Not all childhood rashes are created equal. Some are more contagious, others are life threatening. And, (of course) all are unpleasant! OCH pediatric nurse practitioner, Sandy Hinds shares the top 10 common rashes among children and offers a quick guide to identifying each of them. Learn the causes, symptoms, and treatment options available (Part 1). Take note, moms and family members, and stay tuned for the second set of common rashes to be posted next week.
HAND, FOOT & MOUTH DISEASE
Hand-foot-and-mouth disease is always caused by a Coxsackie A-16 virus. It has no relationship to hoof and mouth disease of cattle. Symptoms include the following: small ulcers in the mouth and a mildly painful mouth, small water blisters or red spots located on the palms and soles and on the webs between the fingers and toes, five or fewer blister per limb and sometimes on the buttocks. Low-grade fever between 100 and 102. It mainly occurs in children 6 months to 4 years of age.
Image of Hand, Foot & Mouth
- Expected Course: Fever and discomfort are usually gone by 3-4 days. Mouth ulcers resolve in 7 days, with the rash lasting 7-10 days. Only complication is dehydration from refusing fluids.
- Home Care: Antacid solution: use for pain relief. Children under 4 yo. ½ tsp. antacid solution in the front of their mouth 4 times a day after meals. Children over 4 yo. 1 tsp. antacid solution after meals.
- Diet: Soft diet for a few days and encourage plenty of liquids. Cold drinks, popsicles, sherbert. Avoid citrus, salty or spicy foods or ones that need much chewing.
- Fever: monitor fever and administer fever reducer as needed.
- Contagiousness: Quite contagious and usually some of your kids playmates will develop it at the same time. Incubation period is 3-6 days. Because the condition is harmless, these children do not need to be isolated. They can return to daycare when the fever is normal. Most children are contagious 2 days before to 2 days after the rash, but avoidance of other children is unnecessary.
Poison Ivy causes redness and blisters, eruption on exposed body surfaces. It is shaped like streaks or patches, very itchy, onset 1-2 days from being in a forest or field.
Image of poison Ivy
Cause: poison, ivy, sumac can cause the same type of rash. More than 50% of people are sensitive to the oil of these plants. The course usually lasts 2 weeks. Treatment reduces the symptoms, but doesn’t cure the disease. Prevention is the best approach.
- Prevention: Learn to recognize these plants. Avoid all plants with three large shiny, green leaves. If exposed wash clothing and areas of skin with soap for 5 minutes, because after 1 hour it is of little value in preventing absorption of the oil.
- Contagiousness: The fluid from the sores is not contagious, however, anything that has poison ivy oil or sap on it is contagious for about 1 week. This includes the shoes, or clothing worn as well as any pets that may have it in their fur. The rash begins 1-2 days after exposure.
- Home Treatment: Cool soaks, Benadryl (weight appropriate dosage).
Ringworm is a ring-shaped pink patch, scaly, raised border, increases in size, clearing of center, mildly itchy. It is caused by a fungus infection of the skin, often transferred from puppies or kittens who have it.
Image of ringworm.
- Contagiousness: it is mildly contagious. It requires direct skin-to-skin contact. It is only transmitted animal to human, not human to human. After 48 hours of treatment it is not contagious at all. Animals must be treated by their veterinarian.
- Home Care: antifungal cream, Tinactin, Lotrimin cream applied twice daily to the rash.
FIFTH DISEASE (ERYTHEMA INFECTIOSUM)
This rash is characterized by bright red or rosy rash on both cheeks for 1-3 days ( slapped cheek appearance) , followed by a pink “ lacelike” or “netlike” rash on extremities. Lacy rash mainly on thighs and upper arms, comes and goes several times over 1-3 weeks. No fever or low grade fever – less than 101F ( 38.4). Fifth disease was so named because it was the fifth pink-red infectious rash to be described by physicians. The other four are: 1. Scarlet fever 2. Measles 3. Rubella 4. Roseola. Fifth disease is caused by the human parvovirus B19.
Image of fifth disease.
- Expected Course: The lacelike rash may come and go for 5 weeks, esp. after warm baths, exercise, and sun exposure. No treatment is necessary. The rash is harmless and causes no symptoms that need treatment.
- Contagiousness: Over 50% of exposed children will come down with the rash in 10-14 days. The disease is mainly contagious during the week before the rash begins. Therefore, exposed children should try to avoid pregnant women, but that can be difficult. Once the child has ‘slapped cheeks’ or the lacy rash, he is no longer considered contagious and does not need to stay home from school. If a pregnant woman is exposed to a child with fifth disease, she should see her obstetrician. The doctor will obtain and antibody test to see if the mother already had the disease and is therefore protected.
Children ages 6 months to 3 years, presence of a fine pink rash, mainly on the trunk. High fever during the preceding 2-4 days that cleared within 24 hours before the rash appeared. Child only mildly ill during the time with fever, child acting fine now. Roseola is caused by the human herpesvirus-6. The rash lasts 1-2 days followed by complete recovery. Some children have 3 days of fever without a rash. No particular treatment in necessary. Roseola is contagious until the rash is gone. Other children of this age who have been with your child may come down with roseola in about 12 days. Call if the rash last more than 3 days, fever longer than 4 days or the spots become purple or blood-colored.
Image of roseola. All pictures courtesy of Instructions for Pediatric Patients, second edition, W.B. Saunders Company, 1999
Sandra Hinds, CPNP-PC works at the OCH Christian County Clinic located in Nixa, Mo. She received her education from the University Missouri-Columbia, the University of Missouri-Kansas City School of Nursing and the Vickie Millazzo Institute. Sandra is currently a member of the following professional organizations: National Association of Pediatric Nurse Associates and Practitioners, American Academy of Nurse Practitioners, Kansas City Nurse Practitioner Networking Association. To contact Sandra, call OCH Christian County Clinic at (417) 725-8250.