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The Youngest Skin by Elvira Maricic

rick Michaels didn't have the perfect childhood. Although he was part of a loving family, the person who seemed to play the largest role in his life was his dermatologist. "I was a mess," says the 29-year-old accountant. I had it all--eczema, rashes, allergies. Several times, I even broke out in hives when stepping into a kiddy pool filled with cold water. Just water, nothing else.

"I remember the dermatologist treating me with creams, pills, and even UV light therapy," he says.  "Things improved when I became a teenager, and my only problem was acne, although now that I'm older, I still have occasional eczema flare-ups."

Michaels' condition wasn't easy to live with, especially for his mother. "She was afraid to take me out in public because she was afraid people would think I was being abused," he says, smiling. Michaels was just one of a large number of children with skin disorders that vary for the mild to the disfiguring. These include eczema (also known as atopic dermatitis) and disfiguring birthmarks.  Fortunately, there are ways to treat them and improve children's quality of life.

The Irritating Itch

Nearly six percent of Americans suffer from the itchy, dry, scaly skin known as eczema. In infants and small children, eczema is most prominent on the face and scalp, but can often cover all areas of the body outside of the diaper area. In infants, it often appears in the skin folds of the arms and legs. It is estimated that 10 to 20 percent of all infants suffer from this condition, but fortunately 40 percent of children outgrow it. The itching can be so severe that children may scratch themselves to the point of bleeding.

"Eczema is a life-altering disease that must be taken seriously," says Guy Webster, MD, a dermatologist at Jefferson Medical College in Philadelphia. "While its causes remain unclear, we know that patients have defects in one or more of their genes that makes their skin's immune system overactive. Environmental irritants, allergens, and stress provoke skin flares." 

While eczema has been on the rise in the past three decades, treatments for it have not. In fact, according to the American Academy of Dermatology, no new topical medications specifically for atopic dermatitis have been introduced in more than 40 years. Current treatment options include topical steroid creams or ointments, antihistamines to control itching, oral antibiotics for secondary infections, oral cyclosporine to suppress the skin's immune system, topical tar-based gels, and ultraviolet light therapy for severe cases.

Fortunately, a new form of relief may soon be here. A promising new class of drugs called topical immunomodulators (TIMs) are in development. TIMs work differently than steroids to relieve the itching, redness, and pain of eczema in adults and children. Studies show that one of these, tacrolimus ointment, improved or completely cleared eczema in over 80 percent of the patients, with a lower incidence of side effects than those seen with topical steroids.

Disfiguring Conditions

Sometimes, a skin condition can hurt more on the inside than on the outside. In addition to living with the disfigurement, children born with conditions such as port wine stains, hemangiomas, and Nevus of Ota often have to deal with staring strangers and other children teasing them.

In the past, this taunting often left marks that couldn't be fixed by surgery. Today, with many more treatment options available, children can have the birthmarks removed early, resulting in higher self-esteem and better quality of life.

Speaking at a recent American Academy of Dermatology conference, Elizabeth I. McBurney, MD, Clinical Professor of Dermatology at Louisiana State University Medical School and Tulane Medical School in New Orleans, noted that new laser wavelengths and pulse durations are able to protect the skin while they reduce the appearance of birthmarks. "Patients find immeasurable relief when their dermatologic surgeon is able to reduce or eliminate the birthmark with a laser treatment."

The latest laser treatment options are available for both children and adults, and can be used to treat a number of conditions, including:

Port wine stains, which are red vascular marks most commonly present at birth on the head and neck. The condition occurs in approximately 1 percent of newborns. While the birthmark may remain flat for years, it can begin to thicken and develop nodules that cause severe deformities as people age.

Hemangiomas, another type of red lesion that appears soon after birth. It is a superficial mass of blood vessels that grows rapidly in the first year of life. The large mass of topical blood vessels can ulcerate and continuously bleed.

Nevus of Ota, a persistent blue, gray, or black flat lesion that looks like a discolored mole. It typically appears on facial skin, primarily affecting females of color such as Asians or African-Americans.

So far, the most effective treatment for port-wine stains has been the pulsed dye yellow light laser. It has also been effective in healing the sores and reducing the bleeding of hemangiomas. Nevus of Ota requires multiple sequential treatments with the Q-switched ruby, alexandrite, or neodymium:-YAG lasers. These lasers offer significant lightening of the nevus, and may result in complete removal.

"It is important for parents to realize that there are treatment options available for their children that can reduce the visibility of most birthmarks. And, it's never too early to consult a dermatologic surgeon about removing birthmarks. We treat children as young as newborns," said Dr. McBurney. "Some birthmarks such as port-wine stains and hemangiomas may seem harmless, but can actually develop into severe deformities later in life. These new laser treatments are highly effective, the risk of side effects is limited, and typically, results are permanent."