Skin Rashes in Children – Causes, Diagnosis, treatment

Skin Rashes in Children

Also called: Pediatric Erythema, Pediatric Dermatitis, Pediatric Skin Lesions, Pediatric Rubor

Summary

A skin rash is an area of inflammation, or a change in the texture or color of the skin (e.g., redness, itching, raised bumps). The condition can result from a range of sources, including irritation, disease or a reaction (allergic or non–allergic) to foods, chemicals, plants, animals, insects or other environmental factors. Children and infants often have skin rashes that are harmless, but some rashes are more serious and require prompt medical treatment.

A rash may be a sign of a generalized, non–skin problem originating elsewhere in the body, simply manifesting itself, but not originating, in the skin.

The visible characteristics, location, distribution, shape, pattern changes and accompanying symptoms vary depending on the cause and type of the rash. Skin rashes can appear on the entire body or be confined to specific areas. They can last for a short time or they can recur. They may or may not be contagious.

Skin rashes are usually not dangerous. However, all children with rashes should be examined by a pediatrician to diagnose an appropriate treatment. Many rashes heal without treatment, but some are potentially life–threatening and require emergency care. Numerous childhood diseases have bacterial or viral causes and have a rash of some type as an evident symptom.

While a variety of skin rash relief products are available over–the–counter, these types of treatment should not be used without first consulting a pediatrician. If the skin rash is being caused by an allergy, treatment focuses on identifying and avoiding the allergen triggering the reaction. Medications are available to help relieve the discomfort associated with skin rashes and to help the rashes heal more quickly.

About skin rashes and children

Skin rashes, for both children and adults, are a common symptom of many types of medical conditions, including many allergies. The condition is characterized by a change in the texture and color of the skin, and often accompanied by localized itching or swelling. Skin rashes themselves are rarely dangerous, though a skin rash can point to an underlying medical condition.

Skin rashes can appear at any age, but numerous childhood diseases have bacterial or viral causes and have a rash of some type as an evident symptom. Most rashes are harmless and clear up on their own in several days. However, parents are encouraged to consult their child’s pediatrician about skin rashes because the presence of a rash could indicate a more serious problem in some cases.

While a skin rash can result from a variety of irritants or conditions, allergies are one of the more common causes of the condition in children. Allergic rashes can be caused by either skin contact with an allergen (allergic contact dermatitis) or as a reaction to an ingested or inhaled allergen.

Allergic contact dermatitis occurs when an allergen (e.g., pollen, latex, pet dander) comes into contact with a child’s skin and is absorbed into the body. The immune system reacts to the allergen at the point of contact, releasing histamines that cause localized symptoms of redness, swelling and itching. Because the skin allows relatively small amounts of the allergen into the body, this reaction is typically less severe, though strong allergic reactions that affect the entire body can still be triggered in this way.

Skin rashes in children can be localized or systemic. Localized symptoms are confined to a certain area of the body. A child coming into contact with poison ivy while playing outside is likely to result in a localized reaction. A systemic response often generates many different kinds of symptoms, including sneezing, nausea and swelling in addition to skin rashes. The rashes generated by a systemic reaction often occur on the face, though they can appear anywhere on the body.

Skin rashes can appear in many different forms on the surface of a child’s skin. Common characteristics of a rash include:

  • Pinpoint red spots
  • Small red areas
  • Bruises
  • Blisters
  • Dry, tough skin growth
  • Scaling or crusting
  • Small elevated bumps
  • Elevated flat area

Hives occur when the symptoms of an allergic reaction take the form of welts or itchy red blotches that appear suddenly. This type of rash is often characterized by a slight swelling of the child’s skin. This swelling occurs at the site of the blotches, or away from the blotches (which is known as angioedema). Hives can quickly migrate to anywhere on the skin and disappear as quickly as they appeared.

Allergic causes of skin rashes in children

The precise cause of many childhood skin rashes is unknown. However, the visible characteristics of a rash and its accompanying symptoms can often help pinpoint the cause.

Many types of skin rashes are the result of an allergic reaction, which is an exaggerated response by the immune system to a substance that, in most people, causes no symptoms. Allergens common in children include certain foods (e.g., eggs, milk), pollen, dander, sun exposure, medications and insect bites.

The most common forms of allergic rash include:

  • Atopic dermatitis (eczema). Inflammation of the skin caused by allergies. The condition produces rashes that are dry, thickened or scaly in appearance. Atopic dermatitis tends to run in families in which family members have allergic rhinitis or asthma. It is a chronic (ongoing) condition that causes the skin to become very itchy and inflamed with redness. Cracking, oozing, crusting and scaling may also occur.
  • Allergic contact dermatitis. Red, itchy welts which rupture, leak fluid and crust, and end up scaling and cracking. Possible allergens causing allergic contact dermatitis in children include lotions, topical medicines, metals, clothing dyes, medications and powders.
     
  • Hives (urticaria). Elevated patches of often discolored and itchy skin. Allergic urticaria is more common in children than in adults. The immune system overreacts to foods, drugs, insect stings, animal dander, or other substances. Hives can also be caused by conditions other than allergies, such as heat, cold and deep pressure.
  • Angioedema. Swelling that occurs deep in the skin instead of on its surface, especially around the face, lips and eyes. The welts may also appear on the hands, feet or genitalia. Swelling generally occurs where the skin is tight. They can be red, itchy, painful and swell if irritated. Angioedema may be caused by allergic reactions to such things as animal dander, medications, food and insect bites. This condition can also be caused by non–allergic triggers.
  • Cercarial dermatitis (swimmer’s itch). Caused by an allergic reaction to infection with parasites. Birds and mammals become infected with these microscopic parasites and then release them into lakes and oceans. Children swimming in water contaminated by the parasites may experience skin tingling, burning or itching.

Other causes of skin rash in children

Although skin rashes are often the result of an allergic reaction, there are a number of other causes that are non-allergic in nature. Other causes of skin rash often found in children include:

  • Bacteria and viruses. Rashes resulting from bacterial or viral infection are typically associated with specific symptoms such as fever, sore throat and red eyes. These types of rash typically require immediate medical treatment. Bacterial and viral conditions associated with rash include:
    • Measles. Symptoms include nasal congestion, fever, cough and eye redness. Symptoms may also include a whitish rash on the inside of the cheeks (Koplik’s spots). On day three or four the child will develop a brownish rash on the face that spreads down the body. Rashes caused by this condition are becoming less common due to childhood vaccinations against the disease.
    • Chickenpox. Symptoms include an itchy rash on the scalp, armpits or groin which spreads over the entire body. In the center of this red rash a small blister develops and then ruptures, leaving a crust. Each phase of chickenpox (scabs, blisters and crusts) begin at the same time everywhere on the body. Rashes caused by this condition are becoming less common due to childhood vaccinations against the disease.
    • Scarlet fever. Symptoms include a mild to severe sore throat, headache, fever and swollen glands. A characteristic red rash also appears one or two days after infection. The rash is coarse, rough or bumpy – much like sandpaper. The face may look flush (except around the mouth).
    • Rubella. Symptoms include a pink rash on the face. It spreads down the body and may swell lymph nodes on the neck and behind the ears. Rashes caused by this condition are becoming less common due to childhood vaccinations against the disease.
    • Roseola infantum. Symptoms include a high fever for two or four days followed by a rash that is small and pink with slightly swollen lesions. The rash starts on the trunk and spreads to the arms and legs.
    • Impetigo. Symptoms include a rash that can spread to other parts of the body (and to other people). It starts with small blisters that rupture, leaving patches of red skin. A light brown crust develops over the itchy rash. Impetigo often results from scratching a mosquito bite and pushing surface bacteria under the skin.
    • Coxsackieviruses and other enteroviruses. Symptoms include a rash that develops after fever or blisters.
    • Hand–foot–and–mouth disease. Symptoms include fever, rash and blisters that develop in the mouth and tongue and then travel to the hands, trunk and feet.
    • Molluscum contagiosum. Symptoms include small, waxy, dome-shaped lesions on the skin. It is benign and painless, and usually goes away spontaneously after a few months to a few years. It is most common in children under the age of 5 years.
    • Fifth disease. Characterized by the appearance of a bright red rash on the face. The rash makes a person appear to have “slapped cheeks” or sunburn. The disease usually affects children ages 4 to 10. It is a contagious condition.
    • Red dots (petechiae). Symptoms include red blood blisters that form on the skin with or without rash, fever, coughing and vomiting. This condition could develop into a life threatening situation.
    • Meningococcemia. Symptoms include a fever with a rash of small bumps, developing blisters or red dots with headache, congestion, nausea, vomiting or aches. Parents should seek emergency attention immediately for their child if meningococcemia is suspected.
    • Rocky Mountain spotted fever (RMSF). Symptoms include headache, high temperature (102° Fahrenheit [39° Celsius] or higher), aches and a rash after a tick bite (sometimes undetectable). The rash begins on day two or three and usually starts with red dots developing on the ankles or wrists that spread inward. Parents should seek emergency attention for their child if RMSF is suspected.
    • Lyme disease. Symptoms include a flu or fever (100° Fahrenheit [38° Celsius] and higher) that occurs after a tick bite. A target–like red rash then develops. It may drastically grow in size at the site of a tick bite. A child with this condition should receive emergency care. 
    • Kawasaki disease. Symptoms include a persistent five–day fever, rash (red lesions or blisters), red eyes, swollen lymph nodes in the neck, swelling fingers and toes, as well as a red tongue, lips and throat.
    • Toxic shock syndrome. Symptoms include a high fever, aches, sore throat, vomiting, diarrhea, low blood pressure and disorientation. A rash develops that may appear like a mild sunburn all over the body. This is a life–threatening condition and parents should seek immediate emergency care for their child if it is suspected.
  • Parasites. These organisms (e.g., mites, lice) live off a person’s skin tissue and often cause a rash. Parasite-related causes of skin rash include:
    • Scabies. Symptoms include an itchy rash that develops around the armpits, wrists and arms and between the fingers. Children should see a pediatrician if scabies is suspected.
  • Fungi. Fungal infection often results in the appearance of a skin rash. Fungus-related causes of rash include:
    • Ringworm. Symptoms include an itchy rash that may appear as dandruff on the scalp. The condition often looks like a ring, with central clearing and a raised area around the outside. The condition is contagious. Children with this condition should see a pediatrician.
    • Athlete’s foot. Symptoms include an itchy rash between the toes.

A baby’s skin commonly has some skin blemishes or blotchiness, but these conditions are usually harmless and need little or no treatment. However, there are some skin conditions that commonly cause rashes in infants. These include:

  • Erythema toxicum. Typical newborn rash that begins with small blisters or redness and may have a white or yellow substance inside. The rash usually begins on the second or third day of life. Treatment is not required.
  • Heat rash. Blockage of the sweat glands that leads to little red bumps or small blisters. This is usually not a serious condition.
  • Cradle cap (seborrheic dermatitis). Scaly, red, slippery, bumpy rash that can be on the scalp, armpits, diaper area or behind the ears. Parents should point out this condition to a pediatrician.
  • Diaper rash. Red rash caused by chafing and moisture in soiled diapers. The rash often appears “beefy red” with little blisters around its edge called “satellite lesions.” If the rash persists, parents should take their infant to see a pediatrician.
  • Strawberry hemangioma. Common, harmless growth that develops during the first year of life. It starts as small pink birthmark but can rapidly grow in size within a couple of weeks. Some specialty treatments are available to treat this condition. 
  • Milia. Tiny white pimples on the chin and nose. It is common for babies to be born with this condition.
  • Prickly heat (miliaria). Rash and blisters found on the nose. This condition commonly occurs when the child is dressed too warmly.
  • Acne. Newborn acne consisting of pimples on the face.
  • Yeast infection (candidal rash). Red rash that thrives in moist environments. It has raised lesions and is usually found in the crease and folds of the baby’s skin.

Other types of common skin rash conditions include:

  • Shingles. Contagious condition caused by the same virus as chickenpox. It may lie dormant in the body for many years. The condition re–emerges as a painful, blistering skin condition. Symptoms are usually limited to one side of the body, almost never crossing the midline.
  • Psoriasis. Red, itchy, scaly patches that appear over joints and along the scalp. The condition is caused by the body’s excessive production of skin cells.
  • Pseudomonas dermatitis (hot tub rash). Skin infection that produces a bumpy, red, often itchy rash that may become tender. It is often caused by a bacteria found in the water and soil and appears within a few days of swimming in a contaminated pool, lake or hot tub.
  • Neurodermatitis. Skin rash that occurs when a tight garment repeatedly rubs against sensitive skin. The skin rash often appears on the wrist, arm and back of the neck and is characterized by rough and thickened patches of itchy skin.
  • Perioral dermatitis. Rash or irritation involving the skin around the mouth and nose that primarily affects younger women and occasionally children or men. The cause is unknown but makeup and face creams and some dental products may be responsible.
  • Seborrheic dermatitis (dandruff). Flaking of the skin that usually affects the scalp. It is more common in children with oily hair and is often inherited. Dandruff is usually treated with a medicated shampoo that contains salicylic acid or a prescription medicine that contains selenium sulfide or pyrithione zinc.
  • Hand dermatitis. Rash on the hands that is red, dry, cracked and inflamed. This condition is often experienced by individuals who are in constant contact with oils and lotions and who perform frequent hand washing (e.g., massage therapist).
  • Stasis dermatitis. Excess of fluid that builds up in the tissues beneath the skin. It thins out the skin and interferes with the body’s ability to nourish it. Fluid build–up can be caused by varicose veins and other chronic conditions.

Diagnosis, treatment and prevention methods

While skin rashes are rarely dangerous, parents should not attempt to diagnose a skin rash condition on their own. Parents should consult a pediatrician for proper diagnosis and treatment.

The methods used for the diagnosis and treatment of skin rashes in children are largely the same as for adults. Skin rashes can often be identified through a visual examination by a dermatologist or other healthcare professional. In some cases, a skin biopsy or other test (e.g., blood test,urine test) may be necessary to determine the exact nature of a rash. Details from a medical history can also aid diagnosis.

Treatment options vary significantly depending on the type of rash. Some rashes clear on their own over time. Others may require treatment with medications. Treatment options for various rashes include:

  • Antibiotics. Topical or oral antibiotics may be used to treat skin rashes caused by underlying bacterial infections. The entire course of prescribed antibiotics should be taken, even if symptoms improve, to prevent recurrence.
  • Antihistamines. Oral antihistamines block the release of histamines into the body. Histamines cause the symptoms – including some skin rashes – that occur during an allergic reaction or other immune system responses. Topical antihistamines can also help prevent the itching that may accompany some rashes. However, topical antihistamines can sensitize the skin and cause reactions themselves. Older antihistamines used to cause drowsiness, but there are newer ones on the market that cause little or no drowsiness.
  • Corticosteroid medications. These potent medications help lessen inflammation. However, they should be carefully used, as they can cause thin skin or other complications. In most cases, a topical corticosteroid will be used. If the rash covers a large portion of the skin or is severe, a physician may prescribe corticosteroid pills or injections. A patient is usually tapered off the medication gradually over a two-week period to prevent recurrence of the rash.
  • Phototherapy. Some skin rashes can be treated by exposing the patient in controlled circumstances to ultraviolet light waves over a period of time.

Keeping a child’s skin healthy is the first step in preventing skin rashes. For individuals with allergies, the key is to identify and avoid contact with any allergens. By limiting contact with allergens, individuals can prevent the allergy attacks that result in skin rash symptoms.

Other tips that can help prevent skin rashes in children and infants include:

  • Breastfeed for at least the first six months of life. This may cause the child to develop fewer food allergies than a child who is not breast-fed. While it is highly debatable whether this technique is effective at preventing food allergies, almost all physicians agree that breastfeeding is greatly beneficial to the overall health of a child. 
  • Vaccinate children against childhood illnesses such as chickenpox, measles and rubella.
  • Instruct the child not to scratch to prevent spreading the rash. Parents can put socks over their babies’ hands to prevent them from scratching.
  • Limit the use of any skin products or laundry products that contain added fragrances.
  • Refrain from exposing the skin to particularly hot or cold air. Children should also stay out of the sun as much as possible.
  • Prevent the development of a contagious rash by regularly changing a child.
  • Since most children do not require daily bathing, do not wash the child too frequently. This can cause dry skin and a rash to develop.
  • Children should be dressed sparingly in hot weather. The fewer articles of clothing, the better. Cotton clothing is generally lighter and less abrasive than other types of clothes.
  • Wash children’s clothes with mild types of soap rather than detergents.

Questions for your doctor

Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Parents may wish to ask their child’s doctor the following questions related to skin rashes and children:

  1. What symptoms may indicate that my child has a rash?
  2. Under what circumstances should I contact you concerning a rash in my child?
  3. What tests will you use to determine the cause of my child’s rash?
  4. Is my child’s rash due to an allergic reaction?
  5. What are my child’s treatment options?
  6. When can I expect my child’s symptoms to subside?
  7. Is my child’s rash likely to spread to other parts of the body or to other people? If so, when will my child no longer be contagious?
  8. Should I keep my child out of school while the rash is present?
  9. Is my child likely to develop a similar rash again in the future?
  10. What steps can I take to prevent my child from developing a skin rash?
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