Friday 22 June 2018

Dear Dr Nina: My four-year-old has bumps on her arm. Should I be worried?

Photo posed
Photo posed

Nina Byrnes

My four-year-old has little white bumps that look like chicken skin on the back of her arms. While they don't seem to bother her, I'm worried about the appearance of them as she gets older. Would you recommend to gently exfoliate or use a particular skincare routine, or should she have them checked out by a dermatologist? Sometimes they gets itchy so I'm worried they will leave her with scarring.

Dr Nina replies: Healthy skin isn't only about physical appearance; the skin is actually a living, breathing organ with important functions such as acting as a barrier to outside toxins, sensation, heat regulation, expression, excretion (sweating) and absorption.

Healthy skin starts from within, so focusing on your daughter's health and nutrition is a good place to start. It is essential to drink at least one litre of fluid a day for a child (1ƒ litres for an adult) to maintain skin health.

Next, reduce sun exposure. Apply Factor 50 and ensure both UVA and UVB protection.

Lastly follow a healthy diet rich in minerals and vitamins and low in processed foods and refined sugars.

One particularly common and unpopular skin condition is Keratosis Polaris (KP), commonly known as chicken skin - it refers to the coarse, dry, sandpaper-like bumps that appear mainly on the arms, thighs and buttocks.

The bumps are usually white but may sometimes be red, and there may appear to be trapped hairs in them at times. It often runs in families.

The severity may vary through the seasons, often worse in winter and easing in summer. It is thought that air dryness cause by central heating may be the reason for this.

Keratin is a tough protein that forms a protective layer on the skin but when built up in the hair follicles forms a scaly plug, which leads to the bumpy texture of the skin. The build-up of these plugs is what we see in KP.

Dry skin makes the condition worse and it is more common in those who have conditions such as dermatitis and eczema. KP usually appears in the first decade of life, and peaks in the teens and 20s, and in many people eases after the age of 30.

It is thought to occur in over 50% of the population, and is more common in women than men. KP is not known to damage skin and there is no underlying disease, so treatment focuses on improving its appearance.

Moisturising is key to its management. A good moisturiser designed for dry skin (those used in eczema are especially beneficial) should be applied daily after bathing. Baths and showers should not be too hot, the skin should be patted dry and moisturiser applied while it is still damp.

Moisturisers that contain urea, are particularly effective and can help remove some of the excess keratin. Hydroxy, lactic and salicylic acid products will also help loosen skin cells and free up keratin plugs. These acids may irritate skin and cause redness and are not recommended in children.

Gentle exfoliation can assist clearing keratin plugs but vigorous scrubbing is likely to make the condition worse. Steroid creams are occasionally used and can help reduce irritation and inflammation. Avoid over-perfumed skin products which may further dry and irritate skin.

If your home environment is very dry, using a humidifier may help reduce skin dryness. Laser treatments have also been used to improve skin surface and reduce keratin plugs.

Treatment, once started, usually needs to be continued as skin changes reoccur on ceasing it. It's important to stress that this is a manageable condition that will not cause any scarring.

Q. I’ve had back pain for two months now, and gone to three different physiotherapists for help, all of which have a different diagnosis and set of exercises. My main problem is that I have a lateral pelvic tilt, but at what point should I have a scan? 

Dr Nina replies: The back is a complex structure that quite literally supports the rest of the body. It is made up of more than 30 bones stacked on top of each other. Back pain is one of the most common causes of chronic pain in Ireland. It causes discomfort and disability to those affected, and it is also has a significant impact on society, employers and the healthcare system as a whole.

Simple back strain is usually treated with a combination of painkillers and physiotherapy sessions — X-rays or scans are not usually necessary.

Physiotherapy can be especially helpful but it is important to remember that if your physiotherapist advises exercises, this is like a prescription from your doctor and doing these exercises daily is essential to your recovery.

Chronic pain is pain that has persisted for more than 12 weeks. Pain due to inflammation may cause stiffness that is worst in the mornings and may be worse after periods of rest — exercise may relieve it. This symptom is very different to that which occurs with osteoarthritis (wear and tear) as in this condition stiffness and soreness is made worse by exercise.

If there is evidence of nerve pressure or damage, further tests may be necessary. X-rays will looks at the bones of the back but the better test is an MRI scan, which can also look at the discs, nerves and tissue surrounding the spine. It is important to state that scans are not always necessary in the diagnosis of back pain, and in fact most causes of back pain can be diagnosed without one.

A lateral pelvic tilt is usually due to a muscular issue and your physiotherapist can best guide and assist you in the management of this. Scans should really only be ordered if it is felt that serious nerve damage needs to be ruled out or if a procedure or surgery is anticipated.

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