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Rashes in Children

By Deborah M. Consolini, MD, Assistant Professor of Pediatrics;Chief, Division of Diagnostic Referral, Sidney Kimmel Medical College of Thomas Jefferson University;Nemours/Alfred I. duPont Hospital for Children

A rash is an abnormal change in the texture or color of the skin.

  • Known causes of rashes include irritation and bacterial, fungal, or viral infections.

  • Symptoms include redness, white or yellow scales, itching, and pearly pimples, bumps, or cysts.

  • Rashes that require treatment can be helped by gentle cleansers, moisturizing ointments, antibiotic or corticosteroid ointments, and/or anti-itch drugs.

Rashes in infants and young children are not usually serious and can have various causes. Irritating substances, drugs, allergic reactions, and disorders that cause inflammation can cause a rash.

Some common causes of rashes in infants and young children include the following:

Diaper rash (diaper dermatitis)

Diaper rash is a bright red rash that usually develops when the infant's skin comes in contact with a diaper that is soiled by urine, stool, or both. The moisture on the infant's skin causes irritation. Typically, the areas of the skin that touch the diaper are most affected.

Diaper rash can also be caused by infection with the fungus Candida, typically causing a bright red rash in the creases of the skin and small red spots. Less often, diaper rash is caused by bacteria.

Breastfed babies tend to have fewer diaper rashes because their stools contain fewer enzymes and other substances that can irritate the skin.

Diaper rash does not always bother the child. It can be prevented or minimized by using diapers that are made with an absorbent gel, by avoiding restrictive plastic diapers or pants that trap moisture, and by frequently changing diapers when they are soiled. Breastfed babies tend to have fewer diaper rashes because their stools contain fewer enzymes and other substances that can irritate the skin.

The main treatment of diaper rash is to frequently remove or change the child's diapers. The child's skin should be washed gently with mild soap and water. Often the rash clears up with these measures alone. Use of a skin moisturizer and an ointment that creates a barrier between the child's skin and the diaper, such as zinc, petroleum jelly, or vitamin A and D ointment, may help. Antifungal cream may be necessary if the doctor diagnoses a Candida infection. Antibiotic cream can be used if the rash is caused by bacteria.

Cradle cap ( seborrheic dermatitis )

Cradle cap is a red and yellow, scaling, crusty rash that occurs on an infant's head. A similar rash can occur occasionally in the infant's skinfolds. The cause is not known. Cradle cap is harmless and disappears in most children by 6 months of age.

Cradle cap can be treated by regularly shampooing with selenium sulfide shampoo and massaging mineral oil into the scalp to help loosen the crust before shampooing. The crust may be worked off with a fine comb. Cradle cap that does not abate with these measures may need further treatment, such as corticosteroid creams.

Atopic dermatitis (eczema)

Atopic dermatitis is a red, scaly, and itchy rash. The rash tends to appear in patches that come and go, often worsening with cold, dry weather. Infants tend to develop red, oozing, crusted rashes on the face, scalp, diaper area, hands, arms, feet, or legs. Older children tend to develop one or a few spots, usually on the hands, upper arms, in front of the elbows, or behind the knees.

Although the cause is unknown, atopic dermatitis tends to run in families and in many cases is thought to be due to an allergy. Its origin may be similar to that of asthma. Most children outgrow atopic dermatitis, but for others it is a life-long condition. Children with severe cases may intermittently develop infections in areas where they have scratched and torn the skin.

Treatment of atopic dermatitis includes use of skin moisturizers, gentle soaps, humidified air, corticosteroid creams, and anti-itch drugs. Efforts to avoid triggers of a child's allergies may help alleviate the condition.

Viral infections that cause a rash

Viral infections often cause rashes in young children. Rashes caused by roseola infantum and erythema infectiosum (fifth disease) are harmless and usually go away without treatment. Rashes caused by measles, rubella, and chickenpox are becoming less common because children are receiving vaccines.

Other causes of rashes

Dermatophytoses (also called ringworm or tinea) are fungal infections of the skin. In children, infections of the scalp (tinea capitis) and body (tinea corporis) are most common.

The diagnosis and treatment of dermatophytoses are the same in children and adults and typically includes antifungal drugs applied to the skin or taken by mouth. Some children have an inflammatory reaction to the fungal infection that leads to a painful, inflamed, swollen patch on the scalp called a kerion. A kerion may require additional treatment.

Molluscum contagiosum is a cluster of flesh-colored pearly pimples or bumps caused by a viral skin infection that usually disappears without treatment. However, the virus that causes this infection is contagious.

Milia are small pearly cysts on the face of newborns. They are caused by the first secretions of the child's sweat glands. Like newborn acne, milia require no treatment and disappear a few weeks after birth.

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