Skincare by the Decades: First Decade

In this episode of Skinside Out, Dr. Zain Husain, Heather, and Courtney kick off a new series: Dermatology Through the Decades. The team starts with the first decade of life, discussing the most common skin conditions seen in babies, toddlers, preschoolers, and school-aged children. 

From cradle cap and baby acne to eczema, birthmarks, warts, molluscum, and sun protection, this episode helps parents understand what's normal, what's treatable, and when it's time to see a dermatologist.

The discussion also covers common misconceptions about "natural" skincare products, how to build a healthy skin barrier, the truth about sunscreen in infants, and practical advice for keeping children's skin healthy as they grow. 

Whether you're a new parent, grandparent, caregiver, or simply curious about pediatric dermatology, this episode provides expert guidance on navigating some of the most common skin concerns during childhood.

00:00 – Introducing Dermatology Through the Decades
01:00 – Common newborn skin concerns parents encounter
02:00 – Dry skin, peeling skin, and newborn eczema
03:00 – Building and protecting the skin barrier
04:00 – Ceramides, moisturizers, and infant skincare basics
05:00 – Natural products vs. evidence-based skincare
07:00 – Cradle cap: causes and treatment options
09:00 – Understanding milia and heat rash (miliaria)
11:00 – Baby acne and the role of maternal hormones
12:00 – Common birthmarks and café-au-lait spots
14:00 – Port wine stains and when they matter
17:00 – Infantile hemangiomas and modern treatment options
19:00 – Best skincare practices for infants
20:00 – Sun protection and sunscreen recommendations for babies
21:00 – Preschool years: warts, molluscum, and eczema
23:00 – When should warts and molluscum be treated?
25:00 – Impetigo and common childhood infections
26:00 – Severe eczema and newer treatment options
27:00 – Insect bites, tick bites, and Lyme disease concerns
30:00 – Cuts, scrapes, and proper wound care
31:00 – School-age children and contact dermatitis
33:00 – Poison ivy, poison oak, and outdoor skin hazards
34:00 – Teaching children lifelong sun protection habits
35:00 – When it's time to see a dermatologist
37:00 – Closing thoughts and preview of the teenage years

Creators and Guests

Host

Courtney Carroll, LE

Courtney Carroll, LE is a licensed aesthetician with extensive experience performing non-invasive cosmetic treatments and customized skincare.

Host

Dr. Zain Husain, MD

Dr. Zain Husain, MD FAAD FACMS is a dual board-certified dermatologist and Mohs micrographic surgeon with fellowship training in cosmetic dermatology.

Host

Heather Murray, PA-C

Heather Murray, PA-C is a distinguished board-certified and fellowship-trained dermatology physician assistant specializing in medical and cosmetic dermatology.

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.

58 - Skinside Out
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[00:00:00]

Dr. Zain Husain: Welcome to Skin Side Out. I'm your host, Dr. Zaine, with Heather and Courtney. So today we're starting our series on dermatology by the decades. So we're gonna be,

um, kind of going over skincare tips, um, skin conditions we commonly see, and how we can optimize our skin health throughout our lifetimes. So let's get right into it.

Heather: Yeah. So we'll cover what's normal, um, common skin conditions for the first decade of life and what parents encounter, um, skin protection, skincare tips, and when it's time to call your dermatology provider.

Dr. Zain Husain: All right. Let's get right into it. So we have a newborn baby. Um, so babies are not just small adults. They have very unique characteristics. So what are some of the things that, you know, new parents or just parents in general [00:01:00] see with their newborn child that they're concerned about when they see them, especially their skin?

Courtney: I like that you're asking the two childless people. Yeah. That's true. I'm like, uh, dogs, cats- Well- ... human babies.

Dr. Zain Husain: Well, in clinic, right? Yeah. We do see newborns, um, and very young patients. So what are the parents coming in to, to see them for?

Heather: Um, I think a lot of things that look very surprising, um, in children but are actually normal, so like, um, dryness, peeling skin, milia, which are tiny little, um, bumps, um, baby acne, birthmarks, rashes.

Um, the birthmarks especially, like, um, not only birthmarks, but, like, hemangiomas I think are very common. Mm. So vascular growths, um, can look concerning but are often-

Dr. Zain Husain: Oh ...

Heather: nothing to worry about.

Dr. Zain Husain: Cradle cap's another really common one. Yeah. Um, parents always come in, like, freaking out about it. I'm like, "It will get better.

Don't worry." Yeah. And but there are treatments, so [00:02:00] we'll definitely get into that.

Courtney: I think people think, like, when their kid comes out, they'll just be, like-

Dr. Zain Husain: Perfect ...

Courtney: per- yeah, like not a- Yeah ... single mark on them, just- Yeah ...

Heather: clean

Dr. Zain Husain: skin. Okay. I will tell you guys, especially if you're not parents- ... they don't always come out looking pretty.

Yeah. Not my kids, of course. Yeah. More alien. I delivered many a baby during my OB rotations. But, I mean, you know, there's obviously a lot of changes that occur from the womb to the real world, and, you know, they were, like, you know, in this small little space, completely, you know, dependent on the mom, no really outside, you know, interference.

And, you know, now they're in the world, and they're exposed to a new environment. Um, and their skin isn't used to it, right? They were in this warm little cocoon, and now they come out, and that's why, like, we wrap those babies up real, really quick. They get cold really quick.

Heather: Mm-hmm.

Dr. Zain Husain: All right, so let's go into, um, some of these specific conditions.

So peeling skin, dry skin, that's a common one [00:03:00] we see with newborns and just, you know, really young patients. So Heather, what type of conditions do we typically see?

Heather: ... We can see, um, eczema in, um, as early as newborns. But I think a lot of, like, diaper rashes- Mm ... for instance, can be, like, dryness, peeling, irritated, very red and inflamed.

Dr. Zain Husain: I mean, I think those are the really common ones.

Heather: Yeah.

Dr. Zain Husain: Um, so eczema is a huge one, right? Yeah. And it presents, you know, slightly different than other phases of life. However, you know, we do see that inflamed skin, dry patches. And when we are looking at our pediatric newborn patients, um, or, you know, young pediatric patients, you know, my goal is to first focus on that skin barrier, right?

So if we can help optimize the skin barrier, because, you know, baby skin's different.

Courtney: Yeah.

Dr. Zain Husain: Um, it's thinner, more sensitive, sometimes it needs a little help. So, you know, [00:04:00] ceramides, um, other topical emollients are helpful, and that is probably the key, and it's the most conservative treatment. I think parents feel really comfortable with that as a treatment option as opposed to, you know, medications.

But sometimes medications are warranted, right? So the common ones we see, um, or we use, you know, topical corticosteroids. Um, you know, sometimes we use calcineurin inhibitors. Um, but it's really that skin barrier that we really wanna focus on to help, um, repair.

Heather: Yeah, I think people often don't realize that the skin barrier is still developing the first couple years of life.

And so you wanna be really gentle with it, and using, like, fragrance-free cleansers and, um, ceramide-rich moisturizers and, like, soft clothing fabrics, and those can really help protect the skin.

Dr. Zain Husain: Yeah. And a lot of my parents come and say, like, "I wanna use something very natural, um, organic, um, you know, chemical-free."

So [00:05:00] Courtney, what are your thoughts on that?

Courtney: No. Um, you know, I always say, like, formaldehydes and preservatives are in washes for a reason. Um, you wanna stick to things that are gentle, of course, and not fragranced. And some of those natural, like, bathing, um, uh, soaps and stuff, I mean, they'll have, like, lavender.

They'll have- Mm-hmm ... like, chamomile, things like that, and that fragrance is definitely gonna be, um, irritating for a, a baby's skin. So yeah, natural is not always better. I think just finding something clean-cut, like, even, like, the CeraVe, um, you know, gentle cleanser, things like that, that just are fragrance-free, rich in ceramides, and gentle is the way to go.

Yeah,

Dr. Zain Husain: and then also with detergents, right? Mm-hmm. It's coming in contact with your skin for extended periods of time. Sometimes fragrances and other, you know, chemicals can lead to irritation. But, you know, based on the science, we know that everything's made out of chemicals. You know, that's just how the world works.

Um, and [00:06:00] there are chemicals, like you said, that are there for a reason, to preserve, um, the product so it doesn't, you know, become an infectious issue. Moldy. Exactly.

Courtney: Yeah. Um,

Dr. Zain Husain: but there are key ingredients that we know science definitely supports. So ceramides, glycerins, squalane, um, you know, various fats like cholesterol, these are all things that we know help, um, the skin barrier.

And with the right education, I think parents would be more comfortable using these products, um, and not really having this resistance that we're seeing so often, um, due to social media or, you know, misinformation on the internet.

Courtney: Mm-hmm. Yeah. We are in, like, a- Like a germaphobic. Like, like, you know, it's like people don't wanna use anything.

They just wanna stick to, like, natural, like, chemical-free. And then I feel like sometimes there's even a little bit of over-washing. I know, like, um, you know, parents will come and ask, like, how often they should be, you know, bathing their child. And, [00:07:00] you know, I think you've told pa- like, patients and parents before, it doesn't have to be every day.

Mm-hmm. You don't wanna do that 'cause you're, you know, ex- almost essentially exfoliating the skin every day.

Heather: Yeah. The more important thing is the moisturizing.

Dr. Zain Husain: Yeah. Exactly. And then for me, I mean, if you're using, you know, gentle products, and you're using proper bathing techniques, you s- also can still, you know, bathe your baby or child every day.

So, like, for my kids, I mean, we bathe them every day. Uh, we use ceramide-containing, um, washes, very gentle, fragrance-free, and they tolerate it just fine. Mm-hmm. Um, so it really is what you're using- Mm-hmm ... and how you're using it- Mm-hmm ... um, as opposed to just dogma, oh, you're supposed to, you know, cleanse and bathe a certain number of times.

Heather: Yeah.

Dr. Zain Husain: Yeah. Yeah. All right. So those are common rashes that we see. Um, we did kind of gloss over the cradle cap issue, but it is another common one we see. Um, and it's due to yeast on our skin, right, leading to inflammation. Really [00:08:00] common. Um, you know, babies, you know, tend to sweat a lot. They're, like, kind of swaddled and bundled.

Um, their skin's not really, you know, completely developed, right? And these yeast are normal, you know, occupants of our skin, right? They're part of our normal flora. And when there's an imbalance, it leads to inflammation, which causes flaking, peeling, scaling, um, and generally in areas that tend to have more oil production, right?

So the scalp is a very common area, but you can see it on the body as well. And generally, I reassure my parents. I mean, this will get better with time. However, if it's a parent who really wants to do something, you know, there's no harm in using topical antifungals. Um, they're benign. They tend to reduce the yeast count and, you know, reduce inflammation.

And if it makes my parents feel better, then I don't see a harm to it. Mm-hmm. What are your guys' thoughts?

Heather: Yeah, I agree.

Dr. Zain Husain: Yeah.

Courtney: I [00:09:00] just... I laugh at the fact of, like, parents being so concerned about, like- Mm-hmm ... a baby with cra- like, you know, I get it definitely from, like, is it uncomfortable, but sometimes I almost wonder if it's like, "Oh, I don't want other parents to see that my baby has cradle cap."

Yeah. It's like a visual thing, so. Yeah. Yeah.

Dr. Zain Husain: Yeah, I mean, and if it's a really severe case, you know, you may need topical steroids. You may need other interventions. But in general, it tends to be a limited condition and tends to get better with age. Mm-hmm,

Heather: and often doesn't bother the baby. The

Dr. Zain Husain: baby, yeah.

Heather: Yeah.

Dr. Zain Husain: Bothers the parents. Yeah. All right. Um, let's talk about milia. So Courtney is the milia queen. So tell me about what a milia is.

Courtney: Um, milia, I know we've probably talked a little bit about them before, but they are just little, um, white bumps, little essentially, like, cyst underneath the skin, clogged pores.

So, um, babies can frequently have them, um, y- like, you know, when they come out of the womb essentially. And most times they will go away on their own. Um, I fortunately have never had to extract a milia on a infant, and I don't [00:10:00] think that I would. Mm-hmm. Um, but I know, again, they can be concerning for parents.

They, um, you know, get a little worried. Is that gonna stay there forever? Like, do I need to do anything, you know?

Heather: I think a lot of parents con- like, confuse it for a rash too- Mm-hmm ... especially if th- they have a lot.

Courtney: Yeah.

Dr. Zain Husain: Um, and then milia is to be contrasted with miliaria- Mm-hmm ... which is a commonly sounding name.

Heather: Yeah.

Dr. Zain Husain: Slightly different rash. That's a heat rash, right? Yeah. So what happens in that kind of rash?

Heather: So typically it's like a, um, a rash that you can get. It's more red and inflamed than milia. And the, um, miliaria is often in, like, skin folds or, like, areas that tend to hold heat a little bit more. Um, but it's usually related to, like, the sweat glands as well.

Courtney: Mm-hmm. So chunkier babies will probably get more .

Heather: Yeah.

Courtney: I was a big baby. I was 9 pounds, 10 ounces. So- Wow. Yeah. I had a lot of heat [00:11:00] rashes.

Dr. Zain Husain: baby acne. Um, so we deal with acne with, you know, all ages, even babies. So tell me a little about, about the baby acne.

Courtney: Baby acne sounds so cute. Like, I don't know.

Heather: It sounds like, like- Baby acne ... sni- like tiny little acne. Like little acne. Yeah .

Dr. Zain Husain: I don't know.

Courtney: Um, yeah, I think same thing. I think these conditions tend to go away- Yeah

um, with time. It's nothing really concerning. I think it's pretty common, honestly. Um, but, you know.

Heather: I think doctor, like Dr. Zane mentioned, the skin is getting used to- Mm-hmm ... the environment and being so, um, like, used to the womb. And it, it's just a very different environment than out here. Um, so just I think sometimes the skin has to go through stages.

Dr. Zain Husain: The interesting thing is, you know, that a lot of acne cases are driven by hormones. So for babies, they still have hormones from mom.

Courtney: Yeah. Mm-hmm.

Dr. Zain Husain: True. And that's really influencing that, that, you know, early period of life, like that first six months of life. Yeah. I [00:12:00] mean, that is really what's causing that inflammatory acne, and it's not just milia like we just discussed.

Mm-hmm. These are like sometimes like, you know, like breakouts- Mm-hmm ... that these babies are getting. So- Yeah ... um, obviously as time goes on, mom's hormones in baby's system tend to decrease, and usually the acne improves. Mm-hmm. But, you know, sometimes we do use, like, medications that we use for our teenage patients, like topical antibiotics and even retinoids sometimes-

Courtney: Yeah

Dr. Zain Husain: uh, for more severe cases.

Courtney: I would do a little baby facial.

Dr. Zain Husain: Oh, that'd be adorable.

Keep that dream. All right. Birthmarks. So- What are the common birthmarks that we see?

Heather: Um, café au lait's are common. Um,

Dr. Zain Husain: we- Can you describe a café-au-lait

Heather: macule? Yes. So a café-au-lait macule is, um, a flat, evenly colored light brown, um, macule or patch. So a [00:13:00] macule is usually like a small, less than one centimeter, completely flat.

You cannot feel a texture to it. Um-

Courtney: Human. Just kidding.

Heather: Yes, kind of like that. Um, and then a patch is typically greater than one centimeter. Yeah.

Courtney: My mom always called them coffee spots.

Dr. Zain Husain: Well,

Courtney: café

Dr. Zain Husain: au

Courtney: lait. Because she... Yeah. Yeah. She said that she craved coffee, and that's why I came out with splotches.

Dr. Zain Husain: Oh.

Courtney: Like, I don't think that's true.

Heather: Yeah.

Dr. Zain Husain: And does it have any, like, clinical significance? Are they just normal or...?

Heather: Um, if you have, like, one or two, it's typically fine. If you have a lot, especially if they're on the same side of the body, then you could potentially have neurofibromatosis. But-

Dr. Zain Husain: Yeah ...

Heather: um, it, it also kind of depends on if you, the baby's having other symptoms.

Yeah.

Dr. Zain Husain: And there are a variety of different classifications for neurofibromatosis. Mm-hmm. So it's not just one disease. Yeah. They're multiple. Um, so you know, we tend to look at the number of café-au-lait macules, how they're distributed, if they're associated with neurological symptoms, um, [00:14:00] if you're having, you know, such as seizures, and- Yeah

you know, if you're having any other, like axillary freckling, things like that, um, you know, we tend to be worried about, like, a syndrome or like- Yeah ... a genetic syndrome. So neurofibromatosis is, you know, a genetic condition, and it varies in severity based on what type. Um, but you know, like Heather said, most of the time there's, like, a singular, you know, café-au-lait macule, nothing to worry about.

Um, sometimes parents complain about how it looks, but I think it's actually cute.

Heather: Yeah. I like them.

Dr. Zain Husain: Um, other types of birthmarks. So you talked about vascular lesions, correct? Mm-hmm. So there's two that come to mind. One, port wine stains. Mm-hmm. What are those?

Heather: So port wine stains are, um- These vascular birthmarks that are, um, typically flat and kind of like purplish pink- Wine colored.

Yeah Like

Courtney: you spilled a glass of wine-

Heather: Yeah ... on your baby. Yeah.

Dr. Zain Husain: Port wine.

Heather: Yeah. Um, typically they're kind of like mottled [00:15:00] appearing, um, not super distinct, like circular borders, just kind of like a little asymmetrical, but, um, they can be anywhere on the body, but they are, uh, maybe a little bit more concerning if they are on certain areas like the middle of the face.

Dr. Zain Husain: Yeah. So there's a syndrome called Sturge-Weber syndrome- Yeah ... that we do, you know, worry about, especially if it's in a distribution like on, you know, the upper portion of the face on one side. Um, but in general, port wine stains are completely normal. Um, they don't really pose any risks. However, there are some severe types where you have, you know, more of a proliferation within it.

Um, sometimes it can be uncomfortable. Yeah. Um, you know, and then sometimes they're in locations that patients feel self-conscious. So, you know, we can use vascular lasers to help improve that. And, you know, I think it's a really rewarding treatment that- Mm-hmm ... you can reduce the appearance of these port wine stains that patients are, you know, just really self-conscious of.

Heather: I think people often don't realize that [00:16:00] they can be treated with a vascular laser- Mm-hmm ... 'cause they think it's a birthmark and you're just gonna have it- Yeah ... for the rest of your life, and that's it. Yeah. Um, so I think patients are often very happy- Yeah ... if they want it removed.

Courtney: Yeah, my cousin, um, growing up, uh, he's a year older than me, and he had one on his forehead.

And once he got to be, I think, like nine or 10, they treated it with a laser- Yeah ... a few sessions, and it definitely cleared up a lot. He's still got residuals, and it's funny because I'll ask him, I'll be like, "I can treat that, you know," and- Mm-hmm ... he's like, "I don't want it to be treated. It's part of me." And- Aw

he likes, he likes it, so. That's great. That's great. Yeah.

Dr. Zain Husain: Yeah, and then also, like, with puberty sometimes, you know, those proliferations can enlarge and, uh, become more of an issue. So, you know, there's no harm in treating it. And, you know, just make sure that whoever's treating you has a lot of experience because, you know, we're using vascular lasers such as pulse dye laser, KTPs, um, ND Yags, and, you know, it can lead to burns if you don't know what you're doing.

Mm-hmm. Um, and it's requires [00:17:00] many treatments. It's not like a one and done thing. I mean, you can do dozens of treatments and still not completely clear it, but it can make it a lot better. Um, the other one, um, that I like mentioning are hemangiomas, infantile hemangiomas. So what are those?

Heather: Those are pretty deep red, not as purple, um, um, vascular growths that are typically more raised.

Um, they can ulcerate, and I think typically when they do ulcerate or they kind of like open up and they're not really healing very well, then I do think that warrants, um, treatment, whether that's topical or considering oral options. Oral, yeah, like beta blockers. Beta blockers,

Dr. Zain Husain: yeah. Yeah. Um, so with these patients...

So my youngest daughter has, um, a hemangioma on her right popliteal fossa, or the area behind your knee. Um, it's really cute. Um, it started off like a very faint blush, and then [00:18:00] as she got a little older, it definitely pronounced itself. And, you know, being you know, a dermatologist, I mean, I know that you don't have to treat it, but, you know, like I said, like if we have treatment options, why not try it, um, and see?

And then we used propranolol on it- Mm-hmm ... and it helped. Um, and you know, she's doing well. It's starting to involute and everything, but it did kind of help reduce the acceleration phase, and I think probably helped in some way.

Heather: Mm-hmm.

Dr. Zain Husain: Um, and then you mentioned ulceration being a risk factor, so definitely one that, you know, I would consider for treatment.

Um, another one is like hemangiomas overlying vital structures- Yeah ... like the airways. Like, say it's on your f- your nose, your mouth, your throat, um, we worry that the hemangioma can extend to these structures and cause a lot of issues. Mm-hmm. So that's really when we want to intervene. Um, and we use beta blockers, which have been found to be helpful for [00:19:00] treating hemangiomas, and they work really, really well.

Yeah. Um, prior to that, you know, we used to use vascular lasers, um, and other treatment modalities, but I feel like beta blockers really change the standard of care-

Heather: Yeah ...

Dr. Zain Husain: for hemangiomas. All right. Let's go to skincare tips for our infants. So Courtney, what do you advise your baby clients?

Courtney: Yeah, all my... all the babies that I see.

Um, normally, a- and as someone that has worked as a medical assistant too, I think, you know, being in rooms with, like, new parents, um, number one, definitely lukewarm water when they're bathing. Um, I think, again, people jump to the hot water 'cause they think, "If I use hot water, it's gonna burn all the bacteria," but it just creates that dryness and, um, yeah, it can be uncomfortable.

So lukewarm water, gentle cleansers, and then definitely things, like mentioned, with a lot of ceramides, moisturizing ingredients. You know, I think CeraVe is great. I think La Roche is great. Anything that's fragrance-free that has things like, you know, squalane, um, glycerin, ceramides. We're not

Dr. Zain Husain: [00:20:00] L'Oréal sponsors, by the way, but we'd like to be.

Courtney: We could be. Um, so yeah, I think just keeping things really gentle, um, is, is important

Dr. Zain Husain: and another thing that we always stress with our patients, including our littlest ones, sun protection.

Courtney: Yeah. It's really important. What's the vibe? Is it... I've heard conflicting things, like you shouldn't use sunscreen for the first six months.

Six

Dr. Zain Husain: months. So I think the reasoning is that because baby skin is so sensitive, you can't adequately rely on sunscreen- Yeah ... to offer full protection. Mm-hmm. It's not that it's not safe. Okay. I mean, we use zinc oxide- Zinc, yeah ... on babies' bottoms all the time. Mm. So it's not a safety issue, but it's more like being cognizant of other modes of protection that will, you know, be I guess a better option for the baby and their skin.

So like sun protective clothing, you know, UV, um, protective, um, hats, being under shade- Mm-hmm ... um, really not [00:21:00] going in the sun and direct- Yeah ... sunlight would be helpful. And I tell my parents, like even after six months, I mean, definitely wear your sunscreen, but, you know, use those tips to really protect your baby's skin.

Courtney: Yeah. Cool. All right. Enough about babies. I'm babied out. So let's get into the preschool years. Okay. The three to five-year-olds. Those are the cute ones anyway. Babies cry, you know. I guess toddlers do too, but then that's- Oh, toddlers can start- ... why you go back to parents ...

Dr. Zain Husain: they can talk and- Talk back.

Heather: Talk back.

Courtney: Yeah. I love when they ta- they're cute until they're sassy, and then I'm like, "All right." Oh, yeah. "Go back to your mom and dad." All right.

Dr. Zain Husain: So let's talk about those kiddos.

Courtney: Yeah.

Dr. Zain Husain: What are common skin conditions we see with these little ones?

Heather: Warts.

Dr. Zain Husain: Mm. So ...

Heather: molluscum. Lots of them. Yeah. Lots of it.

Courtney: Cuts, scrapes.

Dr. Zain Husain: Eczema. Yeah. Again.

Heather: Yeah.

Dr. Zain Husain: Um, so there's a whole host of things. I mean, these are kids that are going to daycare, um, or preschool.

Heather: Yeah.

Dr. Zain Husain: You know? Kids are germy. [00:22:00] Mm-hmm. They are in a Petri dish essentially for all of the entire working days, and then they're coming home, and then the parents are exposed to them.

Mm-hmm. Siblings are exposed to it, and things spread.

Heather: Yeah, and their immune systems aren't, um... haven't seen a lot of these things before. Yeah.

Dr. Zain Husain: So, you know, with warts and molluscum- I tend to be more on the conservative side. I tell my parents, "Hey, this is a viral infection. The baby's immune s- response will take time to mount, but in the meantime, like, don't worry."

I mean, I see so many parents, like, freaking out that, "Oh, my God, does everyone get it? Am I gonna get it?" Et cetera. Mm-hmm. But, you know, it doesn't work that way. Not everyone who comes in contact with it will get it. Mm-hmm. Especially adults who've already had contact with it in the past, and usually their immune systems have come across this virus before, so they won't, hopefully, develop one.

But even if it does [00:23:00] spread, like, so what, right? They'll get through it eventually and develop immunity. Um, so that's my thoughts on it. However, I do get a lot of patients, um, you know, or parents that want it treated. They brought them into the office for a reason. I get it. So what are our treatment options that we offer to these young patients?

Courtney: I was gonna say, too, on top of that, I think sometimes, um, kids at that age ha- obviously don't have the awareness to know not to pick or scratch at things. Yeah. And I think sometimes when they do that, like for example, with molluscum, um, sometimes they can have, like, eczema associated with that. And so when they start kind of...

I've heard numerous parents tell me, like, they just won't stop itching. Yeah. Like, I look over and they're itching, itching. Mm-hmm. And, uh, or I guess I should say scratching. But, um, so I think sometimes, yeah, that's, parents are like, "Oh, I don't want them to, like, keep, like, scratching themselves raw," and that's when it's like- Yeah

"All right, come on in." Yeah.

Heather: Yeah.

Dr. Zain Husain: And oftentimes in that case, I usually treat the eczema- Mm-hmm.

Courtney: Yeah Yeah ...

Dr. Zain Husain: first [00:24:00] because anything that we use to treat topically for molluscum contagiosum- Is gonna flame it ... is gonna c- make it worse. Yeah. Yeah. Yeah.

Heather: Yeah.

Dr. Zain Husain: Um, what other options do you like for our pediatric patients?

Heather: So, um, depending on the age, if they can tolerate liquid nitrogen, I do offer that, but again, it's not something that they have to do. Um, there are topical creams that they can do, like, um, salicylic acid, imiquimod. Um, there's another one. I'm blanking on the name. Sidafumib? Um, I think they- Can work, but they can be really irritating.

So- Yeah ... um, it's really just kind of patient dependent.

Dr. Zain Husain: And then cantharidin-

Heather: Yeah ...

Dr. Zain Husain: was a common treatment.

Heather: Bring back

Courtney: the beetle

Dr. Zain Husain: juice.

Heather: Yeah. Yes, please. I, all right. Bring back the beetle juice. It was nice.

Dr. Zain Husain: Yeah, so, um, cantharidin is blister beetle juice, and it's unique in that, you know, when you apply it, it's painless, but it leads to the production of a blister which destroys the wart or [00:25:00] molluscum.

Heather: Yeah.

Dr. Zain Husain: So I tend to like that, but it's very hard to get now. Actually, it's impossible now to get. Yeah. Yeah. Yeah.

Heather: Yeah, have

Dr. Zain Husain: to get it compounded.

Heather: Yeah. I do not recommend, um, candida injections for kids.

Dr. Zain Husain: Yeah, yeah.

Heather: Yeah.

Dr. Zain Husain: Yeah, for sure. Would

Heather: not be fun.

Dr. Zain Husain: Those aren't fun. Um, so we talked about some of those infectious, um, items.

Um, another one we commonly see is impetigo. Mm-hmm.

Heather: Mm-hmm.

Dr. Zain Husain: Right? So that's caused by staph bacteria leading to these honey-crusted rashes and, you know, also very common and highly infectious. So we often treat them with topical antibiotics and certain washes, and that tends to do the trick. Um, eczema is another huge category in this age population.

So Heather, how does this present in this age population?

Heather: Um, I think it often presents on the face in, like, very classic locations, like on the inner [00:26:00] elbows, behind the knees. But you can also get, like, pityriasis alba, which is like a subclinical form of eczema where you get these, like, fine little white patches or light hypopigmented patches.

Um, very common on the face. But I think it presents d- very differently for, for certain people. I've seen terrible, like s- very severe eczema in, in some kids, and- Oh ... then I've seen just, you know, pityriasis alba.

Dr. Zain Husain: And you know, we have a host of different treatments available. We have steroidal as well as nonsteroidal topicals, which we often use.

Um, but for severe cases, um, we often use biologics now. Mm-hmm. Uh, for like Dupixent, and that's been approved for six months and older. Mm. And it's been a game changer for severe atopic dermatitis patients who previously didn't have, um, great options to control their disease. So, um, I've been very impressed with, you know, the results from that medication.

Heather: Mm-hmm. And Rinvoq is, um, [00:27:00] approved for the second decade of life, I think, right? 12 and up? Yeah, so.

Dr. Zain Husain: Not there yet. Next week. Yeah. Um, okay. Um, insect bites, right?

Courtney: Mm-hmm.

Dr. Zain Husain: Kids are outside, exposed to the elements, lots of mosquitoes and other bugs. So I always tell my patients or parents, um, you know, it's better to kind of reduce the inflammation, stop the scratching, because that disrupts the skin barrier.

So I usually just slap on like a, a topical steroid, um, or other topicals to help reduce the itch so that it can get some relief.

Courtney: Insect bites. People treat insect bites like they are, like, the black plague. They're like, "I've had this for two days, and it's not gone away."

Dr. Zain Husain: I know.

Courtney: Okay. Like, we're in North Carolina.

Like, we live in bug central.

Dr. Zain Husain: Yeah.

Courtney: Yeah. Yeah.

Dr. Zain Husain: But if you see a targetoid rash, um, and you've been out and [00:28:00] about in the woods- Yeah You are concerned about summer diseases? Yeah.

Courtney: A tick bite, of course. But-

Heather: I... There was a tick crawling on my dog the other day. Oh,

Dr. Zain Husain: no.

Heather: Oh. It, it didn't attach, but, um, it was huge.

Ugh. It was huge.

Dr. Zain Husain: I usually find a few ticks on patients a year, and-

Heather: Oh,

Dr. Zain Husain: yeah. That one

Heather: last year ... oftentimes,

Dr. Zain Husain: oftentimes patients don't even know that they're there. Yeah. Or they think it's a mole. They

Courtney: think it's a mole.

Dr. Zain Husain: I'm like, "That's not a mole." That's

Heather: scary.

Courtney: Yeah. Check your kids when they're done playing outside.

Like, that's, I feel like, so important.

Dr. Zain Husain: I, I was listening to this report. Mm-hmm. So you know how, you know, Lyme disease and, like, tick-borne diseases are mostly seen in non-urban areas, more like suburban- Mm-hmm ... rural. But now the ticks are happening, or the tick bites are happening in urban areas now. Mm-hmm. And you know why?

climate change.

Heather: Oh. Well, I've heard that it's- Mm-hmm ... um, it's not necessarily staying to one area of the United States. Mm-hmm. It's coming across- Yeah ... because of climate

Dr. Zain Husain: change. It is. It is. And then in [00:29:00] urban centers now, like, it's warmer.

Courtney: Mm-hmm.

Heather: Mm-hmm.

Dr. Zain Husain: And the ticks survive through the winter.

Courtney: They're adapting.

Heather: I am- I do not want any ticks around.

Dr. Zain Husain: Yeah.

Courtney: I had one tick on my hairline when I was in high school, and my dad had to pull it out, and it was just so nasty thinking about it- I found- ... crawling into my head ...

Dr. Zain Husain: found a tick on Asia once.

Courtney: Yeah.

Dr. Zain Husain: So took that off of her.

Courtney: Mm. Yeah. Yeah.

Dr. Zain Husain: But not all ticks cause Lyme disease, so you know.

Mm-hmm. Just make sure that you look out for the signs and symptoms- Yeah ... and be smart about it. I mean,

Courtney: you got Lyme, but you also have alpha-gal, and then- Yeah.

Heather: Mm-hmm ...

Courtney: I mean, for me- Invalid ... it wouldn't matter. Yeah. Yeah. I could have alpha-gal, and I wouldn't even know it. But, um, where, yeah, you get a meat allergy, um- Oh,

Heather: yeah, dairy.

Don't you eat dairy?

Courtney: Is that part of alpha-gal?

Heather: You can. Dairy? Yeah.

Dr. Zain Husain: Mm-hmm. Meat and

Courtney: dairy. Okay. Well, I don't have alpha-gal, so.

Dr. Zain Husain: All right. Kids are, you know, playing outside. They tend to fall, scrape. What should we advise our parents?

Heather: [00:30:00] Don't do Neosporin.

Courtney: No, just throw some Aquaphor on there.

Dr. Zain Husain: Aquaphor, Vaseline.

Courtney: Yeah.

Dr. Zain Husain: Just keep it-

Courtney: Steroid healing ointment.

Dr. Zain Husain: Yeah, just cleanse the water. Yeah. Soap and water, slap that stuff on, and keep it slathered until it heals, and it does. And

Courtney: kids will heal. I think pa- Oh, yeah ... we get parents in all the time. Yeah. Like, your kid falls, and they're like, "I'm worried this is gonna scar them," and, you know, they're making so much collagen at that point.

Dr. Zain Husain: I-

Heather: Yeah.

Dr. Zain Husain: Must be nice ... second daughter- ... Minnie, anytime she gets a scrape, like, she, she goes hysterical. She needs a Band-Aid. A- and it could be the smallest little scrape. Aw. Like, it's, it's ridiculous. Um, all right, so we have our school-age children now, so what do we see in these kiddos? So we see eczema again.

Mm. Um, we see all those infectious, um, you know, things again, like warts, molluscum. Um, we start seeing more ringworm. Mm-hmm. Um, I feel like there's more contact. There's more, you know, sports, roughhousing, so [00:31:00] maybe that's how it spreads. Mm-hmm. Swimming, things like that.

Heather: Mm-hmm.

Dr. Zain Husain: Um, contact allergies.

Heather: Mm-hmm.

Dr. Zain Husain: So what are the common ones that we're seeing with kiddos?

Heather: Mm, maybe poison ivy, just 'cause they're running around-

Dr. Zain Husain: Oh, yeah ... not paying

Heather: attention, not knowing.

Courtney: Not knowing.

Heather: Sunburns. Well, that's separate, but not s- not technically.

Dr. Zain Husain: Yeah, poison ivy's not fun. Yeah.

Courtney: I still don't know what poison ivy looks like. Yeah.

Dr. Zain Husain: It is the worst.

Courtney: I hate that stupid leaves of three. How many leaves have three?

Heather: A lot. So it, yes. It has the leaves of three, but actually- ... one thing that I think has really helped me, hopefully this is correct, but- ... um, it, they have a little thumb. Each leaf has a little thumb.

Dr. Zain Husain: Oh.

Heather: Okay. So you'll look at the three, and it's, like, you can see a tiny little- Oh ... jut out on one side. Okay.

Interesting.

Courtney: I'll have to look

Heather: this stuff up. Yeah, poison oak.

Dr. Zain Husain: Yeah. Have you guys ever gotten it?

Courtney: No.

Heather: No.

Dr. Zain Husain: I have. It's horrible.

Courtney: I- I thought about trying to get

Dr. Zain Husain: some- Oh, oh my God. What's wrong with you?

Courtney: Just to n- Not everyone is allergic. Like, everyone's allergic. I,

Heather: I don't think-

Dr. Zain Husain: No, every- [00:32:00] everyone is allergic to it, but it's just the concentration of- Yeah

the resin and how

Heather: sensitive your- I feel like I have definitely touched it before.

Courtney: You out of everyone,

Heather: I would agree. And my dogs, like they- Yeah ... they definitely walk through it.

Courtney: Yeah.

Heather: And I've never had it, so. Really?

Courtney: Yeah, and I kind of feel the same. I've done hi- like, I don't know, at the Eno, like two summers ago, they had like these signs that were like, "This is poison ivy.

Don't touch," and I was so tempted just to do- Yeah ... a little, like a little foot rub.

Heather: Yeah.

Courtney: Like, just to see.

Heather: Yeah.

Courtney: Just to see.

Heather: We went, we took our dogs for a walk, um, the other weekend, and there's a, um, trail near our house, but you have to go through woods to get to it. Oh. And it's a pretty far trek through the woods, and you get to a point where you, like, don't know where you are, and you don't know- I do

which way to go. Oh

Dr. Zain Husain: my

Heather: God. Um, so- That's

Courtney: like my

Heather: worst nightmare. Um, but we were in there, and I was like, "If I don't get poison ivy from this- I'm

Courtney: shocked.

Heather: Yeah. I'm literally shocked that I don't have it, so.

Dr. Zain Husain: Oh. Yeah. That. I got it when I was, I think, fifth [00:33:00] grade, and I was, like, covered in this rash. And then I would have to go to the nurse to be putting calamine lotion on

Heather: me.

Oh. And I'd be all

Dr. Zain Husain: pink.

Heather: Dang.

Dr. Zain Husain: Yeah. It was awful.

Heather: Yeah, it's very classic, like streaky- Mm-hmm ... like blistering.

Dr. Zain Husain: Oh.

Heather: Yeah.

Courtney: You know what that just reminded me of? But that's okay. Another, another day we'll do a episode, but we didn't talk about chicken pox. Not that it's super common here in the US anymore, but-

Dr. Zain Husain: Yeah, we'll probably do, like, a separate, like-

Heather: A full viral exempt, um- Yeah.

Dr. Zain Husain: Yeah. That deserves its own episode. Yeah.

Heather: I

Courtney: agree. I agree.

Dr. Zain Husain: Okay. Um, yeah, I mean, sunburns you mentioned, so, you know, kids really aren't very good at putting on- Yeah ... sunscreen or being planned. They hate sunscr-

Courtney: yeah. Mm-hmm. That's where I think the rash guard shirts are so

Dr. Zain Husain: clutch. So much easier. Yeah.

Heather: Yeah.

Dr. Zain Husain: Yeah. I'm a huge fan. Yeah. Like, I, once I started using them, like, never looked back. Yeah.

Heather: Yeah.

Dr. Zain Husain: Um, all right. So I think that this is an age group that we really want to stress sun safety, because they are outside a lot, um, and sometimes not with, [00:34:00] you know, very strict supervision. So what would you suggest to parents on how they can be more compliant with sunscreen and sun protection?

Heather: Um, I mean, setting a timer I think is really helpful.

Dr. Zain Husain: Mm-hmm.

Heather: Um, the sprays I'm not a huge fan of, um, one, because of coverage, but two, because of, um, environmental things. But I think in a pinch or to make it easier for a kid, sometimes it is nicer.

Courtney: You did have a spray- ... at Zane's pool party.

Dr. Zain Husain: Wait. Was that the Trader Joe's one?

Heather: No. Oh.

Courtney: And I was judging

Dr. Zain Husain: from afar. Someone, someone left one there.

Heather: Oh, no, I

Dr. Zain Husain: didn't. And Asya like, uh, like grabbed it and like started spraying herself.

Heather: I did have a spray. Okay. I saw

Courtney: her spraying her back, or maybe Brandon was spraying it, and the wind

Heather: was just...

Because it's easy. It is easy. But yes, I know, I know. It is horrible for the environment.

Dr. Zain Husain: And I think it's, um, important to really teach children at an early age. Yeah. Like, I've trained my kids. Exactly. Like, before they go out of the door, we have this huge pump of like La Roche-Posay sunscreen. [00:35:00] Yeah, yeah.

They put it on. Mm-hmm. Or we help them put it on. Yeah. But they don't step out of the house... And they're doing it, you know, before they go to school. Yeah. Yeah. We have sunscreen at their school. Mm. But Wake County's really weird. Like, it's treated as a medication, and they have to go to the nurse's office to apply it.

But hey, I'm like, "Asya-" Oh. "... go, uh, to the nurse's station before recess- Wow ... and, you know, apply it." She's the only kid who does it.

Heather: Wow.

Dr. Zain Husain: In, like, the entire school.

Heather: I don't know any of- You

Courtney: know your father's a dermatologist, Wyatt. Yes. I

Heather: never did that as

Dr. Zain Husain: a kid. Yeah. All right. Um, so lastly, when should parents seek our expertise and guidance?

Courtney: I think when it starts impacting a child, you know, um, number one, when they're scratching or if you can tell they're, like, picking at something, um, rashes that, like, won't go away, symptoms that interfere with, like, just the child's life, whether that's sleep or playtime or whatnot. Um, anytime anything changes, moles or what have you- Mm

I think that's always [00:36:00] important. Mm-hmm. Um. Yeah.

Heather: Yeah.

Dr. Zain Husain: And if there's something that you're worried about, there's no harm in getting it checked out. Um, if the kid is worried about or feels self-conscious about, I think it's always worth, um, you know, talking to a medical professional.

Courtney: Mm-hmm.

Dr. Zain Husain: There's no judgment.

Courtney: I'll never forget, my mom tells this story all the time, but when I was... Well, I don't... I'll say I'll never forget, but I don't remember this. So anyways, um, when I was a kid, I was probably, like, a baby or a toddler, and I had some, like, baby eczema, and so my parents took me to a dermatologist. And that blew my grandma's mind, 'cause, like, just that older generation.

Mm-hmm. And, you know, dermatologist is a special- specialist, and this is, like, in the '90s, and my grandma's like, "You're taking a f- a three-year-old to a dermatologist?" Yeah. My mom's like, "She has eczema. Like, we need a specialist." Yeah.

Dr. Zain Husain: Yeah. And even I've taken my kids to a dermatologist, like a pediatric dermatologist, when, you know, my baby [00:37:00] had, uh, you know, the hemangioma.

Heather: Mm-hmm.

Dr. Zain Husain: Um, you know, like I wanted to be the parent and not the doctor- Mm-hmm ... at that point and let- You know, him feel and treat her the way he thinks is appropriate. Yeah. So I think that was good.

Heather: Yeah.

Dr. Zain Husain: All right, so this concludes our first decade of life, um, Dermatology Through the Decades series. So hopefully you found this interesting.

Um, if you have any questions, um, definitely shoot them. Um, but we're gonna be continuing our series next week, um, with the teenage years. Great. So that's always a fun time. So until next time, Skin Side-

Heather: Out.

Dr. Zain Husain: Out [00:38:00]