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Guide to Rashes

OVERVIEW

Whether it's pink pimples on a newborn's cheeks or fire-engine-red welts on a feverish toddler, a child's first rash can alarm even the most zen of parents. But bumps and blotches are simply our skin's way of reacting to certain irritants, infections or hormonal changes, and generally are not a cause for alarm. "Because their immune systems are still developing, young children are more sensitive to chemicals, viruses and bugs than we are," says Albert Yan, M.D., chief of pediatric dermatology at Children's Hospital of Philadelphia. "As a result, there are hundreds of different rashes they can get."

While inflamed and itchy skin can be annoying, most rashes are harmless and will fade on their own. There are some rashes, though, like eczema, that can cause ongoing discomfort unless treated with medication. Others, like impetigo, a skin infection, are contagious. The following is a field guide to common rashes. Because it can be difficult to distinguish one type from another, it's a good idea to check in with a pediatrician or pediatric dermatologist when your child's skin flares up. If a rash is accompanied by tightening of the throat, trouble breathing, or a fever (over 100.4 for an infant or over 101.3 for an older child), be sure to see a doctor right away.

Quick Guide

Read on for detailed information about all the most common rashes, but if you have no idea what kind of rash your child might have, here's a quickie primer to point you in the right direction:

If your child has?

 

CONTACT DERMATITIS

Symptoms

With contact dermatitis, a patch of tiny, scaly blisters crops up in an area that tends to rub against clothing or jewelry (like the neck, waist, groin or wrist). It can also show up on the hands or face (where the skin may have been touched by a new lotion, cream, plant, chemical, or food), although the rash often starts in skin folds and joints. Contact dermatitis can be very mild and disappear quickly, or produce large, oozing blisters that last for days. In both cases, it can be very itchy but isn't contagious. Diaper rash, drool rash, and poison ivy are two common examples of contact dermatitis.

Causes

Almost any child can develop irritant contact dermatitis (ICD) after prolonged exposure to a naturally irritating substance, like a scratchy clothing tag, drool, or a wet diaper; or from exposure to solvents and acids that can remove the protective oils and moisture in the skin, such as those found in powerful household cleansers. Allergic contact dermatitis (ACD) is less common and tends to surface around age 2 or 3, after a susceptible child has had enough repeat exposures to a substance for his immune system to recognize and react to it. ACD is often traced to perfumed soaps or lotions, topical antibiotics, plants (in the case of poison ivy), metals (like nickel in play jewelry, eyeglass frames, snaps and buckles), or latex (in balloons). ACD can also occur when the skin is exposed to sun after certain substances are applied, like topical antibiotics and sunscreens.

Diagnosis

A doctor can diagnose ICD by examining the rash and asking about your child's diet, habits and home environment. If your child has recurring contact dermatitis, an allergist might perform a patch test for ACD. He'll place small pieces of paper tape containing certain chemicals on your child's back or arm. The doctor will remove the tape 48 hours later to see which chemicals caused a reaction. (The child needs to be old enough -- around 5 or so -- because the test is not as reliable in younger children.)

Prevention

The best way to prevent contact dermatitis is to help your child avoid the irritant; that may mean cutting tags from shirts, for example, or swapping out metal costume jewelry for rubber bangles. For babies, do your best to keep his face drool-free and apply barrier creams. And of course, change dirty diapers as soon as possible (barrier creams helps here, too). If a child with ACD touches an allergen, wash the skin that's been exposed with soap and water immediately to minimize the reaction.

Treatment

The rash should disappear on its own within two to four weeks. In the meantime, a thin layer of over-the-counter 1% hydrocortisone cream (only use as directed) will help relieve itchiness for small patches, but a doctor might prescribe an oral steroid such as Prednisone for severe cases affecting large areas of skin. 

Complementary/Alternative Treatments

To help dry out a weeping wound that's no more than a few inches in length, you can pat it with gauze dipped in an aluminum-acetate-based topical astringent liquid called Burow's solution. Another option is Domeboro powder, a similar aluminum-acetate product you mix with water and apply as a compress. (Both are available over-the-counter in drugstores.) Baths containing colloidal oatmeal can also soothe irritated skin.

Mom's Experience

"When my second child was around 4 months, he started drooling all the time. His chin and cheeks were always broken out in a red, bumpy rash. One thing helped: I'd wash his face in the evening before bed and apply A+D ointment to the rash areas. In the morning, his face would be clear."  -- Tonya Pettet, mom to daughter Logan, 5, and son Foster, 4).

COXSACKIE

Symptoms

The coxsackievirus can harmlessly exist in the digestive tract at any given time and produce no symptoms, however some kids with coxsackie can develop a high fever and telltale tiny, painful, red blisters that make them extremely irritable (and their moms extremely stressed!). The coxsackie strain known as hand, foot and mouth disease, produces blisters on the fingers, toes, gums, tongue, throat or the inside of cheeks. Some children have one or two isolated blisters, others will have dozens. Another type of coxsackie commonly causes an infection called herpangina, which results in blisters that look like red rings in the back of the throat and tonsils. Fever usually lasts two or three days, but the blisters can remain for a week or more. If your child has a high fever for more than a few days, a bad headache and/or a stiff neck, call your doctor. Although rare, she could have viral meningitis, a serious complication of coxsackie that infects the spinal cord.

Causes

The virus spreads easily between people, usually through hand-to-hand contact, sneezes or coughs, or exposure to (eww) fecal matter on common surfaces. It tends to spread most easily during the warmest months of the year. Kids under 5 are most susceptible; older children and adults will often show no or few symptoms when exposed. Because there are several different strains, your child might come down with coxsackievirus more than once.

Diagnosis

A pediatrician can determine whether a child has coxsackie by examining the blisters and assessing other symptoms, like fever. Swabs may be taken and sent to a lab as well.

Prevention

Since coxsackie is highly contagious, clean your child's hands with warm, soapy water (or if you're not close to a sink, an alcohol-based sanitizer) after school, day-care, a visit to the playground, or post-potty. Wash your own hands thoroughly after changing diapers or going to the bathroom, and before preparing food. If one child in your family has the virus, don't allow sibs to share food or drinks until more than 24 hours after the fever has broken. A couple times a day, wipe down toys and hard surfaces in the house with hot, soapy water or a disinfecting spray.

Treatment/Medication

There's no medication to cure coxsackie, but blisters heal in a week or two on their own. In the mean time, you can help bring down a fever and reduce the pain from blisters with acetaminophen or ibuprofen. If your child has neck pain or a severe headache along with symptoms, or a fever lasting more than a few days, see a doctor immediately to rule out viral meningitis, which can lead to brain damage and death, and should be closely monitored by a physician. Call your doctor if your child has a fever of over 100.4, nausea or vomiting, abdominal discomfort, difficulty breathing, or sores inside the mouth.

Complementary/Alternative Treatments

Cold dairy products like milk, ice cream and yogurt can help soothe blisters in the throat (avoid acidic drinks like orange juice, which can irritate them). You can also dip a cotton swab in a mixture of one teaspoon Benadryl (oral diphenhydramine) and one teaspoon liquid antacid (like regular Maalox, not Maalox Total Relief) and gently swab it over your child's mouth sores a few times a day, which may reduce pain. (Check with your doctor before trying this solution to make sure you aren't using too much; diphenhydramine can be absorbed through the skin, so there's a risk of overdose.)

 

CRADLE CAP

Symptoms

Similar to dandruff in adults, cradle cap is when the skin on a newborn's scalp gets dry and flaky, or forms oily, white or yellowish scales. Red patches can appear where scales have flaked off. It usually doesn't bother babies (but it can be unsightly, irking nervous new moms).

Causes

No one is exactly sure what causes cradle cap, though some experts think that an excess of mom's hormones at the end of pregnancy may overstimulate the baby's oil-producing glands, causing cradle cap's greasy crust.

Diagnosis

Your pediatrician can diagnose cradle cap. If there's any question, she might refer you to a pediatric dermatologist who can rule out a fungal infection or psoriasis, conditions that also produce yellow scales.

Prevention

Washing your baby's scalp and hair every few days with a mild shampoo may help prevent the cradle cap buildup. It's not contagious. 

Treatment/Medication

Cradle cap usually goes away on its own within a few weeks. In the meantime, washing your baby's hair with a small amount of an over-the-counter mild baby shampoo can help eliminate flakes. Do not use a dandruff shampoo without first consulting your physician. Lather up (being sure to keep it out of baby's eyes), let the suds sit for five minutes, and then rinse and gently brush out the flakes with a fine-tooth comb. If cradle cap persists or spreads to other areas, like the eyebrows or folds of skin, ask your pediatrician or a pediatric dermatologist about a prescription cream.

Complementary/Alternative Treatments

Try gently rubbing scales with mineral, olive, or apricot oil and then softly brushing away flakes before washing hair. 

DIAPER RASH

Symptoms

Your baby may seem extra fussy (especially on the changing table) and might try to reach inside his diaper. You open the diaper to discover small pink or red pimple-like bumps or welts around his bum, genitals, or lower belly. Tiny blisters, which can ooze, can sometimes appear too. Some diaper rashes are caused by yeast infections, which will look like bright red patches edged with red spots, usually concentrated around the skin folds of the genitals or belly.

Causes

Almost all children can develop diaper rash, a type of contact dermatitis, if their skin is in contact with a very wet or dirty diaper long enough. Wet skin is more susceptible to irritation from acids in poop and urine. Some children, due to sensitive skin or food allergies or sensitivities, are more prone to diaper rash than others. Diarrhea may also cause diaper rash. 

Diagnosis

Since diaper rash is so common, you'll probably be able to diagnose and treat it on your own (but show your ped at your next well-baby visit, just in case). See a doctor if diaper rash develops open sores, is bright red with dots at the edges (suggesting a yeast infection), or is accompanied by a fever (indicative of cellulitis, a bacterial infection that requires antibiotics).

Prevention

The best way to prevent diaper rash is to change diapers as often as possible -- especially if your baby has diarrhea. During every change, clean the baby's bottom thoroughly with warm water or a fragrance-free wipe, and then gently blot his skin with dry gauze or tissue until it's completely dry. (You can also let his bum air-dry for a few minutes, but watch out for unexpected showers!) Applying a thick layer of a petroleum or zinc-oxide-based barrier cream, before putting on a fresh diaper can also help. 

Treatment/Medication

Use warm water or a squirt bottle to clean the irritated diaper area at every change, and let your child's bottom air out whenever possible. Before diapering, apply a thick coating of a zinc oxide-based cream to protect the rash from further moisture, which can make the rash even worse. You can also ask your doctor for advice about using a mild, topical steroid cream for more severe cases. If you suspect a yeast infection, see a doctor, who can prescribe an anti-fungal cream like over-the-counter clotrimazole (Lotrimin) or prescription nystatin to apply at every diaper change until the rash disappears. If your child has rashes in the diaper area that don't respond to conventional treatments, see your doctor to make sure the rash isn't related to another condition.

Complementary/Alternative Treatments

A daily serving of yogurt or acidophilus, an oral probiotic sold at drugstores, might stave off diarrhea and fight yeast. Ask your pharmacist for a formula and dosage that's safe for babies. 

Mom's Experiences

"My youngest son used to get diaper rash so severe he would bleed. I tried hypoallergenic diapers, yogurt, baking soda and vinegar baths and so on. But it wasn't until I eliminated juice from his diet that he started having less diarrhea, and the rashes cleared up." -- Denise Saylor, mom to boys, a 2-year-old Storm  and 21-year-old Coalton

"My pediatrician taught me this trick: glob Desitin's original diaper cream on your baby's bottom as thick as the icing on a cupcake, and then glob on Vaseline over the Desitin. It will be a huge white mess, as if you just sprayed whipped cream all over your kid's tush. However, the goal is to create a barrier between the skin and the moisture from the wet diapers. Then, when you change the baby, you don't need to wipe, unless it's a poopy diaper. It always worked for me."  -- Brady Pendleton, mom to Catherine, 3, and  Kenneth, 6 months

ECZEMA

Symptoms

Affecting between 10 and 20 percent of kids, eczema (also known as atopic dermatitis) usually surfaces in the first few months of life. Dry red patches with small bumps usually appear first on the face or scalp, and may ooze, crust over, and itch badly. The rash may spread to the arms and legs, often resulting in circular, dry, slightly raised red patches on the elbows, knees, or on the hands and wrists. (Eczema can also sometimes produce a wet, weepy rash.) Symptoms often improve starting around 5 years of age, after which a child might experience only occasional flare-ups.

Causes

No one knows the true cause of eczema, but we do know it tends to run in families. Seasonal allergies, heat, and stress can also trigger eczema.

Diagnosis

There's no test that definitively diagnoses eczema. A pediatrician or pediatric dermatologist will make the call by examining the rash and asking about a child's medical history, since eczema is often inherited and many children with eczema also develop allergies and/or asthma.

Prevention

You can't prevent your child from developing eczema, but you can try to control outbreaks by helping your child avoid things that tend to trigger it. Common irritants that bring on or worsen eczema include fragranced soaps and lotions, perfumes (especially those that contain alcohol), mold, pet dander, pollen, rough fabrics, and food sensitivities (egg white is the most common culprit). Dry winter air can be a trigger too, so keeping skin moist in the wintertime with mild, creamy soaps, fragrance-free lotions, and humidifiers can help.

Treatment/Medication

Your doctor will likely prescribe a topical corticosteroid cream to control outbreaks and itching. Oral antihistmamines like Benadryl (diphenhydramine) may also be used to reduce scratching, which can make eczema worse and possibly open the skin up to infection. Chronic and recurrent eczema that requires ongoing therapy may require other treatments since ongoing steroid use can cause thinning of the skin and other side effects. Other second-line prescription treatments for children age 2 or older may include a short-term regimen of topical calcineurin inhibitors, like Elidel (pimecrolimus) cream or Protopic (tacrolimus) ointment. Milder non-steroidal agents such as Atopiclair (a topical anti-inflammatory) cream or EpiCeram (ceramide-containing cream) may be more friendly to a baby's skin.

Complementary/Alternative Treatments

Since eczema outbreaks can sometimes be triggered by emotional stress, you can ask a doctor or a pediatric psychologist about relaxation exercises that can help your child through challenging times. Encouraging your child to drink more water (give him a cool-looking bottle to carry around during the day) and feeding him a diet rich in healthy fats (with foods like fish, walnuts, some fortified eggs, and flax seeds) may also keep skin more supple and less prone to eczema.

Mom's Experience

"We've suffered for seven years with eczema. Our daughter had it since birth and we found that although steroid creams were helpful for severe outbreaks, Spectro Kids EczemaCare cream from Canada works like magic. The other product we have used with success is called Oilatum Bath Oil. We also found that switching to preservative-free and dye-free foods helped quite a bit. At 7, our daughter's eczema seems to be going away, but we still use these products." -- Angela Mantie, mom to Ellamay, 7 and Adeline, 2

FIFTH DISEASE

Symptoms

Bright red cheeks that looked like they've been slapped are the hallmark of fifth disease, which usually strikes kids between the ages of 5 and 15. The illness begins with a low-grade fever and mild cold symptoms, usually lasting just a few days. The facial rash, which can sometimes itch, usually appears after these symptoms seem to be going away, and spreads from the face to the rest of the body, often sparing only a child's palms and soles of the feet. The rash then develops a lacy appearance, and can take up to three weeks to clear. Older kids often get achy joints too.

Causes

Fifth disease is caused by parvovirus B19, which usually makes the rounds in late winter and spring. It's estimated that 40 to 60 percent of adults have contracted the virus at one point or another, and that only some people experience noticeable symptoms.

Diagnosis

A doctor can typically diagnose fifth disease by its lacy distinctive rash, but if there's any doubt, he can perform a blood test to check for parvovirus B19.

Prevention

You can do your best to avoid parvovirus B19 by keeping your children's hands clean with frequent washing and the use of sanitizer when no soap and water is available. Kids are contagious just before and during the flu-like symptoms, but usually don't pass on fifth disease once they develop the rash, which is the body's immune response to the virus. People who've had fifth disease once typically won't get it again.

Treatment/Medication

There's no cure for fifth disease. As with most mild viruses, rest may be all that's prescribed. Acetaminophen or ibuprofen can be used as directed to relive fever and aches. Your doctor may prescribe Benadryl (diphenhydramine) if the itching from the rash is severe. Children with weakened immune systems or certain blood disorders may require hospitalization, as they can develop severe or chronic anemia with parvovirus B19.

Complementary/Alternative Treatments

Ensuring kids get adequate sleep and good nutrition through a well-rounded diet may keep their immune systems strong, helping to combat viruses.

HIVES

Symptoms

Hives (also known as urticaria) are slightly raised, itchy red welts or blotches that tend to appear suddenly. A welt can stand alone or in clusters, and can be smaller than a thumbprint or bigger than the palm of your hand. They can appear anywhere on the body, and can disappear in one place only to show up in another, lasting anywhere from a couple minutes to several days. Hives are considered acute when they last for less than a day to up to six weeks; chronic hives can occur for months at a time.

Causes

Affecting an estimated 3 percent of preschool-age kids and 2 percent of older children, hives are produced when an irritant causes our body to produce histamine, which can leak from the blood vessels and pool underneath the skin, leading to welts. For many kids, that histamine release is triggered by allergies to things like nuts, shellfish, eggs, berries, milk, certain antibiotics, or insect bites, but others can get blotchy from exposure to sun, a sudden blast of cold air or exposure to cold water, viral infections, or stress. 

Diagnosis

A doctor will examine the rash and ask about your child's diet, habits and family history of allergies to diagnose hives. 

Prevention

Once you know what brought on an episode of hives, you can talk to your doctor about ways to avoid the triggers. It might require eliminating some foods from your child's diet, switching medications, using insect repellent, wearing sun-protective clothing, or avoiding sudden cold temperatures. 

Treatment/Medication

For an acute attack of hives, an over-the-counter oral antihistamine like Benadryl (diphenhydramine) or Zyrtec (cetirizine) can bring down swelling and reduce itching. If these make your child too drowsy, you can also try the non-sedating antihistamines like Claritin or Alavert (loratadine).  Applying 1% hydrocortisone cream to itchy welts can also be soothing.

Complementary/Alternative Treatments

Ask a doctor or a pediatric psychologist about relaxation exercises if your child's hives tend to be brought on by stress.

Mom's Experience

"My five-year-old breaks out in hives fairly regularly. I keep liquid Benadryl and hydrocortisone cream handy at all times. As soon as the hives come on, if we are home, I put her into a cool bath, then we apply cream and take a 1/2 dose of Benadryl. If we are not home, the cream is in my purse and ready to apply."  -- Paige Shoven, mom to Elizabeth, 8, and Kara, 5 

IMPETIGO

Symptoms

An infection of the skin that can occur if bacteria gets into a cut, scrape, or bug bite, impetigo shows up most commonly on the face, arms and legs. (Though less common, impetigo can also occur in perfectly healthy skin.) The telltale red sores often start small, around the size of a pimple, but can grow as big as a quarter and will burst, ooze, and form a honey-colored crust. Although sores are itchy, they aren't painful. 

Causes

Staphylococcus aureus (staph) bacteria cause the majority of impetigo cases but streptococcus pyogenes (strep) can be the culprit as well. These bacteria enter the skin through a cut or other wound, releasing a toxin that disrupts the binding of skin cells.

Diagnosis

Your pediatrician will examine the sores, and ask about any recent skin injuries. A biopsy and culture may also be necessary to confirm the diagnosis or rule out something more serious.  

Prevention

To keep infection at bay, keep boo-boos clean, and apply antibiotic ointment. To prevent impetigo from spreading throughout your household, wash your infected child's sheets, clothes and towels. You can help keep it from spreading to other parts of your child's body by cutting fingernails so they can't scratch the sores, and covering the spots with a bandage.

Treatment/Medication

Because impetigo is very contagious, be sure to keep your child home from daycare, school, and camp, and keep her out of swimming pools, until she has seen a pediatrician. The physician will prescribe either a topical antibiotic, like mupirocin (if the infected area is small), or an oral antibiotic, like cephalosporin. (After 24 hours on antibiotic therapy, your child can return to normal activity.) Again, bandaging the infected area can keep impetigo from spreading and remove the temptation to touch. 

Complementary/Alternative Treatments

Your doctor might suggest removing crusts from the sores to get rid of the bacteria that's collected underneath. Soaking in a vinegar solution (made with 1 tablespoon of white vinegar to 1 pint of water) may help soften scabs for gentle removal (but don't scrub). Then apply antibiotic ointment. 

PETECHIAE

Symptoms

Tiny red, brown or purple spots, about the size of a pin-prick, that appear under the skin are petechiae (also called purpura). These spots are flat and don't itch or blanch (turn pale) when you press gently on them. A child may have just a few spots or clusters of them, often appearing on the face, chest, stomach or feet. 

Causes

Petechiae are caused when tiny blood vessels burst underneath the skin. Kids can develop them after a bout of coughing or vomiting, usually on the face. But widespread petechiae can be associated with serious disorders as well. These include idiopathic thrombocytopenia purpura (ITP), a blood-clotting disorder that may follow a viral illness, or meningococcal disease, which can cause meningitis, a bacterial infection of the lining between the brain and the skull, or meningococcemia, a widespread bacterial infection of the bloodstream. 

Diagnosis

It's important to see a doctor when your child has petechiae, especially if he hasn't been vomiting (which would indicate a less-scary virus), and the spots are below the chest. Blood tests can be performed to diagnose ITP or meningococcal disease. 

Prevention

The Hib vaccine will protect your child from meningitis, but there's not much you can do to avoid most other sources of petechiae. 

Treatment/Medication

Petechiae will fade on their own, but it's important to treat what's causing the spots. Ask your doctor about medications or therapies for vomiting, or a chronic or heavy cough. More serious underlying conditions may need to be treated in the hospital. 

POISON IVY 

Symptoms

You probably remember the rhyme from when you were a kid: "Leaves of three, let them be." The rash caused by the poison ivy plant is red, raised, and can have small bumps and blisters. It usually appears a day or two after exposure and may even show up in streaky lines from the way your child brushed against the plant. A case of poison ivy can be almost unbearably itchy. Poison oak (which also has three leaves) and poison sumac plants also produce the same reaction.

Causes

Kids who develop this rash are experiencing an allergic reaction to the urushiol oil that's in poison ivy, poison oak, and poison sumac. About 85 percent of the population is allergic to urushiol, and will develop the rash when exposed. (Never had it? Don't get cocky -- the sensitivity can develop at any time.) 

Diagnosis

Examining a child's skin and learning about his recent encounters with nature will help a doctor diagnose a poison ivy rash. 

Prevention

Teach your child to recognize dangerous plants and avoid them. Poison ivy has three glossy leaflets with toothed or smooth edges. Poison oak has a trio of dark green, fuzzy leaves that are lobe-shaped. Poison sumac has seven to 12 smooth edged leaflets per plant. Have kids wear long sleeves, pants, and socks or tall boots if they're going for a walk in the woods. If you suspect your child has accidentally brushed against one of these plants, wash his skin and clothes immediately (the urushiol oil can remain in the clothes indefinitely and reinfect him if they're not washed). You don't need to worry about keeping your child away from someone with a poison ivy rash, however; it's not contagious. 

Treatment/Medication

Poison ivy rash usually goes away on its own in one to three weeks. Meanwhile, over-the-counter hydrocortisone cream (1%), calamine lotion, and over-the-counter Benadryl (diphenhydramine) can help control the itching -- important because if a child has germy fingernails and scratches an open poison ivy wound, it can develop a bacterial infection that requires antibiotics. If the rash is widespread or affects a sensitive area such as the eyes, mouth, or genitals, see a doctor who may prescribe an oral corticosteroid such as prednisone.  

Complementary/Alternative Treatments

Dab the rash with white vinegar several times a day, apply cool compresses regularly, and have your child soak in an oatmeal bath. 

PSORIASIS

Symptoms

The most common form, plaque psoriasis, appears as raised red lesions covered with a silvery film. It often occurs on the elbows, knees, and lower back, but can appear on any part of the body. The plaques may be itchy or painful. Psoriasis is a chronic condition that usually first strikes in the teen years, but 20,000 children in the U.S. under age 10 will be diagnosed with psoriasis each year. Guttate psoriasis, another form that's more common in children, is usually triggered by a bacterial infection (often strep throat) and appears as smaller (up to 1 cm), scaly patches on the trunk, limbs and scalp. Though rare in babies, psoriasis is sometimes misdiagnosed as diaper rash or cradle cap

Causes

Normally, the life of a skin cell is about 28 days. Psoriasis is an autoimmune disorder that causes a person to develop these cells at a faster rate than normal, leaving a buildup at the skin's surface. There's a strong genetic component: about 1 in 10 kids with a parent with psoriasis will develop it too.

Diagnosis

A doctor can diagnose psoriasis by examining the lesions and learning about a child's family history of the disease. A skin biopsy, which involves removing a small piece of affected skin for examination under a microscope for confirmation, may also be done in the doctor's office with the help of local anesthetic. 

Prevention

Because up to half of psoriasis cases in kids follow an infection, particularly strep throat, children who are at risk for the condition should take extra care to wash or sanitize their hands regularly, and avoid people who are sick.  

Treatment/Medication

There's no cure for psoriasis, though mild, topical prescription steroid creams can help lesions heal more quickly and control outbreaks. If the psoriasis was triggered by an infection, your child might also need a course of antibiotics. You can ask your doctor about other medications; there are some that are prescribed for kids even though they have not yet received FDA approval for children under 18. 

Complementary/Alternative Treatments

Sunlight can speed healing. Talk to your child's doctor about safe ways to expose her to the sun (sunscreen should still be used on unaffected skin), and about UVB sunlight therapy, which can be administered in a physician's office. Avoid sunburns, which can trigger a bad flare-up of psoriasis. Oatmeal baths and aloe vera gel might help soothe itchy, painful skin.

ROSEOLA

Symptoms

For the first few days of roseola, a high fever might be the only symptom. Some kids might also have mild cold-like symptoms, a smaller appetite than normal, and will be fussy. But after a roseola fever breaks (usually in a few days, but it may last a week), a rash of pink or red flat or slightly raised spots, often with a lighter halo at their edges, appears on the trunk and may spread to the face and limbs. The rash can disappear within hours or a couple of days, and isn't itchy or uncomfortable. 

Causes

Roseola is a virus, spread by coughing, that tends to affects kids between 6 months and 2 years. Once a child has roseola, he probably won't get it again. After exposure to the virus, it can take a week or two for symptoms to appear. 

Diagnosis

A child's age and fever symptoms often lead a doctor to suspect roseola, but it usually takes the appearance of the rash to make a definitive diagnosis. There's no blood test to confirm it, although with a high fever, your doctor might order a test to make sure a more serious bacterial infection isn't the culprit. 

Prevention

Roseola is extremely common, contagious, and often spread by coughing. Make sure your child cleans his hands frequently with soap and water or sanitizer, and discourage the sharing of food or drinks when a sibling or friend is feverish. Once a child is in the rash phase, he can no longer spread roseola. 

Treatment/Medication

Since it's a virus, there's no antibiotic for roseola, but acetaminophen or ibuprofen can be used to bring a high fever down and make a child more comfortable. Up to 15 percent of kids with roseola have a febrile seizure, which usually last for a minute or two and won't harm the child (just make sure your child isn't somewhere where he can fall or hit his head). Call your doctor after a seizure occurs, or call 911 if a seizure lasts more than 10 minutes, or if your child has trouble breathing. 

Complementary/Alternative Treatments

Kids with strong immune systems due to adequate sleep and a well-rounded diet may be able to better fight viral illnesses like roseola.

Mom's Experience

"My daughter's roseola started as a low-grade fever on a Wednesday when she was 17 months old, and it kept getting higher and higher until it was about 103 on Friday. Motrin kept her fever in check, but she was really cranky when the fever was high. On Saturday, the fever broke, and on Sunday, there was the rash -- light red dots on her face, head, neck and chest that didn't seem to bother her at all."  -- Jo Ann Lucas, mom to Sienna, 18 months

SCARLET FEVER

Symptoms

Resembling a bad sunburn, a scarlet fever rash is made up of close clusters of tiny red bumps that start on the neck and face, spreading downward to the back, chest, arms and legs. The rash will leave a ring of normal-looking skin around the mouth and red streaks in the skin folds, and be itchy. Kids with scarlet fever may also have a whitish tongue; a sore, red throat, sometimes with red spots or white patches; a fever over 101; and swollen glands. 

Causes

Scarlet Fever, also known as scarlatina, is most common in school-age kids. It is caused by group A streptococcus bacteria, also the cause of strep throat, which is why kids with a scarlet fever rash usually have a bad sore throat too. Rarely, children with the streptococcal skin infection impetigo can also develop a scarlet fever rash.  

Diagnosis

Doctors can gently and quickly swab a child's throat and send the material to a laboratory to test for strep, which can confirm that a rash is indeed scarlet fever. 

Prevention

A scarlet fever rash itself isn't contagious, but the bacteria causing it can be spread through sneezing and coughing. (If the rash is linked with impetigo, however, a child can pick up the infection through touching an affected child's skin.) Kids can easily pass the streptococcus bacteria to one another, so it's important that children don't share food, drinks or toys with an infected child until he's been fever-free for at least 24 hours. Keep hands clean with frequent hand washing or sanitizing, especially during the colder months, when strep tends to spread. 

Treatment/Medication

Antibiotics can kill strep bacteria, which will ease rash, fever, and throat symptoms. You can also give a child acetaminophen or ibuprofen to bring down a fever and reduce throat and swollen gland pain. 

Complementary/Alternative Treatments

A warm (but not hot) bath containing oatmeal, like Aveeno, might calm an itchy scarlet fever rash. Cool, non-acidic drinks and cold, soft foods like ice cream and yogurt will feel good on a sore throat. 

Mom's Experience

"I was giving my son a bath, and I noticed he had a bright red rash across his torso. He'd also had a slight fever for the last day, and something in the back of my brain just clicked -- red rash, fever...could that be scarlet fever? So I brought him to the pediatrician the next day and sure enough they diagnosed him with streptococcus. They gave me some antibiotics and it went away pretty quickly." -- Alyssa Shaffer, mom to Nolan, 5 

AT THE DOCTOR

You can help your child's pediatrician or pediatric dermatologist diagnose a rash more quickly and effectively if you come to the visit with detailed information about the flare-up. Before you leave for the doctor's office, jot down answers to the following questions:

  • How long has the rash been present?

  • Where on the body did the rash start?

  • Have there been any other symptoms with the rash, such as fever, cough, runny nose, itching, scratching, or trouble sleeping?

  • Are any other family members affected with similar conditions?

  • What treatments have been tried, and for how long?

Dr. Yan of Children's Hospital Philadelphia also suggests that you bring in medications that have been used on the rash before. "It can be hard to remember the exact name and dosage of a medication used, so bringing in the actual bottle or tube can be key," he says. In case your child needs a skin biopsy, bringing along some of his favorite toys or comfort items is also a good idea. "The doctor will typically use a numbing cream, which will help with the discomfort, but distraction is great during the procedure itself,"  says Dr. Yan. "Reading stories, blowing pinwheels, playing a video game, even singing can help."
 

AGE-BY-AGE GUIDE  

0-6 Months

  • Newborns can be born with petechiae caused by pressure on the face during birth, but be sure to have flat pin-prick-sized red, brown or purple spots evaluated immediately to rule out an underlying infection.

  • Children are most vulnerable to the irritant contact dermatitis (ICD) as newborns, because their skin is very thin and sensitive.

  • Cradle cap is common in the first months of life, and will usually clear up on its own.

  • Around two months, a child may develop the first signs of eczema in the form of itching or redness on the face and head.

6-12 Months

  • This is prime time for diaper rash, after a child has started eating a wide variety of new solid foods, which can cause skin-irritating diarrhea.

12-36 months

  • Allergic contact dermatitis (ACD) tends to surface at this age, as a child's immune system can now recognize and react against substances to which he's had repeated exposure.

  • This is prime time for roseola; it usually affects children by age 2. 

3-5 years

  • An estimated 90 percent of children with eczema will have had symptoms before age 5.

  • After age 3, an infection from the strep bacteria causes stronger symptoms and more severe throat pain, so now is the time you want to start to be on the look out for strep throat and strep-related rashes which require antibiotic treatment. 

6-12 years

  • By kindergarten, almost all children have already contracted roseola, and most likely won't get it again.

  • Coxsackie is most often seen in kids 10 and under.

  • Most kids with eczema will experience a dramatic improvement by grade school.

  • Ear piercing is the main cause of nickel allergies, a type of allergic contact dermatits, and the risk increases with the number of piercings.

  • This is the prime age for fifth's disease

Adolescence

  • The risk of getting fifth disease drops significantly after age 15.

 

SUPPORT

National Eczema Association
This highly informative site by the National Eczema Association gives parents tools, tips and research news about eczema in kids.

National Psoriasis Foundation
The National Psoriasis Foundation addresses the unique social and emotional issues children face when dealing with psoriasis.

Skincarephysicians.com
This site from the American Academy of Dermatology provides research-driven information and advice about eczema, psoriasis and more.

Skinsight.com
You can compare your child's skin issue to examples of common rashes in these physician-supplied photos. Gross? Yes -- but very helpful when you're trying to diagnose in the middle of the night.

KidsHealth.org
Older children can learn all about their rashes at this kid-friendly site of The Nemours Foundation, which provides support and research for children's hospitals.

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