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What’s That Rash?

Disclaimer: This article contains general information about common childhood rashes. It is meant to provide talking points for you to bring up with your medical provider. You should always consult your doctor or professional healthcare provider with any medical matter. Do not use any information in this article in lieu of advice from a medical professional.

what's that rash

Both my babies had it: red, bumpy, scaly patches of skin all over their sweet newborn faces. Little whiteheads marred their scrunched up noses and puffy eyelids. My photo editing skills are limited, and I never had one of those lovely newborn photo shoots where the airbrushed baby is wedged into half an eggshell or something. In my photos, the rashes and lumps and bumps live on, but that’s okay. I’ve learned rashes are just part of childhood.

As spring approaches, allergies and rashes are especially in their element. We’ll examine some of the rashes you might experience during your little one’s childhood. Again, seek advice from a medical professional if your child has any type of rash, as it can be a sign of a larger problem.

Milia / Baby Acne

These little whiteheads can be found in my children’s early baby pictures. This acne-like rash is seen on babies very early after their delivery. Typically, milia present as small white bumps on the baby’s nose, face, and chest. It usually resolves by one month of age, and is associated with maternal hormones leaving the baby’s metabolism. (Nothing like a little early introduction to puberty when you’re brand new to the world. Thanks, hormones.) Milia does not blister, itch, or crust over; it simply goes away without treatment.

milia

Milia on a newborn’s nose, characterized by its white spotty appearance. Photo credit: Ed from Ohio / Foter / CC BY-NC-SA

Eczema

Eczema is a chronic, inflammatory, itching, blistering skin rash that is usually fixed in nature. The severity of eczema can wax and wane, and it can last for years. In older children, it is typically on the flexible parts of the elbows and knees, the neck, the hands, the ankles, the feet, and the face. There is no uniform cause of eczema, but it can be exacerbated by contact with dust and grass allergens, bacteria such as staphylococcus, and viruses such as herpes simplex. Eating certain dietary allergens such as milk and egg can also aggravate a child’s eczema.

eczema

Eczema behind the knee of a six year old child. The thickening of the skin, the blistering, and the horizontal fissuring are all characteristic of this rash. Photo credit: Care_SMC / Foter / CC BY-ND

eczema herpeticum

Eczema herpeticum, a viral complication of eczema, on the feet of an infant.

Hives / Urticaria

When my daughter was about a year old, I gave her a teething biscuit for the first time and took her to Steinmart, where I let her play on the dressing room floor while I tried on cheap blue jeans. Soon afterwards, I noticed her legs were covered in little swollen bumps. My daughter wasn’t too bothered, but I was concerned. Was she allergic to something in the teething biscuit? Was it the wheat? Was there something horrible lurking in the Steinmart carpet? What caused these bumps? I NEEDED TO KNOW. (Also relevant: I am an anxious person.) I never got my answer. She never reacted to a teething biscuit again, nor did she react to sitting on strange floors. Diagnosis? Hives of unknown origin.

Hives are a spontaneous itchy rash that is typically red, raised off of the skin, and migratory, in that one hive lesion never stays in the same place for more than one day. It is usually caused by histamine release in the skin layers, but this release may be caused by an allergic reaction to foods, insect venoms, latex exposure, drug reactions, viral infections, or even direct contact with large amounts of dust, pollen, or animal dander. And as I found out, sometimes there is no explanation for why hives occur.

hives

Hives present as raised, itchy areas on the skin and can have several causes. Photo credit: dek / Foter / CC BY-NC

hives of unknown origin

Hives of unknown origin on a child’s leg.

Chickenpox

Since 1995, children in the United States have been vaccinated against chicken pox, so it may seem unusual to include this virus on a list of childhood rashes. However, with some parents choosing not to vaccinate their children, you will want to know the signs and symptoms should they appear. According to the federal government’s website, the chickenpox vaccine is effective for 8 or 9 out of every 10 people, meaning that your vaccinated child has a 10-15% chance of contracting the virus. Fortunately, vaccinated children usually have a much milder case of chickenpox than unvaccinated children, with “fewer skin blisters (usually less than 50), mild or no fever, and few other symptoms.” Worldwide, chicken pox is more common than you may think. In some Western countries, such as the UK and New Zealand, the chickenpox vaccine is still not part of the national healthcare program, although it is available privately and at additional cost.

Chickenpox is a viral infection that is always associated with fever, headache, and fatigue. It is itchy and blistering. It usually starts on the head, neck, and chest, and from there it spreads to the rest of the body. It can be spread from direct contact with the infected blisters or by airborne viral particles transmitted via coughing and sneezing from infected individuals. Since this is a viral infection, it must resolve on its own.

chicken pox 4 year old

Chicken pox on the back of a four year old.  The lesions appear full of fluid and have not drained.  This child is still contagious.

chicken pox 10 month old

A ten month old recovering from the chicken pox. The lesions are dried and blistered over. At this point, the virus is not contagious.

Dermatographia

Dermatographia is technically hives. Unlike allergic hives, these hives are caused by a physical trigger applied directly to the skin. Have you ever drawn a fingernail across your leg or arm and had a long welt appear? Congratulations, you have dermatographia. It often appears as raised lines on the skin, directly where you have scratched yourself or applied some sort of physical pressure (like having a heavy diaper bag over your shoulder). This cause-and-effect relationship might sound obvious, but it can be startling when you first notice the strange lines and raised red areas on your child. I often notice it on my baby’s legs after he’s been in the baby Bjorn. I’ve also seen dermatographic red areas on my child’s back after dancing with him or tossing him in the air during playtime.nSome children are more susceptible to this type of hives than others. Dermatographia is harmless and resolves once the physical trigger has stopped.

dermatographia

The word dermatographia comes from the Greek roots “derm” (skin) and “graph” (writing) — literally, “skin writing.” Photo credit: Jake Wild! / Foter / CC BY-NC-ND

As I’ve come to realize, there are LOTS of common childhood rashes your little one could encounter.

Have you encountered any of these rashes as moms? What course of action did you take?

Thank you to Greg Black, MD, of Carolina Allergy and Asthma Consultants, for serving as adviser on this article.

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