Rash

Rash 2017-03-17T03:58:39+00:00

Newborn Rash: Most rashes in newborn babies are normal and are of no concern. Small white bumps on an infant’s face and nose are called milia. These bumps contain old dead skin remnants. They will eventually wear off in a month or so and they require no treatment. Neonatal acne which resembles acne in older children occurs in infants due to maternal hormone stimulation. This, too, will fade with a little time. Slightly raised red mosquito bite looking lesions are called erythema toxic rash. This is a normal rash which resolves on it own in almost every case. No treatment is needed. Red irritation on the knees and cheeks from rubbing the sheet is common and can be treated by placing the baby on a soft cloth diaper and by applying Vaseline or 1/2% hydro-cortisone cream (Cortaid) to the irritated area two or three times a day. Dry scaly skin is also common in newborns. Because baby lotion can make this condition worse, we do not recommend its use. Instead of baby lotion, apply Vaseline to dry skin. This will seal the dry skin so that no further moisture loss can occur.

Flat red birthmarks (“capillary hemangiomas”, “nevus flammeus” or “stork bites” for short) are common in babies, especially over the eyelids and over the back of the neck. These tend to fade somewhat with time and do not generally get larger. They should be discussed at a routine office visit.

“Strawberry birthmarks” (Cavernous hemangiomas) are red, raised birth marks which for the first year or so of life actually increase in size only to fade with time thereafter. These however unlike flat birthmarks can become quite large and disfiguring prior to regressing at age three to four years. If treated in the first few weeks of life, these birthmarks can be reduced in size or even eliminated. Raised, red birthmarks particularly of the face should be evaluated by us in the first two to three weeks of life to determine if therapy is needed.

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

Chicken pox: Please see the Chicken pox section of this handbook for a discussion of this childhood disease.

Diaper Rash: Diaper rashes are usually due to either irritation of the skin from a wet diaper (ammonia), from the acid of a baby’s bowel movement 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 (we realize this is hard). It is also a good idea to put zinc oxide ointment (Desitin) and Vaseline in those areas. A+D Treatment Ointment is also a good choice to treat this. It is like Vaseline and Zinc oxide mixed together. 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, you should call the office for advice. Your baby may have a yeast infection and need to have an anti-fungal ointment applied. One such over-the-counter ointment is Lotrimin AF.

Eczema: Eczema is a skin condition seen in allergic people which causes the skin to be dry and sensitive. Sometimes, this can progress to a generalized rash 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 well hydrated. To do this, we recommend using the mildest and the least amount of soap as is possible. Examples of mild soap are: Dove, Tone, Basic and Neutrogena. Soap washes away the normal oils of the skin and makes eczema worse. In addition to this, we recommend applying Vaseline, Eucerin or Aquaphor to the affected skin to further seal the skin from continued water loss.  In addition, Cerave Moisturizing Cream is beneficial.  It is important to seal the skin with ointments from water loss, several times per day to prevent worsening eczema problems.

Sometimes exposures to certain things in the environment and/or diet can make eczema worse. This is particularly true of cow’s milk, soy, peanuts and strawberries. Please refer to the section on this website on allergy.

One percent hydro-cortisone ointment may be used to treat this condition. If your child’s dry, sensitive skin continues to be a problem despite the above measures, you should bring your child into the office for a routine office visit. There are effective treatment options available. These include steroid ointments such as desonide and triamcinolone, anti-inflammatory ointments such as Protopic, Elidel and Eucrissa, and wet wraps as described by the National Jewish Hospital in Denver, Colorado. Antihistamines can help.

For more information check out our eczema page on this website.

Fifth Disease (Erythema Infectiosum): Fifth disease is a viral infection which causes a very typical rash in children and adults. It is caused by human parvovirus B19. Fifth disease was so named because it was the fifth pink-red infectious rash to be described by physicians years ago, before those diseases were renamed. For those history buffs out there, the other four diseases are:

  1. Rubella
  2. Measles
  3. Scarlet Fever
  4. Filatov-Dukes disease

Fifth Disease usually begins as a bright red or rosy rash on both cheeks which lasts for 1 to 3 days. Some people say that the rash gives a child a “slapped cheek” appearance. The rash on cheeks is followed by pink “lace-like” rash on the extremities as if the child had been laying on lace for some time. This “lacey” rash mainly appears on the thighs and upper arms. It appears and disappears several times over a 1 to 5 week period. It is especially prominent after warms baths, exercise, and sun exposure. Usually the child has no fever or only a low-grade fever (less than 101 F) with fifth disease. This is a very mild disease with either no symptoms or a slight runny nose and sore throat. No treatment is generally necessary.

Fifth disease is contagious. Over 50% of exposed children will come down with the rash in 10 to 14 days. Because the disease is mainly contagious during the week before the rash begins, a child who has the rash is no longer contagious and does not need to stay home from school or daycare. Most adults who get fifth disease develop just mild pinkness of the cheeks or no rash at all.  In addition to the mild rash, adults can develop joint pains, especially in the knees. These pains may last 1 to 3 months. Taking ibuprofen usually relieves these symptoms. An arthritis workup is not necessary for joint pains that occur after exposure to fifth disease.

The main risk of fifth disease is to pregnant women who are not immune to the disease. Research has shown that 10% of unborn babies whose mothers are not immune to fifth disease who are subsequently infected with the virus before birth, may develop severe anemia or even die. This is especially true of the first 3 months of pregnancy. This virus, however, doesn’t cause any birth defects. If you are pregnant and exposed to a child with fifth disease before the child develops the rash, see your obstetrician. He or she may get a sample of your blood for an antibody test to see if you already have had the disease and are protected from becoming infected again. If you do not have antibodies against fifth disease, your pregnancy will need to be monitored closely.

Hives and Allergic Rashes: Hives (urticaria) is a red, raised rash in various sizes which is 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 at sometime in the past with no reaction.  The treatment of hives is to remove the causative agent and make the child comfortable. Of course, to remove the causative agent requires us to identify it, which is very difficult. We recommend that you write down everything that your child had to eat or was exposed to during the 24 hours 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 (please see Dosing Guide for proper dosage). We sometimes use oral steroids to help stop a hives rash. An appointment is needed to obtain this. If your child develops a breathing problem associated with this rash (very rare), the child should be evaluated 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% to 1% hydro-cortisone cream or ointment (Cortaid) can be helpful. If the rash is particularly severe, you should bring your child into the office for an office visit. A stronger cortisone cream or ointment may be prescribed or an oral even injectable form of cortisone may be prescribed. If an oral form of cortisone is prescribed for your child, your child should take all of the prescription, even if the rash clears before the prescription is finished because a rebound poison ivy rash may result if all of the cortisone medicine is not taken. Benadryl elixir can be used to control itching (see dosing chart for proper dose). 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 cannot catch Poison Ivy rash by touching the rash of someone who has contracted poison ivy (contact dermatitis). Contact dermatitis is not contagious from one person to another. However you can catch the Poison Ivy rash if you come into contact with the Poison Ivy toxin (an oil from the plant) which is on clothing, pets or other objects that have come into contact with Poison Ivy plants. You should thoroughly clean these objects. Poison Ivy toxin can be removed by washing with warm water and soap.

Rashes Due to Drugs: If a rash develops while your child is taking a medication, the medication should be stopped and the office should be notified during regular office hours. See section on allergy and the section on antibiotics in this handbook.

Seborrheic Dermatitis (cradle cap): Cradle cap is a red, scaly rash on the scalp and body of newborns and infants. The exact cause isn’t known. The cause may be different in infants and adults. Seborrheic dermatitis may be related to hormones, because the disorder often appears in infancy and disappears before puberty. Or the cause might be a fungus, called malassezia. This organism is normally present on the skin in small numbers, but sometimes its numbers increase, resulting in skin problems. 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 Selsun Blue Shampoo 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, you should bring your child in for a routine office visit.

Reviewed 3/16/17 by Dr. Byrum