Rashes/ When to worry 2020

Rashes/when to worry

Rashes are a fact of life. Over the course of my career as an advice nurse, you can't imagine the scope of the emails I have gotten from people asking for me to help them figure out what is going on. Some came 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 a while I can look at a photo of a rash and have a good guess of 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?" This has never been more important. Data is continuing to emerge about a multi system inflammatory disorder in children that is apparently connected to COVID-19. It is very rare, but important to be aware of.  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 Do they have a history of eczema or atopic dermatitis (tends to be a common culprit)? Have they had a MMR or chicken pox vaccination within the past 2 weeks? 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 a recent 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 several on the list are used for basic skin care and can be somewhat preventive. Cetaphil cleanser (no water needed, apply and wipe off) Aquaphor or Cerave ointment A good moisturizer You all know that I love adding a splash of apple cider vinegar to the tub for all sorts of rashes Over the counter hydrocortisone cream/ointment for itchy areas Over the counter Neosporin or prescription Mupiricin for any open areas Over the counter anti fungal cream/ointment for any possible yeast rashes. oatmeal bath (don't clog your drain with real oatmeal, there are special products used for this) Zyrtec or Benadryl Bleach! Believe it or not, many dermatologists will suggest a diluted bleach bath for helping clear up eczema or bacterial infections. Of course feel free to call your advice nurse or doctors office to help you troubleshoot. If a rash is persistent and your best attempts at clearing it with a variety of OTC creams isn't helping, You may be sent to 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. Fortunately measles is not common at the moment, 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 a history of impetigo and you already have Mupirocin, 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 clear fluid filled centers, it could be chicken pox! If the rash seems very painful or itchy certainly try Zyrtec or Benadryl, 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. Here is an important update to this post. Data is continuing to emerge about a multi system inflammatory disorder in children that is apparently connected to COVID-19. It has some similarity to a rare illness called Kawasaki Disease that causes blood vessels to become swollen or inflamed throughout the body. This new Pediatric Multisystem Inflammatory Syndrome (PMIS) has many similarities, but where Kawasaki is much more common in patients under 5 years of age, this new illness doesn’t care so much about the age. The kids look sick! As Dr. Ted from Oath Pediatrics says, most parents can easily recognize that these kids need to get right to the hospital, not wait to get a call back from the doctors office. This is a very serious condition. Most kids will recover, but medical treatment and hospitalization are essential. Red flags include: swelling and redness in the hands and feet redness or cracking in the lips or tongue swollen lymph nodes in the neck high fever red eyes belly pain trouble breathing confusion A child who has a rash, but is happily playing and doesn’t have other symptoms mostly likely does NOT have PMIS. Scroll up to the rashes we are curious about. So to recap, if you are WORRIED, make sure that you are seen sooner rather than later. If you are simply curious, it is time to play detective!