Health Library Rash, Age 11 and YoungerFrom Healthwise

Healthy skin is a barrier between the inside of the body and the outside environment. A rash means some change has affected the skin. A rash is generally a minor problem or is part of an illness that will go away on its own. A rash may be caused by contact with a substance outside the body, such as poison ivy (contact dermatitis), or by other, more serious illnesses, such as measles or scarlet fever (strep throat with rash).

Generalized rashes over the whole body that are caused by viruses are more common in babies and young children than in adults. A rash may be caused by a viral illness if the child also has a cold, a cough, or diarrhea, or is in a day care setting where he or she is with other children with viral illnesses. Most rashes caused by viruses are not serious and usually go away over a few days to a week. Home treatment is often all that is needed to treat these rashes.

Once a child has had a rash caused by a virus, his or her body generally builds an immunity to that virus. This immunity protects the child from getting that specific viral illness and rash again. Common rashes caused by viruses include:

• Chickenpox (varicella). This rash is a common, contagious illness caused by a type of herpes virus.
• Fifth disease. This facial rash looks like the cheeks have been slapped. It also causes a lacy, pink rash on the arms and legs, torso, and buttocks.
• Roseola (roseola infantum). This rash occurs about 3 days after a high fever.
• Unknown virus. Sometimes the specific virus that causes a rash is never known.

Localized rashes which affect one area of the body have many different causes and may go away with home treatment. Common localized rashes that occur during childhood include:

• Diaper rash. This rash is caused by rubbing, moisture, chemicals, or bacteria in the baby's urine or stool; substances in disposable diapers; or soaps used to wash cloth diapers.
• Impetigo. This bacterial skin infection is caused by strep or staph bacteria.
• Prickly heat. This rash often results from a well-meaning parent dressing his or her baby too warmly, but it can happen to any baby in very hot weather.
• Cold sores. These are sometimes called fever blisters. Cold sores are clusters of small blisters on the lip and outer edge of the mouth caused by the herpes simplex virus.
• Contact dermatitis. This rash is caused by contact with a substance, such as food, soap, or lotion, that causes an allergic reaction. Most contact dermatitis is mild and goes away when your child's skin no longer comes in contact with the substance.
• Cradle cap. Cradle cap is an oily, yellow scaling or crusting on a baby's scalp. It is common in babies and is easily treated. Cradle cap is not a part of any illness and does not imply that a baby is not being well cared for.

A very rare and serious type of generalized red rash is toxic epidermal necrolysis (TEN). This may cause the skin to peel away, leaving large areas of tissue that weep or ooze fluid like a severe burn. If this type of rash occurs, a visit to a doctor is needed. TEN may occur after the use of some medicines.

To know how serious the rash is, other symptoms that occur with the rash must be evaluated. Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

• Moderate to severe difficulty breathing, wheezing, or tightness in the chest
• Rapid swelling of the throat, tongue, lips, eyes, or face
• Signs of shock
• A rash that looks like bruises or blood spots under the skin and that occurs along with mental changes, such as confusion, irritability, or decreased mental alertness
• Drooling and an inability to swallow
• A severe allergic reaction (anaphylaxis) to the same allergen in the past

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your child's symptoms.

Does your child have any of the following symptoms?

• Your child has hives or you suspect an allergic reaction: Go to the topic Allergic Reaction.
• Your child's rash began after a tick bite, spider bite, or insect bite or sting: Go to the topic Tick Bites or Insect Bites and Stings and Spider Bites.

	Yes	Does your child have a rash that looks like bruises or tiny purple or red blood spots under the skin?
When to See a Doctor See significance of a rash that looks like bruises or tiny purple or red blood spots if you need more information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Has your child had any abnormal bleeding in the last 12 hours? Yes Does your child have other symptoms of a serious illness? These symptoms may include: Fever of 103 °F (39 °C). Severe neck stiffness or pain and is fussy. Very sleepy and hard to wake up, or child is less alert. A bulging soft spot (fontanel) on a baby's head. Rapid, difficult breathing. Drooling and not wanting to swallow. Severe pain. Signs of moderate dehydration. Blue or purple skin or mucous membranes (cyanosis). New swelling, pain, redness, or warmth in one or more joints. Call your child's health professional today if you answer "Yes" to the following question. Yes Does your child have many new tiny purple or red spots (petechiae) or bruises without other symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have a rash with a fever?
When to See a Doctor See significance of a rash with a fever if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Note: If you need information on how to take a temperature, see the topic Body Temperature. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your baby younger than age 3 months have a rectal temperature of 100.4 °F (38 °C) or higher? Yes Do you know or think that your baby younger than age 3 months has a fever but you are not able to measure his or her temperature? Yes Does your child age 3 months or older have a rectal temperature of 104 °F (40 °C) or higher? Yes Do you think that your child age 3 months or older has a very high fever, but you are not able to measure his or her temperature? Yes Does your child age 3 months or older have a fever and any other symptoms of a serious illness? Symptoms such as: Severe neck stiffness or pain and is fussy. Very sleepy and hard to wake up, or child is less alert. A bulging soft spot (fontanel) on a baby's head. Rapid, difficult breathing. Drooling and not wanting to swallow. Severe pain. Signs of moderate dehydration. Blue or purple skin or mucous membranes (cyanosis). New swelling, pain, redness, or warmth in one or more joints. Yes Did your child develop a rash that looks like a sunburn within 2 days of the beginning of a fever higher than 102 °F (39 °C)? Yes Does your child have a rash that looks like a sunburn within 2 days of the beginning a suspected moderate fever but you are unable to measure his or her temperature? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Does your child age 3 months or older have a rectal temperature of 102 °F (39 °C) to 104 °F (40 °C) that has not come down after 12 hours of home treatment and medicine? Yes Do you think your child age 3 months or older has a moderate fever that has not come down after 12 hours of home treatment and medicine? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Does your child age 3 months or older have a rectal temperature of 100 °F (38 °C) to 102 °F (39 °C) that has not come down after 24 to 48 hours? Yes Do you think your child age 3 months or older has a mild fever that has not come down after 24 to 48 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have a generalized rash over his or her body?
When to See a Doctor See significance of a generalized rash if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your child have a red rash that peels away, leaving very large areas of tissue that weep or ooze fluid? Yes Did your child develop a rash that looks like a sunburn within 2 days of the beginning of a fever higher than 102 °F (39 °C)? Yes Does your child have a rash that looks like a sunburn within 2 days of the beginning of a suspected moderate fever but you are unable to measure the temperature? Call your child's health professional today if you answer "Yes" to the following question. Yes Does your child have a rash and a sore throat? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you think your child has rubella (because he or she was exposed to rubella), and he or she is sicker than expected after having a rash for 24 to 48 hours? Yes Do you think your child has chickenpox (because he or she was exposed to chickenpox), and he or she is sicker than expected after having a rash for 24 to 48 hours? Yes Do you think your child has measles (because he or she was exposed to measles), and he or she is sicker than expected after having a rash for 24 to 48 hours? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Does your child have a rash that has not gotten better after 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your child's rash may have been caused by abuse or neglect?
When to See a Doctor See significance of abuse or neglect if you need information to help you answer the question below. Review health risks that may increase the seriousness of the symptoms. Call your child's health professional immediately if you answer "Yes" to the following question. Yes Do you think your child's rash may have been caused by abuse or neglect? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your child's rash may be caused by a medicine?
When to See a Doctor See significance of a medicine if you need information to help you answer the question below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your child have a hivelike rash that covers all or most of his or her body that started in the past 1 to 3 hours? Yes Has swelling in your child's mouth or throat appeared in the past 1 to 3 hours but your child is not having trouble breathing? Call your child's health professional today if you answer "Yes" to the following question. Yes Do you think your child's rash may be caused by a medicine? Note: Many medicines can cause a rash. If a rash occurs after your child has taken a new medicine: Stop giving the medicine to your child. Call the doctor who prescribed or recommended the medicine before giving the next dose to determine whether another medicine needs to be prescribed. If you think your child may be having a reaction to a nonprescription medicine or an herbal remedy, stop giving that medicine and call your doctor to talk about the problem. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have a rash and signs of skin infection?
When to See a Doctor See significance of a rash and signs of skin infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Does your child have increased pain, swelling, redness, or warmth around the rash? Yes Is the area around your child's rash more tender to the touch? Yes Does your child have red streaks spreading from the rash? Yes Does your child have pus in or around the rash? Yes Does your child have a fever? Yes Does your child have a rash with honey-colored drainage which dries into crusts and covers an area larger than 2 in. (5.1 cm)? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Has your child had mild pain and swelling with redness less than 1 in. (2.5 cm) around the rash for longer than 24 hours? Yes Has your child had a lump in the neck, armpit, or groin for longer than 72 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child's rash itch?
When to See a Doctor See significance of itching if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Does your child have a painful rash with severe itching? Yes Is severe itching stopping your child's usual activities or preventing sleep even after 12 hours of home treatment? Yes Does your child have new patches of itchy, oozing rash? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Does your child have moderate itching after 48 hours of home treatment? Yes Does your child have moderate to mild itching that has not gotten better after 1 week of home treatment? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Has your child had itching for longer than 4 weeks? Yes Does your child have patches of itchy rash that have not been checked by a doctor or have gotten worse since being checked? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have a localized rash in one area of his or her body?
When to See a Doctor See significance of a localized rash if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Does your child have a new rash that has lasted for longer than 1 week? Yes Does your child have a mild rash that has lasted for longer than 4 weeks? Yes Is a rash that has been checked by a doctor not following the expected course? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Does your child have any of the following symptoms?

• Joint pain and swelling: Go to the topic Arm Problems, Noninjury or Leg Problems, Noninjury.
• A fever and a sore throat: Go the topic Sore Throat.
• A rash that looks like blisters: Go the topic Blisters.
• A scalp problem: Go the topic Scalp Problems.
• A sore near the mouth or on the lip: Go the topic Mouth Problems, Noninjury.
• A red, painful, swollen bump under the skin: Go the topic Swollen Glands and Other Lumps Under the Skin.
• Skin changes: Go the topic Skin Changes.
• Cracked, blistered, itchy, peeling skin between the toes: Go the topic Toe, Foot, and Ankle Problems, Noninjury.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Most rashes will go away without medical treatment. Home treatment can often relieve pain and itching until the rash goes away.

If your child has come in contact with a substance that may cause contact dermatitis, such as poison ivy, immediately wash the area with large amounts of water.

Once a rash has developed, leave it alone as much as possible.

• Use soap and water sparingly.
• Leave the rash exposed to the air whenever possible.
• Encourage your child not to scratch the rash.

If your child has a rash, he or she should not be in contact with other children or pregnant women. Most viral rashes are contagious, especially if a fever is present.

Relief from itching

Itching with a rash is generally not serious, but it can be annoying and may make a rash more likely to become infected. Rashes caused by chickenpox, eczema, or contact dermatitis are much more likely to itch. Sometimes itching can get worse by scratching.

Home treatment may help the itching.

• Keep your child's fingernails clean and short and encourage him or her not to scratch. Cover your baby's hands with socks to help keep him or her from scratching.
• Keep your child out of the sun and in a cool place. Heat makes itching worse.
• Keep the itchy area cool and wet if your child is older than age 9 months. Put cloths soaked in ice water on the rash a few times a day. Too much wetting and drying will dry the skin, which can increase itching. Do not put cloths soaked in ice water on the skin of a baby younger than 9 months. It may cause the baby's body temperature to go down.
• Try an oatmeal bath to help relieve itching. Wrap 1 cup of oatmeal in a cotton cloth or sock and boil it as you would to cook it. Allow it to cool to room temperature, and then use it as a sponge while bathing your child in cool water without soap. You can also buy a product at the store, such as Aveeno Colloidal Oatmeal bath.
• Dress your child in cotton clothing. Do not use wool and synthetic fabrics next to the skin.
• Use gentle soaps, such as Basis, Cetaphil, Dove, or Oil of Olay, and use as little soap as possible. Do not use deodorant soaps on your child.
• Wash your child's clothes with a mild soap, such as CheerFree or Ecover, rather than a detergent. Rinse twice to remove all traces of the soap. Do not use strong detergents.
• Do not let the skin become too dry, which can make itching worse. See the topic Dry Skin and Itching in Related Information for additional home treatment.

Nonprescription medicines for itching

Carefully read and follow all label directions on the medicine bottle or box.

• Try calamine lotion for a rash caused by contact dermatitis, such as poison ivy or poison oak rashes.
• For severe itching, apply 1% hydrocortisone cream 4 times a day until the itch is gone. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to do so. Do not use in the rectal or vaginal area on children younger than age 12 unless your doctor tells you to do so.
• Try an oral antihistamine to help the scratch-itch cycle. Examples include chlorpheniramine maleate, such as Chlor-Trimeton, and diphenhydramine, such as Benadryl. Oral antihistamines are helpful when itching and discomfort are preventing your child from doing normal activities, such as going to school or getting to sleep.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your child's symptoms if any of the following occur during home treatment.

• Your child's rash worsens even with home treatment.
• Symptoms become so bad that your child is very uncomfortable.
• Other symptoms, such as a fever, feeling ill, or signs of infection, are severe or become worse.
• A new rash lasts longer than 2 weeks.
• A rash that has been diagnosed lasts longer than 4 weeks or is not following the expected course.
• Your child's symptoms become more severe or more frequent.

Several childhood diseases that cause a rash can be prevented through immunization. Immunizations help your child's immune system recognize and quickly attack a virus before it can cause a serious illness. Immunizations for chickenpox and for measles, mumps, and rubella (MMR) can prevent these common rash-causing illnesses.

Other tips for preventing rashes include the following:

• Dress your baby in as few clothes as possible during hot weather.
• Breast-feed your child for at least the first 6 months, especially if either parent has a history of any allergy, including hay fever. Breast-fed children may develop fewer food allergies than those who are not breast-fed.
• Do not bathe your child too often to prevent dry skin. Most children do not need daily bathing. Children with very dry skin may do better if they bath once or twice a week.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:

• What is the history of the rash, including:
  • When did the rash start?
  • Where did the rash start?
  • Has the rash spread?
  • Has the rash changed?
• Has your child had this rash before? If yes:
  • What were the circumstances?
  • When did he or she last have it?
  • How was it treated?
  • How long did it last?
• What other symptoms has your child had? Symptoms may include itching, burning, stinging, tingling, numbness, pain, tenderness to the touch, fever, cold symptoms, or diarrhea.
• Has your child been exposed to a contagious illness, such as measles, rubella, mumps, or chickenpox?
• Have you recently used a new food, medicine, or product, such as soaps, detergents, shampoos, lotions, fabrics, new toys, or other object?
• Has your child been exposed to poisonous plants. such as poison ivy, oak, or sumac?
• Has your child had other health problems during the past 3 months?
• Has your child recently traveled to a rural area or to another country?
• Does anyone in your immediate family have a skin disorder or an allergy?
• Which home treatment measures have you tried? Has anything made the rash better or worse? Be sure to include any nonprescription medicines you have given your child.
• Does your child have any health risks?

• Allergic Reaction
• Arm Problems, Noninjury
• Atopic Dermatitis
• Blisters
• Chickenpox (Varicella)
• Cold Sores
• Diaper Rash
• Dry Skin and Itching
• Fever, Age 3 and Younger
• Fever, Age 4 and Older
• Heat-Related Illnesses
• Immunizations
• Insect Bites and Stings and Spider Bites
• Lice
• Lyme Disease
• Psoriasis
• Ringworm of the Scalp or Beard
• Ringworm of the Skin
• Scabies
• Scalp Problems
• Skin Changes
• Stress Management
• Swollen Glands and Other Lumps Under the Skin
• Tick Bites
• Warts and Plantar Warts

Author:	Jan Nissl, RN, BS	Last Updated: August 29, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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