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_face

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_rash

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.

eczema-photo1.thumbnailAnd 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!

For more info on antibiotic allergies and rash, take a look at Antibiotic Allergy or Harmless Rash? 

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?


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17 responses to “Name That Rash”

  1. christian amezcua

    is their any way that i could send you a picture of my rash and what treatment it needs ?

  2. Beth

    I woke up this morning with a bumpy rash on my arms and stomach. I recently washed my sheets, however, I have been using the same detergent. The rash kind of itches. Its slightly red and they appear to look like goosebumps almost. Can you give me an idea on what type of rash you might think it is?

  3. Hazel M. Wheeler

    Hi– chiming in to Beth’s question– are your sheets new? Some new sheets are made to be wrinkle-resistant and contain formaldehyde. It’s not a common allergen, but a dear friend woke up with a horrible rash from new wrinkle-free sheets, even after washing them well– it turns out that it’s the formaldehyde which triggered the rash. They’ve since stopped using the sheets and the rash has disappeared. Other kinds of chemicals are also used on sheets to prevent wrinkling/shrinking or to provide a sheen. Not sure if this is what you are dealing with, but thought I’d put it out there.

  4. Antibiotic Allergy or Harmless Rash?

    [...] more info about rashes check out our post, Name That Rash. It’s a Mamas [...]

  5. 5 Ways to Think Like a Doctor

    [...] appearance (chicken pox is a classic example). For more detail, take a look at a Mamas favorite, Name That Rash. Other virus varieties, like rotavirus and norovirus, cause GI distress, nausea and vomiting that [...]

  6. Cassandra

    Hi , I have a rash on both of my hands , that my doctors have not been able to figure out . It comes and goes . It’s tiny little bumps that itch really bad they treated it for egsama but it didn’t work it spreads from one spot to my whole hand. My hands get pinkish red. I would apricciate it if you could help soon , Thanks !

  7. Lynette

    I have red bumpy rad on my face it just came up out of nowhere it burns a little

  8. Mel

    My 3 year old has a rash on his whole body that is pink and slightly raised. It doesnt itch him. It has been there for 4 days now. t t is everywhere. Pediatriction said its a reaction to something and let it run its course. Dermatologist said its papular dermatitis and gave a steroid ointment. Its very mild. Any suggestions? Thx

  9. Dolly M.

    I have a bumpy rash all over my face! It isn’t able to be seen so no redness itching or burning. I wouldn’t have known it was there if not for rubbing my face. I went to an amusement park and used a new sunscreen so that may be it. Any suggestions on what it may be?

  10. Holly

    So I’ve had this rash type thing for a good two months it started as a little pink raised slightly patch on my stomach followed by four more in a linear form. They were there for about a week before starting to spread to my chest area and back legs and arms wrist even my bikini line just random spots. All just little pink patches. Kind of dry looking. My doctor gave me a prescription cream thinking it might be some sort of fungal infection but the cream thus far hasn’t done anything besides remove the ringworm I did have. I do however have a large patch on the outside of my areola. None itch or hurt. Just there. My skin has been feeling kind of irritated though. I have always used good and the same laundry detergent and recently when I moved about 2.5 months ago started using arm and hammer. My boyfriends choice. Do you think this could be a allergic reaction? I have another doctors appointment this coming Tuesday.. But in the mean while I was curious on a separate opinion. Please advice!!! Thanks!!!

  11. mintgreen77

    Hello! What is your take on quarantining your child when these mystery rashes occur? My daughter is the queen of rashes but hardly ever with a fever. Is it still okay to go about our usual daily routines (preschool, ballet, library, etc)? Thanks for your input!

  12. Leslie

    My child comes home from school with a rash on his face. Starts out red then turns dark and scaly. No pain and does not itch. Only happens at school. ?? Doctors unsure of cause.

  13. Sheryl

    Okay, my 7 1/2 month old son was diagnosed with RSV. He is 6 days in with the infection. He is on albuterol nebi tx every 4 hours and they put him on amoxicillin at his initial dr appt this past Saturday. He now out of nowhere this morning developed a hive like rash on his legs and under his arms and across his body. He has been on the amox for 6 days now. Could that still be an allergic reaction this far in?

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