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Skin trouble

What you need to know about your child's rash

What you need to know about your child's rash

BY AUDRA KOLESAR
Winnipeg Health Region
Wave, March / April 2012

My son says one of his friends had to stay home from school because he had a rash. Is it possible that my child will also be infected? Should I be worried?

Well, that depends. There are generally two kinds of skin rashes:

  • Localized: This type of rash occurs on one small part of the body. Usually the rash is asymmetrical - i.e., appears on one foot or hand. It is usually caused by something coming into contact with that area of the skin, such as a bug bite, allergen, or bacteria.
  • Widespread: This type of rash occurs on larger areas, i.e., both legs or the entire back or most of the body. It is usually symmetrical (occurs on matching sides of the body - both cheeks), and can be caused by viruses, bacteria, food or drug allergies, or toxins.

It is important to note that most normal rashes are not described as purple, blood-red or deep red spots. This condition is more likely to be petechiae or purpura. They do not disappear (blanch) with pressure like most rashes. Widespread petechaie and purpura often have a more serious cause, especially if associated with fever, and require immediate medical attention.

Here is a brief overview of skin rashes, along with their causes, symptoms and possible treatments:

Scabies

Scabies is a very contagious but treatable skin disease. It is caused by a very small bug (mite) that burrows into the skin, causing a very itchy rash.

The main symptoms of scabies are the rash and intense itching. It appears as tiny blisters or bumps, which break easily when scratched. The blisters are usually in a thin line.

Although the rash can start anywhere, it often starts on the hands, between the fingers or in a crease of the wrist. Other common areas for the mites are the nipples, waistline, and male genital area. After the rash begins, it can spread within a few days to the whole body.

This condition is usually treated by skin cream with insecticide in it. Talk to your health-care provider for more information. The instructions for use of medicines for scabies vary somewhat, so be sure to check and follow the instructions that come with your medicine. Your healthcare provider may prescribe an oral antihistamine medicine, such as Benadryl, Claritin, or Zyrtec, to help relieve the itching.

To reduce the risk of your child developing scabies, you should wash linens and bedclothes in hot water. Because mites don't live long away from the body, it is not necessary to dry-clean the whole wardrobe, spray furniture and rugs, and so forth. You will have itching and a rash for two to four weeks after your treatment with the cream prescribed by your health-care provider. Continuing to have the rash does not mean that the treatment didn't work or that it needs to be repeated. The symptoms will not go away until your body sheds the layers of skin that contain the bodies of the mites, their eggs, and their droppings. Keep taking antihistamines as long as you have itching.

You may need a second treatment if:

  • You have symptoms three weeks or more after your treatment with the cream.
  • Your symptoms get much worse after your first treatment.
  • Live mites can be demonstrated or new lesions appear.

Impetigo

This skin infection is caused by bacteria. It is more common in children than in adults. Impetigo is usually a mild infection but it can spread and cause serious illness if it is not treated.

The two types of bacteria that cause the infection are called Staphylococcus aureus and Streptococcus pyogenes (Group A streptococcus). These bacteria normally live on your skin without hurting you. However, if they get into a wound, they may cause an infection.

Impetigo can occur on any area of skin. It often appears on the face between the upper lip and nose. The infection begins as small blisters. The blisters form pus inside and then break open. The pus from the blisters dries as a gold or honey-yellow colored crust. The blisters or sores are painless.

Treatment depends on age of the patient and the severity and type of infection. Mild infections can be treated by keeping the skin clean so the infection can heal on its own. A health-care provider may prescribe an antibiotic ointment to put on the infected skin. For larger or more serious infections, he or she may prescribe an oral antibiotic medicine or give you a shot of antibiotic medicine.

Follow these tips to ease the discomfort of impetigo:

  • Wash with antibacterial soap. Soak the area for 15 to 20 minutes in warm soapy water. Then gently remove the crusts.
  • Cover the sores with a gauze bandage to keep the infection from spreading and to prevent scratching.
  • Avoid touching the sores more than necessary.

If your provider prescribed an antibiotic ointment, gently pat your skin dry after you wash the infected area and put a thin layer of antibiotic ointment on it. Do not use the ointment more often than directed. Wash your hands thoroughly after using this medicine.

The incubation period for impetigo is usually one to three days for strep and four to 10 days for staph. It is contagious from the onset of sores until 24 hours on oral antibiotic or 48 hours on topical antibiotic.

Fifth disease

Also known as Erythema infectiosum, fifth disease is an infection caused by human parvovirus B19. The name fifth disease comes from being the fifth childhood disease with a pink-red rash to be described.

Most children with the infection feel well. The person exposed to fifth disease usually does not get ill for four to 14 days after being exposed. It can take as long as 20 days. Some children develop symptoms such as a sore throat, slight fever, headache, and tiredness.

Several days later, for both adults and children, a rash appears on the cheeks. The rash looks as though the cheeks have been slapped. This facial rash feels hot and sometimes itches. After a few days, the rash may spread to the upper body and arms in a lacy pattern. The rash may come and go for three weeks, especially after warm baths, exercise, and sun exposure.

Fifth disease does not require antibiotic treatment, because it is a virus. Fever, if present, is treated with acetomenaphen or ibuprofen. Most children recover quickly within one to three weeks and without complications. Once you have fifth disease, you develop immunity and usually do not get it again.

Hand, foot and mouth disease

This condition is a mild illness caused by a virus. It causes sores in the mouth and a rash with blisters on the hands and feet. Human hand, foot, and mouth disease is not related to hoof and mouth disease in cattle.

Symptoms of hand, foot, and mouth disease appear three to six days after exposure and may include:

  • A mild fever
  • Loss of appetite
  • Sore throat
  • A sore mouth, and
  • A general feeling of weakness or tiredness.

Within a day or two, small blisters develop. Blisters generally appear in the mouth, on the hands and feet, and sometimes on the buttocks or other places on the body. The blisters may only appear in the mouth or only as a skin rash. Blisters located outside the mouth generally do not cause itching or pain. These blisters may range in size from one-eighth to one-quarter of an inch. A small area of redness surrounds them. On the skin, the rash is flat or raised with some of the rash becoming fluid-filled blisters. There may be just a few blisters or there may be hundreds on the skin.

The disease is usually mild and lasts only a few days to a week. It may not require a trip to the health-care provider. It can be confused with chickenpox, but the area affected by the rash is somewhat different. The only medicine health-care providers usually recommend for hand, foot, and mouth disease is acetaminophen or ibuprofen for fever and/or pain. The condition is contagious during the course of the illness for around seven to 10 days.

Roseola

This condition is caused by a strain of the human herpes virus. It is most common in children between the ages of six months and two years, but can occur at any age. Roseola is generally a mild illness. It is spread from person to person when an infected person talks, laughs, sneezes or coughs. Children may come down with it five to 15 days after they are exposed.

The first symptom of roseola is a high fever of 39.4 to 40.6 degrees Celsius (103 to 105 degrees Fahrenheit) that lasts two to four days. Even with a high fever, the child is only a little sick. The child may have a runny nose and be irritable and tired. When the fever goes down, a rash usually appears on the middle of the body and may spread to the neck, arms, and face. The rash causes tiny, pink, flat or slightly raised spots and mild itchiness.

The rash seldom lasts for more than two days. Some children who have roseola never develop a rash at all. Some children with roseola also have puffy eyes, a mild sore throat that looks and feels swollen, and swollen glands in the neck and behind the ears. Roseola is contagious until the fever and rash are gone.

Most roseola cases can be treated at home and do not require a trip to the health-care provider. Home treatment includes rest and giving the child plenty of clear fluids. Give acetaminophen or ibuprofen to control fever. Call your health-care provider for advice if the rash lasts longer than three days, becomes severely itchy, or your child complains of ear pain or is tugging at the ear. Call your provider immediately if your child is confused, extremely drowsy, has a severe headache or a headache with a stiff neck, or the rash has small purple spots.

Scarlet fever

This condition is caused by an infection with group A streptococcus bacteria. The bacteria make a toxin (poison) that can cause the scarlet-coloured rash from which this illness gets its name.

The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body.

Aside from the rash, there are usually other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever above 38.3° C (101° F), and swollen glands in the neck. The tonsils and back of the throat may be covered with a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. A child with scarlet fever also may have chills, body aches, nausea, vomiting, and loss of appetite.

When scarlet fever occurs because of a throat infection, the fever typically stops within three to five days, and the sore throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms began, but skin that was covered by rash may begin to peel. This peeling may last 10 days. With antibiotic treatment, the infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal. In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo. In these cases, the child may not get a sore throat.

The bacterial infection that causes scarlet fever is contagious. A child who has scarlet fever can spread the bacteria to others through nasal and throat fluids by sneezing and coughing. If a child has a skin infection caused by strep bacteria, like impetigo, it can be passed through contact with the skin.

When should I consult a primary health-care provider about these conditions?

Some rashes, especially when accompanied by a high fever can indicate an immediate health risk and may require immediate medical attention. Contact your primary care provider or Health Links-Info Santé if you have any questions or concerns. Call your primary care provider whenever your child suddenly develops a rash or if the rash lasts longer than three days, especially if it is accompanied by a fever, sore throat, or swollen glands. This is especially important if your child has any of the symptoms of strep throat, or if someone in your family or in your child's school has recently had a strep infection.

Audra Kolesar is a registered nurse and manager with Health Links - Info Santé, the Winnipeg Health Region's telephone health information service.

The information for this column is provided by Health Links - Info Santé. It is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a health-care professional. You can access health information from a registered nurse 24 hours a day, seven days a week by calling Health Links - Info Santé. Call 788-8200 or toll-free 1-888-315-9257.

Wave: March / April 2012

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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