Some things should not wait for the next free routine appointment. Some things should not wait for the next free routine appointment. Telephone the practice and say what is happening, or go to an emergency room, if you have a mole or a mark that has changed shape, colour or size, that has become raised or uneven, or that bleeds, itches or will not heal; a sore anywhere that has not healed in three weeks; a rash that is spreading quickly, especially with fever, blistering, or peeling skin; a painful rash in a band on one side of the body, particularly near an eye; redness that is hot, swollen, tender and spreading, which can be a deep skin infection; a new rash after starting a medicine, especially with mouth or eye involvement; or a child under three months with any widespread rash. If you have been treated here and something is worse rather than better after a procedure, telephone us rather than waiting for the review appointment. We would far rather field a call that turns out to be nothing.
The appointment is longer and it runs differently. A child is spoken to before being examined, shown the dermatoscope before it is used, and told what is going to happen in words they can follow. That is not decoration — a frightened child cannot be examined properly, and a child who has been frightened at a medical appointment carries it to the next one. Parents are given the reasoning rather than the conclusion, because a parent who has read something alarming at midnight needs to understand why it does not apply rather than simply be told it does not.
The most useful thing a pediatric dermatologist does is decline to treat. A large proportion of what arrives here — molluscum, most warts, many birthmarks, cradle cap, the majority of infant rashes — resolves without intervention, and treating it means putting a child through discomfort for something that was going to go anyway. The counterweight is that the things which do need treatment are frequently under-treated, particularly eczema, because everybody involved is nervous. Both errors are avoidable and they pull in opposite directions.
There is one place where children are genuinely different pharmacologically and it changes prescribing. A child's surface area is large relative to their body mass, and their skin absorbs proportionally more of what is applied to it. That is an argument for choosing the right strength for the right site for a defined period and writing it down — not for choosing something too weak, which is the commoner error and leaves the child scratching for months.
What we see most
With, in each case, whether it usually needs treating.
Eczema — treat it, properly
The commonest reason a child is referred, and the most under-treated condition in this group. A child scratching through the night is not managing, and broken sleep affects growth, behaviour and school. See /childhood-eczema.html.
Molluscum — usually leave it
Small pearly bumps with a central dimple, caused by a virus, extremely common, harmless, and self-resolving over months to a couple of years. Treatment is uncomfortable and often unnecessary. See /warts-and-molluscum.html.
Warts — usually leave them
The majority resolve on their own within two years as the immune system recognises the virus. Treatment is worthwhile where they are painful, spreading fast or causing genuine distress.
Birthmarks — depends entirely on which
Most need nothing. A specific type of raised red birthmark grows rapidly in the early weeks and should be assessed promptly, because the effective treatment window is early. See /birthmarks-and-vascular-lesions.html.
Cradle cap — leave it, soften it
The infant form of seborrheic dermatitis. Harmless, clears on its own over weeks to months, and needs an oil to soften the scale and gentle removal rather than medicated treatment.
Nappy rash — treat the barrier first
Usually irritant, from moisture and friction. Frequent changes, generous barrier preparation, and time out of the nappy. If it involves the skin creases with satellite spots, yeast is involved and needs treating too.
Teenage acne — treat it, and early
The argument for treating adolescent acne promptly is scarring, which is permanent, plus the effect on a teenager at exactly the age it lands hardest. See /acne-treatment.html.
Hives — usually viral, usually settles
Common after a viral illness in children and generally not an allergy. Alarming to look at. See /hives-and-urticaria.html for the features that mean emergency care.
Red flags — the reasons to seek care urgently
Written for a parent reading late at night. If any of these apply, do not wait for an appointment.
A rash that does not fade when pressed
Press a clear glass firmly against the rash. If the spots stay visible through the glass, seek emergency care immediately, particularly with fever, drowsiness, a stiff neck or a child who seems unwell. This is the one to know.
Any widespread rash in a baby under three months
Newborns have limited defences and a low threshold applies. Have it looked at rather than waiting.
Rash with a high fever, or a child who is unwell
Drowsy, floppy, not feeding, difficult to rouse, or breathing quickly. The rash is the least important part of that sentence.
Blistering, peeling or skin that comes away
Especially with fever, or involving the mouth, eyes or genitals. Widespread blistering after starting a new medicine is an emergency.
Rapidly spreading redness that is hot and tender
Suggests a deep skin infection, which needs prompt antibiotic treatment.
Swelling of the face, lips or tongue, or difficulty breathing
Emergency services. Hives alone are not dangerous; airway symptoms are.
A purple or red birthmark on the face, present from birth and growing
Worth prompt assessment. Certain patterns warrant investigation, and the treatment window for some types is early.
How the appointment runs
An hour, and structured around the child rather than the diagnosis.
Talking first, examining second
The child is greeted, spoken to directly at their level, and told what is going to happen. Nothing is touched until they know what is coming.
Parents get the reasoning
Not just the conclusion. If we are recommending doing nothing, you should leave understanding why that is active management rather than a refusal, and knowing exactly what would change it.
The child gets the plan too
Older children and teenagers are spoken to about their own skin. A teenager with acne who has not been asked what they think about it will not use the treatment.
A written plan, and a flare plan
What to use, where, how much, how often, when to stop, and what to do when it flares again — because with children the flare invariably starts on a Saturday.
Bring the actual tubes
Everything that has been tried, in the containers, so the strength on the label can be read. Nobody remembers it accurately and it is usually the key to why something has not worked.
Children's Skin in western Queens
Longer appointments, a low chair, and the plan explained to the child as well as to the adult. A great deal of what worries parents most needs nothing at all — and knowing which part is which is the whole job.
Every appointment here starts the same way: a proper history, an examination in good light, and a named diagnosis said out loud and written down for you to take home. If there is genuine doubt you will be told that, and told what would settle it — usually a biopsy. You leave with a plan that has a strength, a site, a frequency and a date to stop or come back on it, and, where the condition is one that relapses, what to do on the first day of the next flare. If the honest answer is that this is better left alone, or that it belongs somewhere other than here, that is what you get instead, and it costs exactly the same.
This page is not medical advice, and it is not a diagnosis. Nothing on this website is medical advice for you in particular, and it is not a diagnosis. These pages describe conditions in general terms so that you arrive knowing what the questions are — they cannot tell you which condition you have, because that requires somebody to look at your skin, feel it, ask you a hundred questions and frequently take a sample of it. Two conditions on this website can look identical in a photograph and need opposite treatments. If something on your skin is new, changing, painful or not healing, the useful next step is an appointment rather than more reading.
No before-and-after photographs, and no promised outcome. There are no before-and-after photographs on this website and there never will be. Every set you have seen somewhere else was chosen from a much larger pile, and the second picture is usually taken in different light, at a different angle, at a different point in a flare cycle. In dermatology the dishonesty is sharper than in most fields, because nearly every condition here fluctuates on its own — photograph any relapsing skin disease at its worst and again at its best and you have a persuasive pair of images that demonstrates nothing about the treatment in between. What we publish instead is what a treatment typically achieves, in how long, in what proportion of people, and how often it does not work.
The risks, plainly. Every treatment described here has side effects, and some carry real risks. Topical steroids thin skin if they are used at the wrong strength on the wrong site for too long, which is why they are prescribed with a site, a strength and a stopping point rather than handed over indefinitely. Light-based and laser treatment can burn, blister and cause pigment change that lasts months, and that risk is higher on deeper skin tones and on recently tanned skin. Any procedure that breaks the skin can bleed, become infected and leave a scar; on the chest, the shoulders and the jawline, scars are more likely to thicken. Several of the medicines used in this speciality require blood tests, and some cannot be taken during pregnancy. We tell you your own risk rather than the average one, and where the honest answer is that a condition is better left alone, that is the advice you will get.
Nothing is diagnosed from a photograph. We do not diagnose skin from photographs, and we do not answer "what is this?" by email, by message or through a form. This is not caution for its own sake. A photograph has no history attached to it, cannot be felt, cannot be stretched or pressed to see whether the colour blanches, cannot be examined under a dermatoscope, and misreports colour badly — which matters enormously on skin that is not pale. The examination that actually distinguishes a harmless growth from an early cancer involves magnification, cross-polarised light and, when there is any doubt at all, a biopsy. An application that offers to tell you whether a mole is dangerous from a picture taken on a telephone is selling reassurance, and reassurance is the one product in this field that is dangerous when it is wrong. Bring the mark to a room where somebody can look at it.
Questions
Children's Skin — the questions we are asked most
My child has a rash. How do I know if it is urgent?
Press a clear glass firmly against it. If the spots stay visible through the glass, seek emergency care now — particularly with fever, drowsiness or a stiff neck. Also urgent: any widespread rash under three months of age, blistering or peeling skin, rapidly spreading hot tender redness, swelling of the face or mouth, difficulty breathing, or a child who is simply unwell. Ordinary eczema, warts, molluscum and most birthmarks are not emergencies.
Why are you recommending we do nothing?
Because a considerable share of children's skin conditions resolve without treatment, and treating them means putting a child through discomfort for something that was going to go anyway. Molluscum and most warts are the clearest examples. You will always be told what would change that advice, so that doing nothing is a decision with a review date rather than a dismissal.
Are steroid creams safe for my child?
Used at the right strength for the right site for a defined period, yes. Children absorb proportionally more, which is an argument for prescribing precisely rather than timidly — and the commonest problem we see is a child left scratching for months on something far too weak. Every prescription here leaves with a strength, a site, a frequency and a date to stop or review.
Will my child grow out of it?
Many do, particularly with eczema, which improves substantially in a large share of children as they get older. That is not a reason to leave a child uncomfortable in the meantime: sleep, school and behaviour are all affected by itching through the night, and treating it well now does not interfere with growing out of it later.
Should my child be tested for food allergies?
For ordinary eczema without a history of immediate reactions, generally not. Broad testing produces positives that are not causing the eczema and leads to unnecessary food restriction, which carries its own risks in a growing child. Where there is a genuine history of an immediate reaction — swelling, hives or vomiting within minutes of a specific food — that is different and worth investigating.
Can I send a photograph of the rash instead of coming in?
No. We do not diagnose from photographs, and in children the reasoning is stronger rather than weaker: the assessment depends on how the child is in themselves, on the temperature, on whether the rash blanches under pressure, and on what it feels like. If you are worried enough to want to send a picture tonight, that is a reason to telephone or to go to an emergency department, not to wait for a reply.
Related
Often seen alongside this
Pediatric Dermatology
Childhood Eczema
The most under-treated condition in children's dermatology, because everybody involved is nervous of the treatment. A child scratching through the night is not managing, and the plan you leave with should include what to do at the start of the next flare.
Read more
Pediatric Dermatology
Warts & Molluscum
Both are viral, both are harmless, and both resolve on their own given enough time. The honest default is to leave them alone — and the honest exceptions are pain, rapid spread, and a child who is genuinely distressed.
Read more
Pediatric Dermatology
Birthmarks
Most birthmarks need nothing but a name and an explanation. A few need prompt assessment — particularly the raised red ones that grow rapidly in the early weeks, where the effective treatment window is early.
Read moreA named diagnosis and a written plan you leave holding
Book an appointment
Pick a physician and a time from the calendar — it shows only the hours each of them genuinely has free. A new patient appointment is thirty minutes, a full skin examination forty-five, and you leave with a named diagnosis written down. If something on your skin has changed, telephone instead and say that word: it is triaged differently.