Am Fam Physician. 2015;92(3):211-216
Determining the cause of childhood rashes involves a thorough assessment of various factors, including the appearance of the rash, its location, how it progresses over time, and any accompanying symptoms such as fever or itching. Different rashes are associated with different symptoms; for example, roseola, erythema infectiosum, and scarlet fever often present with fever, while itching may be a symptom of atopic dermatitis, pityriasis rosea, erythema infectiosum, molluscum contagiosum, and tinea infections. It is important to take note of specific details, such as the timing of rash onset in relation to fever in roseola, or the distinctive “herald patch” in pityriasis rosea. Understanding the typical progression of certain rashes, such as scarlet fever starting on the upper trunk and spreading, can also aid in diagnosis. Impetigo is a superficial bacterial infection commonly found on a child’s face and extremities, while erythema infectiosum is characterized by a flu-like prodrome followed by the hallmark “slapped cheek” rash. Molluscum contagiosum presents as flesh-colored or pearly white papules with a central dimple and may resolve on its own. Tinea infections are fungal in nature and can affect various parts of a child’s body. Atopic dermatitis, on the other hand, is a chronic inflammatory condition with diverse symptoms.
Every year, a significant number of children seek medical attention for skin problems, often at primary care facilities. Recognizing specific features and patterns can aid in distinguishing between different types of rashes (refer to Table 1). This article focuses on common infectious and inflammatory rashes seen in children.
| Expert advice | Level of evidence | Further reading |
|---|---|---|
| The use of potassium hydroxide testing can help differentiate between pityriasis rosea and tinea or other similar skin rashes. |
| C |
| 6 |
| Accurate detection of streptococcal pharyngitis is provided by rapid antigen tests. |
| C |
| 10 |
| In many cases, impetigo can clear up without treatment, but doctors may recommend antibiotics to stop it from spreading. |
| Y |
| 12 |
It is also important to ask about any recent illnesses, medications, or vaccinations that the child may have received, as these could be potential triggers for the rash. Inquiring about any recent travel or exposure to allergens can also provide valuable information.
In addition to the history and physical exam, laboratory tests or skin biopsies may be necessary to confirm a diagnosis in some cases. Blood tests, culture swabs, or skin scrapings may be performed to rule out infectious causes of the rash.
Educating the child’s caregivers about the importance of proper skin care and avoiding irritants or allergens can help prevent further episodes of rash. Providing recommendations for gentle skincare products and safe practices for itch relief can also be beneficial.
Follow-up appointments may be necessary to monitor the rash’s progress and adjust treatment as needed. Referral to a dermatologist or allergist may be warranted in cases of persistent or severe rashes that do not improve with initial interventions.
Roseola Infantum (Exanthema Subitum)
Roseola is often caused by human herpesvirus 6 in children under three years old. It is characterized by a sudden high fever lasting one to five days. Children may appear well with mild symptoms like cough, runny nose, or diarrhea. Once the fever subsides, a rash appears on the trunk, similar to measles but with a different starting point. Roseola typically does not require treatment and is diagnosed based on clinical presentation.
It is important for parents and caregivers to monitor the child’s fever closely and provide supportive care to keep the child comfortable. Rest and plenty of fluids are recommended to help the child recover from roseola. While the rash may cause some discomfort, it is usually not itchy and will fade on its own without any specific treatment.
If a child with roseola develops any concerning symptoms or if the fever persists for an extended period of time, it is recommended to seek medical attention. In rare cases, complications such as febrile seizures can occur, so it is important to be vigilant and seek medical advice if needed.
Pityriasis Rosea
Around 80% of patients with pityriasis rosea develop a rose-colored patch on the trunk known as the herald patch. Smaller lesions appear over several weeks in a pattern resembling a Christmas tree. The rash can be mistaken for tinea corporis and usually lasts from two to 12 weeks.
Scarlet Fever
Scarlet fever, found in 10% of children with streptococcal tonsillopharyngitis, is caused by specific streptococcal strains. It presents with a rash, sore throat, and fever, with skin changes lasting for weeks followed by skin peeling. Diagnosis is often confirmed through a throat culture, and treatment typically involves penicillin.
Scarlet fever is highly contagious and can be spread through contact with respiratory secretions or infected surfaces. It is important to practice good hygiene, such as washing hands regularly, to prevent the spread of the infection.
If left untreated, scarlet fever can lead to complications such as rheumatic fever or kidney inflammation. It is crucial to seek medical attention if you suspect that you or your child may have scarlet fever.
Impetigo
Impetigo, a common bacterial skin infection, can present with vesicles, pustules, and yellow crusts. While antibiotics may be prescribed to prevent complications, impetigo often resolves on its own.
Erythema Infectiosum
Erythema infectiosum, or fifth disease, is a viral infection that presents with flu-like symptoms and a rash on the face. Some patients may experience joint pain, but treatment usually focuses on managing symptoms with pain relief and antihistamines.
Molluscum Contagiosum
Molluscum contagiosum, a viral skin infection, manifests as flesh-colored papules with a central indentation and can be highly contagious. Diagnosis is based on clinical examination, and treatment options are available if necessary.
The virus that causes molluscum contagiosum is a member of the poxvirus family and is typically spread through close personal contact or through contact with contaminated objects such as towels or toys. It is common in children and individuals with weakened immune systems.
In most cases, molluscum contagiosum is a self-limiting condition, meaning it will typically resolve on its own without treatment. However, some individuals may choose to seek treatment to alleviate symptoms or prevent the spread of the virus. Treatment options include cryotherapy, curettage, and topical medications.
It is important to practice good hygiene to prevent the spread of molluscum contagiosum. This includes avoiding close contact with individuals who have the infection, refraining from sharing personal items, and keeping skin clean and dry.
Tinea Infection
Tinea, a common fungal infection in children, can affect various parts of the body and is diagnosed based on physical examination findings. Treatment varies depending on the type of tinea infection.
Atopic Dermatitis
Atopic dermatitis is a prevalent inflammatory skin condition in children that can cause various skin changes like red plaques, abrasions, dry skin, and blistering lesions. Approximately 20% of children in the United States are affected by this chronic, recurring condition.
Skin rashes in children can differ depending on their age. Young children and infants often have lesions on their extremities, cheeks, and scalp, while older kids and adults commonly develop patches on their arms and legs. Hands and feet can also be affected, with severe cases showing thickened plaques. Dry, flaky skin is common, with a risk of secondary infections. Treatment focuses on symptom management through good skin care and the use of corticosteroids during flare-ups. Lesions that do not respond to traditional treatments may require further evaluation.
Common skin rashes in children include conditions like atopic dermatitis, erythema infectiosum, and impetigo. If your child has a rash with concerning symptoms, seek medical attention. Cellulitis is a skin infection primarily affecting the legs and requires immediate medical help if the skin appears red, hot, and tender. It is diagnosed through a skin examination and treated with antibiotics. Chickenpox typically affects children under 10, causing a rash that turns into blisters.
Eczema is a long-term condition that leads to redness and itching, often seen on the knees, elbows, and face. Creams and ointments can assist in managing symptoms. Erythema multiforme causes target-like spots due to a viral reaction. Hand, foot, and mouth disease is a common infection in young children, resulting in fever and blisters that the immune system can combat naturally.
Impetigo is a contagious skin infection that causes sores and blisters, with different forms affecting distinct areas of the body. Consult your doctor or pharmacist for antibiotics to shorten the duration of the illness. Keep your child isolated from others until the infection clears.