won't cure the hives, but it will reduce their number and relieve itching. Benadryl, one of the most commonly used drugs for hives, has recently become available without prescription. The main side effect of this drug is drowsiness. If you have another antihistamine (e.g.any drug for hay fever) at home, you can use it if you know the dosage until you can get some Benadryl. Continue the medicine until the hives are completely gone for 24 hours.

Itching
Give a cool bath to relieve itching. Rub very itchy areas with an ice cube for 10 minutes.

Avoidance
Avoid anything you think might have caused the hives. For hives triggered by pollen or animal contact, take a cool shower or bath. For localized hives, wash allergic substance off the skin with soap and water. If itchy, massage the area with a cold washcloth or ice for 10 minutes. Localized hives usually disappear in a few hours and don't need Benadryl.

IMMEDIATELY if :

• Breathing or swallowing becomes difficult.
• Your child starts acting very sick.

During regular office hours:

• The itch is not controlled after your child has been taking continuous antihistamines for 24 hours.
• The hives last more than 1 week.
• You have other questions or concerns.

A bite involves biting with the insect's mouth parts and removing a drop of blood from the human. A sting involves injecting a poison into the human from the insect's stinger. The following three types of bites or stings are covered:

1) Bee and yellow jacket stings
2) Itchy or painful bites
3) Tick bites

Your child was stung by a honeybee, bumblebee, hornet, wasp, or yellow jacket. Over 95% are from yellow jackets. These stings cause immediate painful red bumps. Although the pain is usually better in 2 hours, the swelling may increase for up to 24 hours. Multiple stings (more than 10) can cause vomiting, diarrhea, a headache, and fever. This is a toxic reaction related to the amount of venom received (i.e., not an allergic reaction). A sting on the tongue can cause swelling that interferes with breathing.

Treatment
If you see a little black dot in the bite, the stinger is still present (this occurs only with honeybee stings). Remove it by scraping it off. If only a small fragment remains, don't worry about it. Then rub each sting for 20 minutes with a cotton ball soaked in a meat tenderizer solution. This will neutralize the venom and relieve the pain. If meat tenderizer is not available, apply aluminum-based deodorant or a baking soda solution for 20 minutes. For persistent pain, massage with an ice cube for 10 minutes. Give acetaminophen or ibuprofen immediately for relief of pain and burning.

Some bee stings can also be prevented by avoiding gardens and orchards and by not going barefoot. Insect repellents are not effective against these stinging insects.

IMMEDIATELY if:

• Breathing or swallowing is difficult (call 911).
• Hives are present.
• There are 10 or more stings.
• Your child starts acting very sick.

During regular hours if:

• Swelling of the hand (or foot) spreads past the wrist (or ankle).
• You have other questions or concerns.

Bites of mosquitoes, chiggers, fleas, and bedbugs usually cause itchy, red bumps. The size of the swelling can vary from a dot to 1/2 inch. The larger size does not mean that your child is allergic to the insect bite. Mosquito bites near the eye always cause massive swelling. The following are clues that a bite is due to a mosquito: itchiness, a central raised dot in the swelling, bites on surfaces not covered by clothing, summertime, and the age of the child (i.e., she is an infant). In contrast to mosquitoes, fleas and bedbugs don't fly; therefore, they crawl under clothing to nibble. Flea bites often turn into little blisters in young children.
Bites of horseflies, deerflies, gnats, fire ants, harvester ants, blister beetles, and centipedes usually cause a painful, red bump. Within a few hours, fire ant bites change to blisters or pimples.

Itchy Insect Bites
Apply calamine lotion or a baking soda paste to the area of the bite. If the itch is severe (as with chiggers), apply nonprescription 1% hydrocortisone cream 4 times daily. Another way to reduce the itch is to apply firm, sharp, direct, steady pressure to the bite for 10 seconds. A fingernail, pen cap, or other object can be used. Encourage your child not to pick at the bites or they will leave marks.

Painful insect Bites
Rub the area of the bite with a cotton ball soaked in meat tenderizer solution for 20 minutes. This will relieve the pain. If you don't have any meat tenderizer, use a baking soda solution. Give acetaminophen or ibuprofen for pain relief.

Mosquitoes and Chiggers
Many of these bites can be prevented by applying an insect repellent sparingly to the clothing or exposed skin before your child goes outdoors or into the woods. Repellents are essential for infants (especially those less than 1 year old) because they cannot bat the insects away.

Bedbugs
The bed and baseboards can be sprayed with 1% malathion, but young children must be kept away from the area because this substance is somewhat poisonous. You may need to call an exterminator.

Fleas
Usually you will find the fleas on your dog or cat. If the bites started after a move into a different home, fleas from the previous owner's pet are the most common cause. Fleas can often be removed by bringing a dog or cat inside the house for 2 hours to collect the fleas (they prefer the dog or cat to living in the carpet) and then applying flea powder or soap to the animal outdoors. Careful daily vacuuming will usually capture any remaining fleas.

Precautions with Diethylduamide (DEET) Insect Repellents - Insect repellents containing DEET must be used with caution. DEET can be absorbed across the skin into the bloodstream and products with high concentrations can cause seizures or coma. Young children may also have reactions to DEET from licking it off the skin. To prevent harmful reactions, take the following precautions:

• Use DEET products formulated for children. These contain 10% or less DEET. Even adults don't need more than a 30% DEET concentration.
• Apply repellent mainly to clothing and shoes.
• To prevent contact with the mouth or eyes, don't put any repellent on the hands.
• Don't put any repellent on areas that are sunburned or have rashes because the DEET is more easily absorbed in these areas.
• Warn older children who apply their own repellent that a total of 3 or 4 drops can protect the whole body.
• Because one application of repellent lasts 4 to 8 hours, apply it no more than twice daily.
• If repellent is put on the skin, wash it off after your child comes indoors.

IMMEDIATELY if:

• The bite looks infected (yellow pus, spreading redness, red streaks).

During regular hours if :

• Itching or pain is severe after treatment.
• You have other questions or concerns.

A tick is a small brown bug that attaches to the skin and sucks blood for 3 to 6 days. The bite is usually painless and doesn't itch. The wood tick (or dog tick), which transmits Rocky Mountain spotted fever and Colorado tick fever, is up to 1/2 inch in size. The deer tick, which transmits Lyme disease, is the size of a pinhead.

Tick Removal
The simplest and quickest way to remove a wood tick is to pull it off. Use a pair of tweezers to grasp the tick as close to the skin as possible (try to get a grip on its head). Apply a steady upward traction until the tick releases its grip. Do not twist the tick or jerk it suddenly because these maneuvers can break off the tick's head or mouth parts. Do not squeeze the tweezers to the point of crushing the tick; the secretions released may contain germs that cause disease.
If tweezers aren't available, use fingers, a loop of thread around the tick's jaws, or a needle between the jaws for traction. Tiny deer ticks need to be scraped off with a knife blade or the edge of a credit card. If the body is removed but the head is left in the skin, use a sterile needle to remove the head (in the same way that you would remove a sliver). Apply antibiotic ointment to the bite once.
Wash the wound and your hands with soap and water after removal. A recent study by Dr. G. R. Needham showed that embedded ticks do not back out with the application of a hot match or when covered with petroleum jelly, fingernail polish, or rubbing alcohol. We formerly thought that petroleum jelly, fingernail polish, or alcohol would block the tick's breathing pores and take its mind off eating. Unfortunately ticks breathe only a few times per hour.

Children and adults who are hiking in tick-infested areas should wear long clothing and tuck the end of the pants into the socks. Apply an insect repellent to shoes and socks (permethrin products are more effective than DEET products against ticks). During the hike perform tick checks using a buddy system every 2 to 3 hours to remove ticks on the clothing or exposed skin. Immediately after the hike or at least once daily, do a bare skin check. A brisk shower at the end of a hike will also remove any tick that isn't firmly attached. Because the bite is painless and doesn't itch, the child will usually be unaware of its presence. Favorite hiding places for ticks are in the hair, so carefully check the scalp, neck, armpit, and groin. Removing ticks promptly may prevent infection because transmission of Lyme disease requires 18 to 24 hours of feeding. Also the tick is easier to remove before it becomes firmly attached.

IMMEDIATELY if:

• You can't remove the tick.
• A fever or rash occurs within the 2 weeks following the bite.
• Your child starts acting very sick.

During regular hours if:

• You think your child might have Lyme disease.
• You have other questions or concerns.

• Sores are less than 1 inch in diameter.
• Sores begin as small red bumps that rapidly change to cloudy blisters, them pimples, and finally sores.
• Sores (any wounds that don't heal) increase in size.
• Sores are often covered by a soft, yellow-brown scab.
• Scabs may be draining pus.
• Impetigo often spreads and increases in number from scratching and picking at the initial sore.
• Any wound that doesn't heal or increase in size usually has become infected.

Impetigo is a superficial infection of the skin, caused by Streptococcus or Staphylococcus bacteria. It is more common in the summer when the skin is often broken by cuts, scrapes, and insect bites. When caused by a strep infection of the nose, the impetigo usually first appears near the nose or mouth.

With proper treatment, the skin will be completely healed in 1 week. Some blemishes will remain for 6 to 12 months, but scars are unusual unless your child repeatedly picks her sores.

Antibiotic (Oral or Injectable)
Most children with impetigo need an antibiotic. One or two sores following an insect bite or cut may respond to an antibiotic ointment.

Antibiotic Ointment
After the crust has been removed, antibiotic ointment should be applied to the raw surface three times daily. You won't need a prescription. Apply for 7 days or longer if necessary. The area should be washed with an antibacterial soap each time. Any new crust that forms should not be removed since this delays healing. After applying an antibiotic ointment, cover the sore with a Band-Aid to prevent scratching and spread.

Removing the Scabs
The bacteria live underneath the soft scabs, and until these are removed, the antibiotic ointment has difficulty getting through to the bacteria. Scabs can be soaked off using warm water and an antibacterial soap. Take your time. The area may need to be gently rubbed, but it should not be scrubbed. A little bleeding is common if you remove all the crust.

Preventing Spread of Impetigo to Other Areas of the Body
Every time your child touched the impetigo and then scratched another part of the skin with that finger, she can start a new site of impetigo. To prevent this, discourage your child from touching or picking at the sores. Keep the fingernails cut short and wash her hands often with one of the antibacterial soaps.

Contagiousness to Other People
Impetigo is quite contagious. Be certain that other people in the family do not use your child's towel or washcloth. Your child should be kept out of school until she has taken oral antibiotics for 24 hours. For mild impetigo treated with an antibiotic ointment, the child can continue to attend day care or school if the sore is covered with a Band-Aid.

IMMEDIATELY if :

• Spreading redness or red streaks occur.
• Your child starts acting very sick.

Within 24 hours if:

• The impetigo increases in size and number of sores after 48 hours of treatment.
• A fever or a sore throat occurs.
• The impetigo is not completely healed in 1 week.
• You have other questions or concerns.

• Pink, scaly rash
• Usually extremely itchy
• Inner thighs, groin, and scrotum involved
  ( Note: The penis is not involved )
• Almost exclusively in males
• Also called ringworm of the crotch or tinea cruris

Jock itch is caused by a fungus, often the same one that causes athlete's foot. Sometimes it is transferred by a towel because a teenager with athlete's foot dries the groin area after drying the feet.

With appropriate treatment, the symptoms are better in 2 or 3 days and the rash is cured in 3 to 4 weeks.

Antifungal medicine
Buy Tinactin, Micatin, or Lotrimin powder or spray (nonprescription) at your drugstore. Twice a day put the powder or spray on the rash and at least 1 inch beyond the borders of the rash. Make sure you get the medicine in all the creases. Continue using the medicine for several weeks, or for at least 7 days after the rash seems to have gone away.

Dryness
Jock itch will heal much more quickly if the groin area is kept dry. Your child should wear loosely fitting cotton shorts. Shorts and athletic supporters should be washed frequently. The rash area should be carefully cleansed once a day with plain water and carefully dried. Do not put soap on the rash.

Scratching
Scratching will delay the cure, so encourage your child not to scratch the area.

During regular hours if :

• There is no improvement in 1 week.
• The rash is not completely cured in 1 month.
• You have other questions or concerns.

• Nits (white eggs) are firmly attached to hairs
• Unlike dandruff, nits can't be shaken off
• Gray bugs (lice) are 1/16 inch long, move quickly, and are difficult to see
• The scalp itches and has a rash
• The back of the neck is the favorite area
• The nits are easier to see than the lice because they are white and very numerous

Head lice only live on human beings and can be spread quickly by using the hat, comb, or brush of an infected person or simply by close contact. Anyone can get lice despite good health habits and frequent hair washing. The nits (eggs) normally hatch into lice within 1 week. Pubic lice ("crabs") are slightly different but are treated the same way. They can be transmitted from bedding or clothing and do not signify sexual contact.

With treatment, all lice and nits will be killed. A recurrence usually means another contact with an infected person or the shampoo wasn't left on for 20 minutes. There are no lasting problems from having lice and they do not carry other diseases.

Anti lice Shampoo or Rinse
Wash the hair with your regular shampoo, rinse it and towel-dry. Pour about 2 ounces of the shampoo into the damp hair. Scrub the hair and scalp for 10 to 20 minutes. Rinse the hair thoroughly and dry it with a towel. These shampoos kill both the lice and the nits. Most anti lice shampoos need to be repeated once in 7 days to prevent re infection. ( Note: A new anti lice shampoo called Nix only requires one application.)

Removing Nits
Remove the nits by back combing with a fine-tooth comb or pull them out individually. The nits can be loosened from the hair shafts using a mixture of half vinegar and half water applied for 30 minutes under a towel wrap. Even though the nits are dead, most schools will not allow children to return if nits are present. Obviously, the hair does not need to be shaved to cure lice.

Lice in the Eyelashes
If you see any lice or nits in the eyelashes, apply petroleum jelly to the eyelashes twice a day for 8 days. The lice won't survive.

Cleaning the House
Lice can't live for more than 72 hours (3 days) off the human body. Your child's room should be vacuumed. Combs and brushes should be soaked for 1 hour in a solution made from the anti lice shampoo. Wash your child's sheets, blankets, and pillowcases in hot water. Items that can't be washed (hats or coats) can be set aside in plastic bags for 3 weeks (the longest the nits can survive). Anti lice sprays or fumigation of the house in unnecessary.

During regular office hours if:

• The rash and itching are not cleared by 1 week after treatment.
• The sores start to spread or look infected.
• The lice or nits return.
• You have other questions or concerns.

• The rash begins with a single herald or mother patch that looks like large ringworm.
• The herald patch has a scaly, raised border and a pink center.
• The herald patch is 1 to 3 inches across.
• A widespread rash of smaller matching spots on both sides of the body occurs 7 to 14 days after the herald patch first appears.
• This rash consists of pink, oval-shaped spots that are 1/4 to ' 2 inch across. The spots are covered with fine scales, which give the rash a crinkled appearance.
• The rash appears mainly on the chest, abdomen, and back. Sometimes the rash is worse in the groin and armpits. Usually the rash does not appear on the face.
• The rash can be itchy during the first 1 or 2 weeks.
• This rash primarily affects people between the ages of 6 and 30 years.
• Usually a physician needs to examine the rash to diagnose it.

The rash is probably caused by a virus.

This condition is harmless. The rash will disappear without treatment. The skin will return to a normal appearance. The difficult part of this rash is that it lasts 6 to 10 weeks. During this time, however, your youngster will feel fine.

Skin Creams
In general treatment is unnecessary. If the skin is dry, a moisturizing cream may be helpful. For itchiness, use 1% hydrocortisone cream (no prescription necessary) 2 or 3 times a day. For itchiness unresponsive to this, re contact our office for a stronger steroid cream.

Sunlight Exposure
One dose of ultraviolet light may stop itching and shorten the course of pityriasis. Have your youngster sunbathe for 30 minutes (enough to make the skin pink). If this is impossible, use a sun lamp or consider a tanning salon.

(Caution. Avoid sunburn.)

During regular hours if :

• The rash becomes very itchy.
• The rash becomes infected with pus or draining scabs.
• The rash lasts longer than 3 months.
• You have other questions or concerns.

• Redness and blisters
  
• Eruption on exposed body surfaces (e.g., hands)
  
• Shaped like streaks or patches
  
• Extreme itchiness
  
• Onset 1 or 2 days after the patient was in a forest or field

Cool Soaks
Soak the involved area in cold water or massage it with an ice cube for 20 minutes as often as necessary. Then let it air-dry. This will reduce itching and oozing.

Steroid Creams
If applied early, a steroid cream can reduce the itching.
The sores should be dried up and no longer itchy in 10 to 14 days. In the meantime, cut
your child's fingernails short and encourage your child not to scratch himself or herself.

Benadryl
If itching persists, give Benadryl orally (no prescription needed) every 6 hours
as needed.

Contagiousness
The fluid from the sores themselves is not contagious. However, anything that has poison ivy oil or sap on it is contagious for about 1 week. This includes the shoes and clothes the patient last wore into the woods, as well as any pets that may have oil on their fur. Be sure to wash them off with soap and water. The rash begins 1 to 2 days after skin contact.

IMMEDIATELY if:

• The rash looks infected (yellow pus, spreading redness, red streaks)

During regular hours if:

• The face, eyes, or lips become involved
• The itching becomes severe even with treatment
• Poison ivy lasts longer than 2 weeks
• You have other concerns or questions

• Ring-shaped pink patch
• Scaly, raised border
• Ring slowly increases in size
• Clearing of the center as the patch grows
• Usually ½ to 1 inch in size
• Mildly itchy

Ringworm is caused by a fungus infection of the skin, often transferred from puppies or
kittens who have it.

It responds well to appropriate treatment.

Antifungal Cream
Buy Tinactin, Micatin, or Lotrimin cream at your drug store. You
won't need a prescription. Apply the cream twice daily to the rash and 1 inch beyond its
borders. Continue this treatment for 1 week after the ringworm patch is smooth and seems to be gone. Successful treatment often takes 3 to 4 weeks. Encourage your child to avoid
scratching the area.

Contagiousness
Ringworm of the skin is mildly contagious. It requires direct skin-to skin
contact. The type acquired from pets is not transmitted human-to-human, only animal to-
human. After 48 hours of treatment, it is not contagious at all. Your child doesn't have to
miss any school (or day care).

Treatment of Pets
Kittens and puppies with ringworm usually do not itch and may not
have any rash. If ringworm patches are seen, call your veterinarian. If no patches are present but ringworm recurs in your child, also contact your veterinarian. Also have your child avoid close contact with the animal until he or she is treated. Natural immunity will develop in animals after 4 months even without treatment.

During regular hours if

• The ringworm continues to spread after 1 week of treatment
  
• The rash has not cleared up in 4 weeks
  
• You have other concerns or questions

• Round patches of hair loss that slowly increase in size
• A black-dot, stubbled appearance of the scalp from hair shafts
  that are broken off at the surface
• The scalp may have scaling
• Mild itching of the scalp
• Ringworm of the face may also be present
• Usually occurs in children age 2 to 10 years
• This diagnosis requires a positive microscope test
  ( potassium hydroxide [ KOH prep ] ) or fungus culture

A fungus infects the hairs and causes them to break. Ringworm is not caused by a worm. Over 90% of cases are due to Trichophyton tonsurans, which is transmitted from other children who are infected. Combs, brushes, hats, seat backs, pillows and bath towels can transmit the fungus. Less than 10% of the cases are caused by infected animals. The animal type causes more scalp irritation, redness and scaling. If your child has the animal type of fungus, he or she is not contagious to other children.

Ringworm of the scalp is not dangerous. Without treatment, however, the hair loss and scaling may spread to other parts of the scalp. Some children develop a kerion, which is a boggy, tender swelling of the scalp that can drain pus. Kerions are an allergic reaction to the fungus and may require additional treatment with an oral steroid. Hair re growth is normal after treatment but will take 6 to 12 months. In the meantime, your child can wear a hat or scarf to hide the bald areas.

Oral Antifungal Medicine
The main treatment for ringworm of the scalp is griseofulvin taken orally for 8 weeks.
( The product comes in a 125 mg/5 mL suspension and 250-mg capsules. ) Griseofulvin is best absorbed if taken with fatty foods such as milk or ice cream. Antifungal creams or ointments are not effective in killing the fungus that causes ringworm of the scalp.

Antifungal Shampoo
The use of an antifungal shampoo makes your child less contagious and allows him or her to return to day care or school. Purchase a nonprescription shampoo containing selenium sulfide ( e.g., Selsun ). Lather up and leave it on for 10 minutes before rinsing. Use the antifungus shampoo twice a week for the next 8 weeks. On other days, use a regular shampoo.

Common Mistakes
It is psychologically harmful and unnecessary to shave the hair, give a close haircut, or to force your child to wear a protective skull cap.

During regular hours if

• The ringworm looks infected with pus or a yellow crust
• The scalp becomes swollen or boggy
• The ringworm continues to spread after 2 weeks of treatment
• You have questions or concerns

• Scabies are little bugs ( mites ) that burrow under the skin and cause severe itching and little red bumps. They are so small that they can only be seen with a microscope.
• They rarely attack the skin above the neck, except in infants.
• Usually more than one person in the family has them.
• This diagnosis must be confirmed by a physician.

Scabies Cream
Elimate cream is usually prescribed. Apply the cream to every inch of the body from the neck down, after a warm bath. ( Infants less than 1 year old also need it carefully applied to the scalp, forehead, temples and neck. Avoid the lover face. ) Do not forget the navel, between the toes, or other creases. Leave some under the fingernails. Areas that do not seem infected should still be covered.
Eight to 12 hours later give your child a bath and remove the cream. One treatment is usually effective. For severe rashes, repeat the treatment once in 1 week.

Kwell Precautions
If Kwell is used, babies under 1 year of age should have it washed off in 4 hours. Leaving Kwell on longer than this can cause side effects. Swallowing Kwell can be quite harmful, so cover the hands with gloves or socks if your child is a thumb sucker.

Pregnant Women
Pregnant woman need special medicines for scabies. Pregnant woman cannot us Kwell. If you use Elimate cream, wash it off in 8 hours. If you use Eurax, leave the first coat on. Apply a second coat 24 hours later. Wash the Eurax off 48 hours after the second application. The Eurax 2-day treatment needs to be repeated in 1 week.

Itching
The itching and rash may last for 2 to 3 weeks after successful treatment with Kwell or Eurax. This itch can be helped by frequent cool baths without use of soap, followed by
1% hydrocortisone cream, which you can buy without prescription.

Cleaning the House
Machine wash all of your child's sheets, pillowcases, underwear, pajamas and recently worn clothing. Make sure to use a hot cycle. Blankets can be put away for 3 days. Scabies cannot live outside the human body for more than 3 days.

During regular hours if

• It looks infected ( sores that enlarge or drain pus )
• New scabies occur after treatment is completed
• You have other concerns or questions

• Reddened, sunburned-looking skin ( especially of the chest and abdomen )
  On close inspection, the redness is speckled ( tiny pink dots )
• Increased redness in skin folds ( especially the groin, armpits and elbow creases )
• Full-blown rash within 24 hours
• Rough feeling of reddened skin, somewhat like sandpaper
• Flushed face with paleness around the mouth
• Sore throat and fever ( usually preceding the rash by 18 to 24 hours )
• The diagnosis must be confirmed by a physician

Scarlet fever is a strep throat infection with a rash. The complication rate is no different than the complication rate for strep throat alone. The rash is caused by a special rash-producing toxin that is produced by some strep bacteria.

The red rash usually clears in 4 to 5 days. Sometimes the skin peels in 1 to 2 weeks where the rash was most prominent ( e.g. the groin ). The skin on the fingertips also commonly peels. Your child will stop having a sore throat and fever after 1 to 2 days of taking penicillin or other antibiotic.

Antibiotics

• Antibiotics will be prescribed after the diagnosis of strep has been confirmed by a strep test
• Try not to forget any doses
• Give the medicine until all the pills are gone or the bottle is empty. Even though your child will feel better in a few days, give the antibiotic for 10 days to keep the strep throat from flaring up again
• If the medicine is a liquid, store it in the refrigerator.
• Use a measuring spoon to be sure that you give the right amount
• A long-acting penicillin ( Bicillin ) injection can be given if your child will not take oral medicines or if it will be impossible for you to give the medicine regularly

For Relief of Sore Throat
Acetaminophen or ibuprofen are very helpful. Children over age 1 can sip warm chicken broth or warm apple juice. Children over age 4 can suck on hard candy of lollipops.

The Rash
The rash itself needs no treatment. It generally clears in 4 to 5 days.

Your child is no longer contagious after he or she has been on an antibiotic for 24 hours. Therefore your child can return to school after 1 day if they are feeling better. The rash itself is not contagious.

Throat Cultures for the family

Scarlet fever and strep throat can spread to others in the family. Any child or adult who lives in your home and has a fever, sore throat, runny nose, headache, vomiting, or sores; or who does not want to eat; or who develops these symptoms in the next 5 days should be brought in for a throat culture. In most homes we need to culture only those who are sick. We will call you if any of the cultures are positive for a strep infection.

( Exception : In families where relatives have had rheumatic fever or frequent strep infections, everyone should have a throat culture. )

Repeat throat cultures are not necessary if your child takes all of the antibiotics.

IMMEDIATELY IF

• Your child develops drooling or great difficulty in swallowing
• Your child starts acting very sick

Within 24 hours if

• The fever lasts over 48 hours after your child starts taking an antibiotic
• You have other concerns or questions

• There is a linear rash that follows the path of a nerve.
• The rash occurs on only one side of the body.
• The rash starts with clusters or red bumps, changes to water blisters, and finally becomes dry crusts. (It looks like a small group of chickenpox).
• The back, chest, and abdomen are the most common sites.
• The rash usually doesn't burn or itch in children
  (in contrast to the adult form).
• Your child does not have a fever or feel sick.
• Your child had chickenpox in the past.

Zoster is caused by the chickenpox virus. The disease is not caught from other people with active shingles or chickenpox. The chickenpox virus lies dormant in the bodies of some people and is reactivated for unknown reasons as zoster. Children with zoster are usually over 3 years old.

New shingles continue to appear for several days. All the rash dries up by 7 to 10 days. Complications do not occur unless the eye is involved. If zoster involves the nose, the cornea is usually also involved. Most people have shingles just once; a second attack occurs in 5% of children who get zoster.

Relief of Symptoms
Most children have no symptoms. For pain, give acetaminophen or ibuprofen as necessary. Avoid giving aspirin for zoster because of the possible link with Reyes' syndrome. Discourage itching or picking the rash, The rash does not need any cream.

Contagiousness
Children with zoster can transmit chickenpox (but not zoster) to others. Transmis-ion occurs by touching the zoster rash. Although they are far less contagious than children with chickenpox, children with zoster should stay home from school for 7 days unless they can keep the rash covered until it crusts over. Children or adults who have not had chickenpox should avoid visiting the child with zoster (unless the rash is covered).

IMMEDIATELY if :

• Zoster rash involves the eye or nose.

During regular hours if:

• The rash becomes very painful or very itchy.
• The rash lasts more than 14 days.
• The rash looks infected with pus or soft yellow scabs.
• You have other questions or concerns.

The following four skin injuries are covered. Go directly to the type of injury that pertains to your child.

1. cuts and scratches
2. scrapes ( abrasions )
3. puncture wounds
4. bruises

More cuts are superficial and extend only partially through the skin. They are caused by sharp objects. The cuts that need sutures are deep and leave the skin edges separated. Another rule of thumb is that cuts need sutures if they are longer than 1/2 inch ( 1/4 inch if on the face ).

Treatment

• Apply pressure for 10 minutes to stop any bleeding.
• Wash the wound with soap and water for 5 minutes.
• Cut off any pieces of loose skin using a small scissors ( for torn skin with scrapes )
• Apply an antibiotic ointment and cover it with a Band-aid or gauze. Wash the wound, apply the ointment and change the Band-aid or gauze daily.
• Give acetaminophen or ibuprofen as needed for pain relief.

• Do not use alcohol or Merthiolate on open wounds. They sting and damage normal tissue.
• Do not kiss an open wound because the wound will become contaminated by the many germs in a normal person's mouth.
• Let the scab fall off by itself; picking it off may cause a scar.

IMMEDIATLEY if :

• Bleeding will not stop after 10 minutes of direct pressure.
• The skin is split open and might need sutures.
  Note: Lacerations must be sutured within 12 hours of the time of injury, and the infection rate is far lower if they are closed within 4 hours.
• There is any dirt in the wound that you can not get out.
• The cut looks infected ( yellow pus, spreading redness, red streaks ).

During regular hours if :

• If your child has not had a tetanus booster in more than 10 years ( 5 years for dirty cuts ).
• The wound does not heal by day 10.
• You have other questions or concerns.
  

An abrasion is an area of superficial skin that has been scraped off during a fall ( e.g., a floor burn or skinned knee ).

Cleaning the Scrape
First, wash your hands. Then wash the wound vigorously for at least 5 minutes with warm water and liquid soap. The area will probably need to be scrubbed several times with a wet piece of gauze to get out all the dirt. You may have to remove some dirt particles
( e.g., gravel ) with a pair of tweezers. If there is tar in the wound, it can often be removed by rubbing it with petroleum jelly, followed by soap and water again. Pieces of loose skin should be cut off with sterile scissors, especially if the pieces of the skin are dirty. Rinse the wound well.

Antibiotic Ointments and Dressing

• Apply an antibiotic ointment and cover the scrape with a Band-Aid or gauze dressing. This is especially important for scrapes over joint ( such as elbow, knee or hand ) that are always being stretched. Cracking and reopening at these sites can be prevented with an antibiotic ointment, which keeps the crust soft ( no prescription is needed ). Cleanse the area once a day with warm water and then reapply the ointment and dressing until the scrape is healed.

Pain Relief
Because abrasions can hurt badly, give acetaminophen or ibuprofen for the first day.

IMMEDIATLEY if :

• There is any dirt in the wound that you can not get out.
• Skin loss involves a very large area.
• The scrape looks infected ( yellow pus, spreading redness, red streaks ).

During regular hours if :

• If your child has not had a tetanus booster in more than 10 years.
• The wound does not heal by 2 weeks .
• You have other questions or concerns.
  

The skin has been completely punctured by an object that is narrow and sharp, such as a nail. The wound is not wide enough to need sutures. Since puncture wounds usually seal over quickly, there is a greater chance of wound infection with this type of skin injury. Puncture wounds of the upper eyelid are especially dangerous and can lead to a brain abscess. A deep infection of the foot can begin with swelling of the top of the foot 1 to 2 weeks after the puncture. Another risk is tetanus if your child is not immunized.

Cleansing
Soak the wound in warm water and soap for 15 minutes. Scrub the wound with a wash cloth to remove any debris. If the wound re bleeds a little, that may help remove germs.

Trimming
Cut off any flaps of loose skin that cover the wound and interfere with drainage or removing debris. Use a fine scissors after cleaning them with rubbing alcohol.

Antibiotic Ointment
Apply an antibiotic ointment and cover the scrape with a Band-Aid to reduce the risk of infection. Re soak the area and reapply antibiotic ointment every 12 hours foe 2 days.

Pain Relief
Give acetaminophen or ibuprofen for any pain.

IMMEDIATLEY if :

• Dirt in the wound remains after you have soaked the wound.
• The tip of the object could have broken off in the wound.
• The sharp object or place where the injury occurred was very dirty
  ( e.g., a barnyard ).
• The scrape looks infected ( yellow pus, spreading redness, red streaks ).

During regular hours if :

• If your child has not had a tetanus booster in more than 5 years.
• Pain, redness or swelling increases after 48 hours.
• You have other questions or concerns.

Bleeding into the skin from damaged blood vessels gives a black and blue mark. Since the skin is not broken, there is no risk of infection. Bruises usually follow injury caused by blunt objects. Unexplained bruises can indicate a bleeding tendency.
( Exception: " Unexplained " bruises overlying the shins are usually not a sign of bleeding tendency: children often bump this area and then forget about it.)

Bruises
Apply ice for 20 to 30 minutes. No other treatment should be necessary. Give acetaminophen or ibuprofen for pain. Avoid aspirin because it may prolong the bleeding. After 48 hours apply a warm washcloth for 10 minutes 3 times a day to help the skin reabsorb the blood. Bruises clear in about 2 weeks.

IMMEDIATLEY if :

• Bruises are unexplained and several in number.

Sutures are ready for removal at different times, depending on the site of the wound.
The following table can serve as a guide:

• Protect the wound from injury during the following month.
• Avoid sports that could re injure the wound. If a sport is essential, apply tape to the wound before playing.

If your child needed sutures, they will develop a scar. All wounds heal by scarring. The scar can be kept to a minimum by taking the sutures out at the right time, preventing wound infections, and protecting the wound from being injured again during the first month after the injury. The healing process continues for 6 to 12 months. Only after this time will the scar assume its final appearance.

IMMEDIATLEY if:

• An unexplained fever (over 100 °F, or 37.8 °C) occurs.
• There is a red streak or red area that spreads from the wound.

• The wound looks infected ( pus or a pimple).
• The wound becomes more painful than it was on the second day.
• A stitch comes out early.
• You have other questions or concerns.

To much sunlight ( ultraviolet light ) causes a sunburn. This can happen even on cloudy or
overcast days. A sunburn can hurt a lot. It is common to have:

• REDNESS
• ITCHING
• PEELING ( in a few days )

1. Stay out of sunlight
   
2. A cool bath or shower can help the pain
   
3. DO NOT use anesthetic skin creams or sprays ( like benzocaine ) to help the pain. These medicines can hurt the skin more.
   
4. If you must go in the sunlight :

• limit your time in the sun - avoid being out between 1 - 3 pm
• wear cloths to cover most of your skin
• wear a wide-brimmed hat
• use sunscreen with a high SPF ( 15 or more ) - apply sunscreen 30 min's. before going out in the sun. Then reapply every hour during sun exposure.
• wear sunglasses

5. Tetanus shot : Tetanus is a serious ( bad ) disease. A shot will help prevent this. if you have had a shot, write down the date and keep a record of it. You may need another shot in 4 to 6 weeks. Ask your doctor.

• worse pain
• big blisters
• blisters with pus ( thick fluid )
• fever of 101 °F or more
• vomiting that does not get better

A tan is a sunburn. Tanning and sunburns cause permanent skin damage. This can cause skin cancer and aging of the skin. One bad sunburn ( blistering ) in a child increases the risk of cancer.

• The name means " multicolored ringworm ".
• The condition occurs in adolescents and adults.
• Numerous spots and patches appear on the neck, upper back, and shoulders.
• The spots are covered by a fine scale.
• The spots vary in size.
• In summer, the spots are light and don't tan like the normal skin.
• In winter, as normal skin tone fades, the spots look darker (often pink or brown) than normal Caucasian skin.

This superficial infection is caused by a yeast like fungus called Malassezia furfur. It is more common in warm, humid climates.

The problem tends to wax and wane for many years. There are no serious complications. It is solely a cosmetic problem. Itching is uncommon.

Selsun Blue shampoo
Selsun Blue (selenium sulfide) is a nonprescription medicated shampoo that can cure this condition. Apply this shampoo once a day for 14 days. Apply it to the affected skin areas as well as 2 or 3 inches onto the adjacent normal skin. Rub it in and let it dry. Be careful to keep it away from the eyes and genitals, since it is irritating to these tissues. After 30 minutes, take a shower. In 2 weeks the scaling should be stopped, and the rash temporarily cured. Normal skin color will not return for 6 to 12 months.

Prevention of recurrences
Tinea versicolor tends to recur. Prevent this by applying Selsun Blue shampoo on the areas that were affected previously once a month for several years. Leave it on for 1 to 2 hours, then shower. This precaution is especially important in the summer months because this fungus thrives in warm weather.

During regular hours if:

• The rash is not improved with this treatment after 2 weeks.
• You feel your child is getting worse.
• You have other questions or concerns.

If your child has tenderness, redness, and swelling of skin around the corner of the toenail on one of the big toes, your child has an ingrown toenail. Ingrown toenails are usually caused by tight shoes (for example, cowboy boots) or improper cutting of the toenails. They take several weeks to heal.

• Soaking
  Soak the foot twice a day in warm water and antibacterial soap for 20 minutes. While the foot is soaking, massage outward the swollen part of the cuticle.
• Antibiotic ointment
  If your child's cuticle is just red and irritated, an antibiotic ointment is probably not needed. But if the cuticle becomes swollen or oozes secretions, apply Neosporin ointment (no prescription needed) 5 or 6 times a day.
• Cutting off the corner of the toenail
  The pain is caused by the corner of the toenail rubbing against the raw cuticle. Therefore, your physician will cut this corner off so that the irritated tissue can heal more easily. Your physician needs to do this only once. The main purpose of treatment is to help the nail grow over the nail cuticle rather than get stuck in it. Therefore, during soaks try to bend the corners of the nail upward.
• Shoes
  Have your child wear sandals or go barefoot as much as possible to prevent pressure on the toenail. When your child must wear closed shoes, protect the ingrown toenail as follows: If the inner edge is involved, tape a foam pad between the first and second toes to keep them from touching. If the outer edge is involved, tape a foam pad to the outside of the ball of the toe to keep the toenail from touching the side of the shoe.

Prevent recurrences of the ingrown toenail by making sure that your child's shoes are not too narrow. Get rid of any pointed or tight shoes. After the cuticle is healed, cut the toenails straight across, leaving the corners. Don't cut the nails too short. Cut the nail weekly to prevent pressure on the end of the nail, which can push the corners into the skin. Also, after every shower or bath, lift up the corners of the nail.

IMMEDIATELY if:

• Your child develops a fever.
• A red streak spreads beyond the toe.

Call during office hours if:

• Any pus or yellow drainage is not cleared up after 48 hours of treatment.
• The cuticle has not totally healed in 2 weeks.
• You have other concerns or questions.

• Warts are raised, round, rough-surfaced growths on the skin.
• They occur most often on the hands.
• They are not painful unless they are on the bottom of the foot (called plantar warts).
• Unlike a callus, a wart has brown dots in it and has a clear boundary with the normal skin.

Warts are caused by papillomaviruses.

Warts are harmless. Most warts disappear without treatment in 2 or 3 years. With treatment they are usually gone in 2 to 3 months. There are no shortcuts in treating warts.

Wart-removing acids

Ask your pharmacist to recommend an over-the-counter acid for removing warts.
Put the acid on the wart once a day, enough to cover the entire wart. The acid will work faster if you cover the wart with adhesive tape or duct tape after you put the acid on the wart. Keep the lid on the acid container closed tightly so the acid won't evaporate. Make sure that you don't get any of the acid near the eyes or mouth.
The acid will turn the top of the wart into dead skin (it will all turn white). Once or twice a week, remove the dead wart material by paring it down with a razor blade. If that is hard for you to do, rub the dead skin off with a washcloth instead. The dead wart will be softer and easier to remove if you soak the area first in warm water for 10 minutes. If the cutting causes any pain or minor bleeding, you have cut into living wart tissue.

Cover the wart

Cover the wart with a piece of adhesive tape or duct tape. Warts deprived of air and sun exposure sometimes die without the need for treatment with acids. Remove the tape once a week and wash the skin. After it has dried thoroughly, reapply the tape. The tape treatment may be needed for 8 weeks.

Encourage your child not to pick at the warts because this may cause the warts to spread. If your child chews or sucks the wart, cover the area with a Band-Aid and change it daily. Encourage your child to give up this habit because chewing on warts can cause warts on the lips or face. Warts are not very contagious to other people.

During regular hours if :

• Warts develop on the feet, genitals, or face.
• New warts develop after 2 weeks of treatment.
• The warts are still present after 8 weeks of treatment.
• You have other concerns or questions.

A break in the skin shows signs of infection, such as:

• Pus or cloudy fluid is draining from the wound.
• A pimple or yellow crust has formed on the wound (impetigo).
• The scab has increased in size.
• Increasing redness occurs around the wound (cellulitis).
• A red streak is spreading from the wound toward the heart (lymphangitis).
• The wound has become extremely tender.
• Pain or swelling has increased 48 hours after the wound occurred.
• The lymph node draining that area of skin may become large and tender.
• Your child may develop a fever over 100 degrees F.
• The wound hasn't healed within 10 days.
• Most of these diagnoses must be confirmed by a physician.

Most skin infections follow breaks in the skin (e.g. from cuts, puncture wounds, animal bites, splinters, thorns, or burns). Bacteria (especially staphylococcus or streptococcus) then invade the wound through the "portal of entry" and cause the infection. Some infections start with a closed rash (that is, the skin is not broken). Examples are insect bites, chicken pox, scabies or acne. If a child picks at these rashes, the skin can become broken and then infected. Deeper wounds (e.g. puncture wounds) are more likely to become infected than superficial wounds (such as scrapes). The hands are at increased risk for infections from puncture wounds. The teeth or claws of cats pose a major risk for infection.

With appropriate antibiotics and warm soaks, the wound infection should improve within 24 to 48 hours. By that time, your child should stop having any fever caused by the infection. Any red streaking (lymphangitis) or red patches (cellulitis) should stop spreading. The area of the wound should be much less tender within 48 hours. Within 1 week after your child starts taking antibiotics, all signs of active infections should be completely gone.

Antibiotics
This medicine will kill the germs that are causing the wound infection. Try not to forget any of the doses. If your child goes to school or stays with a babysitter, arrange for someone to give the afternoon dose. Even though your child will feel better in a few days, give the antibiotic until it is completely gone to keep the infection from flaring up again.

Warm Soaks or Local Heat
Proper cleansing of an open wound is important for healing. Soak the wounded area in warm water or put a warm, wet cloth on the wound for 20 minutes, 3 times a day. Use a warm salt water solution containing 2 teaspoons of table salt per quart of water. Use this solution to remove all the pus and loose scabs. (Don't use hydrogen peroxide because it is a feeble germ killer.) Your physician may give you a syringe to help irrigate the wound. Continue soaking the wound three times a day until it looks clear of infection. Then continue to cleanse it and change the dressing once a day until the wound has healed. If the wound is closed (e.g. cellulitis), apply a heating pad or a warm, moist washcloth to the reddened area for 20 minutes, 3 times a day. This will help deliver the antibiotic to the infection.

Fever and Pain Relief
Give your child acetaminophen or ibuprofen if he develops a fever over 100 degrees F or the wound is painful.

Contagiousness
The pus from wound infections is somewhat contagious. It can cause skin infections in other people if the pus gets on other people's skin or on an open cut. Be certain that other people in the family do not use your child's towel or washcloth. Encourage your child not to touch the wound because it puts germs on his fingers. Also, ask your child to wash the hands more often than usual, or wash your child's hands for him. Cut the fingernails short. Keep your child out of school until he has been treated by antibiotics for 24 hours and is free of fever.

IMMEDIATELY if :

• The redness keeps spreading.
• The wound becomes extremely painful.
• Your child starts acting very sick.

During regular office hours if :

• The fever is not gone 48 hours after your child starts taking an antibiotic.
• The wound infection doesn't look better in 3 days.
• The wound isn't completely healed within 10 days.
• You have other questions or concerns.