I'm a consultant dermatologist — here's what parents need to know about common skin conditions 

Professor Caitriona Ryan is a consultant dermatologist and co-founder of the Institute of Dermatologists in Dublin

Professor Caitriona Ryan at the Institute of Dermatologists, Ballsbridge, Dublin. Picture: Gareth Chaney

I’m from Killester, in Dublin, and went to school in Holy Faith Clontarf. My mom was a teacher, my dad was an accountant. Both were from the country and very strict. Education was a huge focus in our house.

I did a stint in Temple Street, when I was in transition year, and didn’t love it, so decided I didn’t want to do medicine. I was going to do actuarial studies or maths. It was only on my way to the airport for my Leaving Cert holiday that I posted the change-of-mind form, with medicine on it. I got top marks in my Leaving, so I got a scholarship to UCD [and after my medical training] decided I wanted to go into dermatology.

I was on the Irish Specialist Registrar Training Scheme and very involved in research. I decided to go to the States for a year to do some translational research, and ended up loving it there [and eventually spent] seven years in Dallas.

In the States, in the private sector, you had medical dermatology, cosmetic dermatology, and dermatological surgery all under the one roof — the whole 360 of looking after the skin and skin health. That’s what Professor Nicola Ralph and I have tried to replicate with the Institute of Dermatologists. Our goal was to create a centre of excellence for dermatology in Ireland.

Here are my top tips for children and adults:

Creche skin infections — what parents should look out for

Hand, foot, and mouth is a typical skin condition children pick up in creche. It usually starts with a fever, sore throat, and reduced appetite, followed by painful mouth ulcers and a rash of small red spots or blisters on the hands and feet. It can also affect the buttocks and groin. There is no specific antiviral treatment, but because it’s viral, antibiotics are of no benefit.

Treatment is keeping the child comfortable, with plenty of fluids, paracetamol, or ibuprofen, if appropriate, for pain or fever, and cool, soft foods, if the mouth is sore. Avoid acidic drinks like orange juice. Parents need to watch for dehydration, particularly if painful mouth ulcers mean the child is reluctant to drink.

A child should be reviewed if they’re becoming increasingly unwell, are not drinking or passing urine normally, have a persistent fever, or are not improving after about a week.

Children are usually most infectious during the first few days of the illness, but they don’t need to remain at home until every blister has disappeared. Once they’re feeling better, they can return to creche or school, even if some spots or blisters remain visible.

Good hand hygiene is particularly important, because the virus can spread through respiratory secretions, saliva, and faeces.

Impetigo is a bacterial infection and is highly contagious. It’s especially common in younger children and often develops around the nose and mouth. The classic appearance is a sore or blister that develops a distinctive golden or honey-coloured crust.

Impetigo usually requires treatment by a GP or a pharmacist. A very small, localised area may be treated with a topical antibiotic, while more extensive disease may require an oral antibiotic.

The infected areas should be kept clean and dry, children should be encouraged not to scratch, and towels, face cloths, and bedding should not be shared. A child with impetigo should stay away from school or childcare, while they are contagious. In general, they can return 48 hours after appropriate treatment has started. If the infection is not treated, they should remain at home until the lesions have dried and crusted over.

Psoriasis is much more than a skin condition

Psoriasis is my special interest. It affects 2% to 3% of the general population. It’s less common in children, affecting approximately 1%, but around one-third of those with psoriasis first develop it during childhood or adolescence. It’s an auto-inflammatory condition that’s caused by a combination of genetic and environmental factors.

You could have identical twins; one has psoriasis and the other doesn’t. It’s that you’re genetically susceptible, but you get an environmental hit that triggers it in the first place — stress, a sore throat, or a virus.

Psoriasis is quite a complex disorder, with a huge psycho-social impact, but now that we have brilliant drugs for it, it’s very easy to treat.

In adults, if it’s mild, topical drugs are typically used, and either oral or injectable [medication] for more severe cases. In children, for mild psoriasis, we begin with topical treatments. If the psoriasis is more extensive, children can also have phototherapy.

For more severe disease, we can use systemic medicines. The really exciting development has been the arrival of biologic medicines for children. These are highly targeted treatments that block specific parts of the immune pathway driving psoriasis. Depending on the particular drug, treatment can start from around four or six years of age.

Now, we can clear pretty much everyone, even those with severe psoriasis. We can’t cure them, though they have to stay on the treatment.

Psoriasis is not simply a skin disease. It is a systemic inflammatory disease. People with more severe psoriasis have an increased burden of cardiovascular disease, including heart attack and stroke. Part of this is related to chronic systemic inflammation, and part is because conditions such as obesity, high blood pressure, abnormal cholesterol, and diabetes occur more commonly in people with psoriasis.

The reassuring part is that cardiovascular risk is something we can address. There is increasing evidence that controlling severe psoriasis with systemic or biologic agents reduces cardiovascular risk.

I’d encourage patients with moderate or severe psoriasis to make sure their GP knows that psoriasis carries additional cardiovascular implications, and they should have the usual cardiovascular risk factors checked, particularly blood pressure, cholesterol, and other blood lipids, blood glucose, or HbA1c for diabetes, weight and waist circumference, smoking status, exercise, and physical activity.

• In conversation with Gemma Fullam