Rash

In general

Rashes are one of the most common reasons that parents of small children visit the doctor. In most cases rashes do not suggest a dangerous condition, but sometimes they can be a sign of danger. 

If a child is in good general health and has no other symptoms, you can often observe for a few days. Many types of rashes will disappear without treatment. If the rash is accompanied by high fever, difficulties in breathing, vomiting or reduced general health (that is - just not acting right or like himself), you should seek the advice of a doctor. It is often difficult to describe rashes over the telephone. One type of rash can have different causes.

It is therefore advisable to let your doctor evaluate the rash. It is important to note what the rash looks like, how widespread it is, how many and how big the marks on the skin are, how long the rash has been present and if the rash is itchy.

Rashes due to allergy: Hives (Urticaria)

The most common allergic rash is hives, or urticaria. The rash can be a result of an allergic reaction to various substances.

Medicines, foods, viral infections, insect stings/bites may cause hives in susceptible individuals. A rash occurring because of a medicine may resemble any of the other rashes, as well.

Hives is an extremely itchy rash consisting of large welts raised up from the surface of the body, often circular with a pale center.

The rash moves around the body and usually lasts for 3-4 days before disappearing. Localized hives usually indicates direct skin contact with a substance that the person does not tolerate, such as plants, pollen, or a food

Localized infections with rashes

Infected wound

An infected wound, or pyoderma, occurs when a minor wound caused by a skin irritation, scratching, cut, bite, etc., becomes infected by bacteria found on the surface of the skin, on the mucous membranes or from external sources. The wound becomes red and moist, often with pus and eventually yellowish scabs. The skin around the wound becomes swollen and tender to the touch because of the inflammation. The child's lymphatic nodes may become swollen in the surrounding area and the child may develop a fever. If the child scratches the wound, the bacteria may spread on the skin, giving rise to more sores.

Impetigo

Impetigo is a special type of skin infection involving bacteria of the streptococcus or staphylococcus type.

The rash usually starts as a scratch, bite, or minor irritation that becomes infected with bacteria. The wound becomes red and moist, often with pus and eventually yellowish scabs.

If the child scratches the wound, the bacteria may spread on the skin, giving rise to yet more sores. The sores develop over the course of a few days and last 4-6 days before forming scabs and gradually drying up.

Impetigo can occur on any part of the body that has a wound or break in the skin. It is usually treated with either topical or oral antibiotics.

Cellulitis

Cellulitis or erysipelas is a localized skin infection with bacteria of the streptococcus type. The skin becomes swollen, hot and red in a restricted area clearly delineated from healthy skin. Often, there is no obvious entry point in the skin for the bacteria. Sometimes it can be accompanied by fever and a reduced general condition. Cellulitis should be evaluated and treated promptly, as the infection may spread rapidly.

Fungal rash

Fungal rashes are skin infections caused by two specific types of fungi: tinea and candida. Tinea infections, also known as ringworm, are oval or ring-shaped lesions with an itchy, scaly and slightly raised edge around it and more normal-looking skin in the middle. The rash can be found on the scalp, face, body, or nails. Candida infections may occur in babies as oral thrush, with a white coating on the tongue or mouth mucosa or as a shiny red rash in the diaper region (infected diaper rash). Candida infections may occur in children of any age in the folds of skin that tend to be moist, such as under a baby's chin, or as "Athlete's foot" cracked skin between the toes accompanied by itching and sometimes also nail discoloration. 

Scabies

Scabies is a skin infection caused by the itch mite. The female mite burrows into the skin, especially between the fingers, in the wrist area and armpit. Babies can also get scabies on the palms of their hands and the soles of their feet. Scabies causes intense itching, which can lead to the formation of sores, blisters, scabs and the possibility of secondary bacterial infection. Occasionally, it is possible to observe tiny gray burrows in the skin, made by the mite. Scabies is quite contagious, so prompt treatment by your physician is recommended.

Head lice

Lice are insects that lay their eggs while attached to the hairs of the head. The eggs hatch after approximately 1 week. Head lice cause itching of the hair and scalp. Lice are most commonly found on the neck, behind the ears and on the hairline, and can be seen using a lice comb and a magnifying glass. Although quite contagious, it is important to remember that lice do not cause disease, and will not make children sick. Treatment prevents the spread of lice to other children. 

Warts Warts are a common childhood viral disease of the skin. Warts may be any of several types and can be found either singly or in clusters, usually on the fingers, hands and feet. Most warts have a hard, rough surface and are slightly raised up from the surface of the skin, however warts on the sole of the foot are pressed flat by the body weight of the child. Warts tend to disappear on their own without treatment, but they may return. However, warts on the soles of the feet (plantar warts) often require treatment.  

Molluscum contagiosum

Molluscum contagiosum is another common childhood rash, also caused by a virus in the skin.

The rash takes the form of tiny bumps (mollusks) raised above the surface of the skin. They are 2-5 mm in diameter. The color of the knobs ranges from pale red, flesh color to grayish white or yellow. Each bump has a little dent in the center. They usually do not bother the child but may be tender or itchy and the child may tear the skin by scratching, with a resultant risk of infection.

The mollusks can be found all over the child's body; they may appear singly or in clusters. The mollusks usually disappear without treatment, sometimes after a few weeks but they may persist for several months or years. Treatment is not usually recommended.

Eczema

Atopic dermatitis

Atopic dermatitis is a chronic skin rash that affects children, often in families with a history of allergies.

The rash is usually dry and itchy; the skin becomes red, irritated, and scaly. Scratching because of the itch may lead to breaks in the skin, with resultant secondary infection, and scarring.

Seborrhea

Seborrhea, also known as seborrheic dermatitis, affects children under 2, but especially infants up to 3 months. The cause is unknown, but is thought to be a disturbance in the skin's production of sebaceous matter and sweat. Unlike atopic eczema, the rash is not particularly itchy. The rash is dry, red, and slightly flaky. Seborrhea is usually localized to the face, neck, chest, folds of skin, and in the diaper area. Infants may develop yellowish scabs on the scalp, called cradle cap. This rash generally disappears after a few months. 

Contact dermatitis

Contact dermatitis occurs because certain substances such as nickel, cosmetics, creams and detergents may irritate the skin, and cause a hypersensitivity reaction. The skin becomes red and angry-looking, occasionally giving rise to raised papules, or vesicles in the areas of the skin that have been in contact with the offending substance. The rash is often itchy, but may also be moist, with blisters. Contact dermatitis Poison Ivy is an example of a contact dermatitis.  

Diaper rash

Diaper rash is an irritation that occurs in the diaper area when the skin becomes moist, red and irritated because of urine and stool. This irritation can cause tiny openings in the skin, which allow bacteria or fungi to invade, causing secondary infection, which makes the rash worse.

General infections with widespread rashes

Rubella and measles

Rubella and measles have become rare diseases in the US due to the fact that most children are vaccinated against these viruses when they reach the age of 15 months and receive a booster shot between the ages of 4 and 6.

In fact, rubella has been totally eliminated from the United States, but immunization must continue because there is still rubella in other countries.

In addition to a generalized, macular rash, the child will also have a fever, malaise, and cough.

Chickenpox (varicella)

With chickenpox (varicella), the rash begins as red marks on the face and body, which resemble mosquito bites.

Within a few hours, the marks develop into fluid-filled blisters, which later will burst, leaving scabs. Chickenpox is easily recognized because the skin around the vesicles is normal.

In addition, the child often has fever and congestion. The child may also have blisters in the mouth. Chicken pox is quite contagious, and it is common for a number of children, either at home, or in daycare, to have it at the same time.

The rash is extremely itchy. Preventing the child from scratching is very important, as there is a danger of bacterial infection in the skin, which can spread to other organs, if the child scratches excessively. Bacterial infections can also lead to the formation of wounds and scars.

After 5 to 7 days, all the pox will be dry scabs; at this point, the child is no longer contagious. Anti-chickenpox vaccinations are also a part of the recommended vaccination program in the US, so chickenpox has now become less common among American children.

Scarlet fever

Scarlet fever is caused by a streptococcal infection of the throat.

The child usually has a sore throat and a high fever. The rash begins on the body as a reddening with small "sandpapery" bumps throughout the skin. The rash begins on the neck and face and spreads down through the body.

The area around the mouth is often spared and accordingly appears pale. After 5-6 days, the rash disappears and the child's skin often begins to peel, especially on the fingertips. When scarlet fever is suspected, your child should see a physician to be tested for strep throat, and if positive, be treated with antibiotics. 

Mononucleosis

Mononucleosis or mono, is a viral infection, often affecting school-aged children and adolescents. The child usually will have a sore throat and considerable difficulty swallowing, fever and enlarged lymph nodes in his or her neck. The rash is non-specific, pink and most prominent on the torso.

Roseola

Roseola or exanthema subitum, as the disease is also known, is also a viral disease. Typically, roseola causes a very high fever, which lasts 3-4 days, during which time there are few other symptoms. The fever then drops suddenly, and within a few hours the rash appears. The rash is non-specific, pale pink and is most widespread on the neck and chest. The rash is not itchy and it fades when pressure is applied. It disappears within 1-2 days. Typically, the child with roseola will be crankier when the rash appears, than during the time the child had the fever. 

Fifth disease

Fifth disease is another viral disease that begins with mild cold symptoms and fever. The rash only appears after approximately 1 week and the most characteristic feature is significant redness of the cheeks with paleness around the mouth. The child has what is known as a "slapped cheek" appearance. With some children, the rash spreads down the body, but the palms of the hands and the soles of the feet are often not affected. The rash may be itchy and it lasts 1-3 weeks. The rash is not very pronounced, but it can have a "lacy" appearance. Introduction to Fifth disease Girl with Fifth Disease

Hand-foot-mouth disease

Hand-foot-mouth disease is a viral disease most commonly seen in children under 4. It is caused by the coxsackie virus, which produces little vesicles or blisters in the mouth, on the fingers, or on the feet. The disease often causes a fever and the blisters in the mouth may cause the child to have difficulty eating. The disease normally runs its course over a period of a few days, but the sores in the mouth can last longer. Children can get this illness more than once. 

Lyme disease

Lyme disease is caused by an infection transmitted through a tick bite. It may present with a rash 2 to 6 weeks after the tick bite, or with flu-like symptoms (fever, headache, body pains). The rash usually appears as a red, circular area around the tick-bite, which spreads outward, like a target. There may be more than one such circular rash. Lyme disease can present without a rash; and months later cause joint pains, chest pains, headaches, or neurological problems.

Acne

Acne is a common rash in teenagers and is due to the blockage of hair follicles because of an increase in production of sebaceous matter in the skin. This may give rise to localized inflammation of the skin, with red papules, called comedones, or fluid-filled pimples, called pustules.

If not treated properly, acne may become severe, with cysts that can lead to scarring.

Home treatment

• Bacterial skin infections should be treated with a topical antiseptic or antibacterial treatment. Topical treatment is most often sufficient, but sometimes oral antibiotics are necessary. If the lesions are extensive, or spreading, call your child's doctor. 
• With eczema, it is important to remember that it is the dry skin that gives rise to the itching. Frequent use of moisturizer creams and oil baths will soften the skin and help prevent the itching that leads to scratching and subsequent skin damage.
• In children with atopic eczema, the eczema may become aggravated by certain foods. Try to identify these and avoid them if possible. 
• A child's skin is thin and delicate. It is important to avoid strong substances such as detergents and perfumes that may irritate the skin and make it more susceptible to injury and rashes. Avoid soaps with perfumes. Washing an infant's skin with soap that is too strong will strip the skin's natural protective layer of oil. 
• If your child has just started taking a new medicine, and develops a rash, consult your physician immediately. 
• For all rashes that are itchy, and especially eczema, giving antihistamines (such as diphenhydramine) by mouth will decrease the itch, and will often help the rash. Giving antihistamines before bedtime can be especially helpful, because the medicine often will make children sleepy. Avoid antihistamine creams, because they can be irritating to the skin and often make the rash worse. Cool baths with oatmeal (e.g. Aveeno and others) will also ease an itchy rash. After bathing, calamine lotion or a baking soda solution can be applied. 
• For localized itchy rashes, apply 1% hydrocortisone cream if the rash is not due to fungus, chickenpox, or bacterial infection. 
• Avoid letting a child with a rash wear tight-fitting clothing that irritates the skin, thus increasing the itching. 
• Cut the child's fingernails short to prevent scratching and the associated risk of wound infection. 
• Frequent changes of diapers, with good general hygiene, will often prevent diaper rashes. 
• Almost all rashes will get worse in the sun, and after hot baths. Try to avoid these, if possible.

When to seek medical advice

It is difficult to give completely accurate guidance on when to seek medical advice if your child has a rash.

This will depend on a number of factors.

Most important: How is the child's general condition? Does the child have other symptoms or signs of illness? How quickly did the rash appear? Is it localized or is it generalized all over the body? How much does the rash bother your child? Is your child on any medications? Has your child been exposed to any new foods, soaps, or skin products?

See the doctor immediately or call 911 if:

• The child also has a high fever, headache, or vomiting along with the rash. 
• The child has fever with purplish patches or tiny red dots that do not blanch, which may be a sign of sepsis and meningitis. 
• The rash is intensely red and very tender to the touch. This may be a sign of cellulitis. 
• Suspicion that the rash was caused by a medicine. 
• Hives with simultaneous swelling of the face along with possible breathing difficulties or difficulty swallowing. This may indicate an anaphylactic reaction, which is a dramatic and dangerous allergic reaction that requires immediate medical attention. 

Make an appointment with your doctor if:

• Signs or symptoms of illness accompany the rash, that is, the child is not feeling well. 
• The child has a rash with intense itching of the skin. 
• The rash is close to the eyes or affects the eyes. 
• You believe the rash has become secondarily infected with bacteria or fungi. 
• You suspect your child may have the "bull's eye" rash associated with Lyme Disease. 
• You suspect your child has impetigo, which is commonly a secondary bacterial infection of the skin. 
• The rash is accompanied by fever and/or sore throat. 
• Your child has acne or pimples, and treatment with non-prescription medications has not helped. 
• You suspect the rash is caused by an allergy to food, medications, or something in your child's environment. 
• The rash has persisted for more than 3 days, regardless of cause.