A rash of rashes/when do you need to worry?
If you sneak a peek at the Noe nurses' email these past couple of weeks, most of the subject lines include the words, rash, spots, blotches or bites.
You can't imagine the scope of the emails we get. Some come along with photos of random body parts, not all of them easily identifiable. Rashes can be spotty, blotchy, hivey, oozy. They can be caused by allergies, bug bites, scabies, bed bugs, poison oak, contact dermatitis, virus, bacteria or fungus. They can be on only one body part or cover most of the patient. They can be part of a chronic condition that comes and goes, or something acute.
Once in awhile I can look at a photo of a rash and have a good guess what I am looking at, but more often things aren't completely clear cut. The most important thing really comes down to one very important and basic question: "Do we need to be worried about this rash or not?"
To simplify things, I divide rashes into one of two categories - Am I curious or concerned?
Rashes that I am curious about
If your child is acting fine but has a random rash, ask yourself the following questions:
-Are there any new medications? (especially antibiotics. Even if it is the end of a course, this is important information.)
-Was there a recent illness/fever? If you had a mystery fever and then a rash comes out once the fever is gone, I am NOT as concerned about it. There are quite a few viral syndromes that wave goodbye with a rash
-Are there any new foods?
-Have they been enjoying lots of citrus or berries lately?
-Are there any new soaps, detergents, bubble baths?
-Have you used a new sunscreen or lotion of any sort?
-Do you have pets? (Think fleas)
-Has there been an exposure to a new animal? (think allergies)
-Has your child been in a hot tub?
-Is the weather very warm? (my San Francisco babies don’t like the heat)
-Has your child been laying in the grass or sand?
-Has there been any recent travel?
-Any recent hiking? (think poison oak)
-Has your child done recent a art project with a new substance?
-Have you checked the mattress and area around the bed to see if there are any spiders or insects hanging around? (shudder)
If your detective work has given a promising clue, make the common sense adjustments and see if you see any improvement.
Regardless of what is causing a rash, there are several basic staples that are worth keeping on hand. The first three on the list are used for basic skin care and can be somewhat preventive.
Of course feel free to call the advice nurse to help you troubleshoot. If you are a patient at Noe Valley pediatrics we would likely try to schedule a convenient appointment slot for you to come in and have us take a look if a rash is persistent and your best attempts at clearing it with a variety of OTC creams isn't helping. If the docs are baffled, the next step may be the dermatologist.
Rashes that I am worried about
Any purple rash needs to be evaluated. These rashes don't lighten up when you press on them. If you have a child who has a purple rash and also has a fever and looks ill, they need to get to an emergency room immediately to rule out meningitis. A stiff neck, vomiting and headache would make me even more concerned. These kids look SICK.
Any rash that comes along with a fever at the same time is probably worth being seen. Strep throat can do this. We have still not ever seen an actual case of measles in the office, but that also would present with a rash and fever at the same time. The patient will look sick.
Other viral syndromes that may have the rash and fever at the same time are Slap Cheek and Hand Foot Mouth. We don't have anything other than suggestions for symptomatic relief for those. You simply will need to ride them out.
If the rash is oozy and crusty it might be bacterial. Impetigo is fairly common.
If your child has had it in the past and you already have Mupiricin, you can try to treat a small area. If it isn't clearly taking care of things, an appointment is warranted. Sometimes oral antibiotics are indicated.
If a rash seems to have fluid filled centers, it could be chicken pox!
If the rash seems very painful or itchy certainly try Zyrtec or Benedryl, but if your child is uncomfortable let's get them seen to see if we can help. Some itchy rashes like poison oak may need oral steroids.
Hives are scary because most people associate them with a severe allergic reaction. What most people don't realize is that most of the time hives are not always a big deal. They are a signal that the body is reacting to something, but often it can be viral. I have had patients with mystery hives that have cycled on and off for several weeks before finally fading. If your child has hives along with any facial swelling or difficulty breathing, they need immediate attention. If they have a history of severe allergy to something, you should have an epi-pen or AuviQ on hand and follow that up with an emergency room visit for some close monitoring.
Any painful rash that is only on one side of the body and doesn't cross the midline could be shingles. It is rare for children to get this, but it can happen.
So to recap, if you are WORRIED, make sure that you are seen appropriately sooner than later. If you are simply curious, it is time to play detective.