Facts and advice on childhood rashes directly from a paediatrician. When your child gets red spots or rashes you will start to figure out why. As a paediatrician I will often diagnose a rash in seconds. Other times I will scratch my head, ask colleagues and refer to a dermatologist for a second opinion. Here I will share my best advice for diagnosing common childhood rashes, with pictures of course.
Is the child sick or is it only a rash?
The first thing to evaluate when your child gets a rash is their general condition. Many childhood infections appear with rashes, and often also with fever. If your child is alert and drinking their normal amount of water or milk, you don't need to rush to the emergency room, no matter how much rash there is.
What do the rashes look like and how do they feel?
Many rashes can be recognised by color and shape. Are there blisters, dry rashes or fluid filled lumps with yellowish scabs? Do they look like mosquito bites, like little red dots or like stinging nettle burns?
Stroke with your fingertips Do the rashes feel elevated? Rough bumps? Hard lumps in the subcutaneous tissue? Is the skin very dry? Can't you fell them at all?
Chickenpox and shingles
Chickenpox rashes consist of an itchy red rash with blisters filled with clear contents. They sit individually on the body and there can be just a few or a lot. Chickenpox itches intensely. As a rule, a child will have a fever the day before or for the first few days with the chickenpox.
After a child has had chickenpox, the chickenpox virus lays dormant within the nerve cells. The virus is often kept in check by the child's immune system throughout childhood. However, it can happen that the virus is activated again. At reactivation, the chickenpox (or varicella) virus produces blisters of the same type as chickenpox, but located along a patch of skin, on one side of the body. This is called shingles. The specific location is due to the virus emerging from a nerve whose nerve endings serve that specific part of the skin.
If your child gets shingles on their face, see a GP or an ophthalmologist. Anti-virus medication such as aciclovir may be needed if the rash is close to the eyes.
Hand, foot and mouth disease
Hand, foot and mouth disease is a type of virus- which causes blisters on hands, feet and mouth. Sometimes they can be very painful in the mouth and make it difficult to eat. The blisters often do not contain as much liquid as chicken pox blisters. Some types of hand, foot and mouth disease can cause the nails to fall off in the aftermath. There is no treatment for hand, foot and mouth disease, and there are often epidemics during autumn.
Impetigo is a bacterial infection of the skin. It often occurs around the mouth or under the nose, but can be anywhere on the body. The skin around the impetigo blister is red, and the sores are wet. The liquid solidifies into a honey-yellow crust and impetigo can hurt quite a bit.
Nettle rash or hives
Sometimes children get rashes as if they had been touched by stinging nettles without being near any. That is called nettle rash or hives. Nettle rashes are white and raised in the middle, with irregular shape and red all around. The rash moves around the body and itches terribly.
Nettle rash usually comes without knowing why. The second most common is that they are associated with an infection such as the common cold. Hives can also be a reaction to heat or cold.
Sometimes hives are caused by an acute allergic reaction. Sometimes this just affects the skin, when, for example, a child allergic to milk has tried milk-containing porridge and gets a rash around their mouth. If your child is alert, happy and does not have any breathing problems, you can take a photo, wait and see a doctor at a later stage to check if there is any allergy present.
If, on the other hand, your child seems anxious, vomits, or finds it difficult to breathe, seek emergency medical care, if needed call an ambulance. Hives can be part of a severe acute allergic reaction that needs to be treated at the emergency department of a hospital.
Another type of rash that may be associated with allergies, but in most cases isn't, is eczema. Eczema is a papulous red rash that usually affects children who have dry skin. It is more common in children who have an allergy or asthma.
Scarlet fever rash is red, scattered all over the body and feels like sandpaper. It always comes with fever. Scarlet fever is due to a streptococcal infection. If the infection is located in the throat you also have strep throat. Scarlet fever should be treated with penicillin, so seek medical attention if you suspect scarlet fever.
Lyme disease in children comes from infection through the bacteria Borrelia bugdorpheri which is transmitted from a tick bite. The typical rash is not raised and is circular. A child can sometimes have several circular rashes from a single tick bite and you do not always see the tick before you see the rash.
Borrelia ska behandlas med penicillin så sök vårdcentral om du misstänker borrelia.
Många virussjukdomar – förkylningar – hos barn kan ge ospecifika prickar. Ofta är de små, röda prickar som kan klia lite men inte så mycket. Virusprickar läker ut med förkylningen.
Three day fever
Three-day fever or roseola is a very common viral infection in infants and young children. After three days of high fever without any other symptoms a fine rash spreads all over the body. Affected children are otherwise well and recover quickly. Roseola does not need to be treated or controlled in any particular way.
Newborn infants often get hormonal spots or newborn rashes during their first month. They look much like small pimples and are quite harmless.
Most children get mosquito bites during the summer. Mosquitoes usually sting in the evening or night and the bites itch and swell. Sometimes mosquito bites can get really big.
Femte sjukan är en virusinfektion med ett virus som heter Parvovirus B19. Det är oftast ofarligt för det barn som drabbas men ger ofta feber och utslag. Utslagen är dels girlandformade utslag över bålen, dels väldigt röda kinder.
Parvovirus B19 can in rare cases contribute to a transient effect on the bone marrow, which produces blood cells. If your child seems extra pale, or develops small bleeds under the skin, you should of course seek medical attention, and get their blood count checked.
If a pregnant woman has not previously had the fifth illness and is exposed to infection during pregnancy, her foetus might be affected. If, as a pregnant woman, you are worried about being exposed to the fifth disease, contact your GP, midwife or obstetrician for advice.
Små, knappnålshuvudstora mörkröda prickar som inte försvinner när man trycker på dem kan vara små blödningar under huden – peteckier. Peteckier kan komma i ansiktet och på halsen efter att man har kräkts eller krystat vid förstoppning.
Om ett barn får fler peteckier, på andra ställen av kroppen, eller utan att ha kräkts, behöver man kontrollera blodvärden och särskilt blodplättarna (trombocyterna). Trombocyterna har en viktig del i koagulationsystemet som motverkar blödning. Sök läkare samma dag för ett blodprov.
Den vanligaste orsaken till låga blodplättar (trombocytopeni) är ITP, idiopatisk trombocytopen purpura, som helt enkelt betyder att man inte vet varför barnet får detta. Barn med ITP är i övrigt friska och pigga och det finns behandling att få.
Om barnet får peteckier och samtidigt verkar väldigt sjukt, behöver du akut söka sjukvård, gärna med ambulans, även nattetid om det är på natten du upptäcker det. Vissa svåra typer av blodförgiftning och hjärnhinneinflammation kan ge rikligt med blödningar under huden och måste omedelbart behandlas med intensivvård och antibiotika. De ger oftast feber, men inte alltid. Barn med blodförgiftning eller hjärnhinneinflammation är dock alltid trötta, matta och kan ibland vara svåra att få kontakt med eller klaga på ont i huvudet eller nacken. Det är snabbt insättande sjukdomar och barnen blir försämrade för varje timme.
Prickar hos barn beror ofta på någon form av infektion, men kan också bero på en inflammation som vid eksem eller nässelutslag. Viktigast av allt är (som vanligt) hur barnet mår.