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Rashes in Children

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by Deborah M. Consolini, MD

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

  • 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.

Skin rashes in infants and young children are not usually serious and can have various causes. Some common rashes in infants and young children include the following.

Diaper rash (diaper dermatitis) is a bright red rash caused by irritation from prolonged skin contact with urine or stool anywhere beneath a child's diaper. 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. 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 for 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 barrier ointment, 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.

Eczema (atopic dermatitis—see Atopic Dermatitis) is a red, scaly, dry rash that is most common where the arm and leg joints bend and tends to appear in patches that come and go, often worsening with cold, dry weather. Although the cause is unknown, eczema 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 eczema, but for others eczema is a life-long condition. Children with severe cases may intermittently develop infections of some particularly affected areas. Treatment includes use of skin moisturizers, gentle soaps, humidified air, corticosteroid creams, and anti-itch drugs. Efforts to control dust mites and other triggers of a child's allergies may occasionally help alleviate the condition.

Cradle cap (seborrheic dermatitis) is a red and yellow, scaling, crusty rash that occurs on an infant's head and occasionally in the 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.

Tinea is a fungal infection of the skin. In children, infections of the scalp (tinea capitis) and body (tinea corporis, or ringworm) are most common. The diagnosis and treatment of tinea are the same in children and adults (see see Overview of Dermatophytoses (Ringworm, Tinea)). Some children have an inflammatory reaction to the fungal infection that leads to a scalp mass (kerion), which may require additional treatment.

Molluscum contagiosum is a cluster of flesh-colored pearly pimples or bumps caused by a viral skin infection (see see Molluscum Contagiosum) that usually disappears without treatment.

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

Other skin rashes in young children are often caused by viral infections. Rashes caused byroseola and erythema infectiosum (fifth disease) are harmless and usually abate without treatment (see see Overview of Viral Infections in Children). Rashes caused by measles, rubella, and chickenpox are becoming less common because children are receiving vaccines.