Pediatric Rashes: How to Treat the Most Common Causes

A Guide for Parents

Allergic reactions. Viruses. Sun exposure. There are dozens of reasons why your child may suddenly break out in a rash. These outbreaks of bumps, hives, redness, or scaly areas on the skin can be swollen, itchy, and even painful. If they are not cared for properly, they may become inflamed or even infected.

Most rashes will go away in about a week. But if your little one’s rash spreads or becomes uncomfortable, make an appointment with your pediatrician. If you notice any red flags like difficulty breathing, wheezing, or facial swelling, visit the closest emergency room or call 911.

It is understandable to be alarmed when the skin breaks out. But remember most of these rashes are a normal, and usually harmless, reaction — they tell the child that their body has encountered something foreign or irritating.

“Children tend to get rashes more than adults because they are being exposed to allergens, viruses, and bacteria for the first time,” says Dr. Michelle Mills, a pediatrician at Summit Health. “Kids often do not wash their hands properly, so they pick up germs and irritants more easily.”

There are a few main reasons why children breakout in rashes. Viruses, allergens, a condition called eczema, and bacterial or fungal infections are the most frequent causes.

Viral Illness

When your child has a virus, you expect to see fever, body aches, or a stuffy nose. But did you know that rashes are also a very common sign?

The appearance and location of the rash will vary. Depending on the virus the rash may look like hives, redness, or small pimply bumps. The rash may appear at the same time as flu-like symptoms or once the illness begins to resolve.

Common viral rashes include:

Hand, foot, and mouth disease (coxsackie) – red spots that generally appear on the extremities. Spots can range from flat to blister-like in appearance.
Fifth disease (slapped cheek disease) – raised bright red area often on the cheeks.
Roseola (sixth disease) – small pink spots that usually start on the chest or back.

Treatment for Viral Rashes: “Treatment is generally not necessary for most viral rashes. They are typically benign and will resolve spontaneously over several days,” says Dr. Mills.

Allergic Reactions

Another major cause of rashes in children is an allergic reaction. An allergen is a substance that enters the body and triggers an inflammatory response. Kids are often allergic to food, plants, insect bites, soaps, or fragrances. A rash may come out anywhere from a few minutes to a couple of hours after the child is exposed to the allergen.

Rashes brought on by allergies typically look like hives. Also known as welts or wheals, these raised, red, and round bumps are usually very itchy. Hives may appear anywhere on the body, but most commonly on the neck, arms, and chest.

Common causes of allergic rashes include:

Food – Hives tend to break out shortly after a child ingests what they are allergic to like peanuts, eggs, or milk.
Poison ivy – Red bumps that may turn into blisters in the area that came into direct contact with the plant.
Antibiotics — Nearly 1 in 15 people are allergic to some type of antibiotic, most commonly penicillin. A reaction usually appears after one or two doses of medication but could occur anytime during treatment. If your child develops a rash, do not have them take another dose. Call your pediatrician immediately so they can change the medication.
Heat rash (also known as prickly heat) – This is not an allergic rash, but rather a skin condition caused by blocked sweat ducts. These small, pimple-like spots are caused by prolonged sweating or exposure to the sun.

Treatment for Allergic Reactions: “If this is the child’s first exposure and the only symptom, they have is a rash, I would suggest giving an antihistamine and monitoring their symptoms. Topical steroid cream can be used to control itchiness. In severe cases, when the child is very uncomfortable, oral steroids may be used to control the inflammation,” advises Dr. Mills.

Note: Watch carefully for other systems in the body that may be affected. If your child begins to wheeze, cough, have difficulty breathing, become nauseous or vomit, or develop swelling in the tongue or face, visit the closest emergency room or call 911 immediately. These are signs of an extreme life-threatening allergic reaction known as anaphylaxis, and an EpiPen is usually needed to help improve breathing and reduce swelling.

Bacterial and Fungal Infections

Another trigger of pediatric rashes are various strains of bacteria and fungus in the environment. Children have less developed immune systems and are notorious for picking up germs and other tiny organisms outside or indoors at school.

Common causes of bacterial and fungal infections are:

Impetigo – This contagious skin infection presents with red sores and blisters on the face. Sports with skin-to-skin contact can spread this bacterium.
Ringworm – Caused by a fungus, this circular, ring-shaped rash usually has a clear center. Children often pick up ringworm walking barefoot in a locker room or near a swimming pool.
Athlete’s foot – Peeling, cracked, scaly, or itchy rash that starts between the toes.

Treatment: “Bacterial infections like impetigo require antibiotics so the child will need to be seen in the office,” says Dr. Mills. “If a fungal rash does not respond to over-the-counter creams, make an appointment so your pediatrician can prescribe a stronger medication.”

Eczema

Also known as atopic dermatitis, this condition causes the skin to be red, dry, scaly, and itchy. The exact cause of eczema is unknown, but it is thought to be a combination of an overactive immune system, allergies, the environment, and genetics. Eczema is extremely common in children.

Treatment for Eczema: “Hydration is really the key, so the main treatment is simply moisturizing the skin. Topical steroids may also be used,” says Dr. Mills.

Tips for Parents

Dr. Mills understands how alarming it can be when your little one breaks out in a rash. The first steps, she says, are to identify the cause, help the child feel more comfortable, and watch for any serious red flags. Follow these helpful tips the next time you see a patch of hives.

Take a picture. Rashes often fade by the time the child comes in for an appointment. “If the rash is changing, take additional photos,” notes Dr. Mills. “Marking the borders is also a good idea so you know if the rash begins to spread.”
Look for other symptoms. Is your child itchy and uncomfortable or are they happily playing with their toys? Is the rash confined to a particular area of the body or is it everywhere? Aside from the rash, are they experiencing any other symptoms? These are the first questions Dr. Mills asks her patients.
Clean the area. “Wash the affected spots with a mild skin cleanser and lukewarm water,” advises Dr. Mills. “Pat the area dry to avoid further irritation caused by friction.”
Identify the cause. Did your child eat a new food? Were they outside in the woods? Have they been sick? Answering these questions will help you connect the dots that led to the rash.
Use over-the-counter aids. Oral antihistamines can control the symptoms of an allergic reaction. Cortisone cream can also be applied to reduce inflammation and itchiness. “If the rash is itching or burning, you can apply a cold compress to reduce swelling and inflammation,” says Dr. Mills. “An oatmeal bath also relieves itching.”
Make an appointment. Mills urges patients to come in for a visit if the rash is associated with any of the following:

Fever or other systemic symptoms (sore throat, headache, vomiting, diarrhea, etc.)
Covers the entire body
Progressively enlarging or multiplying
Causes moderate to severe discomfort
Does not improve in 2-3 days
Looks like a bruise without a history of trauma
Located in around sensitive areas like eyes, ears, mouth, genitals
Signs of an allergic reaction or bacterial infection

Visit the emergency room or call 911 in the case of life-threatening symptoms. Seek immediate medical attention if your child begins to wheeze, cough, have difficulty breathing, become nauseous or vomits, or develops swelling in the tongue or face. These could be signs of a life-threatening allergic