Name That Rash

I have a confession to make.  I hate rashes.  Bumpy rashes, itchy rashes, scaly rashes, spotty rashes, red rashes, diaper rashes, I hate them all.  They have thousands of causes that can look exactly alike with maddeningly few identifying characteristics. Matching the treatment with the cause is sometimes like solving a Rubik’s cube, and most go away in their own sweet time.  They make moms crazy (though kids don’t seem to mind them so much) and doctors crazier.

Is this one an allergic rash? Is that one an infectious rash?  Is it viral?  Bacterial?  Is it a drug reaction?  Does it need to be treated?  Will it disappear as quickly as it came if we just ignore it?  Does it look like the rash she had last month?  Is it really there, or are my eyes playing tricks on me? AAARRRGGGHHH!

So let’s take a look at some common rashes and their causes and try to get a handle on what you’re seeing.  A rash is just a reaction in the skin, and the skin only has so many possible responses.  That’s why so many of them look alike.

Lots of childhood viral illnesses cause a rash.  In the dark ages (15 years ago) before the varicella vaccine was available, most of us moms could spot a chicken pox rash from the next room. Reddish spots topped by a clear fluid-filled blister were the itchy giveaway.  The measles rash (also rarely seen now thanks to the miracle of immunization) was more of a  reddish-brown sheet over the face and trunk, and appeared after 2 or 3 days of red eyes, fever and flu-like aches.

Common rash-causing viral illnesses to keep your eye out for today include fifth disease (so named because it was the fifth childhood illness with a rash to be identified … I’m not kidding!).  It’s a mild illness with low-grade fever, headache, and sore throat that precede the characteristic facial rash by about a week.  Once the rash shows up looking like bright pink ‘slapped cheeks’, the virus has peaked and kiddo is on the mend.

Hand, foot, and mouth disease is caused by a virus and appears as small bumps or blisters on the gums, palms, and soles of the feet.  A low grade fever often comes along for the ride, and kids appear a bit cranky, but otherwise not terribly sick.

Lots of other non-specific viruses travel with a rash, so if your child is feeling generally wonky, with a bit of fever, cold symptoms and a mild rash over the face and body, think viral.  The only treatment for viral rashes is Tylenol or Motrin for fever and discomfort.  The rash will pass in 3-5 days along with the virus.

Bacterial illnesses can cause rashes, too.  Scarlet fever is a red sandpaper-like rash over the arms and trunk that appears with some cases of strep throat. It’s important to treat the strep bacteria with antibiotics because untreated strep can cause long-term complications like rheumatic fever.

impetigo

Impetigo is a superficial bacterial infection of the skin itself, usually caused by staph or strep.  It often begins as small blisters or blemishes that spread and form a brown-gold crust.  It’s very contagious and spreads easily to other parts of the body … and to siblings.  Impetigo is easily treated with topical and/or oral antibiotics.

There are some life-threatening infections that can present with a rash and must be ruled out immediately by your doctor.  Bacterial sepsis, particularly caused by meningococcus ( a cause of bacterial meningitis), can appear with fever and petechiae, dark red spots caused by bleeding into the skin itself that do not fade when you press on them as other rashes do. Toxic shock syndrome is a form of sepsis that may be accompanied by a non-specific rash.  Children with a dangerous bacterial infection will appear extremely ill.  Trust your mommy gut and get to the emergency room fast.

To learn about other rare but serious illnesses that cause rash, take a look at this excellent article in emedicine.

Diaper rash can be the most frustrating of all rashes — at least until toilet training is complete.  No matter how thoroughly you clean or how often you change, some babes are plagued by it, while others seem to skate through diaperland unscathed.  Clean with mild, hypoallergenic wipes or pure water when possible, and apply a good industrial strength cream as a barrier.  Two of my favorites are Butt Paste and Triple Paste. If nothing seems to help and your kiddo’s butt looks red and angry, there may be some yeast growing.  See your doctor for an antifungal cream.  To help cut down on the inflammation, try mixing the antifungal with some 1%  hydrocortisone cream in your hand before applying.

An allergic reaction to medicine or food will often cause a hive-like rash over the body, but the catch here is that no two allergic rashes look alike.  Some appear as classic hives — pink, puffy raised areas all over — while others may look spotty or bumpy.  They may itch or they may not.  If a body rash suddenly appears and your child isn’t ill or feverish, think about any meds or food that may be new to the scene.  Problem is, even old foods can cause new allergies and it can be maddeningly difficult to pinpoint the cause.  The only treatment is to remove the offending item.  Sometimes withdrawing things one at a time for several days at a time is the only option.  See your doctor if you suspect an allergy since some allergic reactions can be dangerous, and  two detectives are always better than one.

poison ivy

A contact allergy happens when the skin reacts to something toxic or irritating that’s touching it.  Poison ivy/oak is a contact allergy, so is a  jewelery reaction when those cheap silver earrings make your ears swell and itch.  The rash is usually limited to the area touched, though it may spread as in the case of poison ivy.  Contact allergies can usually be treated with anti-inflammatory creams, but occasionally require oral medicines.

Heat rash (ok, it’s pretty self-explanatory) is harmless and shows up in warm weather without any other symptoms.  It may be raised, or not, and fades as the weather cools or the body acclimates.  No treatment necessary.

And finally, there’s eczema.  An itchy, scaley rash commonly appearing on the face, hands, behind the knees, and inside the elbows, which is caused by inflammation and an immune system in overdrive.  Eczema can be hard to treat, but your doctor can guide you through the mainstays of creams, mild soaps, and moisturizers.  The good news is that lots of kids outgrow their eczema by puberty.

We never even got to scabies, ringworm, athletes foot, or newborn rashes so stay tuned for part 2.  I can’t stand rashes!