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. 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 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 or Aquaphor Healing Ointment to the dry skin. This will seal the dry skin so that no further moisture loss can occur.

Flat red birthmarks called “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”, or Cavernous hemangiomas are red, raised birth marks which for the first year or so of life actually increase in size only to fade years later. 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 or months 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.

Bruises and a Bruise-Like Rash:

Bruising is a common occurrence in childhood, often a natural result of the active and exploratory nature of children. As they grow, children’s exuberance and curiosity lead them to engage in activities where bumps and small accidents are inevitable, such as climbing, running, and playing sports. These minor injuries can result in typical bruising, especially on exposed areas like the shins, knees, and forearms. The colors of bruises can vary from purplish to reddish, gradually fading to yellowish-green as they heal over a week or two. While these bruises are usually harmless and part of normal play, it’s important for parents and caregivers to be aware of any unusual patterns, such as frequent or excessive bruising, large bruises with no clear cause, bruises in atypical locations, or bruise like rashes which might warrant further medical evaluation. Understanding the balance between natural play-induced bruises and signs that might indicate underlying medical issues is important for ensuring a child’s health and well-being. All bruising is not normal.

Most bruise like rashes in children and adolescents are due to two immunological conditions: immune thrombocytopenic purpura (ITP) and Henoch-Schönlein purpura (HSP) also known as anaphylactoid purpura. ITP is a condition where the immune system mistakenly attacks and destroys platelets, which are crucial for blood clotting. As a result, individuals with ITP may exhibit unexplained bruising, pinpoint-sized red or purple dots (petechiae), and sometimes bleeding from the gums or nose. The condition can range from mild to severe, impacting daily activities and necessitating medical attention. Diagnosis commonly involves blood tests to check platelet levels and ruling out other potential causes. Treatment for ITP varies based on the severity and cause but may include medications to increase platelet production or manage the immune response. In rare cases, surgical removal of the spleen may be recommended.

Henoch-Schönlein purpura (HSP), on the other hand, is a type of vasculitis that affects small blood vessels, often associated with a preceding respiratory infection. It predominantly affects children and presents with a distinctive rash, usually appearing on the buttocks, legs, or feet, along with joint pain, abdominal pain, and sometimes kidney involvement. The rash is characteristically purplish and can be raised. HSP is typically self-limiting and usually resolves on its own without specific treatment, although symptoms such as pain might be managed with medications like NSAIDs or corticosteroids in severe cases. Medical monitoring is important, especially to assess for kidney injury.

Other more severe conditions can cause a bruise like rash, such as immune, nutritional, hematologic, or infectious disorders. Causes include purpura from systemic issues, like low platelet counts in leukemia, or vitamin C deficiency leading to fragile capillaries. Serious conditions like disseminated intra-vascular coagulation (DIC) and infections such as meningococcemia can also present with purplish skin discolorations. Additionally, vasculitis, medication side effects, and liver disease, which affect blood clotting and vessel integrity, may produce similar rashes.

In summary, any purple or bruise-like rash which cannot be explained by simple bruising should be evaluated in our office right away by one of our physicians.

Chicken pox: Please see the Chicken pox section of this handbook on page 104 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), or the acids in stool 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 that may be 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 emollients such as Vase- line, 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. A very effective treatment strategy for eczema is to alternate applying Cerave Moisturizing Cream with Aquaphor Healing Ointment to your child’s affected skin. One should be applied in the morning and the other in the evening. Aquaphor is best applied after a bath.

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 in this book on allergy.

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 in this book 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.

Hives and Allergic Rashes: Hives, also known as urticaria, present as a red, raised rash of various sizes and shapes. Hives have numerous potential causes. When parents observe a child with hives, they often notice that the rash appears to move to different areas of the child’s body each time they look. Hives are frequently associated with itching and may occasionally cause swelling in the hands and feet. While the rash is usually not dangerous, it can be quite uncomfortable.

The causes of hives can include anything the child has eaten, inhaled, or come into contact with. Interestingly, hives are rarely triggered by new dietary items; rather, they often result from an exposure to something the child has previously encountered without any reaction. The key to man- aging hives is to identify and remove the causative agent, which is often challenging. We recommend keeping a detailed record of everything your child eats or is exposed to in the 24 hours before the onset of the rash. If the hives recur, repeat this record-keeping and compare lists from each episode to help identify the responsible agent.

In addition to using antihistamines such as Benadryl, which can help reduce the rash and control itching (please refer to the Dosing Guide page 237for the appropriate dosage), hives may sometimes be treated with oral corticosteroids like prednisone. Oral prednisone can be particularly effective for more severe cases of hives or when antihistamines alone do not provide enough relief. Consult us for an office visit if the hives don’t resolve with antihistamine therapy.

If a child experiences recurrent episodes of hives, daily cetirizine may provide effective suppression. Treatment may also involve up to three courses of oral prednisone which we would prescribe during office visits for the problem. If the hives continue to recur despite these treatments, a referral to an allergist might be recommended to further investigate and determine the underlying cause of the urticaria.

It is important to note that certain types of urticaria may persist for several weeks. If this occurs, an office visit is necessary for further evaluation. In rare instances, if your child develops breathing difficulties or moderate to severe swelling associated with the rash, seek immediate medical evaluation, as these symptoms may indicate a more serious allergic reaction.

Pityriasis rosea is a peculiar common, self-limiting skin condition typically seen in children and young adults. It begins with a single large, scaly patch called the “herald patch,” which is often oval-shaped and appears on the trunk. Many people confuse the herald patch with tinea corporis also known as a “ringworm”.

Within a week or two, smaller patches begin to spread, usually aligning along skin fold lines, creating a distinctive “Christmas tree” pattern on the back. Although the exact cause of pityriasis rosea is unknown, it is thought to be related to a viral infection, though it is not contagious. Symptoms may include mild itching, but the rash generally resolves on its own within 6 to 8 weeks without treatment. In cases where itching is bothersome, overthecounter antihistamines like cetirizine or topical 1% hydrocortisone cream can provide some relief. Measures such as using moisturizers and taking lukewarm oatmeal baths may also help soothe the skin. It’s advisable to seek medical advice if you are uncertain about the rash. Recovery time for pityriasis rosea can be as long as six weeks. 

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 irritant oil name urushiol. You should treat poison ivy (contact dermatitis) with five 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. Second, Zanfel, over the counter wash, can remove the urushiol (poison ivy oil) and provide some comfort.

Thirdly, if the rash is particularly severe, you should bring your child into the office for an office visit for more extensive treatment. An oral form of cortisone named prednisone or methylprednisolone may be prescribed for your child. It is important for your child to take all of the steroid prescription, even if the rash clears before the prescription is finished because a rebound poison ivy rash may result if all of the steroid type medicine is not taken. Benadryl elixir can be used to control itching (see dosing chart for proper dose).

Lastly, 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 thorough- ly 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 on page 79 and the section on antibiotics on page 82 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.

Tinea (fungal) conditions: The word tinea is derived from Latin, meaning “worm,” which reflects the appearance of fungal skin lesions that often resemble a worm-like pattern or a ring. These infections are caused by dermatophyte fungi, which thrive on keratin, a protein found in the outer layer of the skin, hair, and nails. Tinea infections are named based on the body part they affect; for example, tinea corporis refers to ringworm of the body, tinea capitis to scalp infection, tinea cruris to jock itch in the groin, and tinea pedis to athlete’s foot on the feet. Each type typically presents with characteristic symptoms such as itching, redness, and patchy, ring-like lesions.

These fungal infections are collectively known as dermatophytoses. These infections are caused by dermatophyte fungi, which thrive in warm, moist environments such as swimming pools, locker rooms, and communal showers. The fungi can spread through direct skin contact with an infected person, animal, or indirectly through contaminated surfaces and objects.

Tinea corporis, or “ringworm” of the body, typically presents as distinct, itchy, circular red patches with clearer centers and slightly raised borders appearing on the trunk or limbs. These patches can spread across the body if not promptly treated. For most mild cases, over-the-counter topical antifungal creams, lotions, or powders are effective. These often contain active ingredients such as clotrimazole, miconazole, terbinafine, or tolnaftate and should be applied to the affected area and its surrounding skin as directed on the package, usually for at least two weeks. In more severe or widespread cases, or if the infection doesn’t respond to overthecounter treatments, make an office visit with one of our physicians to discuss stronger treatments. Remember that pityriasis rosea described above can look like a “ringworm”.

Tinea capitis is a scalp infection that not only causes scaly, red patches but can also lead to hair breakage, resulting in hair loss, known as alopecia. This condition is particularly common in children and often requires oral antifungal treatment to achieve adequate penetration into hair follicles. Maintaining scalp hygiene and avoiding sharing personal hair items can help prevent its spread in community settings. If your child develops tinea capitis or “ringworm” of the scalp, an office visit is needed for a prescription antifungal called griseofulvin. This medication should be taken for 6 weeks with greasy foods such as cow’s milk. Topical antifungal medications do not work for tinea capitis.

Tinea cruris, commonly referred to as jock itch, primarily affects the groin and inner thighs, causing reddish-brown patches that may itch or burn. It is more common in males and can spread if left untreated, especially in warm climates.

Tinea pedis, or athlete’s foot, typically starts between the toes but can extend to the soles and sides of the feet. This condition is characterized by itching, peeling, cracking, and sometimes blistering. It’s more common among those who wear closed footwear often or frequent communal wet areas. Both tinea cruris and tinea pedis are treated identically like tinea corporis with topical antifungals.

More persistent infections and all cases of tinea capitis usually require oral antifungal medications like griseofulvin or terbinafine, which typically need to be taken for several weeks. It’s important to complete the entire course of medication to fully eradicate the infection even if symptoms improve earlier. Keeping the affected areas clean and dry, avoiding tight-fitting clothes, and practicing good personal hygiene are crucial steps in managing and preventing these infections. If symptoms do not improve after a couple of weeks of treatment, or if the infection spreads, it is important to consult us for escalation of care.

Viral exanthem: Viral exanthems are widespread, generalized skin rashes caused by various viral infections. These rashes often appear as red spots or patches on the skin and can be accompanied by other symptoms such as fever or malaise. While some, like measles, chickenpox, and rubella, are well-known, many other viruses can cause a similar rash-related outbreak. Notably, conditions resulting from these viruses are generally mild and self-limiting, and they don’t typically require specific medical treatment.

One notable example of a viral exanthem is Gianotti-Crosti syndrome, which is more commonly seen in children. This distinct rash is characterized by raised, red or purple bumps primarily affecting the face, arms, buttocks, and legs. Occasionally, it can be accompanied by swelling of the lymph nodes or a mild fever. Gianotti-Crosti syndrome is often linked to infections like hepatitis B virus and Epstein-Barr virus (the virus that causes Mononucleosis). The rash itself typically resolves on its own within 2 to 8 weeks without causing significant complications.

It is important to note that antibiotics, which are effective against bacterial infections, do not improve viral exanthems and may even exacerbate the condition. Therefore, antibiotics should be avoided unless there’s a confirmed bacterial infection present alongside the rash.

Enteroviruses, like coxsackievirus, are another common cause of viral exanthems, leading to rashes that typically appear in conjunction with symptoms like fever or sore throat and then resolve on their own without specific treatment. Enteroviruses can also cause a peculiar rash called hand, foot and mouth disease.

Reassuringly, most viral exanthems are benign and self-resolving, with the body’s immune system effectively clearing the infection over time. While these rashes can understandably cause concern, it’s comforting to know that these conditions usually do not signify a serious problem and complications are rare. If there is uncertainty or more severe symptoms accompanying a rash, seeking medical consultation for proper evaluation and guidance is always advisable. Bruise like rashes are much more concerning than the small red dots of a viral exanthem.