Top 10 Childhood Rashes – Part 2

In Part Two of the childhood rashes blog post series OCH pediatric nurse practitioner, Sandy Hinds shares the second set of common rashes among children. See below for a quick guide to identifying each of them and learn the causes, symptoms, and treatment options available.

ECZEMA  (ATOPIC DERMATITIS)

Eczema is characterized by a red, extremely itchy rash. It often starts on the cheeks at 2-6 months of age, and is most common on the creases of elbows, wrists, and knees or occasionally the neck, ankles and feet.

  • Cause: Eczema is an inherited type of sensitive skin.  A personal or family history of asthma or hay fever, makes it more likely that your child has eczema.  Flare ups occur when there is contact with an irritating substances. Certain foods can cause eczema to flare up including cow’s milk, eggs, peanut butter. This itchy flare up could develop 2 hours after eating. 
  • Expected Course: This can be a chronic condition, and will usually not go away before adolescence. 
  • Treatment: Steroid creams is the main treatment for itchy eczema. When the rash quiets down, use it at least once daily for an additional 2 weeks. 
  • Bathing and Hydrating: Hydration of the skin followed by lubricating cream is the main way to prevent flare-ups.  Your child should have one bath each day for 10 minutes.  Water soaked skin is less itchy. Eczema is very sensitive to soaps.  Some lubricating creams are Keri, Lubriderm, Nivea and Nutraderm.  Avoid applying any ointments, petroleum jelly, or vegetable shortening because they can block the sweat glands, increase itching and worsen the rash (especially in warm weather).  
  • Prevention: Wool fibers and clothes made of scratchy, rough materials make eczema worse.  Cotton clothes should be worn as much as possible.  Avoid triggers that cause eczema to flare up such as excessive heat, sweating, excessive cold, dry air (use a humidifier) chlorine, harsh chemicals, and saps.  Never us a bubble bath.  Keep your child off the grass. Try to avoid the foods such as cow’s milk, eggs, peanut butter, wheat, and fish during the first year of life.  

HIVES  (Urticaria)

Hives are a very itchy rash, raised pink spots with pale centers (looks like mosquito bites.) Size can rage of ½ inch to several inches across, shapes variable, and rapid repeated changes of location, size and shape. 

  • Cause: Hives are usually an allergic reaction to a food, drug, viral infections, insect bit, or a host of other substances. Often, the cause is NOT found. Localized hives are usually due to skin contact with plants, pollen, food or pet saliva. Hives are NOT contagious.
  • Expected Course: 10% (or more) of children get hives for 3-4 days and then it disappears. Swelling can be common around the eyes, lips, and genitals. Some may develop as big hives (called popular urticaria) at the sites of old and new bits that can last for months. 
  • Treatment: Antihistamine medicine. This medicine will not cure the hives, but I will reduce their number and relieve itching.  Benadryl is one of the most commonly used drugs for hives, with the main side effect being drowsiness.  Please check the dosage according to your child’s weight. Cool baths are helpful to relive the itching.  Avoid triggers that might cause the hives. Call your pediatrician if your child is having trouble breathing, swallowing or acting sick. Also, if the rash does not go away after 1 week, or 24 hours of antihistamines are not effective.   

SCABIES

Scabies are little bugs (mites) that burrow under the skin and cause severe itching and little red bumps. They are so small that they can only be seen with a microscope.  Usually more than one person in a family has them. 

  • Care: Creams are usually prescribed by your physician.  Pregnant women need special medicines for scabies and need to see their physician.
  • Expected Course: The itching and rash may last for 2-3 weeks after successful treatment with the medication. Cool baths without the use of soap, followed by 1% hydrocortisone cream, which you can buy without a prescription.
  • Contagiousness: Children can return to school after one treatment with the scabies medicine, otherwise scabies is HIGHLY contagious.  The symptoms take 30 days after exposure. Machine wash all your child’s sheets, pillowcases, underwear, pajamas, and recently worn clothing.  Blankets can be put away for 3 days.  Scabies cannot live outside the human body for more than 3 days.

IMPETIGO (Infected sores)

Impetigo, or infected sores, are sores within less than 1 inch in diameter; and begin as small red bumps that rapidly change to cloudy blisters, then pimples, and finally sores. They can be covered by soft, yellow-brown scabs that can contain pus.  Impetigo often spreads from scratching and picking at the initial sore. 

  • Cause: Superficial infection of the skin, caused by Streptococcus or Staphylococcus bacteria.  It is more common in the summer when the skin is often broken by cuts, scrapes, and insect bites.  When caused by the strep infection of the nose, the impetigo usually first appears near the nose or mouth. 
  • Expected Course: With proper treatment, the skin will be completely healed in 1 week.  Scars are unusual unless your child repeatedly picks her sores. 
  • Treatment: After the crust has been removed, antibiotic ointment should be applied to the surface three times a day prescribed by your physician. 
  • Prevention: Discourage your child from touching or picking at the sores.  Keep your child’s fingernails cut short, clean and wash their hands with one of the antibacterial soaps.
  • Contagiousness: Impetigo is quite contagious.  Do not share your child’s towel or washcloth.  Keep your child out of school until she has taken oral antibiotics for 24 hours.  For mild impetigo treated with an antibiotic ointment, the child can continue to attend day care or school if the sore is covered with a Band-aid. 

PITIRYASIS ALBA

Pityriasis alba is characterized by multiple oval, scaly, flat hypo-pigmented patches on the face, extensor surface of arms, and upper trunk.  Multiple patches may be seen. Pityriasis alba occurs predominantly between the ages of 3-16 years, and up to 40% of all children may be affected.  The lesions do not itch, and medical help is sought because of the child’s appearance.  It can be distressing in dark-skinned children.

  • Expected Course: It is a chronic dermatitis and may be recurrent over several years.  It can be diagnosed as atopic dermatitis. 
  • Cause: The cause of the hypo-pigmentation is not known, but is likely related to inflammatory mediators that inhibit melanocyte function.
  • Treatment:  There is no satisfactory treatment for pityriasis alba.  Bland lubricants and topical gluco-corticorsteroids have some influence on the disorder.

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.

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