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Rashes

Newborn Rash

Most rashes in newborns are entirely normal and are of no concern. Small white bumps on an infant’s face and nose are called milia. These require no treatment. They will disappear in a month or so. Neonatal acne which resembles acne in older children occurs in infants due to maternal hormone stimulation. This, too, will fade with a little time. Birthmarks are common in babies, especially over the eyelids and over the back of the neck. These should be discussed at a routine office visit.

Bruise-Like Rash

Any purple or bruise-like rash which cannot be explained by simple bruising should be evaluated right away.

Diaper Rash

Diaper rashes are usually due to either irritation of the skin from a wet diaper (ammonia) or to a yeast infection in the diaper area. A yeast can grow on the skin in moist areas. When a diaper rash appears, try especially hard to keep the skin clean and dry. Change the diaper as soon as it is wet or soiled. It is a good idea to put zinc oxide ointment (Desitin) or Vaseline in those areas. If the rash is due to irritation from urine (ammonia), this treatment will be quite effective and the rash should resolve. However, if the rash does not improve with this treatment, contact your physician.

Eczema

Eczema is a skin condition seen in allergic people, which causes the skin to be dry and sensitive. Sometimes, this can lead to a rash over most of the body which is scaly, red, itchy and sometimes even broken open or weeping. Eczema tends to occur in people with a family history of allergy (asthma, hay- fever, eczema, and/or itchy, watery eyes). The treatment of eczema is primarily directed at keeping the skin will hydrated. To do this, it is recommended that the mildest and least amount of soap possible be used. Examples of mild soap are: Dove, Tone, Purpose and Neutrogena. Soap washes away the normal oils of the skin and makes eczema worse. In addition to this, applying Moisturel or Eucerin lotion to the affected skin to further seal the skin from continued water loss can be helpful. If your child’s dry, sensitive skin continues to be a problem despite the above measures, you should contact your physician.

Hives and Allergic Rashes

Hives are red, raised rashes in various sizes, which are usually due to an allergic reaction. The rash seems to move to different areas of the child’s body. It is often associated with itching and sometimes with swelling of the hands and feet. The rash is usually not dangerous, but can be uncomfortable. Hives can be caused by anything that the child has eaten, breathed or come in contact with. Hives are almost never due to something that is new in the diet. Usually, the child has been exposed to the very thing that caused the hives sometime in the past with no reaction.

The treatment of hives is to remove what is causing the rash and make the child comfortable. Of course, to remove what is causing the rash requires that it be identified, which can be very difficult. Write down everything that your child had to eat or was exposed to during the 24 hour period prior to the break-out of the rash. If the hives recur, this should be done again. With each episode, the list should be compared to try to identify the agent responsible.

Benadryl should be given to your child. This will help resolve the rash and control the itching (see Dosing Guide). If your child develops a breathing problem associated with this rash (very rare), the child should be seen immediately.

Poison Ivy

If your child has come in contact with poison ivy or another irritant, it is important to wash the involved area thoroughly with soap and water to remove the poison ivy toxin. You should treat poison ivy (contact dermatitis) with three types of treatment to speed healing and comfort the child. First, cortisone medicine is quite effective in decreasing the inflammation due to poison ivy. Over-the-counter, 0.5% hydrocortisone cream or ointment (Cortaid) can be helpful. If the rash is particularly severe, you should contact your physician. A stronger cortisone cream or ointment or an oral form of cortisone may be prescribed. Elixir can be used to control itching (see Dosing Guide). Lastly, Calamine lotion and Aveeno baths are sometimes helpful for itching. As with other rashes that cause itching, you should trim your child’s nails to prevent scratching and scarring. You can not catch poison ivy by touching the rash of someone who has contracted poison ivy (contact dermatitis). Contact dermatitis is not contagious.

Rashes Due to Drugs

If a rash develops while your child is taking medication, the medication should be stopped and your physician notified. See section on allergy in this booklet.

Seborrheic Dermatitis(Cradle Cap)

Cradle cap is a red, scaly rash on the scalp and body of newborns and infants. This is caused by excessively oily skin. The use of baby oils can make it worse. Seborrheic dermatitis (cradle cap) is treated by removing the scales with an anti-dandruff shampoo such as Sebulex and scrubbing with a soft baby brush. If the rash on the body is particularly severe or if the cradle cap does not resolve with the dandruff shampoo, contact your physician.

Chickenpox (Varicella)

 

Symptoms

Chickenpox is a common viral infection of childhood. After an incubation period of 10 to 21 days, a child will break out with a rash which begins as small red bumps and which very quickly form clear blisters. The clear blisters then rupture and form dark crusts. These three lesions occur in sequence. Lesions generally begin on the chest or back and then spread to the face, neck, arms, and legs. Children usually run fever for several days. In addition to this, they may have a runny nose, sore throat and/or cough. Chickenpox is highly contagious. The child is contagious one day to two days prior to breaking out with the rash and remains contagious until all lesions have completely crusted over and there are no blisters or fever. This generally takes five to seven days from the onset of the rash. You can usually expect the child will break out with new lesions for two or three days after the first lesion is seen.

Complications

Chickenpox is generally a mild illness with no complications.  If complications do occur, the most common one is secondary bacterial infection of the lesions manifested by redness and/or discharge of pus.  You treat these as you would treat impetigo (see section on impetigo).  Serious chickenpox complications are very rare. These involve pneumonia and encephalitis. Signs of encephalitis include headache, stiff neck, vomiting and lethargy (drowsiness to unconsciousness).  If your child should become lethargic and begin vomiting, contact your doctor right away.

Shingles

Shingles is a reactivation of chickenpox infection and is usually seen in adults. People with active shingles are contagious and can spread the chickenpox virus to others who have not had chickenpox.  You can catch chickenpox from someone with shingles, but you cannot catch shingles from someone else. Shingles only occurs in someone who has had chickenpox at an earlier time in their life.  Parents and grandparents do not need to worry about catching shingles from their children with chickenpox.  Shingles is treated the same as chickenpox unless the child develops painful shingles which should prompt a physician contact.  Shingles is spread by direct contact with the lesions.  Keeping them covered with clothing or a gauze pad will help to prevent spread of the disease.

Treatment

  1. Keep your child away from other children or adults who haven’t had chickenpox and from pregnant patients or patients receiving chemotherapy. Although chickenpox is usually a mild illness in children, it can be quite severe in adults.  If you are unsure as to whether you have had chickenpox and your child catches the disease or has been exposed to someone with the disease, you need to let your physician know.
  2. Use an antihistamine such as Benadryl for itching and trim the child’s fingernails.  If itching is quite severe, even with Benadryl, try Aveeno baths and an emollient lotion (Do not use Benadryl Cream).
  3. For fever and the discomfort of chickenpox you may use acetaminophen (Tempra, Tylenol; see Dosing Guide) if your child is uncomfortable.  Aspirin should be avoided because of the potential for Reye’s syndrome.  Fever is actually beneficial in chickenpox and should not be treated if your child is comfortable.
  4. The child is contagious for about a week after the onset of the rash or until all sores have crusted over and have begun to dry.
  5. It is not recommended that you expose your child to chickenpox in order to get the disease.
  6. It is not recommended that aspirin be routinely used for chicken pox or fever in children.

Prevention

Varivax (live attenuated chickenpox vaccine) is now available and recommended for all children 12 months or older who have not yet had chickenpox. More details about this immunization are presented in the immunization section of this handbook. Your child’s physician can also discuss Varivax with you.