Rashes happen frequently. You can’t imagine the scope of the emails we have gotten from people asking for us to help them figure out what is going on. Many include photos of random, not easily identifiable body parts. It keeps things interesting.
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Rashes can be spotty, blotchy, hives, and/or oozy.
They can be caused by allergies, bug bites, poison oak, contact with an irritant, 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 we can look at a photo of a rash and have a good guess of what we are looking at, but more often things aren’t completely clear cut.
Here are some of the questions that we get all of the time:
Common Rash FAQs (a window into the daily life of a pediatrician):
Do these spots mean I need to keep my kid home from school?
Is this diaper rash worthy of urgent care? It looks so painful. Is it from an allergy to something they ate?
How do I know if my baby’s rash is due to a food allergy?
How do I treat this persistent cheek rash between ages 6 and 24 months? Does this rash mean my baby has a food allergy?
Does this diaper rash need an antifungal or regular desitin/vaseline/barrier cream? Should I change what they’re eating?
You may notice a theme in the most common questions we get from parents, but all kidding aside, the most important thing really comes down to one very important and basic question: “Do we need to be curious about this rash, or actually worried?“
If you learn nothing else:
A child with a random rash who is running around, playing, eating, and acting like themselves is very unlikely to have something serious.
Rashes that we are curious but not worried about
If the rash bothers you more than your child, it likely isn’t urgent, but let’s do some problem solving.
Are there any new medications? Especially antibiotics; even if it is the end of a course or they just finished. This is important information.
Was there a recent illness/fever? If they just had a mystery fever and then a rash comes out once the fever is gone, we are 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. This tends to be a common culprit.
Are there any new foods? Yes sometimes they are the cause, it’s just not as often as you think.
Have they been enjoying lots of citrus or berries lately? This is a mild, temporary irritation due to acid, not an allergy. The anus might also have a characteristic red ring around it.
Are there any new soaps, detergents, bubble baths?
Have you used a new sunscreen or lotion of any sort?
Do you have pets? Flea bites love the ankle areas, but for a crawling toddler, anywhere is fair game.
Has there been an exposure to a new animal? Keep in mind that allergies are more likely if kids are older than 2. It is certainly possible as early as age 1, but unlikely to show up before then.
Have they had a MMR or chicken pox vaccination within the past 2 weeks?
Has your child been in a hot tub 1-3 days ago?
Is the weather very warm? (babies don’t like the heat, especially if they’re over-bundled)
Has your child been laying in the grass or sand?
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, use some of the tools below 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.
Neutral cleanser (Cerave, Cetaphil, Vanicreme, Eucerin are all great, minimal water needed, apply and wipe off with lukewarm water and no rubbing).
Aquaphor or Cerave ointment for broad dryness or redness.
A good moisturizer (Tubby Todd All Over Ointment is fantastic albeit expensive)
You all know that we love adding a splash of apple cider vinegar or baking soda to the tub for all sorts of rashes.
Oatmeal bath (don’t clog your drain with real oatmeal, there are special products used for this).
Bleach! Believe it or not, many dermatologists will suggest a diluted bleach bath for helping clear up eczema or bacterial infections. Directions for this are below.
The following items are worth having in a well-stocked medicine cabinet.
These are targeted treatments for allergic, fungal, and bacterial skin issues, and are usually worth a brief consultation to figure out which ones are appropriate for the situation.
Over the counter Neosporin/Bacitracin or prescription Mupiricin for anything red and painful or yellow crusty.
Over the counter anti fungal cream/ointment for any possible yeast rashes (photos below in the diaper yeast section, but these have a characteristic look).
Over the counter hydrocortisone cream/ointment for itchy areas.
One clear exception to the use of hydrocortisone: discrete red or pink dots in dark wet places, usually the crotch or diaper area, should always start with an antifungal before hydrocortisone. Fungal rashes “eat steroids for breakfast.” They’re likely to make things worse. Not dramatically, but don’t start with them.
Zyrtec, Claritin, or Allegra are antihistamines to have on hand. Benadryl is absent from this list because it lasts ¼ the time but has all the unwanted side effects, especially drowsiness (We see you parents, saying, ‘Hey wait, who said drowsiness is unwanted!?”)
Of course feel free to call your advice nurse or doctor’s 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 need to be seen/Now we are worried
Any purple rash could be an emergency. These rashes don’t lighten up when you press firmly 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 us even more concerned. These kids are not happily playing.
Hives are scary because most people associate them with a severe allergic reaction. If the hives come along with sudden coughing, vomiting, diarrhea, swelling of the lips or tongue, or altered mental status, they need to be seen ASAP.
Once they have a history of severe allergy to something, you should always have an epi-pen, AuviQ, or Neffy (nasal epinephrine) on hand. Treat immediately at first sign of a reaction, but then head right to the ER for some close monitoring. Luckily, hives alone, are not usually urgent. (more on that below)
Urgent, but extremely rare:
One final rash deserves special mention: the rash that comes with Kawasaki disease or MIS-C (Multisystem Inflammatory Syndrome in Children). The good news is that the rash itself is usually not the most important clue. These rashes can be blotchy, widespread, or just plain hard to describe. What matters more is the whole child. These kids have persistent fever and they look sick. They often have very red eyes without any discharge, bright red or cracked lips, a red “strawberry” tongue, swollen lymph nodes in the neck, or redness and swelling of the hands and feet. Belly pain, vomiting, diarrhea, or unusual fatigue are especially common with MIS-C.
These are conditions that need prompt medical evaluation. Fortunately, they are uncommon, and with early recognition and treatment, the vast majority of children recover completely.
It is worth repeating: if your child has a rash but is running around, playing, eating, and acting like themselves, Kawasaki disease, MIS-C, or anything else worrying are much less likely.
Not urgent but potentially worth a visit:
Confer with your provider before just showing up. Some offices may take steps to avoid having someone who is potentially contagious hanging out in the waiting room.
Measles would also present with a high fever and a rash. It is very sad that it needs to be back on this list. Click the link for a full description of symptoms but these patients look sick! It is essential to have it identified as quickly as possible to prevent spread.
Strep throat often presents with fever and a rash, usually there is no congestion. While it will often go away on its own, it is worth treating to avoid potential complications.
If the rash is oozy and crusty it might be bacterial. Impetigo is fairly common. It often presents with a sore around the nose or mouth that doesn’t seem to heal. A yellow crust makes it pretty easy to figure out. If your child has a history of impetigo, you don’t need to rush in. If you already have Mupirocin, you can try to treat a small area. However, if it isn’t clearly taking care of things, an appointment is warranted. Sometimes oral antibiotics are indicated.
If a rash seems to have lots of clear fluid filled centers, it could be chicken pox or herpes!
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.
Some viral syndromes that may have the rash and fever concurrently are Slapped Cheek and Hand Foot and Mouth. Neither of these are urgent, but it’s nice to be seen to differentiate from the others. We don’t have anything other than suggestions for symptomatic relief for those. You simply will need to ride them out.
Hives without signs of anaphylaxis are usually not a big deal, but may be worth a visit. They are a signal that the body is reacting to something, but often it is viral. We have had patients with mystery hives that have cycled on and off for several weeks before finally fading. This is actually pretty common 1-2 weeks after an illness in children, and sometimes kids didn’t show any signs of being sick (i.e. there weren’t any symptoms).
Even if they don’t look terribly sick, if your child has several days of fever, a rash, and that little voice in your head is saying, “Something isn’t right,” trust that instinct. Going in for a little reassurance is never the wrong answer.
If the rash seems very painful or itchy certainly try Zyrtec or Claritin, 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.
Photos
Disclaimer : You may not want to be eating if you scroll down. Seriously, rash pictures can be tough. (Our editor, Sandy, says we needed a stronger warning)
Welcome to our world!
Common Baby Rashes
Diaper yeast/fungal infection:
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We suspect a diaper rash is caused by yeast/fungus/candida when we find the classic “satellite lesions” red dots that are thrown off the main rash. There tend to be lots of little bumps or dots instead of broad smooth red areas.
Diaper “Dermatitis” (not caused by fungus/yeast)
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Source: Uworld Medical
Severe diaper rash (note the skin breakdown, this needs a high concentration Zinc-based barrier cream like Desitin applied like icing on a cake, so you can’t see the skin). Nurse Judy likes Bag Balm for this:
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Drool rash (“irritant contact dermatitis”)
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Neonatal Acne
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Infant Eczema (note the predominance on cheeks and trunk, not behind the elbows and knees like the older kids)
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Illness rashes:
Hand Foot Mouth
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“Slapped Cheek” (parvovirus B19)
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Antibiotic rash (amoxicillin measles)
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Poison Oak or other “contact allergy” rashes (note the streaks where the plant was brushed on the skin):
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Hives/allergic rash (they are raised welts. Lots of little red dots are not hives):
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Impetigo
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References
Bleach Bath Recipe & Dilution
For a full tub: ¼-½ to cup of regular, plain, unscented household bleach (around 5%-6% sodium hypochlorite).
For a half tub: ¼ cup of bleach.
For a baby tub (about 4 gallons): 1 tablespoon of bleach.
Water Temperature: Lukewarm.
Instructions
Mix: Fill the tub with lukewarm water and thoroughly stir in the bleach before getting in.
Soak: Soak only the torso or affected areas for 10–15 minutes. Do not submerge the head or face.
Rinse: Thoroughly rinse the skin with fresh, lukewarm tap water.
Dry & Moisturize: Gently pat the skin dry with a towel (do not rub). Immediately apply any prescribed medications and moisturize
Helpful for eczema or rashes caused by bacterial source (Staph)
Baking Soda Bath
Recipe
Full bathtub: ¼-½ cup baking soda.
Baby bathtub (about 4 gallons): 1-2 tablespoons baking soda.
Water temperature: Lukewarm.
Instructions
Fill the tub with lukewarm water and dissolve the baking soda completely.
Soak for 10-15 minutes.
Gently pat the skin dry (don’t rub).
Immediately apply moisturizer or any prescribed creams.
Helpful for: Itchy skin, nonspecific irritant rashes, eczema flares, and viral rashes.
Apple Cider Vinegar Bath
Recipe
Full bathtub: 1 cup apple cider vinegar.
Half-full bathtub: ½ cup apple cider vinegar.
Baby bathtub (about 4 gallons): 2 tablespoons apple cider vinegar.
Water temperature: Lukewarm.
Instructions
Add the vinegar after filling the tub and mix well.
Soak for 10-15 minutes.
Rinse briefly with clean water if the smell bothers your child (optional).
Gently pat dry and immediately apply moisturizer.
Helpful for: Mild eczema, irritated skin, folliculitis, and helping restore the skin’s natural acidic barrier.
Do not use on large open wounds, severe skin breakdown, or if it causes significant stinging.
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