Rashes and Red Spots

As pediatricians we are trained to evaluate all medical issues that affect children, to treat the great majority of them, and to recognize when to refer complex issues to specialists. Skin problems, along with infections and allergies, are among the most common conditions we see. This month we are highlighting some common skin conditions of childhood.

Eczema, also known as atopic dermatitis, is the most common chronic skin condition of childhood. Up to 40% of children have eczema at some point in the first 10 years of life. It is chronic in the sense it needs ongoing maintenance, there is no one time treatment that will clear it up for good. It is most common in infancy. The good news is that eczema is often outgrown by the age of four. Eczema is often seen in people with a personal or family history of allergies or asthma.

The rash can range from dry skin with rough patches to very extensive large, red, thickened, itchy patches. It is common on the cheeks in infancy and behind the knees and in elbow creases as children get older, but can occur anywhere on the body. A hallmark of eczema is itching. if we can prevent scratching, we can prevent the progression to stubborn rash.This itching can be an overlooked reason for poor sleep in an infant or young child.

Eczema can be triggered by skin sensitivities to soaps and detergents, fabrics such as wool, winter dryness, summer heat, swimming pool chemicals and environmental allergies. Food allergies can aggravate eczema, but the great majority of children with eczema (over 90%) do not have food allergy. Avoiding some of these triggers by using hypoallergenic soaps and detergents can be helpful.

The mainstay of eczema treatment is the liberal use of thick emollient creams. Moisturizing products than come in jars are better than lotions. Most companies known for sensitive skin products make an excellent thick moisturizer with no perfume or coloring. If these products are applied multiple times daily, so they can always be felt on the skin. This is often enough to achieve control. After bathing, lightly patting the skin partially dry and immediately using an emollient cream liberally all over is very helpful. The next step in treatment when needed is adding a mild steroid cream like over-the counter hydrocortisone. You may want to discuss this with your pediatrician. We step up to prescription strength creams or ointments when needed, and refer more severe cases to a pediatric dermatologist.

Rashes caused by viral illnesses, called viral exanthems, are also extremely common in childhood. Chicken pox, caused by the varicella virus, is a distinctive appearing example of a viral exanthem known to many parents from their own childhood. It has become uncommon since the introduction of the varicella vaccine in 1995. Rarer still is measles, which was the most deadly of the childhood rash-causing viruses until a highly effective vaccine was introduced in 1963. Measles is extremely contagious. When vaccination rates drop, it comes roaring back, reminding us of the importance and effectiveness of immunizations.

These days, the most common viral exanthems are less serious. Hand-foot-and-mouth disease, caused by the coxsackie virus is extremely common in children under five. It causes fever, sores in the mouth and a rash which is classically blister-like lesions on the palms and soles. It resolves on its own in 7-10 days without complications.

Fifth disease, caused by parvovirus, is another common and innocent viral rash. It is distinguished by bright red cheeks, the so-called “slapped cheek” appearance followed by a lacy rash over the body which may last for 1-3 weeks. It may be accompanied by fever and feeling ill, but is often asymptomatic. It is no longer contagious by the time the rash develops.

Not all viral exanthems are as distinctive as chicken pox, hand-foot-and-mouth disease and fifth disease. Very commonly childhood illnesses are accompanied by rashes, the large majority of these are innocent and resolve spontaneously. It is best to just call us when you have a concern about a rash and we can determine when a visit is warranted.

No discussion of common childhood rashes would be complete without a mention of diaper rash. Most diaper rashes will resolve in a few days with frequent diaper changes, leaving the skin open to air for periods of time, and covering with a zinc oxide based barrier cream when diapered. Diaper rashes which don’t improve in a few days are often complicated by a yeast infection which will clear with the addition of an over-the-counter anti-fungal cream.

We will wrap this up without getting too deep into acne, which could be a large topic of its own. Acne treatment starts with daily use of over-the-counter products containing salicylic acid or benzoyl peroxide. Treatments must be used daily for weeks before significant improvement is noted, so a highly motivated teen is most likely to have success. Many teens with more severe acne see a dermatologist and there are many great treatment options now, so scarring acne should be a thing of the past.

Written by: Dr. Eileen Beaty

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