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Family Health Magazine - CHILDHOOD

Childhood Rashes
How to deal with the spots on your tot

Almost everyone will have a rash at some point in their life. Most rashes occur in childhood and many of these concern parents. Sometimes the cause of the rash is obvious, but many times it is difficult to determine. Fortunately, most rashes that affect children are self-limited - that is, they will go away without any specific treatment.

The childhood rashes that parents most commonly deal with include baby acne, chickenpox, baby measles, fifth disease, scarlet fever, hand-foot-mouth disease, eczema, scabies and allergies. There are many others. If you are concerned about your child’s rash, see your family doctor as soon as possible.

Rashes of the newborn (Baby Acne)

Many babies develop a rash soon after birth. Parents are often concerned, but these rashes are usually normal. Before birth, the baby is exposed to many hormones produced by the mother to support her pregnancy. After birth this hormone supply suddenly disappears and only the hormones the baby makes are left. With this great change in hormone balance, the baby’s skin may develop an acne-like rash. If simply watched, the rash will usually disappear within a few days, although a few babies may have a rash for weeks.

Viral Rashes

Many viruses cause both cold-type symptoms and rashes in children. Some are distinctive and can be diagnosed, but very few can be treated. Most of them can never be blamed on one specific virus. There are a number of viral rashes that are commonly seen in children, and are worth noting.

Measles - Until the mid-60s, almost every child got measles. Measles is a viral illness that causes a distinctive rash over most of the body. The rash is very red and generally spreads from the head down to the trunk. It is usually blotchy and the eyes are generally red-rimmed. Those with measles are usually very ill, with high fevers and very sensitive eyes. Most healthy well-fed children recover well from measles, but it can be terrible for some children in any society. In Third World countries it can be severely damaging for many children.

With even the best nutrition and medical care, a small number of measles victims will suffer serious damage to their eyes or brains. A few will die. If the affected child is malnourished, and especially if they are low in Vitamin A, there is a much higher risk that they will suffer permanent damage to their eyes. Others will develop a slowly progressing form of brain injury that will eventually kill them.

In Canada, all children are offered free vaccinations against measles at or after one year of age. Those who are vaccinated are usually immune to the disease for life. Some children will develop a measles-like rash after the vaccine, but this will clear without treatment in a few days. Vaccinated children very rarely develop any of the more serious problems caused by the actual measles virus. Some require re-vaccination depending on the year they were immunized. Children who are allergic to eggs may not be eligible for the vaccine. Review the date of child’s MMR (measles vaccine) and your child’s allergies with your doctor or public health personnel.

Measles remains common in many parts of the world, and a few cases are reported in Canada each year. These cases are almost always in unvaccinated travellers who pick it up abroad and bring it home. When this happens, the Public Health departments make vigorous efforts to contain the outbreak, because the potential for serious illness is always there.

Rubella – Rubella, or German measles, is another viral rash that has been largely eliminated by vaccination. In most people, the disease itself is mild. However, it can cause devastating damage to an unborn baby if the mother catches the disease early in her pregnancy. Most pregnant women are now checked to ensure their immunity against rubella.

Chickenpox - Another rash that almost all children get is chicken pox. Children who have chicken pox are often ill for a couple of days before they break out in the distinct rash. The pox are numerous small red raised marks that may be found almost anywhere on the body. After a time, the marks become blisters and then crust over. Some children have only a few pox, but others have hundreds of the marks. New pox continue to appear for several days, and it may be more than ten days before they are all crusted over. The rash is extremely itchy, and there are no really effective treatments for the itch. Calamine lotion is commonly used, but provides only temporary and partial relief from the itch. There are medications that can be given to reduce the severity of chicken pox, but they must be taken soon after the first pox appears for maximum effect.

A vaccine has been released that will prevent this disease. In some areas vaccination is covered by the provincial health care plan. The vaccine can be given after the child’s one year vaccinations (about 13 months of age). The vaccine prevents the disease and complications of the disease which may include pneumonia, meningitis and encephalitis.

Roseola (Baby Measles) - Roseola is often called baby measles. This is incorrect, because the illness is completely unrelated to measles. In this illness, the child is often ill with a high fever for a day or two. The child appears to have recovered, and then suddenly breaks out in a rash over much of the body. The rash appears suddenly, is present for only a few hours, and then disappears. However, it frequently sparks rushed visits to the doctor because the rash is widespread and dramatic. No treatment is needed or available for this rash.

Fifth Disease - Another dramatic rash gives its name to fifth disease, also called Slap Cheek Disease. This illness starts with brilliantly red cheeks, and looks as if the child has been slapped a short time ago. Again, no treatment is needed.

Hand-foot-mouth disease - This disease has no connection to the infamous foot and mouth disease in livestock. Instead, this is a disease caused by a virus. The rash shows as small red marks on the hands and feet, and inside the mouth. It is relatively easy to diagnose, because very few illnesses cause a rash on the hands and feet. This disease is most common in the fall, with outbreaks occurring in most communities every few years.

Non-viral rashes

Unlike viral rashes, non-viral rashes require treatment. The following are common:

Scarlet Fever - This is a disease that alarms many parents. This is basically a case of strep throat, plus a distinct rash. The rash is a mass of very tiny slightly raised red marks over much of the body. When combined with the strep throat symptoms of sore throat, swollen glands, high fever, no cough, and pus in the throat, the diagnosis of scarlet fever is possible. However, it can only be reliably diagnosed if a throat swab confirms the presence of Group A streptococcus bacteria. The great majority of sore throats are caused by a virus, which we can’t treat, and not by the strep bacteria, which we can treat.

Streptococcus causes a wide range of illnesses, from simple sore throats to rheumatic fever and the so-called 'flesh-eating disease.' Fortunately, the serious forms of illness are very rare, and can usually be prevented by treatment with one of the penicillin antibiotics. Drugs do not need to be given immediately. Research has shown giving penicillin within ten days of the first symptoms will prevent most of the serious complications.

Parasites - Kids often bring home the strangest things, as most parents can tell you. One of the least welcome things they can bring home is scabies. This is a very small mite that lives on the skin. This tiny parasite can occur in almost any family if someone comes in contact with the mites. The mites dig tiny burrows in the skin, and leave their eggs, as well as droppings and other fragments behind. This material may trigger allergic reactions, which cause the skin to break out in many tiny red and very itchy dots. These are most commonly found on the hands and in skin fold areas, but they can occur almost anywhere on the body.

Scabies can be treated with an insecticidal cream. The type on the market now uses permethrins, chemicals related to insecticidal pyrethrins that are derived from certain flowers. They are used in many bug-killing products, and are believed to be safe for close contact with children and adults. If your child is under one year of age or if you are pregnant or breastfeeding, check with your doctor before using these products. In addition to using the cream, bedding and linens should be washed very thoroughly. A few mites may be harboring in them, and they could re-infect people.

Even after being treated, an infected child may have new rash areas appearing for a few days. This happens if the mites created new burrows just before the cream treatment. The debris in those burrows, including the dead mites, will continue to trigger allergic reactions and rash for a few days. However, if new rash appears more than four days after applying cream, a repeat treatment may be needed.

Long lasting skin conditions with rashes

Children can suffer from the same long-term skin conditions as adults, though some of those conditions are less common in children than in adults.

Eczema - Common in children, eczema often shows up as dry, flaky and itchy skin patches that either will not heal or will not stay healed. Common areas for the rash to appear are the cheeks, and elbows and knees. In very young children, the insides of the elbows and knees are the areas that are most often affected. Eczema typically moves from the inside to the outside of the knees and elbows, as children age. We do not know why this change happens.

Eczema can be set off by allergies, but most often it is not clear what the trigger is. Similarly, we do not know why one area will be affected, while another area is clear. The usual treatment for eczema is steroid creams. These should only be used on the advice of a doctor as they can have serious adverse effects in children. Even the forms that can be bought over-the-counter in most locales need to be used very carefully in children.

Allergies - Kids are subject to the same allergic rashes that adults suffer from. The severity of the rash depends on the cause of the allergy, the child, the length of time the child was exposed, and other factors. Common causes include cats, the colours and scents in laundry products, some metals such as nickel, and plant pollens. The best treatment for this type of rash is avoiding the cause of the allergy. If that is not possible, many rashes will respond to over-the-counter antihistamines. The most effective treatment for your child will depend on their age and many other factors. Advice on which antihistamines are safe and effective is available from your family doctor, as well as your pharmacist.

If avoiding the cause is not possible, and the antihistamines are not working, treatment usually involves steroids. These can be given as creams and lotions, pills, or even as shots in unusual cases. This treatment requires a visit to your family doctor.

In summary, there are a great many rashes that affect children. Some are short-lived, and result from infections by common childhood viruses. Others are lifetime problems, most of which can be well controlled with careful medical treatments. Remember that vaccinations are available for some diseases. Since vaccinations have been available for use the incidence of many diseases including mumps, rubella, measles, whooping cough and smallpox has been greatly reduced. Please ensure your child is properly immunized. This will protect your child and prevent the spread of these diseases.

FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [CH_FHd01]
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