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.

Take The Survival Doctor with you! Click here for the interactive guidebooks.

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.