Caring for Kids…at Billings Clinic

5 rashes and what to do about them

Itchy, scratchy, weepy and red.  What to do with rashes?   Few things make parents as anxious. Which do you treat at home and when should you seek medical care?  As with all things, if your child looks ill or you are worried you seek care. Here’s the lay of the rash land:

1) See a doctor if your child has a rash that is bright red, hot, painful and rapidly spreading.  How do you tell if a rash is spreading? At home, take a pen and mark around the area of redness, so you can see its growth. If it’s smaller than a quarter, the rash can probably just be watched at home.  Try some over-the- counter antibiotic ointment.  If the area is growing or not getting better, schedule an appointment with your pediatrician.  If you think there might be puss under the skin, this should also be seen.   Rapidly progressing redness (growing before your eyes or doubling in size in just a few hours) means a trip to SameDay Care or the emergency room.

2) Non-blanching is a new medical term that refers to a rash that doesn’t disappear if you press on it.  Blanching rashes briefly become skin color and go back to red after you press on them.  You can test this by pressing a clear glass over the rash and see if it disappears underneath.  Non-blanching will stay red/purple when pressed.  You may see this in the face of a child after vigorous coughing or vomiting, but non-blanching rashes are unusual below the neck and should be seen.  This is especially important if the child looks ill.

3) Hives are red swollen itchy bumps that often spread quickly over the body. This is one of the most common rashes in kids and, believe it or not, usually does not require medical attention.  In kids, hives are commonly caused by a virus.  It can last 5-7 days and be treated with Benadryl to help the itch.  If your child has taken a medicine recently or eaten a new food watch closely for tongue, face, lip or mouth swelling.  This might be a sign of an allergic reaction that would require emergency care.  Hives from the environment are also common.  Playing in grass, new soaps or detergents can all cause them.  Just rinse off and apply an unscented lotion.

4) Dry, flakey red patches of skin are usually eczema, also called dermatitis.   A lot of parents will say “I think this might be eczema” and 99% of the time you smart moms and dads are right.   If it doesn’t have any of the above features go ahead and try treating at home.  Use unscented lotions twice a day, mild soaps, and over-the-counter hydrocortisone for the worst parts.   Don’t use cortisone for more than 2 weeks.  If it’s not better come in for a check.

5) The dreaded full body rash can look like any of  the above rashes, spreads quickly and comes out of nowhere.  Once again if it doesn’t have any of the serious signs mentioned before it is rarely a concern.   It is usually a viral rash that may or may not have other viral symptoms like fever and/or respiratory symptoms.  This rash often happens days after some mild viral symptoms like vomiting or diarrhea.  Keep kiddos comfortable, watch for signs of illness and try not to panic as it spreads to every part of the body.  Kids usually look worse than they feel.  Also remember rashes will always look worse when the skin gets warm (so no, you didn’t make things worse with a bath). It will get better.

Good luck “diagnosing” your next household rash and of course give your provider a call if you are worried.

Kathryn Lysinger, MD

I am a part-time pediatrician and full-time mom of 5 year old Jacob and 3 year old Lauren. After several years away in the “big city” my husband Jeri and I are excited to be back home in Montana. When not working I love to travel, cook and can’t wait to get the entire family back on the slopes in my hometown Red Lodge, MT.

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