Rashes often put parents on high alert. While many are no cause for concern, others can be quite serious.
Dr. Patrick McLaughlin, emergency medicine specialist, provides a look at some of the most frequently seen rashes and what can be done about them.
*This information is for educational purposes and shouldn’t replace a consultation or advice from your child’s health care provider.
What are the most common skin rash concerns in kids?
- Hand, foot and mouth disease
- Cradle cap
- Contact dermatitis
- Stomatitis (HSV)
- Eczema
- Diaper rash
- Warts and molluscum contagiosum
- Ringworm
- Hives
- Impetigo
- Abscess (boils)
- Cellulitis
- Drug reactions
Common rashes where no treatment is necessary and supportive care recommended
Hand, foot and mouth disease (coxsackie virus)
Most common in kids under 5
How it looks:
- Sores in the mouth
- Rash/blisters on hands and feet
- Can also have rash or sores on the bottom
How it feels:
- Mild pain
- Sore throat
- Generally feeling unwell
Cause: It’s caused by coxsackie viruses, most often spread through saliva, fluid from blisters, stool or respiratory droplets. It’s common in small kids because of their tendency to put things in their mouths.
How it’s treated: Hand, food and mouth disease usually goes away on its own in about 7-10 days. Over-the-counter pain relievers, like ibuprofen, and cold popsicles and drinks can help relieve pain.
Seborrheic dermatitis (cradle cap)
Most common between 2 weeks and 12 months of age
How it looks:
- Flaky
- Scaly patches on the scalp, behind the ears or over the eyebrows
- Oily with yellow crust
- Sometimes mild redness
How it feels: Not painful or itchy – usually doesn’t bother babies
Cause: While the exact cause isn’t known, likely factors are the production of too much oil in the oil glands and hair follicles as the result of hormones passed from mom, and a type of yeast called malassezia that’s found on the skin.
How it’s treated: Cradle cap isn’t contagious and usually clears up on its own over a period of weeks or months. You can help the process by washing your baby’s hair every couple days with a mild shampoo and gently rubbing the scales with a soft brush. If it seems to be getting worse, a doctor may recommend medicine.
Contact dermatitis
May occur at any age
How it looks:
- Red rash
- Dry, cracked, scaly, peeling
- Bumps and blisters
- Oozing and crusty
- Swollen
How it feels:
- Itchy, sometimes severe
- Painful, burning or tender
Cause: Contact dermatitis occurs when a substance comes in contact with the skin and irritates it or causes an allergic reaction. This could be plants (poison ivy), soaps, lotions, jewelry, pesticides, etc.
How it’s treated: A contact dermatitis rash usually clears up in two to four weeks. Anti-itch creams and cool compresses can help relieve symptoms. Contact the doctor if it’s extremely uncomfortable, isn’t clearing up after a couple weeks or is impacting the eyes or nasal passages.
Stomatitis (HSV)
May occur at any age
How it looks: Blisters in the mouth and/or on the lips
How it feels:
- Mouth pain
- Painful sores
- Swollen gums
Cause: This infection is caused by the herpes simplex virus, or oral herpes. It can easily be confused with hand, foot and mouth disease, but stomatitis will only be found in or around the mouth.
How it’s treated: Over-the-counter pain relievers, like ibuprofen or acetaminophen, and cool drinks can help relieve the pain. If pain becomes unbearable and your child becomes at risk for dehydration, a doctor may prescribe medication to help shorten the course of the infection.
Confirm with your pediatrician: Treatment may be over-the-counter or prescription medications
Atopic dermatitis (eczema)
May occur at any age
How it looks:
- Red, dry
- Thick, leathery, cracked or scaly
- May have small bumps that leak fluid when scratched open
- Spots of lighter or darker skin
How it feels:
- Itchy
- Sensitive
Causes: The exact cause is unknown, but there’s evidence it could be related to too many inflammatory cells in the skin. It could also be the result of skin that doesn’t retain moisture and protect from bacteria and irritants the way healthy skin does.
How it’s treated: There isn’t a cure for atopic dermatitis, but there are approaches to reduce itching and discomfort. Keep skin clean and moisturized. Try to figure out what causes it to flare up (sweat, heat, cold, allergens, etc.) and limit exposure as much as possible. There are also over-the-counter creams and prescription medications that can help if lifestyle modifications don’t do the trick.
Diaper dermatitis (diaper rash, diaper candidiasis)
Most common in infants and children under 2 years old
How it looks:
- Inflammation under the diaper
- Usually bright red patches
How it feels:
- Sensitive
- Sore
Causes: Diaper rash can be caused by a number of things including irritation from urine or stool, chafing or a reaction to new foods, antibiotics or products.
How it’s treated: Keep the area clean and dry. Try to allow time without a diaper to let the area air dry. Rinse baby’s bottom with warm water and pat dry – avoid scrubbing. Barrier ointments, such as petroleum jelly and zinc oxide, can help keep moisture from penetrating the skin and fend off irritation.
Warts and molluscum contagiosum
Most common in school-aged children
How they look:
- Small bumps of rubbery or hard skin
- Color varies, but often fleshy, grayish-brown or yellow
How they feel:
- Typically painless
- Can be irritating depending on the location
Causes: Warts are caused by different types of human papillomavirus that enter the body through small cuts or scratches. Molluscum contagiosum is caused by a pox virus. Both are transmitted from one child to the next by direct contact with the lesion or from sharing an object that contains the virus, such as a towel or bench. They often develop in warm, moist places like on the hands or feet.
How they’re treated: Both of these bumps will disappear on their own, but can take several months or years to resolve. Many can be treated by over-the-counter or prescription medicine that is applied to the bumps and causes them to dry up. If this doesn’t work, a doctor can burn, freeze or use laser treatment to remove them.
Tinea corporus/capitus (ringworm)
May occur at any age
How it looks:
- Ring-shaped sores
- Slightly red
- May be scaly on the edges
How it feels: Itchy
Causes: Ringworm is caused by a common and contagious fungus. It’s spread through direct contact with an infected person or object, such as a towel, hairbrush or shared sports equipment.
How it’s treated: Tinea on the skin (corporus) is treated with a topical antifungal ointment that is available over the counter or by prescription. Tinea on the scalp (capitus) can only be treated by prescription medicine taken by mouth. Keep the area clean and dry, and avoid picking or scratching.
Urticaria (hives)
May occur at any age, but typically older than 6 months
How it looks:
- Red with pale center
- Swollen/raised
- Individual spots or large blotches
- Can occur in one spot or cover a large area of the body
- May disappear and return in another spot
How it feels:
- Itchy
- Stinging or burning sensation
Causes: Hives are most often the result of an allergic reaction to food, medicine, animals, bites/stings, pollen or other common allergens. In some people, they can be a reaction to infection, stress, sun, cold or exercise. Most of the time the cause is not identified.
How it’s treated: Mild hives will often go away on their own. Over-the-counter antihistamine medications (diphenhydramine or cetirizine) can help with itching and breakouts. In the most severe cases, a doctor may prescribe a steroid for a short period of time. If the trigger is known, avoiding that food, substance or activity is helpful.
Types of common rashes that require evaluation and antibiotics
Impetigo
Most common between the ages of 2 and 5 years
How it looks:
- Red sores or blisters, most commonly around the nose and mouth
- Blisters rupture and ooze, then form a yellowish-brown crust
- Less commonly sores can occur on a child’s trunk or diaper area
How it feels:
- Sores can be itchy
- Blisters may be painful
Cause: Impetigo infection is caused by strains of staph or strep bacteria. The bacteria enters the body through weakened skin (cut, scratch, rash, etc.) and then spreads.
How it’s treated: Topical prescription antibiotics are used to treat impetigo and prevent its spread to others. Rarely, a child may require an oral antibiotic. It’s also helpful to gently clean, soak and pat the sores dry several times a day to aid healing.
Cellulitis
May occur at any age
How it looks:
- Swollen
- Red, dimpled, bruised or blistered
- Sometimes red streaks on the skin
- Most often on the face, arms or lower legs
How it feels: Painful and warm to the touch
Cause: Cellulitis is caused by a bacterial infection, often in a wound or other broken skin. Many different bacteria can cause cellulitis, most commonly group A streptococcus and staphylococcus aureus.
How it’s treated: Treatment depends on several factors including a child’s age and severity of the cellulitis. The first step is typically oral antibiotics. In more severe cases, or if the oral medication isn’t working, antibiotics can be given by IV.
Common rashes where urgent care or urgent evaluation needed
*Note: Other more rare rashes may require urgent evaluation. You know your child. If you see something alarming or are unsure what a rash is, contact your pediatrician or go to the nearest emergency room.
Abscess (boil)
May occur at any age
How it looks:
- Red lump
- White or yellow center often appears (similar to a large pimple)
- Typically less than one inch in diameter, but can be larger
How it feels:
- Painful, even when not touched
- Tender around the lump
- May be itchy
Cause: An abscess occurs when the skin becomes infected with staph bacteria, typically arising from skin breakdown or irritation.
How it’s treated: A warm, moist compress or a warm bath can relieve pain and help the underlying puss come to the surface. It’s important not to try to pop or pierce the abscess. If it’s very painful or large, a doctor may drain it. Occasionally, oral antibiotics will be prescribed to treat the infection.
Drug reactions
May occur at any age
How they look: Appearance varies based on the child and type of drug, but may look like:
- Acne
- Hives (raised red bumps)
- Red, scaly skin
- Blisters
How they feel:
- Often itchy
- Sometimes tender
Cause: Drug reactions are the body’s response to certain medications and can range from mild to severe.
How they’re treated: Notify the doctor if you notice any drug reactions. Rashes usually clear up when the medication is stopped, but other reactions, such as difficulty breathing, can be extremely serious. Seek immediate medical attention if you notice any swelling of the lips, face or throat, or if your child is having trouble breathing.
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