When your child comes to you with a rash, don’t panic—yet. Many childhood rashes are simple to treat or require time to go away. Cindy Gellner, MD, a pediatrician at University of Utah Health, says the five most common rashes she sees are:
- Eczema (atopic dermatitis)
- Molluscum contagiosum
- Pityriasis Alba
- Coxsackievirus (hand foot mouth disease)
- Diaper Rash
There's different types of eczema (intrinsic, flexural, dyshidrotic, nummular), but Gellner says they're all very similar: an itchy, dry, scaly, often red rash likely to affect people with allergies or asthma.
Eczema is not contagious and can be treated with lotions for sensitive skin (no fragrance or dye) or topical steroids such as hydrocortisone or a prescription strength steroid cream if the rash is severe.
Gellner advises not to use steroid creams on a regular basis because it can thin the skin, although eczema is often a lifelong condition. However, without any treatment, eczema can crack the skin, which can lead to a bacterial skin infection called impetigo.
Molluscum contagiosum is a viral rash caused by the poxvirus and it's normally seen in toddlers through elementary age. “At the center of the small flesh-colored papules is a white core," Gellner says. "That is essentially where the virus lives and eventually comes out. It basically looks like the little papule has a belly button.”
Gellner usually lets the rash run its course because the treatment can sometimes be worse. “The rash is actually harmless, but it is contagious. The body's immune system will eventually kill the virus, though it can take months or even a couple of years.
Pityriasis Alba is the loss of skin pigment from melanin due to skin irritation. The hypopigmented patches usually appear on the face, upper chest, upper back, and the upper arms of people with dark skin. While some suspect it's caused by a vitamin deficieny, pityriasis alba is often caused by dry skin. It is not contagious.
“There’s nothing you can do to make it heal faster, but if you keep the skin hydrated you might avoid triggering more patches,” says Gellner. “The bottom line is you just have to wait for the skin cells to start making pigment again.”
Coxsackievirus (Hand, Foot, and Mouth Disease)
“I always joke with parents that it should be called hand-foot-butt-mouth disease because that’s where the rash appears,” Gellner says. “The classic case is red papules on the palms of the hands, soles of the feet, and on the buttocks. You can also get the rash around and inside the mouth.”
Coxsackievirus tends to show up in the summer and the fall. The rash on the hands and feet are usually painless, but the ones in the mouth can be painful. It’s also highly contagious and can last about seven to 10 days. Gellner advises to keep children with hand, foot, and mouth disease well hydrated.
Diaper Rash (Candidal and Irritant)
While yeast is normally on our skin, dark and moist environments can make yeast spread and cause a candida diaper rash.
“Candida diaper rashes have what we call satellite lesions—a red bumpy rash, usually on the front with little red bumps on the fringe area and down the legs," Gellner says. "It’s very itchy and can make the skin peel if it’s not treated.”
Gellner also sees children with standard diaper rashes, mostly from irritation. She advises parents to use diaper rash cream and change diapers frequently.
When to Worry: Purple Paint Specks
So, when might you need to worry? Gellner says to act immediately if your child has something that looks like purplish paint on their legs. “Like somebody took a paint brush with dark purple paint and spattered it on them like tiny dots." This is a sign of a serious infection such as meningitis or idiopathic thrombocytic purpura. These conditions must be treated at a hospital.
Keep the Natural Moisture Barrier
The body has a natural protective moisture barrier that helps keep out bad bacteria. Too much bathing and chemicals can break it down.
“Kids usually don't need a bath every single day and definitely not bath bombs,” Gellner says. “Some parents will overdo baths and then their kids come in with dry, irritated skin. It’s important to keep the body’s natural moisture barrier intact.”