Childhood spots and rashes are usually due to irritation or inflammation of the skin as a result of a local problem such as an allergic reaction. However, a rash associated with a fever may be due to a generalized infection (seeViral infections that cause a rash). A rash without a fever or a feeling of being unwell is probably no cause for concern; but, if it is itchy or sore, consult your doctor. Call an ambulance if a rash is accompanied by difficulty breathing and/or facial swelling.
Warning
Danger signs Call an ambulance if your child has flat, dark red spots that do not fade on pressure (seeChecking a red rash) and seems unwell, because these symptoms can be associated with meningitis.
1Does your child have a temperature of 38°C (100°F) or above?
Possible cause Urticaria, an allergic reaction also known as hives, is likely. The cause of the condition is often unknown. Rarely, it may be part of a more widespread allergic reaction.
Action Usually, no treatment is necessary, but an over-the-counter antihistamine drug may help to relieve itching. Consult your doctor if urticaria persists for more than 24 hours or if it recurs frequently. If swelling affects the mouth or tongue, call an ambulance.
16
Possible cause and action Your child may have been bitten by insects, such as fleas or mosquitoes, especially if the spots have a visible centre. Discourage your child from scratching. An over-the-counter antihistamine drug or calamine lotion may relieve the itching. Consult your doctor if the spots have not cleared up within a few days because he or she may need to exclude scabies as a cause.
17
Possible cause A fungal infection, such as ringworm, is a possibility. Some fungi infect warm, moist areas between skin folds, such as in the groin or the armpit, while others affect the limbs or the trunk. Consult your doctor.
Action Your doctor will probably prescribe an antifungal cream for your child and may also prescribe antifungal tablets.
18
Possible cause Your child may have atopic eczema, an allergic condition. This diagnosis is most likely if other family members also suffer from eczema or other allergic conditions. Consult your doctor.
Action If the diagnosis is confirmed, your doctor may prescribe a corticosteroid or antibiotic cream. Follow the self-help measures for dealing with atopic eczema and also for relieving itchiness. Many children with atopic eczema will grow out of it by 8 years of age.
19See your doctor within 24 hours
Possible cause Scabies, a parasitic infection, may be causing your child's symptoms. Scabies mites burrow under the skin between the fingers and at the wrists and can cause a widespread rash, which may affect the palms of the hands and soles of the feet in babies. Scabies is very contagious.
Action Your doctor will probably prescribe a treatment lotion, which you will need to apply to the whole of your child's body from the neck down. Everyone else in the household will need to be treated at the same time, and clothing and bedding also need to be washed. The mites should die within 3 days of treatment, but the itching may continue for up to 2 weeks.
20See your doctor within 24 hours
Possible cause Your child may have impetigo, a bacterial skin infection that commonly affects the face.
Action If your doctor confirms the diagnosis, you will probably be advised to wash the crusts away gently with warm water. Your doctor may also prescribe an antibiotic cream or, if the condition is widespread, oral antibiotics. Until the infection clears up, you should make sure that your child keeps a separate towel and other wash things to avoid infecting others. Keep your child away from other children while he or she is infected.
21
Possible cause Seborrhoeic dermatitis, a harmless skin disorder, is a possible cause of these symptoms. It often occurs in oily areas of skin, such as the hairline, eyebrows, and nose.
Action Avoid using soaps or other bath products on the affected areas. Instead, use an emollient, such as aqueous cream, to clean and moisturize the skin. The condition often improves if the scalp is treated with an over-the-counter dandruff shampoo or a shampoo containing ketoconazole. If the rash does not improve within a week or if you are concerned, consult your doctor, who may prescribe a corticosteroid cream.
22
Possible cause These may be warts, which are caused by a viral infection of the skin. A wart that grows into the sole of the foot is known as a plantar wart and may be painful.
Action Most warts disappear naturally in time, but this may take months or years. Over-the-counter wart treatments may speed up the process. However, if a wart persists after you have treated it or if it is painful, consult your doctor. He or she may suggest other treatments, such as freezing.
23
Possible cause and action Molluscum contagiosum, a harmless but contagious viral skin infection, is likely. The pimples clear up without treatment, but this may take up to 2 years. Meanwhile, they may catch on clothing and look unsightly. Individual pimples can be treated by your doctor, but because the treatment may be painful and may leave a scar, it is usually best not to treat the condition.
24
Possible cause Your child may have acne, which is very common during adolescence.
Possible cause and action Certain drugs can cause skin problems as a side effect. Stop giving your child any over-the-counter drugs and consult your doctor. Meanwhile, do not stop giving your child any prescribed drugs.
26
Consult your doctor if you are unable to make a diagnosis from this chart.
Self-Help Atopic eczema
The itchy rash of eczema usually affects the skin on the insides of joints such as the elbows and knees. If your child has eczema, the following measures may help ease the symptoms or reduce the number of flare-ups:
Your child should bath in warm water, not hot, and use an emollient bath oil.
Provide your child with a soap-free cleansing agent such as aqueous cream.
Apply emollient cream several times a day.
Make sure your child wears cotton clothing next to the skin to reduce irritation.
Your child should avoid coming in contact with cold sores, which may cause a serious viral skin infection.
Try to identify triggers, such as egg, then discuss an avoidance diet with your doctor.
Family Doctor Health Advisor is for information purposes only, and is designed as a general reference and catalyst to seeking further information.
The RACGP is not engaged in providing medical or other advice or services, and is not responsible for the results of any actions taken by any person on the basis of any information in this publication, or for any error in, or omission from, this publication.
Publication Date: 31 March 2009 Authorised By: RACGP
