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Common Skin Conditions in Children and Adolescents

# 541 Edition | June 2024

Preface

As office-based family physicians, we see patients with skin conditions every day. Worldwide, skin conditions are in the top 5 patient-reported reasons for visits to primary care offices and in the top 10 physician-reported reasons for visits.1 Although we see these conditions on a regular basis, they can present a diagnostic challenge, particularly in patients with different skin tones or various comorbid conditions.

Sometimes it is easy to think that skin conditions are simply a cosmetic issue; however, these conditions can have profound psychosocial consequences for patients. Globally, skin conditions are the fourth leading cause of nonfatal disease burden, accounting for approximately 1.8% of total global disease burden. Dermatitis alone results in the loss of more than 9 million disability-adjusted life-years each year.2

In addition to the significant personal costs associated with skin conditions, there are significant financial costs for our health care system. Acne affects more than 50 million Americans every year, with more than 5 million patients seeking medical care for acne. The annual direct and indirect costs associated with acne are more than $1.2 billion. Approximately 85% of individuals between ages 12 and 24 years have had at least mild acne.3

This edition of FP Essentials reviews the most up-to-date information that family physicians need to know to manage common skin conditions in children and adolescents. Section One reviews the pathophysiology, diagnosis, and management of acne with special consideration of patients with skin of color and gender-affirming care. Section Two explores skin and soft tissue infections, including differentiating among lesions and selection of appropriate treatment. Section Three reviews nonbacterial infections, including tinea infections, warts, and scabies infestation. Section Four includes discussions of atopic and seborrheic dermatitis.

Nearly all of the children and adolescents that we care for will, at some point, experience one or more of the conditions discussed in this edition. The information contained here will enable you to give timely, effective care that can mitigate the significant morbidity that can be associated with these conditions.

Ryan D. Kauffman, MD, FAAFP, CCFP, Associate Medical Editor
Family Medicine Physician
Erie Shores Family Health Team, Leamington, Ontario, Canada

References

  1. 1.Finley CR, Chan DS, Garrison S, et al. What are the most common conditions in primary care? Systematic review. Can Fam Physician. 2018;64(11):832-840.
  2. 2.Seth D, Cheldize K, Brown D, Freeman EF. Global burden of skin disease: inequities and innovations. Curr Dermatol Rep. 2017;6(3):204-210.
  3. 3.American Academy of Dermatology Association. Skin conditions by the numbers. https://www.aad.org/media/stats-numbers

Mengyi “Zed” Zha, MD, is a family physician at Yakima Valley Farm Workers Clinic in Washington, which provides dermatologic care to immigrant and farming communities. She completed the Dermatology Underserved Family Medicine Fellowship in San Antonio, Texas. Dr. Zha will serve as a speaker at the American Academy of Family Physicians (AAFP) 2024 Family Medicine Experience (FMX) conference and a faculty member for the 2024 Skin Conditions and Diseases continuing medical education (CME) course. Dr. Zha has authored numerous academic publications and is a contributor to the Washington Academy of Family Physicians (WAFP) on the topic of dermatology. Her articles on the culture of medicine have been published in several health care–related journals and media outlets.

Richard Usatine, MD, is director of the Dermatology Underserved Family Medicine Fellowship and a professor of dermatology and family and community medicine at University of Texas Health in San Antonio. He has served as chair of the AAFP’s annual Skin Conditions and Diseases CME course for more than 15 years. Dr. Usatine has coauthored 12 textbooks and more than 180 publications on family medicine and dermatology.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

  • Determine appropriate evaluation and management of acne based on patient age.
  • Describe expected outcomes of acne treatments, including potential adverse effects.
  • Diagnose skin and soft tissue infections based on clinical appearance.
  • Discuss treatment options for various skin and soft tissue infections.
  • Describe the various types of tinea infection.
  • Summarize treatment options for warts.
  • Discuss management of atopic dermatitis.
  • Discuss management of seborrheic dermatitis.

Key Practice Recommendations

Sections

Acne

Acne is a chronic, recurrent inflammatory condition of the pilosebaceous unit. It affects approximately 85% of adolescents and creates significant psychosocial and financial burdens. The pathogenesis involves altered follicular growth and differentiation, microbial colonization…

Bacterial Infections

Bacterial skin infections represent a significant health care burden. Cellulitis and erysipelas are rapidly spreading, painful, superficial skin infections, usually caused by streptococci or Staphylococcus aureus. Folliculitis is an infection of hair follicles mostly caused by…

Nonbacterial Infections

Tinea infections are caused by dermatophytes, except for tinea versicolor, which is caused by yeasts in the Malassezia genus. If available, potassium hydroxide preparation should be performed to confirm diagnosis of tinea capitis or onychomycosis. In some cases, fungal culture…

Atopic and Seborrheic Dermatitis

Atopic dermatitis (AD) is a chronic, recurring, inflammatory skin condition. Xerosis, pruritus, and rash make the clinical diagnosis. Adequate skin care and regular emollient use are key in management. Topical corticosteroids are the first-line treatment for AD flare-ups. Wet…

  1. 1.Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131(Suppl 3):S163-S186.
  2. 2.Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116-132.
  3. 3.Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338-351.
  4. 4.Ely JW, Rosenfeld S, Seabury Stone M. Diagnosis and management of tinea infections. Am Fam Physician. 2014;90(10):702-710.
  5. 5.Sidbury R, Davis DM, Cohen DE, et al.. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71(2):327-349.
  6. 6.Sidbury R, Tom WL, Bergman JN, et al. Guidelines of care for the management of atopic dermatitis: section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol. 2014;71(6):1218-1233.
  7. 7.Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):147-159.
  8. 8.Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-973.e33. Erratum in J Am Acad Dermatol. 2020;82(6):1576.

Disclosure
All editors in a position to control content for this activity, FP Essentials, are required to disclose any relevant financial relationships. View disclosures.