Monthly Archives: June 2010

Ringworm

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Posted by admin on June 2, 2010 – 7:47 pm
Filed under Pediatrics

Ringworm is not caused by a worm but, rather, is a fungal (yeast) infection.  It may occur anywhere on the body surface or on the scalp.  

Ringworm of the skin is known as Tinea corpus.  It occurs from the neck down and on the face.  Classic ringworm begins as a flat scaly spot that then develops a raised border.  The border extends out at variable rates in all directions.  The advancing edge may have a red, raised border while the central area clears. 

This type of ringworm usually responds to anti-fungal creams. The spots become non-contagious after several days of treatment.  It takes 2 – 3 weeks to clear the rash, but occasionally the rash may persist for up to 6 weeks.  Medication should be continued for one week after rash is gone to insure the very tiny organisms you cannot see are all killed.

Lotrimin is available over-the-counter.  Lotrimin comes under several names: Lotrimin, Lotrimin AF, or Clortrimazole.  

Please see your pediatrician if over-the –counter Medications do not resolve the rash.  Oxistat , Nystatin, and Spectazole are examples of prescription medications which may be prescribed by your provider.

Ringworm of the scalp is known as Tinea capitis.  It is a fungal infection of the hair and scalp.  It attacks the hair at its root.

The main symptom is loss of hair with patchy baldness.  There may appear to be black dots representing broken hair shafts within the area of baldness.  It may be complicated by an inflammatory reaction that exudes pus called a kerion.  This represents an allergic reaction to the fungus.  The kerion will heal, but some scarring and hair loss can occasionally occur. 

The diagnosis of tinea of the scalp is confirmed with a fungal culture of the scalp sent to the laboratory.  However, because the fungus is slow growing, it takes two to three weeks for the cultures to turn positive.  Tinea capitis must be distinguished from a bacterial infection of the scalp, as the treatment is very different.

Because tinea capitis is a deeper infection, topical anti-fungal agents or shampoos are not effective alone for treating tinea capitis.  The treatment for tinea of the scalp is prescription medication, either Griseofulvin or Ketoconazole. 

Griseofulvin is used most often.  It requires a daily dose for a period of 6 or 8 weeks.   Give the Griseofulvin with fatty foods as milk or ice cream.   

If kerions are present, then oral steroids such as

Prednisone may also be necessary to hasten healing and reduce scarring.  In addition, the use of Selsun Blue shampoo is recommended twice weekly to prevent the spread of the spores to others.  Alternatively, your healthcare provider may prescribe Nizoral,  a prescription shampoo.

Tinea capitis is contagious.  Combs, brushes, and some hair products such as gels and mousse spread it.   The tinea spores remain alive on furniture too.  Meticulous cleaning of all possibly contaminated objects may help prevent re-infection.  Pay special attention to cleaning combs and brushes.  

In addition, all family members should be examined carefully for evidence of ringworm.  Cutting the hair, shaving the head or wearing a cap is not necessary when the patient is treated as outlined above.  The patient may return to school several days after treatment has begun.

Call your pediatrician during regular office hours if:

The ringworm becomes infected with pus or yellow crust or the ringworm continues to spread after two weeks of treatment.

Sports Injuries: Prevention and Treatment

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Posted by admin on June 2, 2010 – 2:59 pm
Filed under Pediatrics

Playing sports can be a big part of a child’s life.  Sports help kids stay active and fit and can boost self-esteem.  While all sports have a risk of injury, proper preparation can help to limit that risk.  Some ways to reduce injuries include:

  • Wear gear that is appropriate for the sport and that fits properly.  This includes pads like soccer shin guards and football shoulder pads, chest and leg protection for catchers, helmets for football and batting, mouthpieces and face guards and protective cups and eyewear.
  • Strengthen muscles – conditioning exercises before games and during practice strengthens muscles used in play.
  • Increase flexibility – stretching exercises before and after games and practice can increase flexibility.
  • Use the proper technique – learning basic skills and techniques should be more important than winning and should be reinforced during the playing season.
  • Take breaks – rest periods during practices and games allow the body to recuperate and can reduce the risk of injury.
  • Play safe – rules against actions that can cause injury such as headfirst sliding in baseball and softball, spearing in football, and body checking in ice hockey should be strictly enforced.
  • Listen to your body – stop if there is any pain. 
  • Avoid heat injury – drink plenty of liquids before, during, and after exercise; wear light clothing; decrease or stop activities if the heat or humidity is high.

Sports related injury can be caused by trauma or by overuse.  An overuse injury, like a stress fracture or tendonitis, usually occurs from repetitive motions without enough rest to allow for healing.  They can occur from overdoing a single motion, such as “pitcher’s elbow” tendonitis caused by too many pitches without enough rest and from too many activities using the same joint, such as a shoulder injury in someone who plays volleyball, softball and swims.  The most common sign of an overuse injury is pain – after a practice or game, during the activity (whether or not the athlete can still play) or constant or chronic pain, even when not playing.  Treatment of overuse injuries generally requires rest and some physical therapy as well as adjustments in training techniques and limited repetitions of the overused motion.  Overuse injuries can be prevented by stopping at the first sign of pain and by avoiding over training.  The best way to prevent over training is to monitor the amount of time spent doing an activity.  Limit sports to one per season and limit training to no more than five days per week.  Encourage varying training exercises from day to day, such as formal skills training one day and general conditioning the next.

Injuries can involve soft tissue and or bones.  Soft tissue injuries can be strains, sprains, or contusions.  A strain is when a muscle or tendon is stretched or torn.  A sprain involves a ligament and occurs when a joint is forced beyond its normal motion.  A contusion is a bruise within a muscle.  Bleeding inside the muscle can lead to swelling, pain, spasm, and restricted movement.  An injured bone can be bruised or broken.

Any joint can be sprained; ankle and finger sprains are common.  Signs that a joint may be sprained include pain, swelling around the joint and being unable to move the joint.  A broken bone can have the same symptoms, and an x-ray is often ordered to look at the bones.  Rest, ice on the injured site and elevation of the injured area to help prevent swelling can be started right after any injury.  After an x-ray is done to look at the injured area, a more targeted treatment can be started.  A fractured bone or a complete tearing of a ligament may require a referral to a specialist for casting and further treatment.  If the x-ray does not show a fracture, a sprain needs protection and immobilization.  An uninjured finger can be used to splint the injured finger by “buddy taping” them together.  An injured ankle can be wrapped with an elastic bandage or splinted.  After a week or two, once the joint is no longer painful or tender, stretching and resistance exercises can be done to loosen the joint, strengthen the surrounding muscles, and restore function.

Sports learned in childhood can become life-long activities.  Proper training and preparation can limit injuries and maximize fun.

Sources: www.healthychildren.org