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Tropical skin diseases can be diagnostic challenge in children

With an increase in international travel and new mass migration and immigration patterns, health care providers in developed countries need to become familiar with tropical skin diseases in order to ensure optimized care for returning travellers or immigrants. That is according to the authors of a report published in Pediatric Dermatology (June 2016; 33(3):253– 274).

“Having more knowledge and awareness about dermatological conditions and infectious diseases that occur in other areas of the world is important because some diseases and conditions are no longer exclusive to tropical areas,” said Dr. Maria Garcia-Romero, lead author of the report called Tropical Skin Diseases in Children: A Review Parts I and II.

Creating awareness important

In both reports, Dr. Garcia-Romero and her colleagues review the epidemiologic, clinical, diagnostic, and therapeutic aspects of some of the most common tropical dermatologic conditions that occur in children.

“We hope that our published review will help educate and create awareness to aid clinicians with the diagnosis and treatment of dermatologic conditions that they might not be used to seeing,” said Dr. Garcia-Romero, dermatologist, and researcher at Instituto Nacional de Pediatría in Mexico City. At the time of the study, she worked at The Hospital for Sick Children in Toronto.

Examples of the types of tropical skin conditions reviewed by the authors in this report include:

• Fungal disease: Superficial fungal infection and subcutaneous fungal infection;

• Bacterial and pseudobacterial infections;

• Mycobacterial infections;

• Protozoan infections;

• Parasitic infections; and

• Viral infections.

“Clinicians who are not used to seeing some of these tropical skin conditions such as fungal or parasitic infections might mistakenly confuse these infections with other dermatologic diseases,” Dr. Garcia-Romero noted.

Presentation differs between children, adults

The clinical presentation of some tropical dermatologic conditions may vary between children and adults in several ways clinically, particularly because many of these diseases are chronic and tend to progress slowly, said Dr. Garcia-Romero.

“In the case of adults, they may have the disease for several years before they decide to seek medical attention. Of course, because the skin disease has progressed we can normally identify it by looking at clinical images in dermatology textbooks,” she said.

“If a child acquires a dermatologic disease, medical attention is usually sought earlier. However, because the condition is slowly progressive it might not be as clinically identifiable, and a misdiagnosis is more likely.” Dr. Garcia-Romero indicated that some tropical skin diseases that present differently clinically in children than adults include:

• In children, sporotrichosis clinically presents on the face, whereas in adults it is typically found on the extremities.

• Mycetoma can present as small lesions on the face, often in children, and in adults, it usually presents on the extremities or trunk as large exophytic lesions.

• Adults typically get cutaneous larva migrans on their feet. In children, cutaneous larva migrans sometimes presents on their thighs or buttocks because children are more likely to sit or lay down on the sand than adults. When considering fungal and parasitic infections, many of these conditions have a different presentation in childhood, which changes the diagnostic approach and management options, she noted.

Does treatment differ between children, adults?

“Most medications used for the treatment of tropical skin diseases in children and adults are the same, however, many of the treatments that we do use are not approved for use in children,” she said.

“We are always more cautious about side effects when treating children. I think one of the reasons we wrote this article is to provide clinicians who treat children with a bit more knowledge, research, and understanding of how to treat these tropical skin diseases.”

Dr. Garcia-Romero encourages clinicians to reach out to colleagues or experts for assistance or advice if there is any uncertainty about the particular dermatologic condition that they are dealing with.

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