Ask Nurse Judy: All About Rashes

Written by

Judy Kivowitz

12:45 pm
05/13/15

Photo Via Today’s Parent

The seen-it-all, treated-it-all Nurse Judy Kivowitz of San Francisco’s Noe Valley Pediatrics shares her advice on common child health and behavioral conundrums.

Rashes can be spotty, blotchy, hivey, and oozy. They can be caused by allergies, a virus, bacteria, or fungus. They can cover the entire body or be in one concentrated area. They can be part of a chronic condition that comes and goes, or something acute. The most important thing really comes down to one very important and basic question: “Do we need to be worried about this rash?”

I divide rashes into 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?
– Are there any new foods?
– Are there any new soaps, detergents, bubble baths?
– Have you used a new sunscreen or lotion of any sort?
– Has there been an exposure to a new animal?
– Has your child been in a hot tub?
– Is the weather very warm?
– Has your child been laying in the grass or sand?
– Have they been in a hot tub?
– Has there been any recent travel?
– Any recent hiking?
– Have you checked the mattress and area around the bed to see if there are any spiders or insects hanging around?

If your detective work has lead you to an answer, make some common sense adjustments. Then work to clear up the rash using some basic staples that are worth keeping on hand:
Cetaphil cleanser (no water needed, apply and wipe off)
Aquaphor
– Over the counter hydro-cortisone 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!)
– A favorite—add a splash of apple cider vinegar to the tub

If the rash is persistent, it is worth having your health care provider take a look. From there, they may recommend a dermatologist.

*I am not as concerned about a mystery fever that is followed by a rash once the fever is gone. There are quite a few viral syndromes that wave goodbye with a rash. Feel free to call your nurse line for trouble-shooting help.

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 be cause for more concern.
– 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 our office, but that also would present with a rash and fever at the same time. The child will look sick.
– Other viral syndromes that may include rash and fever at the same time are Slap Cheek and Hand Foot Mouth. Unfortunately, these are cases you have to ride out as there are not suggestions for symptom relief.
– 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 resolving, 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 call your health care provider. Some itchy rashes like poison oak may need oral steroids.
– Hives are scary because most people associate them with a severe allergic reaction. It is true that 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. Even after you use it, it is worth having your child checked out. 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 they come along with a virus. I have recently had a bunch of patients with mystery hives that have been cycling on and off for several weeks.
– 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.

Want more medical advice? Find out how to sign up for Nurse Judy’s San Francisco-based classes and workshops here.

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