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Daily Dose

Skin Lesion: Staph or Pimple?

1:30 to read

I just received an email question from a teenager who happened to attach a picture of a skin lesion she was worried about. I think it is great that teens are being proactive about their health and are asking questions about issues that are concerning to them.  BRAVO!!

So, this “bump” sounds like it started out as a possible “zit” on this 16 year old girl’s neck.  She admitted to lots of “digging” into the lesion and then became concerned that it didn’t seem to be getting any better.  She said that friends told her that it could be scabies, or possibly staph.  Leave it to friends to make you more apprehensive about the mystery bump. Looking at the picture it looks like it could be a simple pimple and in that case the best medicine is to LEAVE IT ALONE. The hardest thing to get teens to do (and also adults) is not to pick at pimples or bumps on their bodies, as this could lead to a skin infection. Many times just washing the “zit” and leaving it alone, it will go away.  When you go “digging” into it you break the skin and allow bacteria to enter the now open wound and you can get a skin infection. 

In many cases this may be due to staph or strep from your hands.  This may sometimes require a topical or oral antibiotic to treat the infection, when it may have been something that should have been left alone. There are skin infections that we are seeing in the community that are due to MRSA (methicillin resistant staph) which have become quite frequent in the last several years. In this case that small “bump” usually arises quite quickly, often times it is confused with an insect bite. But very quickly the bump becomes more inflamed, tender and often quickly grows in size. Many times there will be drainage from the bump which now resembles a boil.  In my experience the hallmark of MRSA infections is how quickly they arise and how painful they are.  They have a fairly classic appearance (see old post on Staph).

MRSA infections often have to be drained and require different antibiotics than ”regular” skin infections. In most cases it is necessary to obtain a culture of the drainage so that the appropriate antibiotic may be selected. In some circumstances the infection is quite extensive and may even require surgical drainage and IV antibiotics, requiring a stay in the hospital.  MRSA is a serious infection and is often seen in teens who share articles of clothing or participate in sports where they are showering, using equipment etc that is shared. Remember to use your own towels, and athletic equipment when you can.

This teen also asked “if you have staph would you have it forever?” In actuality, many of us harbor staph in our noses and we all rub our noses throughout the day and then touch other parts of our body as well as other objects. This then passes the bacteria from person to person, sometimes via another object. If you are not symptomatic, don’t worry about whether you have staph in your nostrils, but do adhere to good hand washing and try to keep your hands away from your face. For patients who have had recurrent skin MRSA infections, I often prescribe an antibiotic cream to be put in the nostrils as well as in the nostrils of all close contacts (family members). I also recommend that the patient bath in an anti-bacterial soap and take a bleach bath every week to help decrease the bacterial colonization with staph. It seems that this has helped prevent reoccurrences of staph for the individual as well as for other family members. Lastly, this is certainly not scabies, but we have an older post on that too with pictures!

That’s your daily dose for today. We’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

When Bug Bites Get Infected

1.00 to read

It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions. 

The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks.  This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed. 

Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that “baby fat” reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites. 

Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer. 

Severe local reactions are called “skeeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms  (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from infection.

Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins, but are extremely rare. 

The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion, Sarna lotion and Dommeboro soaks.  This may be supplemented by topical steroid creams (either over the counter of prescription) to help with itching and discomfort. 

An oral antihistamine (Benadryl) may also reduce some of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites. 

Due to an exceptionally warm winter throughout the country the mosquito population seems to be especially prolific. The best treatment is prevention!! Before going outside use a DEET preparation in children over the age of six months, and use the lowest concentration that is effective.  Mosquito netting may be used for infants in strollers.  Remember, do not reapply bug spray like you would sunscreen. 

Daily Dose

Hand, Foot & Mouth Disease is Back

I have been seeing a lot of cases of "hand, foot and mouth disease" (HFM) in the office. This illness is usually caused by a Coxsackie virus A-16, a member of the enteroviral family. These viruses are typically seen in the summer and early fall. Don't worry, this illness is not related to "hoof and mouth" disease seen in animals.

Hand, foot and mouth disease is most common in younger children and often is seen in the toddler crowd. You can see "hand, foot and mouth" in older children, but most children have had it at younger ages and are immune as they get older. It is not unusual to have outbreaks of HFM in child-care centers or pre-schools. How is Coxsachie virus transmitted?  Person-to person contact as well as from contact with contaminated surfaces. The incubation period from time of exposure is about three to seven days. The typical child with HFM will present with fever, which is often fairly high. If seen early in the illness they may not have any other physical findings but over several days they will develop a sore throat with painful sores on the tongue and throat. Several days later they may develop the classic small, red, blister like lesions on their palms, soles of feet and often in the diaper area. When they have all of the symptoms it is an easy diagnosis, but not everyone who gets Coxsackie virus will have every symptom. Sometimes you see a child with the classic rash on palms and soles, but they have never had fever or even felt badly, lucky for them! One of the most common complaints may be drooling and irritability in a child with fever as the mouth and throat are sore, even before the classic lesions appear. Because this is yet ANOTHER viral infection, there is no specific treatment and antibiotics won't help. Keeping your child comfortable with Tylenol or Motrin/Advil will help with both fever and pain. This is a good time to try things that would help soothe a sore throat, things like ice cream, popsicles, pudding, Jell-O and even a Slurpee, especially in a child who is refusing fluids. The main concern is keeping your child hydrated during the illness. Once your child is fever free for 24 hours and feeling better they may return to child-care or school. The small lesions on the palms and soles will clear over the next five to seven days. The best way to prevent others from getting sick is with good old hand washing. That's your daily dose, we'll chat again soon.

Daily Dose

How to Treat a Baby With Thrush

I have received some recent e-mails and now an office visit regarding the possibility of a baby having thrush. Thrush is a yeast (fungal) infection that involves the mouth, and is most typically seen in infants.I have received an email via our iPhone App and now an office visit regarding the possibility of a baby having thrush. Thrush is a yeast (fungal) infection that involves the mouth, and is most typically seen in infants.

The yeast infection usually involves the inside of a baby’s cheeks and lips and occasionally the tongue. It appears as white, almost cottage cheese like patches, and is often visible when a baby is yawning or crying. A baby who only has a white tongue typically does not have thrush, but just a milk coated tongue (see if you can wipe some of the milk off of the tongue, as yeast is usually more adherent). Thrush is fairly common as we all have yeast in our digestive tracts, and babies are often colonized with yeast as they travel through the birth canal. For unknown reasons, in some infants there is an overgrowth of yeast and thrush may develop. Many mothers feel guilty that they “gave their baby” a yeast infection. They worry that thrush has something to do with cleanliness (NOT) and somehow that maternal guiles thing is already beginning. (Dads have already cut to the chase and say, how do you treat it?!) Thrush can happen to any infant. In a breast feeding baby it may also cause a mother to have inflamed and tender nipples, and the baby and mother actually pass the yeast back and forth during feeding (no guilt, as breastfeeding is good!) In most babies thrush does not cause a lot of problems and may go away by itself. But if the infection becomes extensive it may become painful and cause an infant to be uncomfortable when nursing or taking a bottle. If you notice that your baby has white plaques in their mouth or under their lips it may be worth a phone call to your pediatrician. (This is not an emergency and can wait till office hours.) There are several prescription preparations that may be used to treat thrush. The most common being Nystatin, which is a liquid medication that is given to the baby after they have been fed, and is squirted into the mouth on the inside of the cheeks, to treat the yeast infection.  It is also beneficial to treat a nursing mother’s nipples with an anti-fungal agent. I usually tell patients to use the medications for at least seven days or until the white patches have been gone for several days before stopping treatment. It is not uncommon to get thrush again, so don’t fret if your baby develops another infection, at least you know what it is and how to treat it. A yeast infection in the mouth may often lead to a yeast infection in the diaper area (candidal diaper dermatitis), because as you know what goes in the mouth comes out in the poop. But that rash is for another day…. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

HELP! I Have A Nail Biter!

Dr. Sue answers a common question: how to stop your child from biting their nails!Dear Dr. Sue: My daughter bites her fingernails and now it looks like her finger is infected. I have been trying to get her to stop biting and hoped this would not happen. Now what? Thanks! Monica.

Hi Monica: this is really a common problem among children who are nail biters and cuticle pickers. (FYI…I will admit I was a nail biter until I was a teenager and decided I had “ugly” nails. I stopped biting and my parents were thrilled!). It’s also common to see similar infections of the toenails as some children bite their toe nails or pick and pull them off. In either case, you can develop an infection around the skin that hangs over the side of the nail, and this is called a paronychia. A paronychia may start off with just a tender red swelling around the edge of the nail. In many cases, if caught early enough it may be treated simply by using warm soaks and applying a topical antibiotic such as polysporin (OTC) or even mupiricin (by script). If the area continues to be inflamed and gets larger and more painful it will require a visit to the pediatrician. The infection is typically caused by staph, or strep and is then treated with an oral antibiotic that works against these “skin bacteria”. In most cases a culture of the area will not be needed. The best way to prevent a paronychia? Keep those fingers and toes out of the mouth! I know this is easier said than done, and I have yet to find a fool proof way to stop the biting. If I had, I would not still be bugging my own boys about nail biting (but I will not say who is still an offender).

Daily Dose

Pink Eye

1:30 to read

This is another time of the year that I see a lot “pink eye”.  Any time the eye is have “pink eye”, which mothers seem to be quite confused by!!   They often comment…”this is pink eye?” , to which I respond, “well, the child’s eye (conjunctiva) is pink (red), so yes…this is pink eye”.  The term is just a description of the eye….but then you need to determine why the eye is “pink”.


Conjunctivitis is one of the most common causes of a pink eye….and there are many different types of conjunctivitis.  As with any condition the history is really important in helping to determine why a child’s eye is inflamed.  Several of the most common causes of the “pink eye” are bacterial, viral and allergic conjunctivitis.


Bacterial conjunctivitis often shows up in younger children and they have lots of matting of the eye lids and lashes and a mucopurulent discharge (gooey eyes). Some moms say that the “goo of gunk” comes as quickly as they can wipe it.  The child often has a lot of tearing and will rub the eyes as they feel that something is in their eye and it is irritated.  Bacterial conjunctivitis will typically resolve in 8 -10 days on its own, but antibiotic eye drops are used to shorten the course  of the pink eye and also reduce the contagiousness.  It seems as if every child in a day care class room will get conjunctivitis as they constantly rub their eyes and touch toys!!  Hand washing helps….but you can’t wash a child’s hands every time they touch their eyes.


Viral conjunctivitis usually occurs in combination of with systemic viral illness. Sore throat, fever and bright red eye are often seen in older children and teens and is due to adenovirus.  While the eye is red, the discharge is typically watery and matting is much less common. These patients are contagious for up to 12 days so it is important to practice good eye/hand hygiene, especially in the household. Artificial tears may help the feeling of eye irritation, but antibacterial eye drops rarely help except in cases of a secondary infection.  I get many phone calls from parents saying, “we tried prescription eye drops and they are not working”. I make sure to tell my older patients to take out their contacts and wear glasses for 7-10 days.


At this time of year I am also seeing a lot of seasonal allergic conjunctivitis.  These children have intensely itchy and watery eyes, as well as swelling of the eyelids and area surrounding the eyes. They look like they have been crying for days as they are so swollen and miserable. Many also have a very watery nasal discharge. They do not have fever. Using over the counter medications for allergy control, such as nasal steroids and anti-histamines will help some of the allergic symptoms. There are also over the counter eye drops (Zaditor, Patanol) that help when used daily.  During the worst of the season I make sure that the child has daily hair wash and eyelash and eyebrow wash with dilute soapy water to make sure the pollen is removed after they have been playing outside. It is nearly impossible to keep a child indoors for the 6 or more weeks of allergy season!


Daily Dose

How To Treat Ringworm

What is ringworm, is it contagious and how do you treat it?The saying, “a picture is worth a thousand words”  is so true.  I saw a cute 4 year old little girl today with “ a rash” on her arm.  This is the first “good” case of ringworm I have seen in a while, so I snapped a shot with my trusty iPhone camera to be able to show you.   

Ringworm is a skin infection that appears as a “ring like” rash.  Although many parents are concerned that is it caused by worms, it is actually due to a fungal infection of the skin. The medical term for ringworm on the skin is tinea corporis. The fungus can also affect the skin on the scalp, tinea capitis,or on the feet, athletes foot, or in the groin where is it commonly referred to as jock itch.

The fungus that causes ringworm is contagious and likes to live in warm and moist areas. It can easily occur after any minor break in the skin (not always visible to the naked eye), and it should not be thought of as due to being “dirty”.  It really has nothing to do with cleanliness as the fungus can be passed from person to person by direct contact, or may also develop after contact with contaminated clothes, or shower and pool surfaces.

It is also not uncommon for household pets like cats and dogs to have the fungus and pass it to a child who spends a great deal of time hugging, petting and loving their pet (which is really quite healthy). The most common way ringworm is diagnosed is by clinical appearance alone. A scraping of the area may also be done to be examined beneath the microscope to confirm the diagnosis. The treatment of most ringworm infections on the skin is with a topical antifungal cream, many of which can be bought over the counter.  The most common topical agents contain miconazole or clotrimazole.  The cream may be applied as directed and it may take up to 4 weeks to completely treat the infection. There are cases, especially with ringworm involving the scalp or feet that a systemic prescription medication may be needed.  When using the cream it may take 4 – 6 weeks for the infection to be completely treated, if you stop too quickly it may re-occur. If the lesion is not improving after a week or so it may be resistant to over the counter creams and require a broader spectrum antifungal cream that is available by prescription only. Nummular eczema is often mistaken with ringworm and using a steroid cream on eczema will treat the dry patches but will not treat ringworm at all.  If the  “ring like dry patch” is not improving with a steroid cream it I might try an antifungal and if neither seems to work time for a visit to the doctor! That's your daily dose. We'll chat again tomorrow! Send your question to Dr. Sue!

Daily Dose

Teens And Sexually Transmitted Infections

An alarming study in Pediatrics reveals a rise in STD among sexually active teens. Recently, I was reviewing an alarming study in an issue of Pediatrics. Although I use the word alarming, unfortunately it is better stated as “sobering reality” as the statistics only corroborate what I have seen in my own pediatric practice where I take care of many adolescents.

Despite our parental and societal “admonitions” not to have sex before marriage, teenagers are engaging in sexual activity, and they are also developing sexually transmitted infections. The statistics continue to show that somewhere between 60 to 70 percent of high school seniors have had “sex”, and by 12th grade, more girls than boys admit to having had intercourse. More than 15 percent have had multiple partners. In this study, which was done by the Centers for Disease Control and Prevention (CDC), 838 girls ages 14 to 19, who were participating in the National Health and Nutrition Examination Survey 2003 – 2004, provided specimens that were tested for gonorrhea, Chlamydia, trichomonas, herpes, and HPV (human papilloma virus). The prevalence of any of the five sexually transmitted infections (STI) was 24.1 percent. When results were broken down further those teens who reported only one lifetime sexual partner had 19.2 percent prevalence of any STI and for those teens who had more than three sexual partners the prevalence increased to 53.3 percent for an STI. Once again, as in previous studies the most common STI was HPV (types 6 and 11), followed by Chlamydia. HPV infections accounted for nearly three- quarters of the overall STI prevalence. Both of these infections may be silent, in other words, young girls may not have outward evidence of these infections but HPV may lead to cervical cancer and Chlamydia may cause problems with infertility. Unfortunately, I don’t think many teens are thinking about long-term consequences when they engage in pre-marital sexual behaviors. Teens are impulsive, live in the moment and typically feel that “these things happen to other people.” Even when talking about these issues with my own teenage sons I often hear “Mom, we get it we are smart!!” Smart kids get STI’s too. We need to continue discussing sexuality with our children, even at young ages. The more knowledge the better and while still supporting abstinence, they need to learn how to protect themselves if they do have sex. Abstinence only education has not been successful as we see our teen pregnancy rates rising and now the rate of sexually transmitted infections are even more prevalent and occur quickly after a girl’s sexual “debut”. All girls (and now boys) ages 11 – 26 should receive HPV vaccinations and sexually active adolescent females need to be screened yearly for Chlamydia. We need to ensure that all of our adolescents have access to sex education and sexual health care.  Keep up the dialogue. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Ear Infections

1.30 to read

The American Academy of Pediatrics (AAP) has released new guidelines for the diagnosis and treatment of acute otitis media (AOM) which is ‘doctor speak’ for an ear infection.  

An ear infection is one of the most common infections of early childhood and is also one of the most common reasons that antibiotics are prescribed.  Guidelines from 2004 recommended that pediatricians use “watchful waiting” before prescribing antibiotics for an ear infection in some children. 

The new guidelines for treating an ear infection with oral antibiotics are even more specific than those in 2004, and further clarify who are the best children to observe and those that should be treated right away.  This will reduce the number of unnecessary antibiotics that are prescribed, which in turn may help prevent antibiotic resistant bacteria. 

Many parents worry that their child may develop an ear infection after having a cold, but for a child between 6 months and 12 years of age, a mild ear infection found during a visit to their pediatrician may now be observed for 72 hours.  

According to the new AAP guidelines, children need to receive immediate antibiotics if they have a severe ear infection (with a fever of 102.2 degrees or higher or significant pain), have a ruptured ear drum with drainage or an ear infection in both ears in a 2 year old or under.  This will really change current treatment and the number of antibiotics prescribed. 

As both pediatricians and parents know, there are all sorts of things that cause ear pain:  an erupting new molar, a cold, or a sore throat can all result in ear pain and a “cranky” child.  But if the eardrum is not bulging the best treatment is pain control. This can be accomplished with acetaminophen or ibuprofen and watchful waiting to see if a child’s symptoms worsen or if the pain and symptoms resolve.  In studies, 2 out of 3 children get better without an antibiotic. 

More and more parents are responsive to using fewer antibiotics for their children and these recommendations reinforce that antibiotics don’t treat viral infections or pain.   Save the antibiotics for use when there is evidence of a bacterial infection. 

The next time your child has a cold and complains of an earache, try this approach and you may see that the ear pain resolves in 24-48 hours and you have one less trip to the pediatrician!


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Your child has Coronavirus. Now what?

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