Rashes in children
Created: 03.08.2023
Updated: 20.12.2023
Authorised by: General Practitioner, Dr Binita Parmar
Most children will experience rashes at some point, and there are many different types of rashes they can be affected by. Some types of rashes only occur in children, other types occur in childhood but can persist into older age or for a lifetime.
Different types of rashes
Milia
These are small yellow-white bumps that can last for a few months. Usually seen on the forehead, nose, and cheeks. They occur due to blocked sebaceous glands and are completely harmless. Requires no treatment, and resolves itself.
Heat rash (Miliaria)
These are small bumps that occur due to heat and sweat retention. They appear as small bumps/ blisters with clear fluid in them. These can be avoided by ensuring that the child does not get too hot.
Stork bite
This first appears as a red mark on the neck and then spreads to the middle of the forehead, upper eyelids, and bridge of the nose. It will fade and disappear on its own with time.
Erythema toxicum neonatorum
This is a red rash, sometimes with small pimples, that appears in the first few days of life. This is a common condition and it resolves on its own after a few days.
Infantile seborrheic dermatitis
Appears as a flaking rash that starts on the forehead and can spread to the rest of the face, skin folds behind the ears, in the armpit or nappy area. It usually occurs during the first weeks of life, and the child is usually unaffected by it. The treatment consists of applying emollients and possibly using mild steroid creams. The rash disappears relatively quickly, but treatment must continue for a while to prevent recurrence.
Nappy Rash (Napkin Dermatitis)
This is a rash in the nappy area, which can have many different causes. There is a risk of skin under the nappy becoming warm and moist leading to a fungal infection or irritated skin, which will cause a rash. The rash usually resolves quickly with frequent nappy changes and ‘nappy free’ time to avoid the nappy being wet for too long, good hygiene, and a good barrier cream or other over the counter options including Zinc and Castor oil. In some cases, it may be necessary to use a mild steroid cream for a shorter period, typically once a day for up to 7 days. If there is a fungal infection, cream with an antifungal agent can be used.
Atopic dermatitis
This condition usually does not occur before 3 months of age, and appears as dry, red and irritated skin typically in the neck area, elbow creases, behind the knees and other places on the body. The child often seems uncomfortable as this rash typically itches and irritates. This is a skin disease that often persists for a few years, and the child has an increased risk of developing food allergies and asthma later. The treatment of atopic eczema consists of not bathing/showering the child too often (between 2-3 times a week), using a mild shower oil or soap-sparing agent, and thoroughly moisturising the skin with a thick moisturiser several times a day. If the rash is more noticeable or severe, treatment with steroid creams may be needed, but the doctor examining the child will assess this.
The classic childhood diseases
- Chickenpox (varicella) is caused by a virus that causes fever and rash on the scalp and body. The rash starts as small red bumps, which then turn into small blisters that burst and leak, and then crusts form. It usually resolves on its own, and there is rarely a need for treatment.
- Three-day fever (exanthema subitum), also called roseola infantum, is due to infection with a herpes virus. It usually shows up with high fever but otherwise, the child is unaffected. When the fever drops the child develops a pale red rash that disappears on its own after a few days.
- Slapped cheek disease (erythema infectiosum) is also a viral disease (human parvovirus) that usually occurs in 5-15 year olds. The child typically develops a red rash on both cheeks, and shortly afterwards a red rash also appears on the body, arms, and legs. It subsides by itself after a week, and the rash will then clear up from the middle.
- Scarlet fever is caused by infection with group A streptococcus bacteria, this bacterium can also cause a sore throat. Scarlet fever starts with a sore throat and a bright red tongue that can look like the surface of a strawberry. About 1-2 days after the sore throat has started, the child develops small raised bumps, the red sandpaper like rash usually starts on the chest and abdomen which then spreads to the rest of the body. The face also turns red, with a characteristic clearance around the mouth. This can be treated with antibiotics.
- Hand-foot-mouth disease is caused by the Coxsackie virus. It typically presents with a mild sore throat, scattered lesions in the mouth, and small, greyish blisters that can appear on the hands, feet. The condition usually resolves itself within 1-2 weeks, without the need for medical treatment.
When to contact a doctor
Most rashes are harmless and resolve on their own, but if you are unsure what it could be, whether it could be contagious or if your child is unwell with a high fever, you should contact a doctor for an assessment who can also recommend whether your child needs to stay off from nursery or school.
Examination
The doctor examining the child will ask a series of questions about the rash, such as when it was first noticed, how the child seems affected, whether there are other contacts who have something similar, whether the child is vaccinated etc. The doctor will assess the skin carefully, and check the child’s temperature if they are unwell. Sometimes a sample can be taken to look for bacteria, fungi or viruses if the doctor feels this will help with the diagnosis.
Treatment
The treatment depends on what has caused the rash, and most rashes in children resolve on their own. Some rashes can benefit from treatment with a steroid cream and a good moisturiser, other types of rash require antibiotics either in pill form or in cream form. If it's a rash that itches intensely, there are also creams or tablets that soothe this. The doctor examining the child will assess which treatment is best.
