It can be quite alarming if your child suddenly develops a rash, especially with a high temperature. But the good news is that most rashes are harmless and disappear reasonably quickly without the need for any treatment.
Parents often panic and immediately jump to the conclusion that a rash with a fever means meningitis. Thankfully, meningitis is rare compared to other more common causes of rashes in children and is very distinctive – small purple spots or patches like bruises which don’t turn white when you press them. If you do suspect meningitis seek urgent medical attention.
If any rash is accompanied by a high fever, breathing difficulties, vomiting or your child feels very unwell, it may be a sign of something more serious. Always trust your instinct as a parent and never feel embarrassed to seek the advice of your GP or, if they are closed, to take your child to the nearest emergency department.
What's causing my child's rash?
There are numerous reasons children get rashes but in general it is due to one of the following:
- The skin comes into contact with an irritant, for example a plant such as poison ivy
- We have an allergy. Think about any new or irregular items your child might have come into contact with that could have triggered a rash, for example latex, a new washing powder or any new medication.
- Insect bites.
- An illness. Many diseases can cause a rash but the most common in children are chickenpox or measles. Your doctor may recommend a vaccine to prevent these illnesses.
Here we take you through a pictorial guide to childhood rashes commonly seen in the UAE...
Slapped cheek syndrome (also called fifth disease or erythema infectiosum)
What is it?
Slapped cheek syndrome is caused by parvovirus B19. It is most common in children although it can occur in people of any age and patients usually develop symptoms 4-14 days post infection. Although the rash can look quite alarming, it is normally a mild infection which clears up on its own in one to three weeks. The good news is that once you’ve had the infection you are usually immune to it for life.
The defining feature of slapped cheek syndrome is a bright red rash on one or both cheeks, often with a paleness around the mouth. Patients might also develop a light pink, itchy rash, which is often raised and lace-like in appearance, on the chest, stomach, arms and thighs. Other symptoms can include a low-grade fever, runny nose, sore throat, headache, upset tummy and generally feeling unwell.
Interestingly, infection is seasonal and we tend to see increases in slapped cheek syndrome during the spring and early summer, with additional increases in incidence occurring every three to four years as well.
Children should be encouraged to rest and drink plenty of fluids and babies should continue their normal feeds. Fever, headache and joint pain can be treated with paracetamol and ibuprofen and antihistamines and/or a moisturising cream can be used to deal with any itching.
It’s very hard to avoid spreading the virus because it can only be spread before the rash appears and most people don’t know they have it until they get the rash. I do however advise parents to identify anyone who has been in contact with the child in the run up to the rash appearing so those people can be managed appropriately. Anyone who is pregnant, has a blood disorder or a weakened immune system, who thinks they may have been exposed to the virus should seek medical advice as it can be more serious in these people.
What is it?
Chicken pox is caused by the varicella zoster virus (VZV) which is usually self-limiting. Most children will catch the virus at some point and it commonly affects those under 10 years of age.
Symptoms develop one to three weeks after infection. First a rash of itchy spots will appear on the face or chest before spreading to other parts of the body. Over the next few hours or the following day, very itchy fluid-filled blisters will develop on top of the spots. They crust over to form scabs, which after a while drop off.
Some children will have only a few spots, whereas others will be covered from head to toe. Chickenpox is contagious until all the blisters have scabbed over, which is usually five or six days after the initial spots first appeared.
There's no specific treatment for chickenpox, but you can take steps to relieve the symptoms. Give paracetamol to help relieve fever. Calamine lotion, cooling gels, sodium bicarbonate baths and colloidal oatmeal baths can help to relieve itching.
It is very important, if your child is aged less than 28 days and develops symptoms of chickenpox to seek immediate medical advice.
Hand, foot and mouth disease (HFMD)
What is it?
Hand, foot and mouth disease is a very common, contagious infection. It is seen mostly in young children, particularly those under 10, but can also affect older children and adults.
The first symptom is usually a low-grade fever, followed by mouth ulcers and spots and blisters on the palms of the hands and the soles of the feet.
Lesions may also develop on other parts of the body such as the buttocks and the groin.
There is no cure but your child’s own immune system should fight off the virus within seven to 10 days. It’s a good idea to keep them off nursery or school until they are better because the virus is very easily spread.
Make sure your child drinks plenty of fluid and if eating is difficult give soft foods. Give paracetamol or ibuprofen for fever and any pain.
Seek medical advice if your child shows signs of dehydration such as not passing any urine, develop seizures, their temperature goes above 39ºC (38ºC for children under three months), if they have a pus discharge or if symptoms do not improve after ten days.
What is it?
Scarlet fever is a highly infectious bacterial infection caused by group A streptococcus bacteria. It usually affects children between the ages of two and eight. Any child showing symptoms of scarlet fever should be taken to their GP immediately.
These include a distinctive pink-red rash, which feels like sandpaper to touch and can be very itchy. Children often become ill very quickly with a sore throat, headache, fever, abdominal pain and vomiting. A distinctive pink-red rash, which feels like sandpaper to touch and can be very itchy develops 12-48 hours later, usually starting on the chest and stomach before spreading to other parts of the body.
The tongue may also be covered in a heavy white coating which disappears after a while leaving the tongue with a ‘beefy red’ appearance (known as strawberry tongue).
Scarlet fever is treated with antibiotics. Give paracetamol to treat fever and give plenty of fluids. Symptoms usually clear up within seven days.
What is it?
Measles is a highly infectious illness caused by the measles virus. Although measles is relatively rare thanks to the measles, mumps and rubella (MMR) vaccine, it is worth mentioning because in recent years, due to a decline in the uptake of the vaccine, there has been an increase in cases.
If you think your child could have measles you should contact your GP by telephone for advice.
Measles usually affects young children. Symptoms include a rash characterised by red-brown blotches, which normally start on the head or upper neck before spreading across the rest of the body. Your child may also have a fever and cold-like symptoms.
Symptoms normally disappear within seven to 10 days. Give paracetamol or ibuprofen to treat fever, aches and pains as well as plenty of fluids.
What is it?
Molluscum contagiosum is a common, contagious infection caused by the molluscum contagiosum virus (MCV). It generally affects children aged one to five years, who tend to catch it after close physical contact with another infected child.
The virus is characterised by clusters of small, firm, raised dome-shaped spots which are usually skin-coloured. The rash is painless although some children might find it itchy. It’s really important not to squeeze the spots because the white substance contained within them is highly infectious.
There is no specific treatment and molluscum contagiosum normally goes away after about 18 months.
Ringworm (also known as tinea)
What is it?
Ringworm is a highly infectious, common fungal skin infection caused by dermotophytes.
It causes a ring-like red or silvery patch on the skin. It can appear anywhere on the body but is often on the arms and legs. Blisters and pus-filled sores sometimes appear around the rings too. If it appears on the scalp it can cause patches of hair loss.
Ringworm is not serious and can usually be easily treated with antifungal medicines.
If the child has ringworm on the scalp, the ringworm hasn’t improved with over-the-counter treatment or there is an underlying condition it is advisable to see your GP. Babies less than a month old who develop symptoms should also be referred to a GP.
What is it?
Impetigo is the most common skin infection seen in young children and is caused by a germ known as Staphylococcus aureus, although in hot climates such as Dubai it may be due to Streptococcus pyogenes. It is highly infectious and can spread quickly through families and schools.
It is much more common in warm, humid weather.
Impetigo starts with sores and blisters which break quickly leaving oozing patches covered with a honey-coloured or brownish crust. The patches start of small but tend to grow bigger. It can be quite sore and itchy and is most common on the face and hands.
If your child has symptoms of impetigo you should contact your GP as they will need to be treated with an antibiotic cream or tablet.
Rashes in newborns
What is it?
Milia, sometimes referred to as ‘milk spots’ are very common in newborn babies, seen in between 30-50% of neonates.
Milia consist of 1-2mm while or yellowish bump-like cysts, usually on the face and predominantly on the nose, eyelids and cheeks.
Milia is completely harmless, does not require treatment and spontaneously disappears within a few weeks.
What is it?
About half of all newborn babies develop a blotchy red skin reaction called erythema toxicum. It is sometimes referred to as baby acne or acne neonatorum. The exact cause is unknown although it certainly isn’t due to an infection. It is thought it is probably a normal effect of a baby’s immune system.
It is characterised by blotchy red spots on the skin with overlying white or yellow papules or pustules. The spots usually appear on the trunk but may also be found on the arms, legs and face.
It tends to last up to five to seven days and no treatment is required.
Dr Richard Jones is a British family medicine doctor (GP) who treats children and adults, specialises in sport and exercise medicine, and is also medical advisor to the British Embassy in the UAE