TERMINOLOGY

It is important for you to understand the words we will use in this discussion to describe a rash. This will also help you more accurately describe a rash to your doctor's office over the phone. Raised this means you can feel a bump when you rub your fingers over the rash. Flat opposite of raised. The bumps are flush with the skin and can't be felt. Lacy this looks as if someone placed a piece of fancy lace material over the skin and then removed it, leaving a red imprint of the lace on the skin. Pimply this refers to very small raised bumps with a tiny white head in the middle, just like a pimple. Bumps this means exactly when it sounds like a raised bump. Spots this refers to flat spots that can't be felt. Blistery this means a bump with a clear fluid-filled middle. Pustule a pus-filled blister. Welt this is a raised, part red and part skin-colored area. It can be small or large. An example of a welt is hives. Blotches like a welt, but flat, and usually not a uniform color part are red and parts are flesh toned. Patch this refers to a flat area of the skin larger than just a little bump. Trunk the chest, tummy, and back.

11 MOST COMMON RASHES IN CHILDREN

Hives these are welts. They can appear suddenly out of nowhere, and can spread rapidly. They are most common on the trunk, but can also be on the extremities, and rarely on the face. A very distinct characteristic of hives is that each welt will often come and go over a period of 10 to 15 minutes or as long as a few hours. You will see some welts on the tummy, and then look again an hour later and find them gone, only to see new ones on the back. The welts can be small or very large, round or irregularly shaped, single or clustered together and over-lapping. They usually itch, but not always.Hives are caused by the body having an allergic reaction to a variety of things including foods, medications, external irritants such as soap, detergent, clothing material, or grass. Children can also get hives during a normal illness such as a cold or fever. Because this is an allergic reaction, you need to observe your child for other signs of a severe allergic reaction such as throat tightness, wheezing, breathing difficulty, or persistent vomiting. Go to the ER if these happen. For a full discussion click on Hives. The standard treatment for hives is Benadryl. Eczema Eczema is a condition caused by two factors: first, a genetic tendency toward dry, irritated skin; and second, skin allergies to a variety of irritants and foods. Eczema has two different appearances. When this rash is mild it looks like flat, dry, white patches. During flare-ups it appears

as red, irritated, raised patches. This rash characteristically occurs on the inner elbows and behind the knees in infants and young children. In older children it usually affects the front of the knees and outside of elbows. In can also appear on the trunk, face, hands and feet. Your child can have as little as one patch, or dozens. Eczema can either be a short-lived temporary reaction to something in your child's environment, or it can be a chronic condition lasting for years. The diagnosis and treatment of eczema is extremely involved. Click on Eczema for a full discussion. The standard treatment is hydrocortisone cream 1%, over the counter.

Viral illness the most common rash suddenly appearing on your child is rash due to a variety of viruses. Some viruses can be easily identified, including chicken pox, fifth disease, and roseola. Most viruses, however, do not cause their own specific type of rash as chicken pox does. These generic viral rashes can have many different appearances, such as lacy or pimply, raised or flat, bumps, spots, or blotches, and they often (but not always) start on the trunk, and then spread to the extremities. The most important thing to understand here is that if your child has a fever or is not feeling well, and breaks out in one of these generic rashes, then it is probably a harmless virus and nothing to worry about. Here is a brief description of some identifiable viral rashes: o Chicken pox this starts off with a few red spots or bumps (often mistaken for insect bites). Fever is common. The next day many more bumps will appear, and the first bumps will have turned into blisters. On the third day, new bumps will appear, and the secondday bumps will start to blister. On day 4 the original blisters will start to crust over. Usually by day 5, no new bumps will appear, and more blisters will crust over. By day 7, most or all of the blisters will be crusted over. The fever can last for 5 days. Once the fever is gone and all the blisters are crusted over, your child is no longer contagious. If this sounds like what your child has, click on chicken pox for a complete discussion. Very important note it is nearly impossible to diagnose chicken pox on day 1, and still difficult to know for certain on day 2. Therefore, do not bring your child into the doctor on day 1 or 2 and expect a definite diagnosis. If you think its chicken pox, then quarantine your child until day 3. If the spots have progressed as described above, then you probably don't even need a doctor to confirm it. Dr. Sears advises: When you first notice some spots draw a circle around a few of them. If they change into blisters within 24 hours, consider it chicken pox. o Fifth disease (or Slapped Cheek disease) this is a very common virus. It starts out causing bright red cheeks (it looks like your child has been slapped), and sometimes a fever. Then a generic lacy or pimply rash spreads from the trunk to the extremities. There may also be a runny nose and cough. If this sounds like what your child has, click on it for a detailed discussion.

Roseola this is one of the most common causes of fever and rash in infants and young children. It starts out with three days of moderate to high fevers, with no other symptoms. Just when you start to get worried, the fever breaks on day four and your infant develops the rash yet acts almost entirely well. The rash consists of red spots and bumps starting on the upper back and neck, spreading down the trunk and into the extremities. It sometimes has a lacy appearance. If this sounds like what your child has, then click on it for more info. Coxsackie: Blisters on hands, feet, or mouth - this is called hand, foot and mouth disease and is causes by a virus called coxsackie. Click here for a picture. Contagious period in general, most viral illness are contagious starting the day before the rash and fever start, and are no longer contagious after the fever has been gone for 24 hours (and no Tylenol given to hide the fever), even though the rash will continue. Chicken Pox is the exception (see above).

Insect bites this is a very common occurrence in children, even if you don't have pets and you clean house regularly. If your child develops several (generally less than 20) red bumps with a visible pinpoint hole in the middle, then it is probably an insect. Click on it for a detailed discussion. Heat rash this appears as tiny red pimples, bumps, or spots. It usually appears on the back of the neck or lower back, but can involve the entire trunk. It occurs due to a mix of sweat, heat and clothing. Treat this by cooling your baby off, airing out the area, or applying a cool washcloth. Contact rash there are two types of contact rash. The first appears as red, raised bumps or patches, and can have a slight crusty surface. This is generally confined to one or two small areas on the body. It is caused by contact with an irritant such as poison ivy, other plants, cleaners or other chemicals. It is treated with over-the-counter hydrocortisone 1%, or prescription-strength cream if severe or persistent. Click here to view this type of contact rash. The second type of contact rash is more generalized throughout the body, very similar to the generic viral rashes discussed above. It occurs as fine, red pimples or small spots. It can be caused by a huge variety of irritants such as new clothes, soaps, shampoos, bubble baths, detergents or fabric softeners, suntan or other lotions, bed sheets, grass, swimming pools or anything else that comes into contact with your child's skin. The treatment is to figure out the cause, and use hydrocortisone as above if needed.

Impetigo this is a bacterial infection in the skin that can occur just about anywhere, but is most common around the mouth and nose. It appears as red, raised bumps or patches with a honey-colored crust on the surface. It is treated with a prescription antibiotic ointment. Click on it for more detailed info. Facial rashes virtually all infants and young children will get a rash around the mouth and cheeks at some point during their childhood. It usually appears as flat patches, or slightly raised patches, with tiny red bumps scattered around the mouth and chin. This type of rash can be cause by drooling, pacifiers, allowing smeared food to remain too long on the face, or rubbing face against parent's clothes. This rash will often remain for weeks at a time. Just when it seems to finally clear up, something irritates it again and it returns for another few weeks. In time, this will clear up for good, and no treatment is really necessary. If its appearance bothers you, you can try applying Aquaphor healing ointment, lanolin ointment (used for sore nipples during breastfeeding), or hydrocortisone 1% cream twice a day until clear. But be warned, it will probably come back. Ringworm this appears as a red, raised ring, with almost normal skin in the middle. Itching is common. There can be any number of these rings, from just one to 10 or more. A fungus causes it. It is transmitted from other infected animals or people. A general rash of fine, red bumps can appear elsewhere on the body this is an allergic reaction to the fungus that causes the rash. The treatment is over-the-counter Lotrimin AF (clotrimazole) twice a day for several weeks, or until clear. Click on ringworm for a more detailed discussion and a photo. Warts these are usually fairly obvious, and usually occur on the hands and feet. Click on it for a full discussion. Molluscum warts these are another type of wart, but have a different appearance and usually occur on the chest or upper thighs. They are skincolored bumps, can vary in size from the tip of a ball-point pen to about half the size of the eraser end of a pencil, are smooth surfaced, often have a dimple in the center, and usually occur in clusters. They can itch. Click on it for a full discussion and picture. These are the 11 most common rashes in children. None require an urgent page to the doctor or visit to the ER. They can all wait until the next day to be evaluated, unless your child is acting extremely ill.