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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?

You may also like:

 

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.

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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

  • NATALIE COGAR

    MY 4 YEAR OLD DAUGHTER DEVELOPED SMALL BUMPS ON HER INNER THIGH. I TOOK HER TO A DERMATOLOGIST AND SHE WAS DIAGNOSED WITH MELLESCUM CONTAGIOSUM. THIS CAN LAST YEARS IF NOT TREATED RIGHT AWAY. MAYBE YOU CAN ADD THIS TO YOUR LIST WITH IMAGES I FOUND ON THE WEB.

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

      That’s a good one, Natalie. Thanks.

  • Jessica

    Hi
    My son who is three just got over a viral rash but he had no temperature with it. When he was 3 weeks he had a rash that targeted the hands and feet and caused them the swell. It stumped the doctors at first but then they said it was the human parvo virus. The rash cleared up by the next day. 3 years later and he gets this ” viral” rash that “stumps” them again only he had this one for about 4 or 5 days. They told us that it was just a weird rash and that weird rashes happen all the the time. Comments on this?

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

      Jessica, viral rashes can be very tricky. Fortunately, most go away and that’s that. Unless the rash is pretty well “textbook,” or unless lab tests are done, many a diagnosis is the best, educated guess. It’s not unusual for a child to have 2 “viral rashes.” The key is they should go away after a few days, with all their related symptoms (fever, swelling, aching, etc.) If that’s not the case, or the same rash occurs again and again, it needs to be checked out further. Specifically for your son, if you trust the doctor, that’s the best you can do. If you don’t, get a second opinion.

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  • Kris

    Doc–in a TEOTWAWKI scenario, what is an appropriate way to treat yeast infections in young children? Mine are no longer in diapers, but if hygiene becomes an issue (especially for a pre-teen who hasn’t had much practice or any previous issues), can children be treated with over-the-counter creams? Will a yeast infection resolve itself in time? Would a more natural remedy better or possible?

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

      First and foremost, keep the child’s bottom clean and dry. Yeast loves warmth and moisture. You can use any of the over-the-counter yeast infection products. A good natural remedy is tea-tree oil diluted–a few drops of the pure stuff in 1/2 cup warm water. Gently apply it to the affected area with a soaked cloth. If you use something like that, I’d test it out on a small area of the child’s skin for 24 hours to make sure there’s no bad skin reaction.

      Eating yogurt or taking pro-biotics is good to do also. Avoid sugars. Eating a bit of garlic might help also.

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

    Thanks, Emily. That’s an incredibly long time to have pityriasis–and so many times. Hopefully you have a regular doctor you can trust and knows about all of these occurrences.

  • Emily Pennington

    2 of children have Rash #4. The doctors we saw told us that it is a very rare skin problem and when someone gets it, It is likely that they will only have it once within there life! My oldest is the one that has it the WORST right now. She is 7 years old and has had it about a dozen times in her life so far. The first time it lasted for about 6-8 months. It usually doesnt last that long, so the doctor says… Last year she was sent home from school 3 times over it until I said enough was enough, it wasnt going to hurt anyone and its a skin problem, its not like lice or anything! The ONE thing I have found that has stopped it is Melaleuca! It is pretty pricy, BUT worth every penny! I buy then the Renew stuff…. Renew Intensive Skin Therapy Moisturizing Body wash, Lotion, and hand soap. Her rash now appears most often when her Bio father lets her get in hot tubs! I have told him over and over and he doesnt lesion to me. The last time, I printed a bunch of stuff out about it and talked to him for a few hours about it. I think he finally got it! So, I just wanna say, If you think your child might have this, Google it! This site doesnt go into much detail about it. My youngest is 3 and has had it 2 or 3 times so far and the first time she had it lasted just about as long as my oldest’s first time with it. People kept telling me it was ring worm and I couldnt even take her into churches cuz they where uneducated about it! Really though, look into it if your not sure! :-)