Newborn Rashes
When to Worry
Rashes on face and scalp
Diaper Rashes
 

Beyond the newborn
Impetigo
Poison Ivy
Eczema & Contact Dermatitis
Ringworm & Athlete's Foot
Hives (whelps) & Urticaria

Infectious Rashes
Scarletina (Strep Rashes)
Chickenpox
5th Disease
Hand Foot & Mouth

Things you don't want to have UNDER CONSTRUCTION
Head lice
Scabies
Warts
Molluscum contagiosum

When to Worry

• Blisters over a purple base in an infant under one month.  This may be a herpes infection in a newborn.
• Maroon color spots the size of a pin head or larger at a time a child has fever that do not temporarily blanch or disappear when pressed. Look in the arm pits and groin region for these.  This is called purpura and can be a sign of Meningococcal infection
• Small red dots over the arms and lower legs that do not blanch or whiten when pressed.  These may be petechia and are seen in a number of illnesses.

Rashes After Fever

• Rashes that occur after a fever has resolved are usually a sign that a virus has been in a child's body and are rarely serious.  They usually begin at the hairline over the forehead and behind the ears.  From here they may progress downward over the trunk.
• Such rash usually occur on infants and toddlers.  They would be rare in older children and should be seen if on a child over three years of age.
• These are viral exanthems.  Roseola is an example of such a rash.
• Sometimes these rashes seem to itch or bother a child for a day or so.  Bendadryl can be given (See Medications for dose)
• These rashes should disappear in 3 to 5 days.  If they persist they should be seen.

Strep Rashes (Scarletina)

• One exception to the rule that rashes that appear after a fevers leave are virus is scarletina.
• Scarletina is a sign of  a strep or possibly a staph bacteria in your child.
• Scarletina is a fine sandpaper like rash over the abdomen that is usually more prominent in the diaper area and under the arms.  It can be red but may be more easily felt that seen on darkly pigmented individuals.
• Scarletina may itch and benadryl should be given.
• This rash may be present with fever.
• Sore throat may or may not have been present.
• Not all strep bugs do this.
• These rashes need to be seen and need medication for the strep.

Newborn Rashes

When to worry:

• Blisters over a purple base in an infant under one month.  This may be a herpes infection in a newborn.
• Generally any fluid filled blister on a newborn should be seen.

Rashes on the face and scalp of infants

• Infantile seborrhea is a common rash on infants often present in the scalp, over the forehead, behind and on the ears, in front of the ears and may spread down the back.  This can be treated with 1& hydrocortisone cream or lotion.
• Infantile acne looks like pimples over the cheek and generally requires no treatment, however, there is a treatment available if desires.

Diaper Rashes

• As disposable diapers have become better at removing moisture from contacdt with a baby's skin, diaper rashes have cdhanged. When cloth diapers were common infant often got ammonical and irritant diaper rashes. Nowadays these are uncommon unless there is a great deal of diarrhea. For irritant rashes resulting from loose stools Aquaqhor and avoidance of wipes can be helpful.
• Most rashes that fail to respond in 2 to 3 days to typical diaper rash medicines are monilial or yeast infections. These are found in young infants or can follow antibiotic use or infections. These can be treated with a number of different medications. Over the counter medicines to try are nystatin and lotrimin.
• Yeast rashes a generally raised an bumpy
• Think of yeast if the rash is on the scrotum, on the area at the base of the penis, or over the labia of a little girl.
• Think of yeast also if the infant has had thrush.

Beyond the Newborn Period

Impetigo is a rash from a strep or staph bacteria that presents as spreading sores.  Often it follows a bug bite in the summer that was scratched until sore or sometimes presents as spreading sores around the nose as face.  Although there are over the counter medicines that can be helpful such as polysporin call the office during regular office hours for prescription medicines that are more effective.

Poison Ivy

• Poison IVY can be helped with medicine, however, it is never absolutely necessary to treat.
•  Contrary to popular opinion, once a child's skin is washed, poison ivy is not spread from contact with the rash even if it is weeping.
• Poison IVY around the eyes is uncomfortable but not serious
• Over the counter treatment considers of hydrocortisone topically and treating the itch of poison ivy with Aveno baths, Itch X, Caladryl clear and oral antihistamines for itching such as benadryl.
• In cases that are particularly uncomfortable oral steroid are sometimes given.
   

Contact Dermatitis results from something that has come in contact with the skin.  It can be treated in a manner similar to poison ivy with emphasis on placing hydrocortisone on the spots several times a day. 

Eczema is as term for dry itchy skin.  There are several type of eczema.  Contact dermatitis is a contact eczema.  Infantile eczema and atopic eczema are common in young children and present with patches of dry slightly pink skin that itch.  Treatment of eczema consists of the following:

• In the summer using steroid creams such as over the counter hydrocortisone
• In the winter using steroid ointments that help keep moisture in.
• There are prescription steroids that are stronger but check with your doctor before using these on the face
• Newer prescription agents such as Elidel or Protopic are helpful for  some.
• Mild soaps such as Dove or Cetaphil
• Avoidance of harsh detergents and fabric softener.  Consider double rinsing clothes.
• Maintain moisture in the skin.  After a bath only gently pat your child to remove excess water then apply a moisturizer.
• Generally the greasier the moisturizer the more effective.  Vasoline, Aquaphor, Moisturel and even Crisco can be used.
• If itching bother the child at night benadryl can be given.
   

Ringworm

Not all rashes that appear in circles  are ringworm.   Nummlar eczema is  dry patch of eczema that presents in a circle.  Generally ringworm has a slight scale and central clearing but not always.  Think of ringworm especially if you have a new cat or dog in the house. If you are placing a topical steroid such as hydrocortisone on a circular and it is not getting better or is getting worse then it might be ringworm.  Use antifungal creams such as lotrimin.
 

 Athlete's Foot

Athlete's foot cures are promoted on radio and television which suggest antifungal sprays and creams.  A fungus can be the cause of athlete's foot, however, eczema can also be the cause.  If the athlete's foot does not improve using antifungal medications think of eczema and use topical steroids.  This is particularly true if the child has a history of eczema elsewhere or his feet sweat a lot in shoes.

Hives & Urticaria

Hives are whelps or raised spots that itch.  Hives look like little mosquito bites.  Hives come one place, disappear and crop up elsewhere.  Scratching hives seems to make them worse.  

Hives are a form of urticaria.  Urticaria also comes as  flat circles of various sizes that come and go.  Often there will be half circles or target like lesions.  Sometimes as urticaria leaves the skin is temporarily discolored.

Hives and urticaria generally are reactions that come from within rather than something on the skin.  Hives and urticaria have many causes:

• Allergic reactions to medicines.  If your child is on a medicine that can be safely stopped such as  an antibiotic stop the medicine and call the doctor during regular office hours.
• Allergic reactions to foods.  Think if a new food has been introduced--particularly nuts, shell fish, etc.
• Allergic reaction to bee stings.  If your child develops hives after a bee sting be sure to discuss this with your doctor.
• Reactions to infections.  The body can react to infections with urticarial rashes.  Common infections that do this are viruses such as the cold sore virus and mycoplasma bugs that cause bronchitis.
• Idiopathic.  This means the cause is unknown but some people suspect that the word idiopathic is a combination of the words pathetic and idiot that might suggest the doctors are pathetic idiots and since they can't figure it out they have to give it an unusual code name.

Are Hives Serious?

• Most of the time hives and urticaria require no treatment unless the child is uncomfortable from itching. 
• Generally they last a few days and then resolve.
• It is important to stop medicines that may be causing hives.
• Rarely do they progress, however, if your child has hives and difficulty breathing or new onset cough and wheeze you need to call 911.
• If your child develops hives after a bee sting be sure to discuss this with your doctor.
• Since hives and urticaria come from within, if you are going to treat them you can give an oral histamine such as benadryl, Claritin or Zyrtec.

Infectious Rashes

Chicken pox

• Often there is an exposure history.
• A significant exposure is one hour around an infectious person.
• The incubation period is 11-21 days after exposure.
• Chickenpox  begin as little red bumps that become fluid filled then break, crust and itch.
• Pox tend to be concentrated on body areas with a lot of blood flow such as the scalp and underpants area
• A person who has received the vaccine can sometimes get chickenpox but often the pox are very few in number and hard to tell for certain
• A person is infectious with chickenpox from  24 hours before the pox begin until they all crust over, however, they are most highly contagious the first 4 days.
• Chicken pox can occasionally be serious. Watch for:
  • fever several days into chickenpox
  • a new red rash in the background
  • redness and tenderness around pox
  • vomiting with chickenpox
• For symptomatic relief frequent Aveno baths and benadryl can be given.
• There is a medicine that will lighten the course if give early enough (Think about this if there is a susceptible sib)
• A vaccine is available which is nearly 100% effective in preventing severe pox.

Fifth's Disease

Fifth Disease is so called because it is the 5th of 6th childhood exanthems. It is also called Erythema Infectiosum and is caused by a Parvo B19 virus.

Fifth's Disease comes in epidemics every 3 to 5 years and typically gives a "Slapped Cheek" appearance with a bright red rash over the face and a lacy flat rash over the inner thighs and arms. Often the rash is worse after a warm bath or activity. Sometimes the rash itches. Adults and older children who get this will sometimes have joint aches.

The incubation period is thought to be 4 to 14 days but may be as long as 21 days. Once the rash comes the child is no longer contagious.

Hand Foot and Mouth

Hand, Foot and Mouth disease is caused by a virus that causes spots in and on places where the name suggests: the palms, soles, and mouth (roof of mouth, tongue, inner walls of mouth).  Sometimes the buttocks are involved.  The rash will occasionally look like chickenpox. There is no treatment other than making the child more comfortable.