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120
Report of the Principal School Medical Officer for the Year 1969
SKIN TROUBLES IN SCHOOL CHILDREN
Some infectious diseases have a habit of recurring in cycles, some at short, others at longer
intervals. Whooping Cough commonly occurs in Winter and early Spring, Rubella in Spring and
early Summer; Measles occurs in two yearly cycles as a rule, but with the increasing number of
children receiving measles inoculations this periodicity is being disturbed. Other conditions appear
to return at longer and often unpredictable intervals. Among these conditions are various types of
influenza, and scabies.
Scabies
Scabies was common during war-time and during other conditions which resulted in the close
herding of people with insufficient means of cleansing, and other deleterious unhygienic facilities.
In such conditions scabies can spread rapidly unless adequate measures of control are undertaken.
It seems strange therefore that the disease is now occurring among the general population as is
shown by the number of cases being seen in school children. From the end of the Second World War
until a year or so ago very few cases were reported, now it is becoming increasingly common and a
disproportionate amount of medical and nursing time is needed to deal with it, mainly in tracing
contacts and ensuring prompt treatment. Why this disease should be prevalent now in a population
with an undoubtedly improved social background is difficult to understand.
This is a household disease, and must be treated as such; by this is meant that if one member
of a household is infested then the whole family must be treated thoroughly. The disease is caused
by an acarus (mite) which is transmitted directly from one individual to another. The female acarus
burrows beneath the horny layer of the skin and deposits its eggs, which eventually hatch into larvae.
These develop into adult males and females. The impregnated female begins the whole process again.
Within two weeks itching begins in the area of attack, being particularly irritating at night time and
continuing until treatment is begun. Fortunately this is simple and effective. After a bath a special
lotion or cream is applied to the whole body below the neck and allowed to dry on. A further application
next day followed by a bath on the third day completes the regime. It must be stressed again
that it is essential that all the household members, non-itching ones included, receive this application.
Verrucae
Verrucae or common plantar warts are also seen all too frequently in school children, the incidence
probably in the region of 0.5 to 1%. The verruca is an infectious epidermal tumour probably
caused by a virus entering the horny layer of the skin of the feet through an abrasion or break in the
surface, and can be very painful. Treatment is not so simple and straightforward as in the case of
scabies. In the past a variety of methods were employed. The charming of warts (and plantar warts)
has its adherents even today. Hypnosis, too, has been used with varying degrees of success. It must
be noted that most warts will disappear completely in time since they have a natural life span which
may vary from one kind of wart to another and from one person to another, but these are inevitably
slow uncertain ways of dealing with them. More orthodox methods employ chemicals, either
keratonising or keratolytic; that is to harden the skin preparatory to paring it away with a scalpal
or softening the wart and extracting it from the skin. Carbon dioxide snow, liquid nitrogen, electro
cautery, and curretting are also employed by dermatologists, who must be expert in these procedures.
Since there is an infectious element in the disease, no one who has a plantar wart should walk barefoot
in places of public use such as swimming baths, gymnasia, public baths, etc. This simple precaution
would considerably reduce the incidence among the population as a whole.
Acne
Among older children, acne of the face, upper chest and back causes much distress. This eruption,
occurring about puberty, is common in a mild form in many boys and girls. The majority of adolescents
produce a few spots for some months, and then the condition clears spontaneously. In a few it may
progress to a more chronic stage. This requires energetic measures of control, and the young patient
should be placed under expert medical supervision, for its management can be protracted, and much
perseverence is required on the part of the doctor and sufferer for an effective cure to be achieved.