Your child with ichthyosis has an impaired skin barrier function which can leave them more susceptible to infection. Thick moist scale can trap bacteria, yeasts, and fungi, and the cracking and fissuring of the skin also leaves the body open to infection. Your child’s dermatologist can help you watch for fungal, yeast and bacterial infections, and teach you how to distinguish between them. All infections require prompt medical attention and can usually be treated with topical prescription ointments and creams, however some cases may require oral medication.
If your baby’s skin is open or raw, begin with applying the antibiotics suggested by your dermatologist to these areas. Infections may begin as raised white bumps, raw areas that are weeping, or areas covered with a yellowish crust. If your child seems particularly itchy and uncomfortable, or has a low fever without any other obvious symptoms, he or she may have an infection. If your child develops a high temperature, or if the infection spreads, contact your doctor immediately. Treatment with either oral or parenteral (intramuscular or intravenous) antibiotics may be needed. This is particularly important in newborns, in whom infections can spread rapidly and can be serious.
As always, it’s important to get to know your child’s skin and skin cycle. If something looks unusual, it is always recommended to seek medical attention.
Below is the article, “Skin Infection in Ichthyosis,” from Dr. John Browning, of FIRST’s Medical & Scientific Advisory Board, discussing signs, prevention and treatment of infection in ichthyosis.
John C. Browning, MD, FAAD, FAAP
Assistant Professor, Baylor College of Medicine
Chief of Dermatology, Children’s Hospital of San Antonio
Skin Infection in Ichthyosis
Since patients with ichthyosis have an impaired or abnormal skin barrier, they are at higher risk for certain types of infection. In particular certain fungal infections can often hide out from the immune system while infecting areas of thickened scale in the skin. This has been reported most frequently in cases of ichthyosis vulgaris, lamellar ichthyosis, and keratitis, ichthyosis and deafness (KID) syndrome, although any type of ichthyosis with thickened scale is at higher risk.
People with ichthyosis can also be at high-risk for certain types of bacterial infection. In particular individuals with epidermolytic ichthyosis can become colonized with staphylococcus aureus, as well as other skin pathogens. This colonization can lead to infection.
Colonization vs. Infection
Colonization refers to bacteria living on our skin for long periods of time without the onset of infection. It can often be noted from increased irritation and maceration (wetness) of the skin with a faint odor. Active infection occurs when a bacterial strain undergoes uncontrolled growth, causing fever our illness. When the body attempts to mount a defense against this overgrowth you begin to see the typical symptoms of infection. Infection is characterized by warm and tender skin with increased drainage. If there is concern for a bacterial infection, a swab can be taken in the clinic, which can let you know if an infection is present. However it takes 48 to 72 hours to have results from a bacterial culture.
Prevention & Treatment
For patients who are at risk for infection, doctors sometimes recommend adding a few drops of antibacterial soap or even bleach (e.g. Clorox®) to the bath. Although the precise measurement of the mixture varies from person to person, it is recommended to use approximately 1 to 2 teaspoons per gallon of water. Be sure to consult with your child’s doctor before starting any treatment or prevention plan for a newborn, infant or toddler.
Lastly, scabies is a parasitic infection where mites invade your skin. It is characterized by increased itching and scale. Often patients have itchy bumps on their wrists, ankles, and waist line. In severe cases the palms and soles become thickened. Your dermatologist can do a quick skin scraping and make this diagnosis in clinic. It is always important if there are areas of your child’s skin that are not healing or worsening to visit your doctor and see if any additional test should be done.
Tele-ichthyosis - Since ichthyosis is a rare condition, sometimes your healthcare practitioner will need guidance from ichthyosis medical experts. Remember that FIRST has a Tele-ichthyosis portal, where medical staff can upload questions and photos and an ichthyosis expert will respond as soon as possible. If it is an urgent matter please call the FIRST office and we will try to connect directly with a member of our Medical & Scientific Advisory Board.