A child's skin is thinner, has a weaker barrier, and has a larger surface area relative to body weight than an adult's. As a result, children absorb topical drugs more easily (more systemic side effects), lose heat and fluid faster, and are more easily injured by adhesives, friction, and burns. Preterm infants have the most fragile skin; the Neonatal Skin Risk Assessment Scale (NSRAS) and the Braden QD scale are pediatric tools for pressure and skin injury risk (the Braden, Norton, and Waterlow scales were built for adults).

Common pediatric skin conditions

Atopic dermatitis (eczema) — the most common chronic skin disease of childhood. A defective skin barrier (often filaggrin gene variants) lets water out and irritants and allergens in; immune (type 2) inflammation causes intense itching, and scratching damages the barrier further (the itch–scratch cycle). It often begins in infancy and is linked with food allergy, asthma, and allergic rhinitis ("atopic march"). Affected skin is prone to S. aureus infection and eczema herpeticum (herpes simplex).

Burns in children — scalds are the most common type in young children; contact, flame, and electrical burns occur in older children. Children have a larger head and smaller legs relative to body size, so TBSA is estimated with the Lund–Browder chart (or the child's palm including fingers ≈ 1% TBSA for scattered burns). Burns with sharp margins, stocking-glove or symmetric immersion patterns, cigarette-shaped marks, or a story that does not fit the child's development suggest abuse.

Burn pain assessment — use the Faces Pain Scale–Revised for children about 4–12 years, the numeric rating scale for older children, and the FLACC behavioral scale for infants and nonverbal children; assess before and after every analgesic dose and procedure.

Atopic dermatitis

• Daily emollients (fragrance-free ointments or creams) — the foundation of treatment
• Topical corticosteroids (TCS) for flares — lowest effective potency, low potency on the face and skin folds, used for the prescribed period then tapered or switched to maintenance twice weekly
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) — steroid-free option for the face, eyelids, skin folds, and chronic lichenified areas
• Other nonsteroidal topicals: crisaborole (from 3 months); ruxolitinib cream (a topical JAK inhibitor, approved in the US from age 2 in 2025) for mild-to-moderate disease in non-immunocompromised children, on no more than 20% of body surface area
• Moderate-severe disease: dupilumab (from 6 months), phototherapy, or systemic immunosuppressants
• Infected eczema: antibiotics; eczema herpeticum: urgent acyclovir
• Bleach baths (dilute) and wet wraps in selected children

Other conditions

• Impetigo: gentle removal of crusts with soap and water; topical mupirocin or retapamulin for limited disease; oral antibiotics (e.g., cephalexin) for extensive or bullous disease
• Omphalitis: prompt medical evaluation and systemic antibiotics — cleaning with antiseptic alone is not enough
• Tinea capitis: oral griseofulvin (6–8 weeks or longer) or terbinafine; topical agents alone do not penetrate the hair shaft; antifungal shampoo reduces spread
• Head lice: permethrin 1% or other pediculicides (ivermectin lotion, spinosad — from 6 months; permethrin from 2 months) as directed, often repeated in 7–10 days, plus wet combing
• Scabies: permethrin 5% cream from neck to toes (include scalp and face in infants), left on 8–14 hours, repeated in 1–2 weeks; treat all household contacts at the same time; oral ivermectin for children 15 kg or more
• Urticaria: second-generation antihistamines; epinephrine for anaphylaxis
• Burns: cool with running water for 20 minutes (not ice); fluid resuscitation for burns of about 10–20% TBSA or more (lower thresholds than adults; superficial burns are not counted) — about 3 mL × kg × %TBSA in the first 24 hours as a starting estimate, plus maintenance fluid with dextrose in small children, titrated to urine output about 1 mL/kg/h in children under 30 kg; moist dressings (antimicrobial dressings, silver products) to keep the wound moist, protect from infection, and reduce dressing-change pain; excision and grafting for deep burns

Drug safety (doses weight-based and verified against a pediatric reference)

Listed in priority order.

1. Airway, breathing, circulation (burns and severe reactions)
   • Facial burns, singed nasal hair, soot, hoarseness, or stridor → inhalation injury — prepare for early intubation
   • Circulation first in the acute phase: monitor HR (tachycardia is the earliest sign of hypovolemia), perfusion, and hourly urine output; fluid via pump
   • Urticaria with stridor, wheeze, or hypotension → anaphylaxis protocol (IM epinephrine)
2. Infection prevention
   • Contact precautions for impetigo, MRSA, scabies, and draining lesions; airborne and contact for varicella until all lesions crust
   • Burns: aseptic technique, protective environment for large burns
   • Omphalitis: report and prepare for sepsis evaluation
3. Pain and itching
   • Scheduled analgesia; premedicate before dressing changes; distraction and comfort positioning
   • Itching: keep nails short and clean, cotton mittens for infants, cool compresses (urticaria), lukewarm oatmeal baths (varicella); avoid overheating
4. Skin care (atopic dermatitis)
   • Short (5–10 minute) lukewarm baths, gentle fragrance-free cleanser, pat dry and apply medication and emollient within 3 minutes ("soak and seal")
   • Cotton clothing, avoid wool, synthetic fabrics, fragranced products, and fabric softeners; comfortable room temperature — avoid overheating and sweating; avoid very dry air, but excessive humidification can promote dust mites
5. Wound care — moist dressings, observe for infection (color change, odor, fever), protect grafts; positioning and splints to prevent contractures
6. Nutrition and growth — high-calorie, high-protein diet for burns; daily weights
7. Safeguarding — document burn pattern, history, and developmental fit; follow abuse reporting rules

• Eczema is chronic — emollients every day even when the skin looks clear; use TCS exactly as prescribed (amount, strength, duration); do not stop suddenly or overuse; apply steroid to affected skin only, then emollient
• Identify and avoid triggers (heat, sweat, harsh soaps, wool); use a humidifier only moderately
• Cord care: keep the stump clean and dry, fold the diaper below it; report redness spreading around the navel, pus, foul smell, fever, or poor feeding
• Impetigo, lice, scabies: wash hands, do not share towels, combs, hats, or bedding; wash bedding and clothing in hot water and dry on high heat; seal non-washable items in a plastic bag for about 2 weeks (lice) or 3 days (scabies)
• Impetigo: child may return to school 24 hours after starting antibiotics; head lice: no need to exclude from school
• Tinea capitis: take griseofulvin with milk or fatty food for the full course; check family members and pets; do not share combs or hats
• Varicella: no aspirin (Reye syndrome); avoid scratching; do not pop blisters
• Burn prevention: set water heater at or below 49 °C (120 °F); test bath water; keep hot drinks and pot handles out of reach; smoke alarms; cover outlets; sunscreen and shade

• Children absorb topical drugs more — TCS: lowest effective potency for the prescribed time; overuse → atrophy and systemic effects
• Atopic dermatitis: short lukewarm baths, emollient within 3 minutes, cotton clothing, short nails, avoid overheating
• Topical calcineurin inhibitors = steroid-free option for face, folds, lichenified skin
• Omphalitis: spreading redness and pus around the umbilicus = infection needing medical evaluation and antibiotics
• Erythema toxicum: harmless newborn rash — observation only
• Impetigo: honey-colored crusts; contagious — contact precautions, no sharing
• Tinea capitis: scaly hair loss with broken hairs; oral griseofulvin with fatty food
• Scabies: treat the whole household at the same time; itching can last weeks after cure
• Full-thickness burn = painless, white or leathery; Lund–Browder chart for children; urine output about 1 mL/kg/h in children under 30 kg
• Tachycardia is the earliest sign of burn hypovolemia; moist dressings promote healing and reduce infection
• Faces Pain Scale–Revised for children about 4–12; FLACC for nonverbal children