Skin, Hair, and Nails Problems

Things That Can Go Wrong With the Skin, Hair, and Nails

Some of the things that can affect the skin, nails, and hair are described below.

Dermatitis

The term dermatitis refers to any inflammation (swelling, itching, and redness) possibly associated with the skin. There are many types of dermatitis, including:

• Atopic dermatitis (eczema). It's a common, hereditary dermatitis that causes an itchy rash primarily on the face, trunk, arms, and legs. It commonly develops in infancy, but can also appear in early childhood. It may be associated with allergic diseases such as asthma and seasonal, environmental, and food allergies.
• Contact dermatitis. This occurs when the skin comes into contact with an irritating substance or one that the person is allergic or sensitive to. The best-known cause of contact dermatitis is poison ivy, but there are many others, including chemicals found in laundry detergent, cosmetics, and perfumes, and metals like nickel plating on jewelry, belt buckles, and the back of a snap.
• Seborrheic dermatitis. This oily rash, which appears on the scalp, face, chest, and back, is related to an overproduction of sebum from the sebaceous glands. This condition is common in infants and adolescents.

Bacterial Skin Infections

• Impetigo. Impetigo is a bacterial infection that results in a honey-colored, crusty rash, often on the face near the mouth and nose.
• Cellulitis. Cellulitis is an infection of the skin and subcutaneous tissue that typically occurs when bacteria are introduced through a puncture, bite, or other break in the skin. The area with cellulitis is usually warm, tender, and has some redness.
• Streptococcal and staphylococcal infections. These two kinds of bacteria are the main causes of cellulitis and impetigo. Certain types of these bacteria are also responsible for distinctive rashes on the skin, including the rashes associated with scarlet fever and toxic shock syndrome.

Fungal Infections of the Skin and Nails

• Candidal dermatitis. A warm, moist environment, such as that found in the folds of the skin in the diaper area of infants, is perfect for growth of the yeast Candida. Yeast infections of the skin in older children, teens, and adults are less common.
• Tinea infection (ringworm). Ringworm, which isn't a worm at all, is a fungus infection that can affect the skin, nails, or scalp. Tinea fungi can infect the skin and related tissues of the body. The medical name for ringworm of the scalp is tinea capitis; ringworm of the body is called tinea corporis; and ringworm of the nails is called tinea unguium. With tinea corporis, the fungi can cause scaly, ring-like lesions anywhere on the body.
• Tinea pedis (athlete's foot). This infection of the feet is caused by the same types of fungi that cause ringworm. Athlete's foot is commonly found in adolescents and is more likely to occur during warm weather.

Other Skin Problems

• Parasitic infestations. Parasites (usually tiny insects or worms) can feed on or burrow into the skin, often resulting in an itchy rash. Scabies and lice are examples of parasitic infestations. Both are contagious and can be easily caught from other people.
• Viral infections. Many viruses cause characteristic rashes on the skin, including varicella, the virus that causes chickenpox and shingles; herpes simplex, which causes cold sores; human papillomavirus, the virus that causes warts; and a host of others.
• Acne (acne vulgaris). Acne is most common in teens. Some degree of acne is seen in 85% of adolescents, and nearly all teens have the occasional pimple, blackhead, or whitehead.
• Skin cancer. Skin cancer is rare in children and teens, but good sun protection habits established during these years can help prevent skin cancers such as melanoma (a serious form of skin cancer that can spread to other parts of the body) later in life, especially among fair-skinned people who sunburn easily.

In addition to these diseases and conditions, the skin can be injured in a number of ways. Minor scrapes, cuts, and bruises heal quickly on their own, but other injuries — severe cuts and burns, for example — require medical treatment.

Disorders of the Scalp and Hair

• Tinea capitis, a type of ringworm, is a fungal infection that forms a scaly, ring-like lesion in the scalp. It's contagious and common among school-age children.
• Alopecia is an area of hair loss. Ringworm is a common cause of temporary alopecia in children. Alopecia can also be caused by tight braiding that pulls on the hair roots (called tension alopecia). Alopecia areata (when hair falls out in round or oval patches on the scalp) is a less common condition that can affect children and teens.

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Mouth and Teeth Problems

Problems of the Mouth and Teeth

Proper dental care — including a good diet, frequent cleaning of the teeth after eating, and regular dental checkups — is essential to maintaining healthy teeth and avoiding tooth decay and gum disease.

Common mouth and dental diseases and conditions — some of which can be prevented, some of which cannot — are :

Disorders of the Mouth

• Aphthous stomatitis (canker sores). A common form of mouth ulcer, canker sores occur in women more often than in men. Although their cause isn't completely understood, mouth injuries, stress, dietary deficiencies, hormonal changes (such as the menstrual cycle), or food allergies can trigger them. They usually appear on the inner surface of the cheeks, lips, tongue, soft palate, or the base of the gums, and begin with a tingling or burning sensation followed by a painful sore called an ulcer. Pain subsides in 7 to 10 days, with complete healing in 1 to 3 weeks.
• Cleft lip and cleft palate are birth defects in which the tissues of the mouth and/or lip don't form properly during fetal development. Children born with these disorders may have trouble feeding immediately after birth. Reconstructive surgery in infancy and sometimes later can repair the anatomical defects, and can prevent or lessen the severity of speech problems later on.
• Enteroviral stomatitis is a common childhood infection caused by a family of viruses called the enteroviruses. An important member of this family is coxsackievirus, which causes hand, foot, and mouth disease. Enteroviral stomatitis is marked by small, painful ulcers in the mouth that may decrease a child's desire to eat and drink and put him or her at risk for dehydration.
• Herpetic stomatitis (oral herpes). Children can get a mouth infection with the herpes simplex virus from an adult or another child who has it. The resulting painful, clustered vesicles, or blisters, can make it difficult to drink or eat, which can lead to dehydration, especially in a young child.
• Periodontal disease. The gums and bones supporting the teeth are subject to disease. A common periodontal disease is gingivitis — inflammation of the gums characterized by redness, swelling, and sometimes bleeding. The accumulation of tartar (a hardened film of food particles and bacteria that builds up on teeth) usually causes this condition, and it's almost always the result of inadequate brushing and flossing. When gingivitis isn't treated, it can lead to periodontitis, in which the gums loosen around the teeth and pockets of bacteria and pus form, sometimes damaging the supporting bone and causing tooth loss.

Disorders of the Teeth

• Cavities and tooth decay. When bacteria and food particles stick to saliva on the teeth, plaque forms. The bacteria digest the carbohydrates in the food and produce acid, which dissolves the tooth's enamel and causes a cavity. If the cavity isn't treated, the decay process progresses to involve the dentin. The most common ways to treat cavities and more serious tooth decay problems are: filling the cavity; performing root canal therapy, involving the removal of the pulp of a tooth; crowning a tooth with a cap that looks like a tooth made of metal, porcelain, or plastic; or removing or replacing the tooth. A common cause of tooth decay in toddlers is "milk bottle mouth," which occurs when a child goes to sleep with a milk or juice bottle in the mouth and the teeth are bathed in sugary liquid for an extended period of time. To avoid tooth decay and cavities, teach your kids good dental habits — including proper tooth-brushing techniques — at an early age.
• Impacted wisdom teeth. In many people, the wisdom teeth are unable to erupt normally so they either remain below the jawline or don't grow in properly. Dentists call these teeth impacted. Wisdom teeth usually become impacted because the jaw isn't large enough to accommodate all the teeth that are growing in and the mouth becomes overcrowded. Impacted teeth can damage other teeth or become painful and infected. Dentists can check if a person has impacted wisdom teeth by taking X-rays of the teeth. If the X-rays show there's a chance that impacted teeth may cause problems, the dentist will usually recommend that the tooth or teeth be extracted.
• Malocclusion is the failure of the teeth in the upper and lower jaws to meet properly. Types of malocclusion include overbite, underbite, and crowding. Most conditions can be corrected with braces, which are metal or clear ceramic brackets bonded to the front of each tooth. The wires connecting braces are tightened periodically to force the teeth to move into the correct position.

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Metabolism Problems

Metabolism Problems

In a broad sense, a metabolic disorder is any disease that is caused by an abnormal chemical reaction in the body's cells. Most disorders of metabolism involve either abnormal levels of enzymes or hormones or problems with the functioning of those enzymes or hormones. When the metabolism of body chemicals is blocked or defective, it can cause a buildup of toxic substances in the body or a deficiency of substances needed for normal body function, either of which can lead to serious symptoms.

Some metabolic diseases are inherited. These conditions are called inborn errors of metabolism. When babies are born, they're tested for many of these metabolic diseases in a newborn screening test. Many of these inborn errors of metabolism can lead to serious complications or even death if they're not controlled with diet or medication from an early age.

Examples of metabolic disorders and conditions include:

G6PD deficiency. Glucose-6-phosphate dehydrogenase, or G6PD, is just one of the many enzymes that play a role in cell metabolism. G6PD is produced by red blood cells and helps the body metabolize carbohydrates. Without enough normal G6PD to help red blood cells handle certain harmful substances, red blood cells can be damaged or destroyed, leading to a condition known as hemolytic anemia. In a process called hemolysis, red blood cells are destroyed prematurely, and the bone marrow (the soft, spongy part of the bone that produces new blood cells) may not be able to keep up with the body's need to produce more new red blood cells. Kids with G6PD deficiency may be pale and tired and have a rapid heartbeat and breathing. They may also have an enlarged spleen or jaundice — a yellowing of the skin and eyes. G6PD deficiency is usually treated by discontinuing medications or treating the illness or infection causing the stress on the red blood cells.

Galactosemia. Babies born with this inborn error of metabolism do not have enough of the enzyme that breaks down the sugar in milk called galactose. This enzyme is produced in the liver. If the liver doesn't produce enough of this enzyme, galactose builds up in the blood and can cause serious health problems. Symptoms usually occur within the first days of life and include vomiting, swollen liver, and jaundice. If galactosemia is not diagnosed and treated quickly, it can cause liver, eye, kidney, and brain damage.

Hyperthyroidism. Hyperthyroidism is caused by an overactive thyroid gland. The thyroid releases too much of the hormone thyroxine, which increases the person's basal metabolic rate (BMR). It causes symptoms such as weight loss, increased heart rate and blood pressure, protruding eyes, and a swelling in the neck from an enlarged thyroid (goiter). The disease may be controlled with medications or through surgery or radiation treatments.

Hypothyroidism. Hypothyroidism is caused by an absent or underactive thyroid gland and it results from a developmental problem or a destructive disease of the thyroid. The thyroid releases too little of the hormone thyroxine, so a person's basal metabolic rate (BMR) is low. In infants and young children who don't get treatment, this condition can result in stunted growth and mental retardation. Hypothyroidism slows body processes and causes fatigue, slow heart rate, excessive weight gain, and constipation. Kids and teens with this condition can be treated with oral thyroid hormone to achieve normal levels in the body.

Phenylketonuria. Also known as PKU, this condition occurs in infants due to a defect in the enzyme that breaks down the amino acid phenylalanine. This amino acid is necessary for normal growth in infants and children and for normal protein production. However, if too much of it builds up in the body, brain tissue is affected and mental retardation occurs. Early diagnosis and dietary restriction of the amino acid can prevent or lessen the severity of these complications.

Type 1 diabetes mellitus. Type 1 diabetes occurs when the pancreas doesn't produce and secrete enough insulin. Symptoms of this disease include excessive thirst and urination, hunger, and weight loss. Over the long term, the disease can cause kidney problems, pain due to nerve damage, blindness, and heart and blood vessel disease. Kids and teens with type 1 diabetes need to receive regular injections of insulin and control blood sugar levels to reduce the risk of developing problems from diabetes.

Type 2 diabetes. Type 2 diabetes happens when the body can't respond normally to insulin. The symptoms of this disorder are similar to those of type 1 diabetes. Many kids who develop type 2 diabetes are overweight, and this is thought to play a role in their decreased responsiveness to insulin. Some can be treated successfully with dietary changes, exercise, and oral medication, but insulin injections are necessary in other cases. Controlling blood sugar levels reduces the risk of developing the same kinds of long-term health problems that occur with type 1 diabetes.

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Lungs Problems

Problems of the Lungs and Respiratory System

The respiratory system is susceptible to a number of diseases, and the lungs are prone to a wide range of disorders caused by pollutants in the air.

The most common problems of the respiratory system are:

Asthma. More than 20 million people in the United States have asthma, and it's the #1 reason that kids chronically miss school. Asthma is a chronic inflammatory lung disease that causes airways to tighten and narrow. Often triggered by irritants in the air such as cigarette smoke, asthma flares involve contraction and swelling of the muscles lining the tiny airways. The resulting narrowing of the airways prevents air from flowing properly, causing wheezing and difficulty breathing, sometimes to the point of being life-threatening. Management of asthma starts with an asthma management plan, which usually involves avoiding asthma triggers and sometimes taking medications.

Bronchiolitis. Not to be confused with bronchitis, bronchiolitis is an inflammation of the bronchioles, the smallest branches of the bronchial tree. Bronchiolitis affects mostly infants and young children, and can cause wheezing and serious difficulty breathing. It's usually caused by specific viruses in the wintertime, including respiratory syncytial virus (RSV).

Chronic obstructive pulmonary disease (COPD). COPD is a term that describes two lung diseases — emphysema and chronic bronchitis:

• Long-term smoking often causes emphysema, and although it seldom affects children and teens, it's a condition that can have its roots in the teen and childhood years. Learning to talk to your kids about smoking is a key part of preventing smoking-related diseases. In emphysema, the lungs produce an excessive amount of mucus and the alveoli become damaged. It becomes difficult to breathe and get enough oxygen into the blood.
• In bronchitis, a common disease of adults and adolescents, the membranes lining the larger bronchial tubes become inflamed and an excessive amount of mucus is produced. The person develops a bad cough to get rid of the mucus. Cigarette smoking is a major cause of chronic bronchitis in teens.

Common cold. Caused by over 200 different viruses that cause inflammation in the upper respiratory tract, the common cold is the most common respiratory infection. Symptoms may include a mild fever, cough, headache, runny nose, sneezing, and sore throat.

Cough. A cough is a symptom of an illness, not an illness itself. There are many different types of cough and many different causes, ranging from not-so-serious to life-threatening. Some of the more common causes affecting kids are the common cold, asthma, sinusitis, seasonal allergies, croup, and pneumonia. Among the most serious causes of cough iare tuberculosis (TB) and whooping cough (pertussis).

Cystic fibrosis (CF). Affecting more than 30,000 children and young adults in the United States, cystic fibrosis is the most common inherited disease affecting the lungs. Affecting primarily the respiratory and digestive systems, CF causes mucus in the body to be abnormally thick and sticky. The mucus can clog the airways in the lungs and make a person more vulnerable to bacterial infections.

Lung cancer. Caused by an abnormal growth of cells in the lungs, lung cancer is a leading cause of death in the United States and is usually caused by smoking cigarettes. It starts in the lining of the bronchi and takes a long time to develop. Symptoms include a persistent cough that may bring up blood, chest pain, hoarseness, and shortness of breath. Radon gas exposure (radon is a gas that occurs in soil and rocks) may also be a cause of lung cancer. Radon is more likely to occur in certain parts of the United States. You can check your home's radon level by purchasing a radon kit at your local home supply or hardware store.

Pneumonia. This inflammation of the lungs usually occurs because of bacterial or viral infection. Pneumonia causes fever and inflammation of lung tissue, and makes breathing difficult because the lungs have to work harder to transfer oxygen into the bloodstream and remove carbon dioxide from the blood. Common causes of pneumonia are influenza and infection with the bacterium Streptococcus pneumoniae.

Pulmonary hypertension. This condition occurs when the blood pressure in the arteries of the lungs is abnormally high, which means the heart has to work harder to pump blood against the high pressure. Pulmonary hypertension may occur in children because of a heart defect present at birth or because of a health condition such as HIV infection.

Respiratory diseases of newborns. Several respiratory conditions can affect a newborn baby just starting to breathe for the first time.

Premature babies are at increased risk for conditions such as:

• Respiratory distress syndrome of the newborn. Babies born prematurely may not have enough surfactant in the lungs. Surfactant helps to keep the baby's alveoli open; without surfactant, the lungs collapse and the baby is unable to breathe.
• Apnea of prematurity (AOP). Apnea is a medical term that means someone has stopped breathing. Apnea of prematurity (AOP) is a condition in which premature infants stop breathing for 15 to 20 seconds during sleep. Apnea of prematurity generally occurs after 2 days of life and up to a week of life. The lower the infant's weight and level of prematurity at birth, the more likely the baby is to have AOP spells.
• Bronchopulmonary dysplasia (BPD). BDP involves abnormal development of lung tissue. Sometimes called chronic lung disease or CLD, it's a disease in infants characterized by inflammation and scarring in the lungs. It develops most often in premature babies who are born with underdeveloped lungs.

Other respiratory conditions in newborns include:

• Meconium aspiration. Meconium aspiration occurs when a newborn inhales (aspirates) a mixture of meconium (baby's first feces, ordinarily passed after birth) and amniotic fluid during labor and delivery. The inhaled meconium can cause a partial or complete blockage of the baby's airways.
• Persistent pulmonary hypertension of the newborn (PPHN). In the uterus, a baby's circulation bypasses the lungs. Normally, when a baby is born and begins to breathe air, his or her body quickly adapts and begins the process of respiration. PPHN occurs when a baby's body doesn't make the normal transition from fetal circulation to newborn circulation. This condition can cause symptoms such as rapid breathing, rapid heart rate, respiratory distress, and cyanosis (blue-tinged skin).
• Transient tachypnea of the newborn (TTN). Rapid breathing in a full-term newborn (more than 60 breaths a minute) is called transient tachypnea.

Although some respiratory diseases can't be prevented, many chronic lung and respiratory illnesses can be prevented by avoiding smoking, staying away from pollutants and irritants, washing hands often to avoid infection, and getting regular medical checkups.

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Urinary Tract Problems

Problems of the Kidneys and Urinary Tract

Like other systems in the body, the entire urinary tract is subject to diseases and disorders.

In kids, the more common problems include:

Congenital problems of the urinary tract. As a fetus develops in the womb, any part of the urinary tract can grow to an abnormal size or in an abnormal shape or position. One common congenital abnormality (an abnormality that exists at birth) is duplication of the ureters, in which a kidney has two ureters coming from it instead of one. This defect occurs in about 1 out of every 125 births and can cause the kidney to develop problems with repeated infections and scarring over time.

Another congenital problem is horseshoe kidney, where the two kidneys are fused (connected) into one arched kidney that usually functions normally, but is more prone to develop problems later in life. This condition is found in 1 out of every 500 births.

Glomerulonephritis is an inflammation of the glomeruli, the parts of the filtering units (nephrons) of the kidney that contain a network of capillaries (tiny blood vessels). The most common form is post-streptococcal glomerulonephritis, which usually occurs in young children following a case of strep throat. Most kids with this type of nephritis recover fully, but a few can have permanent kidney damage that eventually requires dialysis or a kidney transplant.

High blood pressure (hypertension) can result when the kidneys are impaired by disease. The kidneys control blood pressure by regulating the amount of salt in the body and by producing the enzyme renin that, along with other substances, controls the constriction of muscle cells in the walls of the blood vessels.

Kidney (renal) failure can be acute (sudden) or chronic (occurring over time and usually long lasting or permanent). In either form of kidney failure, the kidneys slow down or stop filtering blood effectively, causing waste products and toxic substances to build up in the blood.

Acute kidney failure may be due to many things, including a bacterial infection, injury, shock, heart failure, poisoning, or drug overdose. Treatment includes correcting the problem that led to the failure and sometimes requires surgery or dialysis. Dialysis involves using a machine or other artificial device to remove the excess salts and water and other wastes from the body when the kidneys are unable to perform this function.

Chronic kidney failure involves a deterioration of kidney function over time. In children, it can result from acute kidney failure that fails to improve, birth defects of the kidney, chronic kidney diseases, repeated kidney infections, or chronic severe high blood pressure. If diagnosed early, chronic kidney failure in children can be treated but usually not reversed. The child will usually require a kidney transplant at some point in the future.

Kidney stones (or nephrolithiasis) result from the buildup of crystallized salts and minerals such as calcium in the urinary tract. Stones (also called calculi) can also form after an infection. If kidney stones are large enough to block the kidney or ureter, they can cause severe abdominal pain. But the stones usually pass through the urinary tract on their own. In some cases, they may need to be removed surgically.

Nephritis is any inflammation of the kidney. It can be caused by infection, medications, an autoimmune disease (such as lupus), or it may be idiopathic (which means the exact cause may not be known or understood). Nephritis is generally detected by protein and blood in the urine.

Nephrotic syndrome is a type of kidney disease that leads to loss of protein in the urine and swelling of the face (often the eyes) or body (often around the genitals). It is most common in children younger than 6 years old and is more prevalent in boys. Nephrotic syndrome is often treated with steroids.

Urinary tract infections (UTIs) are usually caused by intestinal bacteria, such as E. coli, normally found in feces. These bacteria can cause infections anywhere in the urinary tract, including the kidneys. Most UTIs occur in the lower urinary tract, in the bladder and urethra. UTIs occur in both boys and girls. However, uncircumcised males are about 3 to 12 times more likely than circumcised males to develop a UTI before age 1. In school-age children, girls are more likely to develop UTIs than boys; this may be because girls have shorter urethras than boys.

Vesicoureteral reflux (VUR) is a condition in which urine abnormally flows backward (or refluxes) from the bladder into the ureters. It may even reach the kidneys, where infection and scarring can occur over time. VUR occurs in 1% of children and tends to run in families. It's often detected after a young child has a first urinary tract infection. Most kids outgrow mild forms of VUR, but some can develop permanent kidney damage and kidney failure later in life.

Wilms' tumor is the most common kidney cancer occurring in children. It is diagnosed most commonly between 2 and 5 years of age and affects males and females equally.

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