Common Rashes in Children: How to Recognize, What to Do

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Your Child Has a Rash. Do You Know What to Do? Part 2

by James Hubbard, MD, MPH

My post on rashes in children is by far my most popular. If you haven’t read it, please do. And note the many helpful comments that continue to come in almost daily. It was out of these comments that I picked my next batch of common childhood rashes.

My first post mainly focused on rashes associated with fever (either before or with the rash). The ones below are rashes that usually have no associated fever.


Pop Quiz 2!

Common Rashes in Children With No Fever or Cold Symptoms

Rash 1.


Rash 1

Where is it? It can be anywhere on the body, but particularly the inside of the knees and elbows.
Is it raised, flat, blistered, or scaly?
Scaly, sometimes with a few blisters.
Does it itch? Yes.

Most likely cause: Eczema, the most common chronic skin problem in children. It starts in kids as young as a few months and continues with some into adulthood. Eczema is sometimes generalized, sometimes patchy. This trait of dry, easily irritated skin tends to run in families. By far, the most common type of eczema in children is atopic dermatitis. Atopy means having a tendency for allergies, and children with atopic dermatitis usually have hay fever or asthma.

What can you do? Use mild, nonallergenic moisturizing creams. Aloe vera is also good. One reader has had good results with black-walnut extract. If there is oozing, swelling, or increased redness, the area may be getting infected. See a doctor. To prevent the rash in the future, avoid cow’s milk. If your child seems to break out after eating other certain foods, avoid them also.

More information: Click here for more simple tips to prevent and soothe eczema.

Rash 2.


Rash 2

Where is it? In the groin on or around the genitals, in the creases of the hips, or on the buttocks.
Is it raised, flat, blistered, or scaly?
Red and raised.
Does it itch?
Yes, or it’s just irritating.

Most likely cause: Diaper rash. Think diaper rash with yeast infection if the rash is hard to clear up or if there are little round, red lesions close to but separate from the rest of the rash, called satellite lesions (which you can see in the picture to the right).

What can you do? Keep the area as dry and clean as possible. Change diapers as soon as they’re wet or dirty. No plastic pants. Try cotton diapers. Having the child occasionally go bare will help—right after a good bowel movement might improve your odds against a mess. You can try A and D ointment or zinc oxide (for both prevention and treatment). Powders are frowned upon these days since children can inhale them into their lungs.

If it’s a yeast infection, do the above to keep your child clean and dry, and use over-the-counter or prescription creams for that.

Rash 3.


Rash 3

Where is it? It tends to be anywhere on the body that’s not getting cool air, such as skin folds or areas where the clothing is tight. Happens to overdressed children also.
Is it raised, flat, blistered, or scaly?
Raised, usually red, sometimes with small blisters.
Does it itch?
Sometimes, but this isn’t an identifying factor.
Most likely cause:
Heat rash.

What can you do? Allow the area to cool. Have the child wear more loose, cotton clothes. Cool bath cloths can help, as can lanolin. Avoid heavy ointments and creams. If the rash is spreading or if there’s any fever or pustules, see a doctor since it might be getting infected.

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Rash 4

Rash 4.

Where is it? About seventy-five percent of the time it starts as a large, red patch on the trunk. This is called a herald patch or mother patch and is often mistaken for ringworm. (You can see it in the picture to the right.) In a week or two come much smaller, pink, oval patches all over the trunk and arms, and rarely on the face, neck, palms, or soles. This rash lasts a long time—six to eight weeks or longer.
Is it raised, flat, blistered, or scaly?
Flat or slightly raised. Sometime scaly.
Does it itch?
About fifty percent of the time.

Most likely cause: Pityriasis rosea, a rash that’s more common in teens and young adults but may occur at any age. We’re not sure what causes it. It may be a virus, but the rash doesn’t appear to be contagious. The rash can last three to six weeks and even up to twelve weeks for some.

What can you do? Because of the length of time you have it, and the fact it’s sometimes hard to differentiate it from ringworm, you’ll usually end up seeing a doctor.

A little natural sunshine—about 10 minutes per day—may help. Getting hot (by playing, hot baths, etc.) makes it more pronounced and more likely to itch. For itching, take antihistamines such as diphenhydramine (Benadyl) or loratadine (Alavert, Claritin). Oatmeal baths and calamine lotion can help too. The rash goes away when it’s good and ready. Fortunately, it doesn’t scar.


Rash 5

Rash 5.

Where is it? Can start anywhere on the body.
Is it raised, blistered, or scaly?
There are flat, red marks under the skin that are usually small but sometimes large. Some large splotches turn purple.
Does it itch?
No.

Most probable cause: Henoch-Schonlein purpura, a disease that causes inflamed blood vessels. (Those red marks are tiny blood vessels that are leaking.)

What can you do? Get to a medical facility as soon as possible. This one’s serious. Over sixty percent of those affected will have abdominal pain; seventy percent will develop short-term arthritis. Fortunately, most time this rash goes away, but it can take some strong medicine to treat the fifty percent of people with it who develop kidney problems. About five percent of those who get the renal disease have permanently damaged kidneys.

Note: The baby pictured is jaundiced (has yellowish skin) for another medical reason. Children with petechiae won’t necessarily have jaundice.

 


 

The thing I’ve learned about rashes (actually about medical problems in general) is they don’t read the textbook. They may not look as they do in the photos. They can be confusing. If you have doubts, or if the child looks sick, see a doctor.

Have any of you had experience with these rashes? Were they like I described?

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Photos 1, 3 and 5 by Care_SMC (eczema), jonfaustman (heat rash) and Jacob Johan (Henoch-Schonlein purpura)—all via Flickr. Pityriasis rosea photo by Grook Da Oger (GFDL or CC-BY-SA-3.0-2.5-2.0-1.0, via Wikimedia Commons. Diaper rash photo courtesy CDC.

  • Linda

    18 mo old I’m a nanny for has a rash on the bottom of only one foot. It looks like small red bumps & is not on top if his foot. He doesn’t seem to be bothered by it. Not scratching it or has a temp etc. Cant find what looks like a bug bite or any infection. Has had it for 4days.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Linda, sorry, but I can’t specifically diagnose without an exam. In general something like that that is so localized could be something he’s coming in contact with or, you’re right, a bite.

  • Deb

    My son when he was younger developed a rash that resembled ringworm and we treated like it was and it didn’t go away. My doctor did research and found out it was not, it was something that is common in young African American boys and had to treat it with a steroid cream and an antibiotic. My doctor was hit by a car a couple years back when he was jogging real late at night, his wife ran the office and never turned in their medical files. So from birth to about two years ago my kids have no medical history. Does this sound familiar? The doctor he has now thinks he has ringworm. But its spreading its now 3 patches on his chest two on his head and one on his foot.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Deb, I wish I could help, but I don’t know. Have you checked with the pharmacy where you got the prescription filled to try to find out the exact medicine? However ringworm is common in African American children and, in doubt, a skin scraping looked at under the microscope and/or a culture would ensure a correct diagnosis. Also, some people respond better to oral ringworm medicine than they do to topical. As far as other rashes that may look like ringworm and be treated with antibiotics, hmm. Lyme disease (one spot and usually not recurrent), nummular eczema (for some reason antibiotics help some cases), pityriasis rosea (cause unknown. Usually goes away in several weeks without treatment.)

  • Ashlea Summers

    My son developed a small rash under his arm after his 1st Birthday party. I figured it was an irritation from the dress shirt he wrote that day. This was Feb 9th… Today is March 1st. Rash has spread to underside of top of arm… down side of trunk. Some spots on both legs. Pediatrician gave me Rx for steroids to clear it up and “we’ll go from there.” Disheartening to say the least. I’m giving it a week from now after rewashing all his clothing, blankets, toys, etc in free and clear detergent before reconsidering the steroids or a diet change. The rash has now turned to a big flat red area with raised bumps in the newest areas. Feels like and paper. It doesn’t seem to bother him in the slightest. Seems most inflamed after his bath before bedtime. Using scent free soothing aveeno baby wash and lotion. I don’t know what else to do. Any thoughts?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Ashlea, it’s often very difficult to know what a rash is from. Especially if it is the first. Also a rash from something that just irritated the skin can look like an allergy rash. Certainly, I would consider switching to a soap like Ivory, allergy-free lotions, etc. And wash all his clothes before wearing, with a mild detergent, maybe like Arm and Hammer. When the rash is gone, you can if you wish, switch back one-by-one to what he was using before and see if anything breaks him out. Then you will know. Rashes like that typically take a week or two or more to go away. Also, hopefully you have a follow-up appointment and will call or go in sooner if it gets a lot worse.

      • Ashlea Summers

        Thanks so much for your response. You have published a great resource here- so helpful!

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          Ashlea, you’re so welcome. Please let me know how it goes.

  • CandiceC

    My son is 7. We are on day 5 of what looks like a heat rash on his face and neck… It is now on his stomach, his groin in broken out badly and peeling down his scrotum to his anus. Yesterday we were told it was unknown what it was and given cream… Did not work. Called his Doctor and given more cream but nothing is stopping the itching and it’s painful to touch it. Oh I forgot to mention from the swelling he was urinating in 3 directions instead of a stream. I’ve given Benadryl daily. No answers from docs, everyone is so unsure of what it is, I’m ready to scream!!! Any clues.

    • Sandy

      At that age, my son became highly sensitive to his own sweat. After extensive tests, journaling and changing potential culprits like soaps and detergents, we realized that if sweat sat on skin for more than 30 mins, a red rash developed and skin swole up. At 15 he now takes showers immediately after sweating and aquaphore lotion helps. Best of luck figuring it out, I know it’s frustrating.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      No, but I didn’t understand if you had taken him to the doctor or just called. He needs to be seen, or rechecked. He may need oral medicine. If the doctor has no idea, and he’s getting worse, you should get a second opinion, even if it means go to the ER.

      • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

        By the way, this could be anything from an allergic reaction, to some sort of reaction to a virus, to a bad case of a yeast infection, to something more rare or more serious. The part that bothers me is it’s getting worse after 5 days without really any idea of what it is?

  • M Hatfield

    My 6 year old grandson has a rash mostly on torso some on arms legs bumps have puss in them treated for psoriasis with antibiotics and cream but no help. It’s itchy and said they hurt when I put cream on them please help

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I can’t diagnose individuals without a direct exam. I only give general information. Sounds like he should go back to the doctor.

  • Mike Larry

    My 2 year old daughter has been getting random raised bumps on her arms, legs, neck, and hands. She has even had them on her butt once. They look like bug bites or red pimples and itch. Every time we take her to the dr. he says bug bites. I find that hard to believe because this has been going on for 4 months now. The bumps on her hand caused it to swell badly, but it went away in 3 days. Now she has 4 on her neck and shoulder. It just seems to jump from arm to leg to neck, etc. always in groups of no more than 4bumps. Has anyone seen this before?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      If you’re noticing them first thing in the morning, you could try having her sleep in another bed in your room for a few nights and, if she has none, then they must be bites. If she still has them they could be something else and you might want to take her to a pediatric dermatologist. Do you have a pet?

  • Savannah Foulke

    My son (20mos) has been messing with his feet all night in his sleep, this morning he had redness between his toes and now has red raised areas on his heel..it bugs him but doesn’t seem to be painful and otherwise is acting normal…I’m not sure what it is or what to do..?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I suggest you call or have him see his doctor. I can’t diagnose or treat individuals without an exam. In general, you should decide whether these are bug bites, or whelps from an allergic reaction, or a reaction to lotions, soaps, etc., or some sort of infection (it would usually be spreading). I do have other posts on various rashes.

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  • southerngal100

    Didn’t see the rash caused when one is allergic to Penicillin. My son broke out from head to toe on Day 7 after taking his first round for an ear infection at 14 months old. It took two weeks for the rash to go completely away. It did not itch.

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Thanks, southerngal.

  • Jen Fish

    Could you please address Kawasaki Disease? A timely diagnosis and treatment is so vital with this illness! My son had it this spring, so thankful that his pediatrician recognized it and he received treatment in time!

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Jen, I have a new post on Kawasaki Disease. http://www.thesurvivaldoctor.com/2012/12/27/red-tongue/

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Rose, sure. I’ll try to post it within the next month.

      Thanks