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Health Information | 04/02/2021

Childhood Rashes: Childhood Skin Problems and What They Mean

By  Dr. Anna Rosenquist
Asian boy scratching his arm
If you have children, you know that rashes, welts, bumps, and other skin irritations are common occurrences. While some skin conditions can be treated with over-the-counter medicine or at-home remedies, there are many rashes that may require a closer look. Sometimes, rashes can be a warning sign for more serious illness, so you should pay attention to your child’s skin and seek medical attention if you’re unsure what’s causing the rash.

Viral and Bacterial Rashes

Many viruses and bacterial infections cause contagious rashes. While many rashes go away on their own, some infectious rashes require topical or oral treatments to resolve faster or to keep your child more comfortable until they go away.

Ringworm: Ringworm is a fungal infection of the skin that causes a red, scaly patch or bump with a red ring around it. It can sometimes be itchy but often causes no discomfort. Ringworm is spread by skin-to-skin contact with an infected person, and doctors may treat it with prescription or over-the-counter antifungal creams.

Fifth Disease: Fifth disease is a mild illness in children that causes flu-like symptoms, a distinctive rash on the face, often likened to the look of “slapped cheeks,” which is followed by a rash on other parts of the body. It’s spread through coughing and sneezing and requires no treatment. The virus that causes fifth disease, parvovirus, can be serious for pregnant woman, but by the time the rash displays, the child is no longer contagious. Impetigo: Impetigo is a highly contagious skin condition caused by common skin bacteria. Impetigo results in red sores, often with a yellow crust, typically around the mouth and nose. Doctors may treat impetigo with antibiotic ointment or oral antibiotics.

Warts: Warts are viral, painless, and usually harmless skin growths that are passed from person to person. Warts typically grow on the hands and feet and usually subside without medical attention. If warts are causing discomfort, they can be treated with over-the-counter medications or through a freezing treatment which can be done in your pediatrician’s office. Rarely do warts require a special trip to the dermatologist.

Molluscum Contagiosum: These small, wart-like, flesh-colored bumps often appear in groups, and they can remain on the body for months, sometimes up to 1-2 years. They do not cause scarring or pain, but they can at times be itchy. Keeping the bumps moisturized and advising your child not to scratch them is the best way to avoid further spread. Treatment with prescription creams can often irritate the bumps more and is often not advised, but may be warranted if mollscum is found on the face or genital area.

Hand-Foot-and-Mouth Disease: Hand-foot-and-mouth disease, also known as coxsackie, is a common childhood illness that spreads through coughing, sneezing, or close contact with an infected person. The illness starts with a fever, followed by sores on the hands and feet and often a full body rash. Hand-foot-and-mouth disease usually resolves within a week; however, if your child has hand-foot-and-mouth and is unable to drink due to mouth pain, you should call your doctor to make an appointment.

Strep Rash: Strep throat, which is a bacterial infection, can be accompanied by a red rash with a sandpaper texture that appears on the body. Although initial symptoms of strep throat usually include sore throat, fever, headache, stomach pain, and swollen neck glands, a rash can appear at the same time or develop a few days after other symptoms. Strep rash used to be call scarlet fever, but it’s not a separate illness, just a symptom of bacterial strep throat. Strep throat is treated with antibiotics, and no special treatment is required for the accompanying rash.

Roseola: Roseola is a viral illness that is most common among children 6 months to 2 years old. Roseola typically causes a high fever followed by a rash of small red bumps on the chest, back, hands, and feet, often appearing after the fever has fully or mostly subsided. Roseola is contagious and should be treated with rest, fluids, and medications to reduce fever. The rash itself will resolve without any special treatment.

Non-Infectious Rashes

Allergens in the environment, food, or everyday products can also cause rashes. These types of rashes are not contagious, and the allergies that cause them typically improve with age.

Eczema: The exact cause of eczema is unknown, but children with this skin condition may have food allergies, environmental allergies, or asthma. Eczema causes a slightly raised, itchy rash with dry skin. Eczema can often be prevented or its severity minimized by reducing contact with skin irritants and also through consistent, frequent use of skin moisturizers. Detergents and body cleansers without dyes or scents are preferred. For example, All free clear detergent and Cetaphil cleanser are examples of hypoallergenic products that can protect the skin. Ointments or thick white creams such as Vaseline, Aquafor Cetaphil, Eucerin, Vanicream and Cerave are good examples of moisturizers that should be used after bathing and 2-3 times daily as needed to help prevent eczema. If flare-ups cannot be prevented, your provider might recommend a topical steroid or prescription cream for more severe cases.

Heat Rash: Heat rash, also known as prickly heat, is a common condition in babies caused by blocked sweat ducts that leaves an uncomfortable rash on the skin. Heat rashes are harmless, but they are preventable by dressing children in breathable clothes.

Contact Dermatitis: Contact dermatitis is a rash that occurs after touching certain foods, soaps, plants, and other products. Minor cases of contact dermatitis cause mild redness and a small rash, while more severe cases cause swelling and larger blisters. Using an anti-inflammatory cream like hydrocortisone can help speed up recovery in most cases. Call your provider if the rash covers a large area or if the itchiness cannot be controlled.

Hives: Hives are itchy or burning patches or small welts that are triggered by various allergens, including medicines, food or environmental allergens. In up to half of cases of hives in children, the trigger is caused by a virus or may never be found. Hives often come and go for up to a week and are usually treated with an over-the-counter antihistamine.

If hives appear after the introduction of a new food or if they are accompanied by wheezing; shortness of breath; throat, tongue or lip swelling; or vomiting, you should immediately seek medical attention.

When to See a Doctor

It’s best to call your pediatrician when:
  • A rash is accompanied by a fever, respiratory distress, an inability to stay hydrated, or your child is not responding normally.
  • The rash is purplish or bright-red and does not blanch, meaning that the rash does not momentarily lighten in color when you press on it.
  • Your child’s rash doesn’t improve with at-home remedies or over-the-counter medications.

About The Author

Dr. Anna Rosenquist

Dr. Rosenquist joined Atrius Health in 2008 and practices pediatrics at Harvard Vanguard Kenmore. She attended medical school at the University of Pennsylvania School of Medicine in Philadelphia, PA, and completed both her internship and residency at Massachusetts General Hospital in Boston. Dr. Rosenquist enjoys working with families and children of all ages, from newborns to adolescents, and she has particular clinical interests in obesity and injury prevention.

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