When to Worry About a Child's Rash

Featured Expert:

One of the hardest things to deal with as a parent is a rash on a child’s skin. As a parent, it’s hard to know whether a child’s rash is something that you need to worry about or not. The problem is that when you’re a parent, all rashes look bad. Patrick Mularoni, M.D., from Johns Hopkins All Children’s Hospital, explains some common rashes seen in children.

Is there a way to tell if a rash is dangerous?

Unfortunately, there isn’t one rule about dangerous rashes that I can give parents. Looking at rashes and identifying their cause is very difficult for even pediatricians who have seen thousands of children with rashes in their career. There are several things that parents do need to look for and the most important is how your child is acting. Many rashes are associated with an illness and how the child looks is more important than the rash. Some children can have a rash that is covering their whole body, but they are happy and playful and don’t feel sick at all. There is a particular infection called roseola. With this viral infection, most kids will start with a simple cold and then they develop a rash that covers their entire body, but this happens after the child’s fever subsides. When the rash comes, the child is actually acting and feeling better. So look at how the child with the rash is doing. Are they alert? Are they well hydrated? Are they working hard to breathe as if they just ran the 100-yard dash? If the child looks sick or if any of those symptoms are happening when looking past the rash, then that will help a parent know when it is time to see their doctor or seek emergency care.

How about rashes that don’t come with a cough or cold. We have heard a lot about MRSA or staph aureus rashes lately. Is there a way to tell if your child may have MRSA?

MRSA stands for methicillin resistant staph aureus. Staph infections are common and can cause pneumonia, ear infection and blood infections, but when we talk about MRSA, we are typically talking about a specific type that causes skin infections called an abscess. Some people also call these boils or rhizons, and if you talk to older folks, they may initially mistake this swelling for a spider bite. In my experience with the increase in MRSA skin infections that we are seeing in the community, if there is a localized abscess or red painful swollen area on a child’s skin, it is much more likely due to MRSA than it is a spider bite. As recently as 20 years ago, this was a bacteria that caused infections seen primarily in hospitalized patients. But over the past 20 years, we have seen a change in the presentation and now it is found quite often in skin infections. A MRSA abscess starts when the bacteria, which seems to be everywhere nowadays, gets through the skin through a cut or an abrasion. The area will initially look red and then the redness will grow and become swollen and painful. We can see these anywhere on the body but they are seen more often in the diaper region of children even after potty training. MRSA abscesses are painful because pus builds up inside them, and they often need to be drained at the doctor’s office or the Emergency Center in order to heal. In addition to drainage of the abscess, doctors may try oral or topical antibiotics or even bleach baths. I have seen these infections in children who have poor hygiene and also in children who bathe multiple times a day. Unfortunately in individuals or families who have recurrent MRSA infections, frequent bathing and proper hygiene can help, but this often doesn't completely solve the problem.

There is another skin infection that many parents have seen called impetigo. Can you tell us what to look out for with that infection?

Impetigo is a contagious bacterial skin infection that unlike MRSA can be caused by many different bacteria. When we describe this we often describe honey-crusted lesions because the skin will scab and the lesions will look like they have dried honey or dried maple syrup on them. There are typically multiple small lesions that eventually create bigger lesions. Many people mispronounce this as INFANTigo rather than Impetigo because it is seen more often in infants, and it is often seen around the nose and mouth of a child who is sick with another illness. This rash is an issue in schools and in contact sports like wrestling, football and basketball because it can be passed by person to person skin contact. If your child does have these honey-crusted lesions, you should definitely see your doctor because your child will need to be put on antibiotics before returning to school or sport.

Pediatric Care at Johns Hopkins Medicine

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    The Pediatric Emergency Department at the Johns Hopkins Children's Center in Baltimore, Maryland, is staffed by pediatric emergency medicine specialists and provides high quality care to children with multisystem illness and trauma — 24 hours per day, seven days a week.

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    The Johns Hopkins All Children's Hospital Emergency Center in St. Petersburg, Florida, treats all emergency conditions and is staffed 24 hours a day by pediatric emergency medicine physicians, general pediatricians and nurses, all specially trained in pediatric emergency medicine.

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