Rashes and Other Skin Diseases

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Rashes have lots of different causes from allergens to viral infections, insect bites, parasites, and skin disorders such as eczema. The treatment depends on the cause of the rash. The illnesses listed here usually cause rashes.

Chicken Pox (varicella)

Chicken pox is a viral illness with itchy red raised bumps that become blisters and crust over. They usually show up on the face, chest, and back, but may appear anywhere on the skin. It takes 10 to 21 days after exposure to break out with the rash. The child is contagious for one to two days before the rash appears and approximately six days afterwards, or until all the itchy bumps crust over. A fever of 102 to 103 degrees and severe itching may accompany the rash. Symptoms are usually at their worst from the third to fifth day.

Calamine lotion, baking soda and oatmeal baths, and cool compresses can help control itching. If it is severe, a medicine can be prescribed. Use children’s acetaminophen to control fever with chicken pox. Do not use aspirin; there is a link between aspirin, chicken pox, and Reye’s syndrome, a dangerous disease.

Call the pediatrician’s office if your child has chicken pox and any of these signs:

• won’t drink.
• becomes extremely irritable or lethargic.
• has a fever that lasts more than 72 hours.
• is vomiting.
• complains of a sore throat.
• develops a severe headache or stiff neck.
• has trouble breathing.
• the rash appears to be infected.

A vaccine against chicken pox is included in your child’s immunization schedule at age 12 to 18 months, and a booster is given between 4 and 6 years. An older child who has not received the vaccine or had chicken pox can get the vaccine at any time.

Coxsackie (hand, foot, and mouth disease)

This disease can spread quickly and happens most often in late summer and fall. It is caused by the coxsackie A virus. A rash appears on the hands and feet and in the mouth and can last from one to six days. The disease usually occurs in children 6 months to 4 years of age.

Hand, foot, and mouth disease is characterized by the following:

• small ulcers in the mouth.
• a mildly painful mouth.
• small water blisters or red spots located on the palms of the hands and soles of the feet and between the fingers and toes.
• sometimes small blisters or red spots on the buttocks.
• low-grade fever (over 100 degrees).

Acetaminophen may be given for a few days if the fever is above 102 degrees.

Hand, foot, and mouth disease is very contagious, and your child’s playmates may develop it at about the same time. The incubation period after contact is three to six days. Because the spread of infection is hard to prevent and the condition is harmless, a child can return to school when his temperature returns to normal range.

Call the pediatrician’s office if the following signs are present:

• fever lasts more than 72 hours.
• your child refuses to drink.
• there are signs of dehydration (no tears, no urinating in eight hours, dry mouth).
• your child becomes lethargic.

Eczema

Eczema, a very common skin problem that often runs in families, may be mild or severe. The cause is not known. It is most often found around the creases of elbows, wrists, knees, neck, ankles, and feet. Flare-ups may occur when the skin comes in contact with irritants like soap, chlorine, and certain foods. It may be a long-term (chronic) problem, although some children outgrow the condition.

Children with eczema have constant dry skin, itchy red rash that becomes irritated when scratched, skin color that is darker or lighter in certain areas, and skin that looks somewhat thickened. The pediatrician will plan a treatment. The mainstay of treatment is hydration of the skin using a thick, non-perfumed cream (such as Eucerin) daily after baths. Inflamed areas may be treated with steroid creams. Keep the child’s fingernails short to discourage scratching, follow the doctor’s advice about bathing and taking medications, and avoid hot water. It also helps if you switch to a mild laundry detergent, soap, and shampoo.

Fifth Disease

If bright red, warm patches suddenly appear on the child’s cheeks and you detect a mild fever, fifth disease could be the cause. A lacy rash also develops, especially on the arms and legs. Your pediatrician will be able to tell you if the rash is caused by fifth disease, a mild parvovirus that usually clears up in about 10 days without specific treatment. It can, however, recur. The child should not be in contact with pregnant women or individuals with sickle cell disease until after 10 days.

Impetigo

Spreading red blisters that form crusty scabs are usually a sign of impetigo, a very common contagious skin problem in children. It’s a streptococcal or staphylococcal infection and should be treated by the pediatrician with antibiotics. Keep the child’s fingernails cut short and seek medical attention. Most impetigo will begin to improve after about two days of medicine.

Pityriasis Rosea

A school-age child or teenager can develop a rash with oval, coppery patches of scaly skin, usually on a part of the body not ordinarily exposed to the air. If it starts on the trunk, you can suspect pityriasis rosea, a condition your pediatrician will have to see for a definite diagnosis. Heat, including hot baths, can make the itching worse. The doctor can recommend a cream to ease the itching. The rash should disappear in several weeks.

Ringworm

Ringworm is caused by a fungus. Ringworm of the skin usually looks scaly with a slight red ring that slowly gets bigger. Ringworm of the foot (called athlete’s foot) is a flaky, red, moist, very itchy rash on the sole of the foot and between the toes. Ringworm of the scalp causes a scaling of the scalp and can cause loss of hair if not treated.

All forms of ringworm must be diagnosed and treated by the doctor. Because it is contagious, it should be treated in the earliest stages before severe symptoms occur.

Roseola

This viral illness begins with a temperature of 102 to 103 degrees for three to five days, followed by a pink, raised, lacy-looking rash around the time the temperature disappears. It has a one to two week incubation period and is contagious for seven days. There is no specific treatment for this virus. Control the fever with children’s
acetaminophen and plenty of liquids to help make the child more comfortable.

Rubeola (measles)

This is a viral illness not commonly seen today, thanks to immunizations. Although recent outbreaks have occurred in non-immunized populations. The virus appears as white spots inside the cheeks, followed by a raised, reddish brown rash starting on the face and quickly spreading down the body. The child may have a temperature of 104 to 105 degrees, runny nose, harsh cough, and red eyes that are sensitive to light. After exposure, it takes up to 14 days to become sick. From three days before the rash to five days after the rash starts, the child is contagious. Measles are prevented by a vaccine your child receives at 12 to 15 months and 5 years of age. If you suspect measles, begin treatment with fever control, fluids, bed rest and dim light. Call your pediatrician before seeking medical evaluation so they can take steps to prevent the spread of a possible outbreak.

Scabies

Scabies are small mites (insect-like creatures) that dig under the skin, lay eggs, hatch, and spread to other parts of the body. They are highly contagious. If you notice a fine very itchy red rash on the groin, buttocks, arms, hands, feet, and legs, call the pediatrician to have your child evaluated for scabies. Treatment with a special cream or lotion is necessary to clear up the rash. Make sure you alert your babysitter, daycare, or school if your child is diagnosed with scabies.

Wash your child’s clothes and bedding often to avoid re-infestation. The treatment will clear up the condition right away, though the itching may not go away for two or three weeks.

Scarlet Fever

Scarlet fever is a strep throat infection with a red rash that makes the skin look sunburned (especially on the chest and abdomen). A fever usually precedes the rash by 18 to 24 hours. The rash usually clears up in four or five days, and sometimes the skin peels in a week or so. Scarlet fever is very contagious and needs treatment. But after 24 hours of treatment with antibiotics, the child will no longer be contagious. Acetaminophen or ibuprofen is helpful for any sore throat symptoms, which will disappear within 24 hours of beginning the antibiotic.