1) Miliaria: Also known as "prickly heat", this is an itchy eruption, often on the trunk, with sheets of tiny red bumps that can appear after heavy sweating. Heavy sweating and occlusion of the skin by clothing or skin care products create a blockage of sweat glands by dead skin cells and bacteria. It’s the bacteria, not the amount of sweat that is the driving factor. The normal skin flora is disrupted and the ecosystem is thrown off. Miliaria is best treated by encouraging a more healthy population of bacteria. The best initial approach is to restore an optimal acidic pH to the skin to encourage healthy skin bacteria populations. Dilute vinegar solution (2 tablespoons of vinegar per cup of water) applied as a compress will often cause rapid improvement. I recommend Bragg’s Raw Apple Cider Vinegar but any white vinegar will also work. As this often occurs under snug clothing, any bra, underwear or workout clothing should also be washed with a ½ -1 cup of vinegar added to the load.
3) Acne: We all know it when we see it but often parents wait too long (for so many good reasons) to seek treatment. Waiting for it to "blow over" just allows the inflammation to coarsen and possibly even scar the skin. The way to avoid oral antibiotics is through good education and encouragement with the topical regimen. Sleep and diet are important but they aren't the whole story and over-emphasizing their role runs the risk of bringing on more guilt and shame. Extractions can be very helpful and need to be performed in the right setting with the right tools. The immediate benefit of extractions can help with a kid's morale while waiting for the effect of the daily regimen to kick in. Salicylic acid, benzoyl peroxide and retinoids are the mainstay--and they really work when they're used properly.
4) Staph Aureus: Much more serious and increasingly common are the Staphylococcal infections that can be spread at camp. With all the skin exposure and shared use of life jackets and other equipment, summer camp is a breeding ground for staph aureus. Typical manifestations include:
- Classic impetigo with honey colored crusting: This is less often brought to the dermatologist b/c parents and their pediatricians are quick to diagnose and manage impetigo.
- A prickly heat or folliculitis-like form: A full-blown folliculitis with pustules pierced by a hair shaft is pretty straight forward, but the healthy young campers often come home with a slightly different morphology. Theirs appear as small clusters or even sheets of individual, tiny red papules and pustules. If it's fairly localized it may respond very well to topical antibiotic cream (prescription form, not over the counter) but if extensive or not responding, oral antibiotics may be necessary. It’s important to get a culture performed before implementing treatment. The culture identifies which strain of Staph is at play and what antibiotics would be effective.
I pick up my children next week and hope my inspection will reveal just the usual mix of bug bites, pricker bush scratches and just the faintest sign of a tan line. I hope yours shows the same. Stock up on vinegar and be on the lookout for any of the above mentioned that may need early attention.