My Child Has a Rash

Rashes in children are quite common and can have multiple causes. Sometimes a specific rash is associated with a specific illness or exposure, such as chicken pox or a bug bite. Other times a rash may present with no other symptoms and finding the etiology can be quite challenging! Most rashes will be nonspecific in presentation and may be due to multiple things including infections, new food/environmental exposure, medications, systemic illnesses, or even exposure to cold environments. Unfortunately, rashes are difficult to diagnose over the phone and usually require an office or telehealth visit to evaluate. In most cases a rash that is bothersome or associated with significant symptoms such as fever, vomiting, headache, and sore throat should be seen in the office sooner than rashes that are not bothersome and lack other symptoms. Some common rashes that can usually be taken care of at home initially will be discussed below. As always if there is any question if the child needs to be seen, please call the office to speak with one of our health care providers.

Diaper rash

Typically, the reason for diaper rash is frequent pooping/diaper changes in an infant that causes irritative damage to the skin around the anus. In this case diapers should be changed often, and excessive wiping of the area should be avoided. Wiping takes essential oils and protective skin cells away and leads to further irritation. Skin should be mostly dabbed with perhaps one gentle wipe at the end of the changing. A generous amount of barrier cream such as Desitin, Balmex, or even Vaseline should be applied. There is no need to get every bit of cream off the area with the next diaper change, just remove the contaminated cream by dabbing and apply more over top. If the rash does not resolve after a few days with these interventions or becomes very bothersome, an office visit should be made.

Hives

The causes of hives are almost as varied as the number of fish in the sea! Almost any exposure can cause hives in a susceptible patient. Hives are generally raised, welt like lesions that are very itchy and tend to come and go on different areas of the body. They can last minutes or weeks depending on the exposure. Hives associated with lip or tongue swelling, vomiting, wheezing, or difficult breathing can represent a medical emergency and medical care should be sought immediately. Hives that do not have any other associated symptoms can be treated with an antihistamine like Benadryl (diphenhydramine) while a cause is explored. Believe it or not most times we are not able to identify a specific trigger in a child with hives and as long as there are no other symptoms and the child is comfortable a few days of watchful waiting and symptomatic treatment with Benadryl may be all that is needed. If the hives last for more than 2-4 days an appointment should be made. Most of the time if the parents cannot identify a specific trigger; we will not be able to either! If the hives become recurrent or are persistent, allergy testing may identify the problem but with so many triggers out there it can be like finding a needle in a haystack and typically require either blood work or a visit to an allergist.

Eczema

Eczema is also known as atopic dermatitis and is typically due to a defect in the skins ability to keep moisture in the deeper layers. This leads to skin damage that causes itching and redness on different parts of the body. It typically begins as a patch of dry scaly skin that becomes increasingly itchy and bothersome. Eczema is known as the itch that rashes as most of the skin damage is done by the patient while itching the skin. The rash tends to cluster on the back of joint surfaces (behind knees, in elbow crook, ankles) although it can occur anywhere on the body. Eczema is a chronic condition and unfortunately there is no cure, however there are multiple treatment options and most kids do tend to grow out of eczema as they get older. Moisturizing the skin often is the most important treatment in eczema. Using a thick ointment instead of a cream or lotion is often helpful, and application multiple times per day is usually needed. If there is itching, starting a thin layer of 1% hydrocortisone cream twice per day in addition to moisturizing may be helpful. Nails should be kept short and clean to minimize skin damage from itching and to help prevent infection. If bathing seems to make the eczema worse, bathing the child every other day may be helpful as well. In a minority of cases eczema is worsened by food exposure, such as milk, soy, or wheat. If there is a question of possible food sensitivity it is important to talk with your provider prior to instituting any significant dietary changes.

Fifths Disease

This is a viral infection that causes a distinct “slapped cheek” rash after a few days of cough, congestion, and possibly fever. It is spread by person to person by droplets in saliva or mucous. It is typically not a serious infection unless the child has a certain kind of anemia; however, it can cause serious illness in a fetus if the exposure occurs early in the pregnancy. For this reason a child that is suspected of having fifths disease should not be around pregnant women, and if a pregnant woman is exposed to a child with fifths disease, especially early in the pregnancy, she should contact her health care provider. Most children will not need any special treatment for fifths disease, just comfort care consisting of plenty of fluids, and Tylenol/Motrin for fever. The rash fades after a few days and the child can return to school when they feel better.

Hand-Foot-Mouth disease

This rash is commonly seen in children under 7 years old and tends to occur in the summer and fall months. It is caused by a virus and is a self-limited lasting 5-7 days. As the name suggests the rash tends to involve the hands and feet preferentially, and cause painful blisters in the mouth, however the rash can appear anywhere on the body. It typically starts as small red blisters that are not initially very bothersome. This may be accompanied by fever and fatigue. The mouth blisters tend to cause most of the problematic symptoms as they tend to be painful and cause loss of appetite and difficulty drinking fluids. Ibuprofen may be given for pain and fever and the child should be encouraged to drink their favorite fluids. If the child refuses to drink an appointment should be made.