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Rash Decisions: How to Soothe Kids' Skin

One minute, your child seems fine. The next, she's scratching at an angry-looking rash, and you've shifted into amateur-M.D. mode to try to figure out the cause of those itchy, red patches. The wilderness hike she took last week? The new shirt she wore yesterday? To the rescue: our figure-it-out guide to the usual types of skin upsets.

The Could-That-Be-a-Pimple? Outbreak

You've always loved (and envied) your 7-year-old's clear complexion, but one day, you notice a small, red bump or two on her face. "Those pimples are a very early sign of the hormonal changes of puberty," says Susan Boiko, M.D., a staff dermatologist with Kaiser Permanente in San Diego. "Small pimples and whiteheads can appear even in five- and six-year-olds."

What it looks like

Usually, one or two small blackheads or pimples (with or without a tiny, pus-filled whitehead) on the nose, cheeks or forehead. About half of all 10-year-olds will get them. Big, pus-filled bumps and cysts are unusual, however, even in a 12-year-old, and can be a sign of potentially scarring acne that requires medical intervention.

Treatment tips

Most minor eruptions will clear up on their own, so let them be. For more frequent breakouts, a dab of an over-the-counter product containing five percent benzoyl peroxide will dry up the spots.

Prevention plan

Get your child in the habit of washing her face at night with a gentle cleanser like Cetaphil (if her skin is very oily, have her use an acne soap) to exfoliate dead skin cells and remove the surface dirt.

The Post-Scrape Infection

Your 10-year-old got a small cut on his leg two weeks ago, and now the wound is covered by red bumps and blisters. Even minuscule scratches can become infected with bacteria—usually streptococcus or staphylococcus—and turn into a skin infection called impetigo.

What it looks like

Red bumps that develop into small, pus-filled blisters. When the blisters rupture, they leave soft, honey-colored scabs. "Impetigo is most common on the face, arms and legs, but it can happen anywhere there's been a scrape—even one too small to see," says Anthony J. Mancini, M.D., a pediatric dermatologist at Children's Memorial Hospital in Chicago and an assistant professor at Northwestern University School of Medicine.

Treatment tips

Impetigo will usually clear up on its own. But because it's very contagious, be sure to take your kid to the pediatrician, who will prescribe either a topical antibiotic, like mupirocin (if the infected area is small), or an oral antibiotic, like cephalosporin. Although impetigo usually doesn't leave scars, it can if your child picks at the scabs.

Prevention plan

Encourage your youngster to wash his hands frequently and keep his nails short. "You can harbor bacteria underneath your nails, and if you scratch a bug bite or scab, it can become infected," says Dr. Mancini.

The Circular Rash

Your 5-year-old wakes up one morning with a weird, circular rash on her torso. Maybe it's a bug bite, you think. But a more likely cause is ringworm, a fungus (not a worm) that children pass along through skin-to-skin contact. Although once thought to be under control in the U.S., ringworm is on the rise and affects up to 15 percent of kids ages 5 to 10. "If you have a new kitten and your child breaks out in a rash, suspect ringworm, because children often get it from touching pets," says Susan Mallory, M.D., professor of dermatology and pediatrics at Washington University School of Medicine.

What it looks like

Red, scaly patches with normal skin at the centers. Ringworm of the scalp, however, looks like mild dandruff but often causes patches of hair loss and enlarged lymph nodes at the base of the hairline.

Treatment tips

An over-the-counter antifungal cream, clotrimazole, is used twice daily for two weeks. The scalp version requires a prescription oral antifungal medicine.

Prevention plan

Since ringworm of the scalp is often passed along on brushes, combs, and hats, warn your child not to share these items with her pals. While there's no absolute way to prevent body-to-body transmission, you should have pets and other family members tested if your child comes down with the fungus. "Even if you don't have symptoms, you can be a carrier and pass it along to other people," warns Dr. Mancini.

The Bumpy-Palm Problem

Your 8-year-old decides to hold your hand for the first time in months, but instead of sharing a tender moment with your youngster, you become alarmed at several odd bumps on his fingers. "Warts are a common viral infection," says Dr. Boiko. "About one third of school-age kids get them."

What it looks like

There are two types: a flesh-colored bump with a rough texture and, often, little black dots inside (blood vessels that have clotted off), and a flat wart, which looks like a pink, waxy spot. Both kinds can appear anywhere on the body but are most likely to crop up on the hands and the soles of the feet.

Treatment tips

Apply an over-the-counter salicylic acid product, such as Compound W, daily (except on the eyelids or the lips). Covering the wart with a Band-Aid also helps. If it doesn't go away in a month or is painful, inflamed or bleeding, see your doctor. "For a wart on your child's face, tongue or gums," says Dr. Boiko, "ask the pediatrician or a dermatologist about removing it by freezing it with liquid nitrogen."

Prevention plan

Since warts can be caused by any one of 80 viruses, there's no surefire way to avoid them, but you can keep them from spreading with prompt treatment. "Having your kids wash their hands thoroughly and frequently is the best defense," says Dr. Boiko.

The Corner-of-the-Mouth Malady

Shortly after your 12-year-old got braces, she started getting irritated, cracked patches of skin around her mouth. What gives? "It's a rash called perleche, and it's caused by excessive drooling," says Dr. Mancini. "Yeast likes to grow in these moist areas and often sets up a secondary infection."

What it looks like

Red cracks in the corner of the mouth, sometimes accompanied by white discharge.

Treatment tips

You can try two over-the-counter products together—a hydrocortisone cream and an antifungal, like clotrimazole—or ask your doctor for a prescription product, Lotrisone, that combines the two. Apply twice daily.

Prevention plan

Though your child will probably outgrow the condition, encourage him to blot the area to keep it as dry as possible in the meantime.

The Great-Outdoors Irritation

When your 11-year-old starts itching at a red spot on his legs, you might not suspect that last week's camping trip is the culprit. "The timing can really throw people off: It's possible to break out as late as ten days after being exposed to poison oak, ivy or sumac," says Dr. Mancini.

What it looks like

Itchy red bumps and blisters that form streaks, usually on the legs and arms. The rash is an allergic reaction to the resin of the plants and typically lasts about three weeks. (Many boys who get the sap on their hands unwittingly transfer it to their genitals when they go to the bathroom.)

Treatment tips

Apply cool compresses several times a day, as well as an over-the-counter hydrocortisone ointment or calamine lotion. Steep and cool some tea bags, and apply them to the rash; the tannic acid will help dry it up. An oral antihistamine can quell the itching so he doesn't get a secondary infection from scratching. For very severe cases, see your pediatrician or a dermatologist, who might prescribe stronger medication, such as steroids.

Prevention plan

Try Ivy Block, a lotion specifically formulated to prevent the skin from absorbing the plants' resin. Be sure to show your child pictures of common itch-inducing plants and teach him the rhyme "Leaves of three, let it be." When you see poison ivy, oak or sumac in the wild, point it out. Carry moist, alcohol-based towelettes when hiking, so if your kid brushes against a rash-causing plant, you can swab the resin off his skin (which can minimize—and sometimes even prevent —an outbreak). When you get home, wash the area with either soap and water or an over-the-counter product designed to counteract the sap, like Ivywash. Be sure to launder all the clothes he was wearing in hot, soapy water.

The Unsightly-Elbow Effect

You're giving your 6-year-old a bath when you notice her elbows look dirty and have odd bumps on them. No matter how hard you rub, they don't seem to get clean. "That's because they're not actually dirty," says Dr. Boiko. Your child has elephant elbow, a condition caused by friction from scratchy clothes and sun exposure; it strikes a lot of kids who spend the better part of the day playing outdoors.

What it looks like

Clusters of raised, colorless bumps on the elbows. The skin appears rough, dry and dirty.

Treatment tips

Apply a hydrating cream in the morning and at night, preferably after a bath or shower.

Prevention plan

Use moisturizing lotion daily to keep skin hydrated, and make sure your kid puts on a thorough coat of sunscreen before going outside. Wearing clothing made of soft fabrics, like cotton, also helps.

Ginny Graves, a mom of two, lives in the San Francisco area and is the author of Pregnancy Fitness. She covers health and fitness for many national magazines.

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