Dr. Suvash Sahu
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
Answered by
Medically reviewed by
Patient's Query
Hello doctor,
My four-year-old son has a one-inch dry scaly pink (sometimes red) patch next to the corner of his mouth. He is healthy. He uses hypoallergenic sunscreen at his camps. It has been five weeks and it is not getting better. He does not have a history of eczema, etc. It does not itch or hurt. I read a lot about perioral dermatitis and other things. I started Clotrimazole cream four days ago. It is less red and just pink, but dry and scaly still. It is not getting bigger and there are no pimples or crusting. I do not want to give him oral antibiotics. What should I do? Should I try Metrogel? What is it?
Hello,
Welcome to icliniq.com.
I have seen your query and concern.
From your description, it seems like your son has either have pityriasis alba, impetigo or cheilitis (perioral dermatitis). Stop all applications and get a review with a picture at the earliest.
Patient's Query
Thank you doctor,
It is not impetigo. It has been five weeks, and it is still dry and flaky with no drainage or crusts ever. And. angular cheilitis is only at the corners of the mouth. But, cheilitis you say is the same as perioral dermatitis? It says not to use steroids but with angular cheilitis, I remember using it for me. I want to take a break from sunscreen for him if I can. What should I do?
Hello,
Welcome back to icliniq.com.
Thanks for sharing the pictures (attachment removed to protect patient identity). I can see in the given picture, a solitary erythematous scaly plaque involving the right side of the chin, extending up to the angle of the mouth on the right side. So, as you rightly described, it is not an impetigo or cheilitis. Clinically, it looks like tinea faciei or discoid dermatitis. Since there is unilateral involvement and short duration with a history of slight improvement with Clotrimazole, the diagnosis goes in favor of tinea faciei. Please get a skin scraping for KOH mount. If it turns positive for fungal elements, then start applying 2 % Sertaconazole cream locally application twice daily for a month and use KZ (Ketoconazole) soap for cleaning the face twice a day. There is no need to apply sunscreen.
Patient's Query
Thank you doctor,
I have Econazole 1 % at home. Is that just as good? And can I use a non-soap based Cetafil cleanser? It takes forever to get into a dermatologist. So, I will not be able to get that scraping. How do you think he got it? Is it due to repetitive sunscreen usage? Is it common in kids and not contagious?
Hello,
Welcome to icliniq.com.
I have seen your query.
You can use Econazole 1 % twice daily for a month. It is always better to use an antifungal before applying a topical steroid because if it turns out to be dermatitis, the application of steroids over a fungal infection may cause the disease to spread. But you may require to apply it for around one and a half months to see tangible results. Tinea is common, and it is contagious too. Skin scraping for KOH is simple and a useful procedure. It can be done by a microbiologist.
Patient's Query
Thank you doctor,
Should I scrub the flakes or gently wash it with Cetaphil? We have two other kids under five and he constantly kisses everyone and anything and it is frustrating. So will this fully resolve in four weeks? And it is summer and he needs sunscreen at times. I bought a zinc based one. Or should I put a bandaid on it? The camps will try to apply sunscreen. Is it fine and not impede the healing?
Hello,
Welcome to icliniq.com.
Skin scraping is a diagnostic test and not a treatment. Do not cover the area. Keep it open. Just ensure he avoids touching it and kissing others. Do not apply sunscreen on that particular area.
Patient's Query
Hello doctor,
Thanks for replying. It has been one week since the steroids. I used clotrimazole for the first five days twice daily and then Econazole nitrate 1 % twice daily for the last two days. The last two days, it became more pink and dry looking. Also, this morning there are red cracks on the spot. So, I am afraid of putting anything on it. Maybe Econazole is too strong. I am not sure if the skin looks broken. It is still not itchy or hurting. What should I do?
Hello,
Welcome back to icliniq.com.
I have seen your query and examined the picture (attachment removed to protect patient identity). Yes, it looks slightly different, may be due to the steroid withdrawal effect. I suggest you switch over to Clotrimazole in place of Econozole. And, use Clotrimazole for at least a month. Apply Fusidic acid cream for five days because I can see few abrasions over the lesion.
Patient's Query
Thank you doctor,
Is Econazole a steroid? I thought it was an antifungal just like Clotrimazole. What is Fusidic acid? Is it OTC? What does it do and how do you apply it when using Clotrimazole timing-wise?
Hello,
Welcome back to icliniq.com.
No, Econazole is not a steroid. It is an antifungal, but it is a newer generation topical antifungal. It may not be suitable for some. The Fusidic acid cream is an antibacterial cream. The reason I suggested it was because your son's lesion has few abrasions over the annular plaque. So, this will prevent a secondary infection. You can use it for five days along with Clotrimazole. I am not sure if it is an OTC (over the counter) drug in your country. The other option is Mupirocin ointment. You can take a prescription from your general practitioner.
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