Laserklinik DRes Steinert

Children are not little adults. But they may also have skin diseases, often specific for certain stages of life. Haemangiomas occur during the first year of life and can grow considerably larger and thicker twice during this period. Treatment of flat haemangiomas with a pulsed dye laser used to be the gold standard in the past and still continues being it today. However, there are the so-called high-risk haemangiomas, which either tend to monstrous growth if localised on the eyes, nose, fingers or toes, or often lead to ulceration in the genital and anal areas. They do not respond to dye laser therapy in a satisfactory way. A coincidental observation in France has shown considerable effects in the regression of even large haemangiomas due to systemic administration of propanolol. That is why children with high-risk haemangiomas should be introduced as soon as possible to a centre performing this treatment in cooperation with dermatologists and cardiologists in the framework of scientific studies. Up to now, the results have been encouraging.

Until today it has been recommended for the mothers with allergy predisposition in the family to breastfeed their babies for at least 6 months. Now it is easier: the latest findings show that 4 months would be enough. They are followed by a time window (5th – 12th months of life) best suited for the development of food tolerance. During this time window, it is also necessary to introduce food allergens frowned upon in the past into a baby’s diet, e.g. hen’s eggs.

Should breastfeeding be impossible during the recommended period (1st – 4th months of life), it is necessary to avoid milk hydrolysates and also soya milk, representing an important allergen.
For the first time it is recommended for mothers to eat fish, whether river fish or seafish, during pregnancy and breastfeeding. It is also recommended to add fish into a baby’s diet after the 4th month of life. But it must remain open to what extent babies accept it.

Children are fond of animals. However, many parents are uncertain, whether domestic animals do not increase the risk of allergy for the baby. A prophetic test before buying a domestic animal is sure to be unreasonable. The latest publications have shown cats multiply the risk of getting eczema. This does not apply to dogs! In general, you must not always follow the advice to refuse from domestic animals due to the fact that dogs are not considered to be responsible at least for the development of eczemas. Still this has not been examined for allergic reactions, affecting the eyes, nose or lungs.

After the therapy with calcineurin inhibitors lost its position among the first line therapies for neurodermatitis, tacrolimus has proven itself in studies as the so-called “proactive therapy” for adults and children. As soon as the acute episode of neurodermatitis has healed, a 0,03 % tacrolimus ointment should be applied to the previously affected areas twice a week. This helps to extend the intervals considerably up to the next episode and the patients get less eczema in general.

Accompanied by broad media interest, the ARD channel used pictures of a bandaged baby to propagate a vitamin B12 cream with a supposedly very high effectiveness in the treatment of neurodermatitis and psoriasis. Until the present day there have been 2 (!) right-left comparative studies on neurodermatitis with the effectiveness of 48 and 21 patients respectively. These show just low to moderate effects of the cream in comparison with placebo. It is absolutely exaggerated to speak of “healing”. The number of patients in the previous studies is in no way enough for a well-founded scientific statement. Healthy scepticism towards wonder healing is still necessary, even if it is very well represented in the media.

The treatment of tinea capitis in childhood still remains a problem. Intraconazole is effective in treatment of tinea capitis caused by Microsporum canis, but it is not approved for that purpose in Germany. The only possibility a doctor has is to prescribe this medication in the sense of a treatment attempt, after the previous education of the patents. The therapy should be administered at a dosage of 5mg/kg/day over 3-6 weeks. During this time, laboratory tests are not required. As an alternative, it is only grisoefulvin of 20 mg/kg that comes into question. Terbinafin is indicated for children having trychophytes.
After every school holiday there is a louse warning in kindergartens and schools. A great number of children come into practices after the treatment with various substances, in order to get a medical certificate. In most cases, there is still nit infestation observed. However, neither nits alone, nor accumulation of nits near the scalp demonstrate any infectiveness. On the other hand, not every new louse attack can be detected through a mere physical examination. The best method of evaluating the existing infectiveness is to comb the wet hair with a fine-tooth comb after washing it and applying a conditioner (wet combing) and to search for living lice.

Dimethicone preparations are particularly suited for the treatment. Due to their physical effect, they work safely and are not as irritating as the previously applied insecticides, against which increasing resistances have already been formed. If necessary, the second treatment to secure the result should follow in 10 days.

In adolescence, more or less pronounced acne is a part of normal appearance. Androgenital syndrome may often be the cause for therapy-resistant acne in young males, as well as in diseased females additionally tending to hirsutism. The lack of 21-hydroxylase results in enhanced production of ACHT and increased formation of adrenal androgens. If there is any suspicion, it is necessary to check for 17-Hydroxyprogesteron in the urine and blood. The therapy consists in the administration of prednisolon of 2-4 mg/d during 6 months.

Depressive symptoms are still listed as side effects in the package insert for systemic isotretinoin therapy for acne. In recent years, however, numerous studies have shown that there is no connection between the intake of isotretinoin and depressions. This should be explained to concerned parents during an individual consultation. All in all, the low dose therapy (<0,2mg/kg/d) has proven itself effective, because it is considerably well-tolerated due to the few side effects it has and helps to improve the compliance of the patients.