ReviewDermatological conditions in international pediatric travelers: Epidemiology, prevention and management
Introduction
Regardless of travel activity children frequently present with skin findings. Although most are not harmful and can be easily treated, clinicians who see children need to be skilled in recognizing potential life-threatening conditions that require specific treatment, and at times protective public health measures. Nowadays, families frequently travel with their children to international, and at times tropical destinations. According to a recent multicenter study of U.S. travel clinics 10% of all travelers receiving pre-travel care were children [1]. Furthermore, some children born in the U.S. or other developed nation return home after an extended sojourn in the tropical country of origin of their families, whereas other children travel for the purpose of immigrating or to live with a new family after an international adoption.
With such an increasing number of children traveling internationally, there has been growing interest to better understand the burden of travel-associated illness in children, and how it affects the range of diagnoses seen in acute and routine pediatric health care [2], [3], [4], [5], [6]. This paper will review the reported spectrum of dermatological conditions and manifestations in pediatric international travelers [2], [3], [4], [5], [6], and highlight how this range of diagnoses may differ from those reported for adult travelers. Implications for pre- and post-travel care of children are emphasized.
Section snippets
Epidemiology
Prospective observational studies of children traveling to the tropics showed that while preexisting skin problems such as eczema may frequently be present at the time of departure (11% of 157 Swiss children traveling to the tropics for a median of 16 days) and hence can potentially exacerbate during travel, an incidence rate for a “rash” (its nature was not further defined in this study) of 1.5 episodes per 100 person-weeks was calculated for the period during travel plus 4 weeks after return.
Fever and skin manifestations
Children presenting with a fever and skin manifestations need to be handled with care. Subtle skin findings may represent the only early clue to an underlying systemic disease process, may indicate a contagious disease, and may be an early sign of a life-threatening infection. Cosmopolitan bacterial skin infections are reported frequently among returning pediatric international travelers (Table 1). They are usually caused by infections with Staphylococcus aureus or Streptococcus pyogenes. Of
Parasitic skin infections
CLM also known as “creeping eruption”, caused by a skin infection with the larval stage of the dog or cat hookworm (Ancylostoma braziliense) represents the most common travel-associated skin disease acquired in the tropics among adult and pediatric travelers alike. While this infection is widely distributed in tropical and sub-tropical regions, most pediatric cases reported to GeoSentinel occurred after exposure in the Caribbean [6]. CLM is usually acquired by direct skin contact with infective
Arthropod-related dermatoses
Bites from arthropods, including mosquitos, flies, fleas, lice, ticks, and mites, can cause a wide clinical spectrum ranging from minor pruritic bites to severe systemic illness. Most travelers to the tropics, adults and children alike, report insect bites, primarily due to mosquitos, as a common reason for seeking medical care during or after travel [3], [5], [6], [29]. Frequently such bites lead to a secondary bacterial infection, hence local wound care and the use of systemic or topical
Animal bites
It is of concern that returning pediatric travelers seeking care at a GeoSentinel clinic were more likely to present with an animal bite than adult travelers. First, animal bites will often lead to wound infection. The rate of infection after cat and dog bites is up to 50% and 10–15%, respectively. Microorgnisms found in animal bites include Pasteurella spp, S. aureus, streptococci, anaerobes, Capnocytophaga spp, Corynebacterium spp and Neisseria spp. Apart from thorough wound cleansing,
Rarer but potentially acquirable tropical dermatoses
Other tropical dermatoses, some of them potentially serious, including loiasis, onchocerciasis, and leprosy have been reported in pediatric travelers seeking care at GeoSentinel clinics (Table 1). All cases of filarial infections have been reported in children returning from West Africa. While Loa Loa is transmitted by the Chrysops deer or antelope fly, presenting with transient, migratory and painful subcutaneous swellings (Calabar swelling), the main vector of onchocerciasis also known as
Conclusions
Dermatologic conditions occur frequently among pediatric international travelers to the tropics and most are mild, and self-limited. Review of multicenter post-travel data of pediatric travelers show a wide spectrum of dermatologic diagnoses and health conditions with significant skin manifestations. The top three skin conditions were dog bites requiring rabies post-exposure prophylaxis, creeping eruptions due to CLM, and arthropod bite-related problems. Compared to adult travelers pediatric
Conflict of interest
None.
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