Dr Julius Parker: Dry skin and persistent coughing

Q. My nine-year-old suffers from dry skin on her arms and legs. Her siblings do not seem to suffer from this condition, and she is constantly looking for a good cream to alleviate the itch and irritation it causes. She no longer wears long-sleeved clothes as a result, and would wear shorts and T-shirts all year round if she could. The skin on her limbs is quite flaky, but not on her face or torso, where it seems quite normal. Her knuckles can also get very dry. Can you recommend a good moisturiser?

A. Dry skin is a common complaint in adults and children. The usual underlying cause is eczema — even if only mild with no typical red patches. Did your daughter have eczema as a baby or is there a close family history of atopy, such as eczema or asthma?

There are other causes, and the distribution of your daughter’s symptoms make me suspect keratosis pilaris.

This is a harmless condition, more common in girls. It produces small bumps on the skin surface around the hair follicles, which are sometimes slightly reddened, giving a ‘goose-skin’ appearance. Typically these affected areas are mildly itchy. The back and sides of the upper arms and front of the thighs are commonly affected.

In most cases it improves during teenage and early adulthood. There is no cure, but this and all cases of dry skin can be improved with careful skin care.

It sounds like you’ve tried several moisturisers. Using quite thick non-perfumed moisturiser is helpful but the key step is to apply your moisturiser liberally when the skin has been gently dried after a bath or shower. This traps moisture in your skin. Your daughter should avoid long, hot, showers or baths.

All nine year olds will need soap at times, but avoid over-usage. Bubble baths also strip away the protective oils which keep the skin moist. Aqueous cream is often recommended as a cleanser and moisturiser, but your doctor or pharmacist may recommend trying creams containing urea or salicylic acid.

Your daughter is right to avoid clothes that irritate the skin, as this aggravates itching. Cotton is best.

Q. My 10-year-old child has a persistent cough that has been treated with two courses of antibiotics this winter, to no avail. It’s a hard cough that has endured for almost two months now, and while it has improved, it shows no signs of disappearing. She does not suffer from asthma, panic attacks or any breathing difficulties. She is a happy, fit and energetic child but the cough is really trying her patience and it seems most persistent at night and mornings.

A. Having a persistent cough eventually becomes troublesome for most children, and worrying for their parents. This isn’t an uncommon problem. Studies have shown up to 10% of young children have a persistent cough unrelated to having a cold and which are not, as you say, associated with a wheeze.

During the winter months coughs and colds are common, and viral infections may occur back-to-back, giving the impression of a persistent cough. A lingering cough is more common if children are exposed to smoke. It’s also usual for a cough to be more troublesome at night, when mucous accumulates in the airways.

You’re right to think about asthma and in some children wheeziness is much less noticeable. A close family history of asthma or other atopy such as eczema also supports this possibility. Many GPs would suggest a short course of asthma treatments in children with a persistent cough, as a sustained improvement suggests this is the underlying explanation and a trial is risk free.

Your GP may also suggest a chest X-ray. If this is normal, and your daughter’s growth is normal, several rarer possibilities are ruled out.

If at this point, having seen your GP, your daughter’s symptoms persist, I would recommend seeing a paediatrician.

Some infections can produce a persistent cough and blood tests can check for these.

Most studies of persistent cough in children are reassuring, in that no serious underlying illness is found and the cough eventually settles.