Children’s illnesses with exanthemas such as chickenpox, scarlet fever or measles often cause nervousness in parents – but telemedical diagnosis and therapy recommendations can help. How to deal with concerned parents.
Thanks to the pandemic, my fMFA advise more on the phone. They have always done this, and the parents are very happy to accept this service, but to reduce contacts in the practice, we have increased it significantly since Corona: The fMFA are trained to triage: This means that they answer key questions (age of the child, drinking behavior, state of consciousness, breathing problems, etc.) in order to assess the urgency of an appointment and to assess whether advice on the phone would not be sufficient.
Telemedical initial assessment: Noticeable relief for everyone
Excitement often arises with skin rashes. There are few diseases that unsettle parents more. The skin has to be clean, smooth and rosy, any irritation irritates the subjects. Since Corona, we have also been working with telemedical methods, which in the case of skin symptoms means nothing other than that parents send us a photo of the rash, pimple or wart by e-mail – anonymously, without recognizable facial features and without a picture of the genitals (at diaper rash sometimes difficult, but doable).
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Of course you can’t see everything in the pictures – the proportions are difficult to assess, the third dimension is missing, the palpation, the morphology of the skin. But it’s enough for a first impression. In this way we can safely assess 80% of the skin symptoms and at least rule out “bad” – even make therapy recommendations. The remaining 20% will be adjourned or summoned. The parents are very grateful for this opportunity, and our office hours are noticeably relieved.
When skin looks “weird”.
From the layman’s point of view, skin changes always look “strange”. It is hardly surprising that this is also the most common word in descriptions over the phone. We can exclude many important illnesses from the pictures and the explanations given by the parents: Children’s illnesses with Exanthemen how chickenpox, Scarlet fever or measles have a typical distribution of the rash and they are actually always accompanied by additional symptoms, such as a cold or fever. That’s why the question is always where else can the rash be seen – in the mouth, in the hair or in the skin folds? Or is the rash just in one spot?
Then there are typical skin symptoms that are queried: i.e. itching, dryness or moisture of the rash, size of the redness (small or large spots, isolated or merging), different colors or other noticeable things such as pus, blueness or secretions? Now it’s getting complicated, we can see some things in the pictures, some things we just have to see live.
Finally, the fMFA always ask the question: “How long has the rash existed” and “What have you already done?” Procedures and therapy attempts are incredibly important criteria for how urgently a rash needs to be looked at. In other words: “Five minutes ago my child had a red spot on his left shinbone, now you can hardly see anything” (yes, yes, there is…), does not require an urgent consultation. These two criteria are logically inferior to the passage of time. It is not uncommon for an exanthem to have disappeared by the time the child is presented, or a banal body lotion makes simple reddening disappear by the time a doctor visits.
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Are there dermatological emergencies?
Hardly any in pediatrics. Inflammation of the skin, e.g. B. following contamination in the event of an injury, is one of them, as well as an allergic skin reaction, but then additional symptoms such as fever, malaise, itching or an insect bite or an injury usually appear. So-called Petechien are small skin hemorrhages that indirectly indicate an irritation of the blood vessels or blood clotting and are sometimes triggered by severe systemic infections. They are rare but need them immediate medical assessment.
A lot of redness is caused by dryness of the skin, either because the skin is like that or because the outside air is causing it. A tried and tested remedy for many exanthemas is therefore to apply body lotion or, in winter, a greasy ointment. Important: The skin is a complete Organ and must therefore also completely be cared for, so: don’t just apply lotion to the redness. If the symptoms do not improve with this simple measure, or if the picture sent by e-mail is no longer sufficient, then the parents come by with the child.
Together with the parents, we plan a care concept for the skin: when and how often to bathe, what does the basic care look like, when do we need cortisone preparations and, above all, why. This goes beyond the acute consultation, but we have enough time to discuss skin problems, especially during check-ups.
Image source: Bekky Bekks, unsplash
