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Dr. Zain hosts Dr. Amna, Heather, and Courtney on Skin Side Out to explain common pediatric “lumps and bumps,” emphasizing that most are benign and often best left alone. They review cysts (and when locations like the gluteal cleft/spine or airway patterns warrant imaging), molluscum (contagious, sometimes self-limited, often linked with eczema and scratching), hemangiomas (growth then involution; treat high-risk sites or ulceration with beta blockers like topical timolol or oral propranolol), pilomatricomas, dermoid cysts (midline/airway concerns may need MRI/ENT), abscesses (may require drainage), reactive lymph nodes, and warts (HPV; contagious; treatments include freezing and topicals). Red flags include rapid growth, color change, uncommon lymph node areas, and systemic symptoms. They stress avoiding picking or squeezing lesions and seeking in-person evaluation when unsure.
00:00 Hands Off Acne Rule
00:22 Show Intro And Goals
01:12 Why Parents Notice Skin
02:48 Epidermoid Cysts Basics
03:30 Red Flag Cyst Locations
04:37 Watchful Waiting And Consent
08:35 Molluscum Explained
09:46 Molluscum Management Tips
12:48 Hemangiomas Growth And Risks
14:36 Hemangioma Treatments Today
15:55 Pilomatricomas And Dermoids
18:12 Abscesses Not Always Infection
19:08 Kids Skin Infections
20:10 Reactive Lymph Nodes
22:10 Warts Explained
26:04 When To Worry
28:32 Counseling Parents
29:26 Abscess Reality Check
33:19 Common Myths
34:36 Final Takeaways
Creators and Guests
Host
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
48 - Skinside Out
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[00:00:00]
Courtney: Yeah. I think the best piece of advice I ever got is the cyst, or like the acne bump that is untouched is always gonna heal faster than the one you touched. And it stands true time after time. If you go after something, that inflammation's gonna last a lot longer than if you just left it alone.
Welcome to Skin Side Out. So today I'm your host, Dr. Zane, with a special guest, Dr. Amna, Heather and Courtney. So we're gonna be talking all about pediatric lumps and bumps from the inside out. So we're gonna be going over what these type of growths are, um, whether they are something that we need to be worried about and how we can, you know, advise parents on how to deal with these type of lesions.
Dr. Zain Husain: So we're gonna get right into it. So let's go into some of these common bumps and lumps that we see.
Heather: Um, so for broad terms, we'll talk about cysts, birthmarks, infections, and [00:01:00] rare tumors. Um, most of the growths or the lumps and bumps in kids are benign and very common. Um, but the skin is dynamic and reactive in pediatric patients.
Dr. Zain Husain: So, Dr. Amna is a pediatrician. So in your practice, do you see a lot of parents asking about, you know, these growths or bumps, um, that they see in their children?
Dr. Syeda Amna Husain: So I think generally just because the skin is so visible with little kids, we're always changing their clothes, changing diapers, you know, holding them in our laps.
It's one of those common things that you might be running your hand over your kiddo's arm and then all of a sudden. It feels dry or it feels bumpy, so you might feel like you're worrying about your kid's skin a lot more than you actually worry about your own skin as an adult. So it's one of those common topics that some might be concerning, some might not be concerning, but we just find ourselves hearing a lot of questions about from parents.
Dr. Zain Husain: Yeah. And as being parents, I think we've seen our fair share of skin [00:02:00] conditions with our kids. So like with our eldest, um, Assia, she has this beautiful little neeva phis on her neck. Which she was born with, um, Minnie, she had a streak, um, along her arm, like in Satu. So it was initially like a rash and then it became hypopigmented, and that's just her little swirl on her arm.
And then our youngest, Sarah had this big hemangioma on her, popliteal fossa, her leg. So we have, you know, had our fair share of skin condition with our kids.
Courtney: What is Popo fossa for the people that don't know it.
Dr. Zain Husain: That's right. The jargon. Sorry about the jargon. Um, it's the crook of your knee, so like the area that's behind your knee.
Courtney: Yeah.
Dr. Zain Husain: All right, so let's get right into it. So some common benign lesions. Let's start off with cyst because we see this all the time. So, Courtney, what do we see with these benign epiderm white cysts?
Courtney: Um, so typically with cyst, you'll see kind of a lump underneath [00:03:00] the skin. Um. When cysts become inflamed or infected, that's when you'll get that abscess or what some people refer to as boils, where you'll see that little head, they're really red and angry, and that's where you get more of the actual, like, fluid filled puss that's coming out.
But cysts can be just benign and underneath and not bothering anyone or anything for a long time. Um, sometimes they'll kind of, you can almost like move them around in the skin. Um, but like I said, they, they do have that potential to turn into something like an abscess and rupture.
Dr. Zain Husain: Yeah. Dr. Amna from embryology in medical school.
You know that there are certain like cysts and lumps in locations that we tend to be a little bit more concerned about.
Dr. Syeda Amna Husain: Sure.
Dr. Zain Husain: So what are those locations that we are worried about with cys?
Dr. Syeda Amna Husain: So usually we think of things. On a conservative side, anywhere along this spinal cord, so especially towards the bottom.
So right at sort of that using a medical term, but like that gluteal cleft, so right where sort of the butt [00:04:00] cheeks of the baby begin. If there's any kind of. Birthmark, anything of that nature. Tuft of hair, even like a cyst that looks kind of funny. I don't hesitate to do something called an ultrasound. So literally just like a mom would have when she's pregnant, we would just ultrasound and kind of check the spine underneath.
Dr. Zain Husain: Um, also like we see some, you know, embryologic structures, um, that look like cysts along airways, along certain patterns, and that can also be signaling an underlying, you know, defect or something that we have to be concerned about, especially on like the airways. Um, we do have to be concerned. Okay. Um, and these cysts typically behave benignly.
They're usually quiet. We don't have to do anything. We often reassure parents, and that's just kind of a mantra with our pediatric patients, we tend to be more conservative, a lot more watchful waiting if we see that, you know, it's following all the rules, not really behaving badly. You know, we just tend to leave things alone because [00:05:00] other interventions are obviously more invasive, um, can lead to permanent sequelae, like scarring.
And it's also traumatic for little kids. I mean,
Courtney: so traumatic mm-hmm. As someone that's had to numb a 7-year-old on her forehead. Mm-hmm. Yeah. It stays with me and I'm sure it stayed with that 7-year-old. So
Heather: when I was doing a rotation in the picu mm-hmm. There was a, um, nurse practitioner who was doing a, um, spinal tap on a.
And I think it was like the sixth try and I felt so bad. Just like observing. Yeah. It looked so painful.
Dr. Zain Husain: Yeah, I mean we went through that with, um, Sarah. She had a little spinal tap in the er and that was pretty traumatic on, was there with her. Um, and usually
Dr. Syeda Amna Husain: after six tries though, I think.
Dr. Zain Husain: Yeah, it's a bit much.
Heather: Yeah.
Dr. Syeda Amna Husain: I think the other thing we, um. I think sometimes gets ignored a lot is that can children feel pain? And at that young infant age, they might not be able to say like, ouch. Mm-hmm this hurts. And Oh, everything's gonna make a kid [00:06:00] cry, so we have to, yeah. One thing I always tell parents is, is it bothering you or is it bothering them?
Courtney: Mm-hmm. Mm-hmm. Mm-hmm.
Dr. Syeda Amna Husain: And if it's bothering the parent, we just say, okay. This is what it's gonna look like. Do you want us to do that? Versus I think an eight, 9-year-old child can tell you if something's bothering them. Mm-hmm. Mm-hmm. So yeah,
Dr. Zain Husain: sometimes I find this dilemma where the parent really wants you to do something.
Yeah. They want intervention. They brought them to the doctor. Mm-hmm. And they don't like hearing that, Hey, let's just watch this, or there's nothing for us to really do. It's benign. Like they really want something to happen. Um, and get rid of the problem that. They're worried about. Mm-hmm. Or that they're concerned about cosmetically.
And I do think that we have to take a firm ground with these parents and really say like, you know, these children are not going through a necessarily like easy treatment. They do feel pain. There's aftercare often. Mm-hmm. And, you know, it's, it goes back to the, you know, the idea of autonomy and consent.
[00:07:00] Like these little kids really can't make those choices. Their parents do. But we also have to advocate for our patients too.
Courtney: Mm-hmm. We had a patient at my previous practice who was a 9-year-old boy, and he had a mold that we'd been watching on his, the bottom of his foot, and it had been stable over the course of a year or so, but the mom was really adamant about taking it off, which my doctor was more than happy.
To do, but it was the beginning of summer and my doctor said if we take it off now and he's running around barefoot or going in the pool or things like that, it can be really uncomfortable. She said, I really don't mind taking it off, but I'd rather do it in the fall when he's not outside so much. And the mom was so adamant about taking it off and I just felt for that kid because we ended up doing the biopsy and mm-hmm.
You know, I'm just thinking about him like running around at summer camp or running around barefoot and that. Sight, just being so sore and agitated. Mm-hmm. You know, unfortunately the mole came back as benign. Um, because if he needed that surgery, that's another wound that we're creating. So just being cognizant, I think, of factors like that.
Dr. Zain Husain: And many time at these young ages, I mean, these kids are not fully [00:08:00] grown, right? They're gonna be growing. And any scar that we create at a younger age as the patient grows, um, you know, it stretches on those scars. They don't look as good cosmetically. If it's not something that needs to be done, like something that's malignant or cancerous, I often tell the parents like, Hey, why don't we wait until they're done growing?
They'll also be of age to consent, and they can determine whether they want it removed or not. Mm-hmm. So I always. Tend to kind of be on the conservative side and let you know, let us do a little bit of waiting game because what if the kid doesn't even want it done? Mm-hmm. All right, so let's go on to another common bump we see in our clinic.
So Molluscum. So Heather, what's Molluscum? Molluscum
Heather: is a virus. Um, molluscum. Coag. So it is contagious. Um, it is very, very common in kids. Sometimes it will go away on its own. We do often see it with, um, kids who [00:09:00] have pretty flared eczema, but you can have it regardless, like even if you don't have eczema.
It's usually these tiny little pink dots. Um, they're raised little bumps and they have this central umbilical in the middle, so it kind of looks like it has its own little belly button. Um, sometimes they're itchy, but usually not really. But there are some great treatments, but sometimes they can be stubborn.
Dr. Zain Husain: Yeah. And do these Molluscum always have these, um, publications?
Heather: Not always. Mm-hmm. That's like, kind of like the classic
Dr. Zain Husain: Yeah.
Heather: Version.
Dr. Zain Husain: Sometimes it can be hard to distinguish between molluscum and warts at times. Mm-hmm. Um, especially if you don't have that, um, telltale sign. Um, and are these typically infectious, contagious?
Heather: Yes.
Dr. Zain Husain: Yes. Just like the name implies. Yeah. So coag some Dr. Alna, how do you typically deal with, um, kiddos with molluscum?
Dr. Syeda Amna Husain: So usually I tell parents, again, we go back to the Is it bothering you or is it bothering the child? [00:10:00] If it bothers the child, it's worth, you know, thinking about strategies. I will say there's not too much in the way of strategies and it is helpful, I think, to tell parents sometimes that it can get more widespread before it gets better.
Courtney: Mm-hmm.
Dr. Syeda Amna Husain: Usually I kind of tell them that there's a period of time where they might be seeing, quite seeing them quite frequently and then. The virus kind of burns its way out and it's done. You might see it go through the family. Um, again, there are certain things that used to be on the market to treat them, um, but no longer.
Um, and definitely not in the US so we don't see 'em as much. Sometimes you can go down the wart cycle and sort of start some of the therapies we use for warts. I think the big thing is, um, education. I will say that usually in your healthy run of the mill child, this isn't bothersome, but if you have an immunocompromised child, um, which is kind of a big way of saying your child's immune system isn't functioning completely normal, these can become quite [00:11:00] bothersome, quite troublesome, quite widespread.
Um, and it is something that we might be noting and taking count of, but again, that's a very small subset of population, thankfully in pediatrics. But it is important to be aware of.
Dr. Zain Husain: I see a lot of these patients having concomitant eczema, so like they're, you know, already dry, their skin barriers compromise and I suspect that because their skin barrier compromised, they're more prone to this infection.
Um, but it also presents a challenge because, you know, the eczema is dry and irritated. Many of the treatments we use to treat molluscum can be drying and irritating, so it can sometimes flare the eczema. So sometimes I feel like doing less is more. Um, if you're gonna be putting on like, you know, high concentration salicylic acid.
If you're gonna be putting on like immunomodulators or if you're gonna be putting on like a topical acid, um, for instance, all of these are gonna irritate the skin locally and it's [00:12:00] very hard to precisely put it on just those spots. It's gonna get around and then you are left with a kid who is really upset, irritated, and their eczema often flares.
Heather: I've had some good success with. F focusing on treating the eczema. And once the eczema calms down, the molluscum calms down too and goes away.
Dr. Syeda Amna Husain: Right. Because if their eczema, if they're scratching it, they're basically, you know, auto inoculating, basically taking that virus, the particles under their nails, and then moving it onto another part of the body.
Mm-hmm. Yeah.
Courtney: Yeah. And kids don't have, obviously the same, you know, mindset. To say, you know, when they're itchy, they're gonna scratch it. So it's, it's harder, I think, um, to control some of those like aspects with children than it is with adults
Dr. Syeda Amna Husain: for sure.
Dr. Zain Husain: Okay, so let's move on to some common birthmarks and vascular lesions.
We're gonna start off with hemangiomas. So Dr. Amna, what are hemangiomas and how do they present? [00:13:00]
Dr. Syeda Amna Husain: So these are vascular proliferations. Um, they are typically. Ben nine. But that being said, our treatment is very much geared towards where they appear and, um, the effect that they might have on the child. So.
Usually they present in the first few weeks after birth, sometimes in the first, um, couple of months. And then there's a rapid sort of growth phase as you can imagine, because they are blood vessels. Um, they will rapidly grow and then they, um, sort of die out, just, just similar as we mentioned. They rapidly grow and then they'll sort of shrink and go away on their own.
That will happen a little bit later though in life, a little bit closer to school age, child age, so maybe 4, 5, 6. Um, that being said, the very first few years of life is very, very important. So if these, um, hemangiomas are on the eyes, the nose, the lips, these are places that could [00:14:00] impact how they learn, to see how they breathe, how they will learn to speak, and of course, their self-esteem.
And so that's something that we have to think about and usually we will treat based off of how rapidly it's going to grow, where it is, the texture of the hemangioma and all of those pieces.
Dr. Zain Husain: Another key consideration is if there's ulceration. Mm-hmm. So even if it's not on a high risk area, on say like in the airway area or along along the neck, if it's ulcerating, there's trauma to the area, um, potential infection.
So I tend to treat those patients as well. And going into the treatment options, the mainstay of therapy, prior to the, you know, discovery of propanolol as a good solution, um, we were using vascular lasers, so pulse eye laser, other vascular lasers to help treat these hemangiomas. Um, steroids were also used in the past.
Um, but you know, with [00:15:00] research, um, and finding that there was a. A molecule. This transport, the glute one transporter that is in our cells, they find that those are like expressed in these human Gs. And by using propanolol, which is a beta blocker, that can actually reduce the growth and actually cause it to involute faster.
So beta blockers can be in topical forms like timolol, or you can take it orally, um, as propanolol. Heman is the name brand that we typically prescribe, but it's been a game changer for a lot of these patients. They don't have to be hospitalized. They don't have to go through painful procedures or be sedated for them.
And you know, I think that has really changed the way we treat these vascular anomalies.
so let's talk about other benign but concerning appearing lesions. So let's talk about ome comas. Courtney, why don't you talk about that?
Courtney: Sure. Um, I don't know much about [00:16:00] them other than they, they kind of look, um, sometimes they can look like almost milia, but like kind of, um, like almost multiple.
So it's basically a little like calcification underneath the skin. So it gives this white-ish appearance. Um. If you've ever seen like, yeah, just a standalone milia, it almost looked like a bundle of them, essentially. Um, they are benign. Um, they can feel kind of firm underneath the skin. Um, typically, you know, it's origin is coming from the hair follicle.
So, um, like I said, it's nothing of concern, but typically, you know, visually impairing, I guess.
Dr. Zain Husain: Yeah. And depending on where it's located in the skin, sometimes it can have like a bluish gray kind of appearance to it. Sometimes has an oblong shape, so not as, you know, perfectly round like many cysts are. So a little more like a football shape.
And you know, the cool thing about these lesions, um, on pathology, there's something called ghost cells. So that's a hallmark. Um, you know, histologic finding that we see like these empty looking cells, um, and this like cystic [00:17:00] lesion. So that's kind of cool.
Courtney: Hmm.
Dr. Zain Husain: All right.
Courtney: How do you usually treat them?
Dr. Zain Husain: Same thing like with cyst, to be honest.
I mean, if it's not bothering the kid, I just say just leave it. Um, and if it is bothering them, then you know, we wait for a good time to excise it surgically. But that's kind of the options.
Courtney: Yeah.
Dr. Zain Husain: All right. Dermoid cysts. So Heather, tell us a little bit about those.
Heather: Um, dermoid cysts are growths that can happen.
Usually they're congenital. Um, they're, they can be in any area, but they're very common, like on the eyebrows or the scalp. Um, usually it's something that happens very early in life, um, but it's usually benign and nothing that you have to treat.
Dr. Zain Husain: Yeah. However, there are instances where dermoid says can be concerning.
So, Dr. Amna, what would we be concerned about with dermoid cyst, like along the midline and the airways?
Dr. Syeda Amna Husain: Yeah.
Dr. Zain Husain: So oftentimes we require imaging for that. So MRIs, um, typically, and you know, oftentimes we [00:18:00] have our ENT colleagues help out with those cases. All right, now let's move on to some more infectious and reactive lumps and bumps.
So let's talk about abscesses. So what are abscesses?
Courtney: So they're like. As we kind of talked a little bit earlier, um, when a cyst becomes inflamed, um, it will become an abscess. So not all the time. It's funny, sometimes you'll culture it. Um, you'll send a bacterial culture off and sometimes it's not always infected.
I think a lot of people have this preconceived notion that. It's definitely a female, especially
Heather: if it's like red and tender. Yeah.
Courtney: Like it's infected. It's infected and it's weird. 'cause yeah, sometimes you send the culture off and there's just no, it's, you know, natural skin flora. So it doesn't always mean that there's a true infection.
But that being said, sometimes they might recommend something like an antibiotic just to calm down the inflammation 'cause they can be tender
Dr. Syeda Amna Husain: Sometimes I think what we anticipate and think of as a bacterial infection too, it can be the body's, [00:19:00] um.
Courtney: Inflammatory
Dr. Syeda Amna Husain: process. I guess I was trying to think of the word for cytokines, which is messengers, like the body's trying to sort of attack this, whatever it might be, a collection of skin cells.
Let's say it's a cyst or something like that. And or it's been picked at. Mm-hmm. And there is some skin flora that has sort of embedded inward and caused a reactive inflammatory process. Yeah. It's not uncommon to see it with kids. And I think the other thing about kids is. Depending on the age, um, they might not tell you, especially if your kiddo's potty trained, commonplace, we see this is sort of the genital urinary area.
Kids might, you know, very easily get a scratch or something like that, a little pimple or a pustule, and there is a lot of cause for getting an infection in that area. Mm-hmm. Especially if they're not great wipers, great cleaners, and you're not gonna think to look in at your kiddos. Private areas to see, hey, what's bothering them, and then it'll be a big rip roaring infection, skin infection or an abscess.
Something that's brewing [00:20:00] underneath.
Dr. Zain Husain: Yeah,
Courtney: that's true.
Dr. Zain Husain: So let's talk about reactive lymph nodes. So Dr. Ana, you see this a lot in your pediatric patients, so tell me what those are and how we distinguish it from other lumps and.
Dr. Syeda Amna Husain: Yeah, so lymph nodes, um, it takes, I think an understanding of the human body and where lymph nodes are, they're pretty much scattered everywhere in the body.
There's more superficial lymph nodes. There's deeper lymph nodes. And with children, oftentimes there's not a lot of body fat. They're very easily palpable. Um, and you can just kind of feel along and feel like this sort of chain of small tender. Mobile non-tender, excuse me, mobile bumps, and those are lymph nodes.
You can see them very quickly, get larger and inflamed because again, kids get a lot of viral illnesses. Those lymph nodes are kind of like a hub center for the, um, immune system and they can get larger, but I usually don't worry about 'em when I tell parents, I think it's a sign of the body sort of fighting the [00:21:00] infection.
It's a good thing, you know, the hub is active. But when they're tender, that's a good time to kind of, kind of open your eyes up and say, okay, is it red, is it tender? Um, and we can always do ultrasounds for things like this as well, which are, which are very easy, um, and not radiation producing for kids.
Dr. Zain Husain: Yeah. And there are certain infections that we see in kids that have really prominent lymph nodes. So like tinia capita for instance. Mm-hmm. So where do we typically see those in large lymph nodes?
Dr. Syeda Amna Husain: Typically you'll kind of see them along the, well we call it posterior auricular, but behind the ears. And again, very easy to palpate in children.
You can also kind of feel them down their, their neck. Um, I think a lot of the viral infections, typical viral infections that we see in kiddos, um, and even some of the ones that we vaccinate for, like rubella, you can, um, really quickly be able to feel lymph nodes very [00:22:00] quickly with children.
Dr. Zain Husain: Yeah. Um, so we did skip one group of lumps, um, warts.
I mean, they're very common in the pediatric population,
Heather: so common population. Mm-hmm.
Dr. Zain Husain: So let's just chat a little bit about that because sometimes that can be hard to distinguish with some other bumps like molluscum, for instance. So. What are warts?
Heather: Warts? Um, a wart is another virus. It's usually in a class of, um, HPV, so human papilloma virus.
That is kind of the. General virus, but there are different strains. So, um, with kids they're very contagious. Um, you could have one and then again scratching it can auto inoculate and cause another to pop up. You can spread them to friends or siblings. Um, very common. Usually these. Um, [00:23:00] do not go away on their own.
There are some special cases where they can, but there are some good treatments for it. So typically if the kiddo can tolerate it, we would try freezing with liquid nitrogen. There are some other topical medications though too that can be, um, a little bit easier on the patient.
Dr. Zain Husain: And I find that your immune system will eventually fight off and, you know, prevent these from forming in the future.
But it can take months to years and obviously it's distressing for the parent, um, especially as they're spreading. Um, usually doesn't bother the kids that much, but I mean, cosmetically it can be really, you know, disfiguring for patients and also the itch associated with it can be really bothersome.
Dr. Syeda Amna Husain: I will say too, that it's helpful to know, um, on the hands.
A common place to see it for children, especially. 'cause you know, the, they might be sweating in that area, but you're also learning to write maybe not so much now with the kids, they, it's a lot of typing, but if you're writing, it's a very common [00:24:00] place that the wart can really irritate. Mm-hmm. So that would be a time where I would definitely.
Lean towards treating because you don't want them to be uncomfortable learning. Um, a really basic and important skill like writing.
Courtney: Mm-hmm. I feel like we always see them like a good crop after summer, like on the feet. Mm-hmm. Or, you know, the kids are around the pool swimming out, it's hot, you know, there's sweat going on and that virus just loves that like, humid environment.
And then, yeah, I feel like in the fall we get that crop of kids.
Dr. Syeda Amna Husain: And I think speaking of like, we didn't mention it, but um, certain. Some of these skin findings, they really thrive in like humid environments, but also athletic environments. Mm-hmm. Mm-hmm. So like, you know, a lot of these we talk about, we're thinking about young children, but I have seen grown, you know, wrestlers also have molluscum, have warts.
Mm-hmm. Um, tinia and potato. Yes. Mm-hmm. Um, because it's skin on, skin contact, and then a lot of sharing of towels, sharing of very close contact. [00:25:00] So it, it's something to consider that I always tell parents like, Hey, does your child play sports? Okay. They play X, Y, Z sports. Just know that I might be able to help treat this wart.
Courtney: Mm-hmm.
Dr. Syeda Amna Husain: And they might get another wart. Mm-hmm. Or they might get another skin finding. And that's just knowing what their sort of. Sports and athletic exposures are gonna be, I think it helps prepare the parent a little bit.
Courtney: Mm-hmm. Their lifestyle activities. My pro tip is don't go to a waterpark without water shoes.
Dr. Syeda Amna Husain: Hmm. Yeah.
Courtney: Because that's how I got my work.
Dr. Zain Husain: And, you know, as a former athlete, like locker rooms are disgust. Oh, I'm sure absolutely filthy like people,
Courtney: especially high school.
Dr. Zain Husain: Oh yeah. Like that would be like you, wouldn wouldn't clean anything. Our uniforms would used to like soak with sweat. That's disgusting. Our helmets were never cleaned, our gloves were never cleaned.
It was just like disgusting. So I'm surprised I didn't get any infections,
Dr. Syeda Amna Husain: but you know.
Dr. Zain Husain: All right, so we've talked a lot about these [00:26:00] benign lumps and bumps. When should we be worried about, you know, a growth on a child? Um, what are some of those signs and symptoms that we look for that, hey, there might be something going on that we need a little bit more further investigation?
Courtney: I think anytime anything is, you know, increasing in size, that should always be kind of a red flag, especially if it's rapidly.
Um, but yeah, if you've kind of been monitoring something that just keeps getting bigger and bigger, that should kind of, you know, let you know, okay, it's time to go check this out. Hmm.
Dr. Syeda Amna Husain: I will say too that we talked a little bit about lymph nodes. Um, there's common places that we see lymph nodes, um, enlarge with children come and go.
Mm-hmm. Um, but there's also uncommon areas, um, some of them closer to the shoulders, some of them closer to the elbows, um, in the groin area. It's helpful that if you have any spot, I always tell parents, just bring it up. Let 'em know. Let us know. 'cause even then we can document it. And then if it does change in nature, and even if it's in two years.
We have an idea of, hey, [00:27:00] something that we thought was benign and might still be benign, slightly changing in appearance. It's good to get like a baseline.
Dr. Zain Husain: Yeah. In the dermatology office, we see changes sometimes occur in. Moles, um mm-hmm. And nail lesions, um, like, especially like molan and Nickia. So anything that's changing colors rapidly, I do definitely think that's a red flag.
Courtney: Mm-hmm.
Dr. Zain Husain: Um, in addition, I mean, if you have other symptoms going on. Systemic symptoms, fevers, chills, weight loss, um, other unexplained things that you wouldn't expect a healthy child to be encountering. That is a red flag as well, because, I mean, in the pediatric population, I mean there are, you know, kids who get leukemia, lymphoma, um, as well as other types of cancer that can also be tied to some of these systemic symptoms.
Dr. Syeda Amna Husain: Yeah, I will say that just in general pediatrics, it is. [00:28:00] It's important, but it's also one of those like really crucial skills to be able to do a really good physical exam. So even if it's something like, Hmm, this is something on the belly. Listen, it's not a big deal. We'll just throw an ultrasound if we can on it and get a baseline.
There's no radiation involved. Mm-hmm. But if we're concerned, that's something we could always do to check it out. It's always not a bad idea to just let your doctor know if there's a bump or a lump that you're concerned about.
Dr. Zain Husain: Mm-hmm. Yeah. So, Dr. Alna, as a pediatrician, how do you approach parents in terms of, you know, how to counsel them regarding these, you know, growth that they're bringing their kid in for?
Dr. Syeda Amna Husain: So, just like I had mentioned, um, a few. Is it bothering you or is it bothering the child? How long has it been there? So does it flare, does the molluscum flare at a certain time, when their eczema's flared? That kind of thing. Um, I think it's also helpful to know that if they're picking at it, um, even if it might not be bothering them, it's just something that they pick at.
Courtney: Mm-hmm.
Dr. Syeda Amna Husain: You might wanna counsel the patient, but [00:29:00] also counsel the parent. Um, you can't just, like Courtney said, stop a child from itching. Mm-hmm. You can't stop them from picking at a scab. Sure. You can tell 'em a billion times. But it's helpful to counsel a parent that this is something that you'll be concerned about.
Um, with abscesses, I think some parents think that if you just take an antibiotic, it'll be okay. Sometimes they need to be drained and that can be traumatic for everybody involved. I remember an abscess in the ER that was a, like a gluteal abscess, and it took three or four people to hold down this 4-year-old little girl.
And it was, it was something that had to be packed. And, um, and so essentially you create, you see that the infection creates like a, a tract mm-hmm. Um, going downward. And what you don't want is that is now a potential space. So once you even drain it, you don't want it to reform with puss. Mm-hmm. So sometimes you'll see that, um.
Some of these really deep abscesses in children. There is a, I mean, adults too, but [00:30:00] I always counsel with children is you kind of have to fill it, get it seen by either surgery or mm-hmm. Your dermatologist who might do surgery locally. Um, but we sometimes send these patients to the ER because they are big mm-hmm.
Abscesses that need drainage and there's a lot that can entail with that. Mm-hmm. Um, giving
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Dr. Zain Husain: that story and that, and that's happened to me personally. I wasn't a child at the time, but. I was an intern after, you know, medical school. I was working long hours in the ICU and I got this small infection, little folliculitis, which turned into an abscess and I was an idiot.
And I did not seek any treatment. I just kept getting sicker. And then I had like systemic symptoms. I was like literally turning green. And my attendings like, you need to go to the ER right now. And, you know, they had to gimme IV antibiotics, but that wasn't enough. They actually had to take me to the OR to drain it, and it was like a bit of a recovery.
I, I definitely would not, um, want to mess around with [00:31:00] that ever again because, you know, it's painful. Like after the, um, you know, the, the incision and drainage in the or, I was like knocked out. But afterwards it's very painful.
Dr. Syeda Amna Husain: And
Dr. Zain Husain: they're changing the dressings and packing and all that.
Dr. Syeda Amna Husain: Not to scare everybody.
I feel like everybody's getting like a worst case scenario. But I just think it's helpful to tell, especially parents that hey, even though we're putting in an antibiotic on this mm-hmm. Or giving you an oral antibiotic, there is a chance that it still might not improve. This is the signs of symptom symptoms to think of.
And um, kind of sometimes letting 'em know about the worst case scenario. Mm-hmm. Especially as a parent. I'll say that. Um. Sometimes you get a lot of information overload and you're like, what? I don't even know what's going on. And the kid's running around the room. But then later on something will click and be like, oh yeah, I think the doctor said that was something I need to think about.
Oh wait, this could happen. And so it's very helpful to know.
Dr. Zain Husain: Yeah. 'cause we do encounter a lot of parents who don't want to give their kids any medicine. They're very scared about [00:32:00] potential side effects, or they don't think it's natural. Sometimes you do need. You know, those medications to prevent this from getting way worse.
Courtney: Yeah. I think also, you know, and I feel like we see this in like some parents, but not, luckily not all, but I think like knowing. Like to take your child in versus trying to like drain it yourself at home or do stuff. And like sometimes you'll hear a parent say like, oh, I tried to squeeze at it. And I'm like, no, don't do that.
Like, don't squeeze at it, it's gonna make it worse. Just bring them in where we can do it like cleanly and you know, the right way. So I think, yeah, knowing, um, again, like not to try to do these things at home.
Dr. Syeda Amna Husain: Right.
Dr. Zain Husain: And then going back to your comment about a good physical exam, I think that's crucial.
These are not visits you can do on telemedicine. Mm-hmm. Absolutely not. I do think that you have to evaluate it in person. You really can't capture all those details, you know, on a fuzzy, you know, video screen.
Heather: Yeah. Even just being able to see if it's [00:33:00] like movable, movable versus fixed.
Dr. Zain Husain: Yeah.
Heather: You can't see.
Dr. Syeda Amna Husain: Right.
Heather: Yeah.
Dr. Zain Husain: All right, so let's go over some common myths, um, that we, we see with pediatric lumps and bumps. So, do all bumps require removal?
Heather: No,
Courtney: no, no,
Dr. Zain Husain: no. Most bumps don't. Right? So they behave benignly. You can leave them alone. They often stay quiet and you don't have to do anything. So when we have a bump, should we manipulate it?
Should we be trying to pop it or pick it?
Courtney: No. Unless you're me, all in my mirror.
Dr. Zain Husain: And why don't we wanna do that?
Dr. Syeda Amna Husain: Yeah, there's a risk of not only introducing more bacteria from, you know, your nail or a break in the skin, but also driving the infection deeper. Mm-hmm. And we talked about that, creating tracks, creating a deeper infection
Heather: and scarring.
Dr. Syeda Amna Husain: Mm-hmm. Yes. Yeah.
Courtney: Yeah. Yeah. I think the best piece of advice I ever got is the cyst, or like the [00:34:00] acne bump that is untouched is always gonna heal faster than the one you touched. And it stands true time after time. If you go after something, that inflammation's gonna last a lot longer than if you just left it alone.
Dr. Zain Husain: Yeah. Although my breakout from two weeks ago, I don't know what would've happened if we didn't intervene.
Courtney: Yeah, that was a lot of intervention. You could intervene and just do it the right way. Just go see your doctor.
Dr. Zain Husain: Great. So let's wrap up this episode. I think what we'd like to let our audience know is that most pediatric lumps and bumps are benign.
So most of what we see are, you know, completely normal. You don't, don't have to intervene at all. And I think that we can reassure many of our parents, um, also, they're often self-limited. Important principles, we should monitor changes. So if we do see rapid changes in signs or symptoms, that's important to take into account, um, trusting clinical judgment.
So we, as healthcare professionals, like when we're [00:35:00] assessing and doing our physical exams, we are able to evaluate it and kind of get almost like a gestalt of, Hey, is this something that we need to worry about? If this, is this something that we can treat, or can we just leave this alone? Then lastly, when you are uncertain, always seek expertise.
So see your board certified dermatologist, pediatrician, um, healthcare provider to really determine if this lump is something that you need to be concerned about. 'cause sometimes you do. So any other comments, questions to wrap up this episode? All right. Well I think that we kind of covered a lot of the common lumps and bumps.
There are obviously many more in the pediatric dermatology literature, but I think this gives a fair assessment of the most common ones we see in practice. So please like follow. Um, and until next time, skin side. out.
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