Many children are headed back to school. School brings more exposure to germs, more infections, and more rashes. When your child breaks out in a rash, you may wonder if it is a rash due to eczema, allergy or sickness. Dr. Amy and the Baby Pibu team review the most common childhood rashes and what to look for.
Eczema (aka Atopic Dermatitis)
- Who? Affecting all ages
- What? Eczema affects approximately 20% of children, and children with parents having an atopic background of hayfever, asthma or eczema are at a higher risk of developing eczema.
- Presentation? Eczema typically appears as an ill-defined erythematous, scaly rash that is located on different areas of the body depending on age. In babies less that 2 years old, the cheeks and the outer sides of the arms and legs are commonly affected. In children older than 2 years old, the flexural areas of the arms and legs are the most commonly areas affected.
- Treatment? At the first signs of eczema, change your child’s moisturizer to an ointment. Ointments are the best at locking in the moisture that is needed. A daily bath using soap on the dirty areas of the creases, armpits, groin, hands and feet is important to maintain in order to keep the germs away that can further trigger a case of eczema. OTC topical hydrocortisone 1% can be used twice daily for two to three days. If there is no improvement, seek further advice from your pediatrician or dermatologist.
- Who? Affecting all ages
- What? Caused by different triggers including irritants, food, medications and illnesses. Common foods include nuts, berries, and shellfish. When you see hives, think of what exposures there were within the previous 24 hour period.
- Presentation? Hives appear as welts. They are typically puffy, red welts that do not last more than 24 hours. Many times, the welts will come and go. They can persist for many hours to just 15 minutes. They are mostly itchy but sometimes not. Hives typically appear on the trunk but can start in one place and then generalize. If there is associated wheezing, difficulty breathing, or throat tightness, call 911 or go to the ER.
- Treatment? Benadryl is the best antihistamine to give. It can be dosed at 1 mg for every 3 pounds. For example, if your toddler weighs 30 pounds, then 10mg of Benadryl would be recommended. If there is any concern of giving Benadryl, contact your pediatrician. Topical OTC 1% hydrocortisone can be applied to the hives to act as an anti-inflammatory to clear the welts. This can be applied two to three times over two to three days. If there is any concern or the hives are not improving, see your pediatrician or dermatologist for further direction.
- Who? Affecting both babies and toddlers but more common in toddlers
- What? Caused by bacteria Streptococcus or Staphylococcus
- Presentation? Impetigo typically appears as honey-colored crust on a red and inflamed base. Common areas are around the nose and mouth as well as the buttocks, arms, and legs. It typically presents as a secondary infection to a primary rash such as eczema, runny nose or drooling mouth.
- Treatment? For early cases of impetigo, simply cleaning well twice daily with soap and water and applying with OTC antibacterial ointment may be enough to clear the impetigo. For more developed cases, see your pediatrician or dermatologist because a prescription topical antibiotic ointment called Bactroban (mupirocin) or oral antibiotic may need to be prescribed. The primary rash will also need to be addressed to prevent repeated flares of impetigo.
Roseola (Exanthum subitum)
- Who? Affecting children ages 6 months old to 2 years old
- What? Caused by the human herpesvirus type 6
- Presentation? The typical presentation is one of high fever (usually > 102-103°F) for 3 days followed by an end to fever and a diffuse rash on day 4. The rash may last hours to days. The rash typically begins on the trunk and spreads to the rest of the body.
- Treatment? The management of roseola is supportive care. It is recommended that age-appropriate doses of acetaminophen or ibuprofen be given to control the fevers. Aspirin should not be used as aspirin used in children with viral illnesses can lead to Reye’s syndrome, which can lead to liver failure and even death. Prevent dehydration by providing your child with regular fluids (breastmilk, formula, Pedialyte, popsicles, ice chips). For the rash, an over-the-counter 1% hydrocortisone cream can be used to calm the rash. Take your child to the doctor if the fever is uncontrollable or if your child is dehydrated or lethargic. Take your child to the emergency room if an uncontrolled fever leads to a seizure.
Slapped cheek (Fifth’s disease or erythema infectiosum)
- Who? Affecting children between 3 and 10 years old
- What? Caused by Parvovirus B19
- Presentation? Associated symptoms include fever, headaches, achiness, and stomach aches. A bright rash usually appears on the cheeks giving a “slapped cheek” appearance. In older individuals, the rash may also present as a lacy-like rash affecting the arms, legs, chest and back.
- Treatment? Over-the-counter 1% hydrocortisone cream can be used to calm the rash. Special consideration is given in immunosuppressed children, children with sickle cell anemia and pregnant women with unknown exposure to parvovirus. All of these individuals should seek attention by a doctor if there is known exposure to parvovirus.
Hand, Foot, and Mouth Disease
- Who? Affecting children 1 to 4 years old
- When? Common in the summer to early fall
- What? It is usually caused by enteroviruses, specifically coxsackie virus
- Presentation? The rash appears as blister-like lesions in the mouth, specifically the throat, tongue, inside cheeks, gums, and hard palate. Juicy red bumps can also appear on the palms and soles and a general rash may also appear on the trunk and buttocks.
- Treatment? Over-the-counter 1% hydrocortisone cream can be used to calm the rash. Fever is usually associated with this rash. Age-appropriate doses of acetaminophen and ibuprofen can be given to manage the fever. Aspirin should not be given to any viral rash including Hand, foot, and mouth disease as Reye’s syndrome may be present. Reye’s syndrome can lead to liver failure and even death. Because of the pain from the blisters, children may lose their appetite and not eat or drink. Push fluids as much as possible with icy treats like popsicles and fluids with added electrolytes like Pedialyte. If your child refuses to drink or eat, seek attention from a doctor as the doctor may be able to prescribe something to help with the pain. If your child becomes dehydrated and lethargic, take your child to the doctor or even the emergency room.