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Hem Rashes and red dots in children – a pictorial guide

Rashes and red dots in children – a pictorial guide

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Facts and advice about rashes and red spots on children. With pictures directly from pediatricians. When your child gets a rash or red spots, naturally, you will wonder why. As a pediatrician, I can sometimes recognise a rash in seconds. Other times I scratch my head, ask colleagues and dermatologists before I know what the rash is. Here you will find out how you can recognise different rashes, what viral spots are and what to do.

Is the baby sick or is it just spots?

The first thing to consider when the child has a rash is how the child is feeling. Several infectious diseases have rashes as symptoms, and in most infectious diseases the child also has a fever. If the child is fit and well, you do not need to seek emergency medical care, no matter how many spots the child has.

What does the rash look like and how do they feel?

Many rashes can be recognised by color and shape. Are they blisters, dry rashes or exuding rashes with yellowish crusts? Do they look like mosquito bites, like little red dots or like the child has burnt himself on stinging nettles?

Feel the rash with your fingertips. Do they feel elevated? Course bumps? Hard bumps under the subcutaneous skin? Is the skin very dry? Can you feel it at all?

Chickenpox and shingles

Chickenpox presents as rashes consisting of blisters with clear contents eg. vesicles, and are often red at the base. They can sit one by one on the body and can be just a few or very many. Chickenpox itches a lot. Generally, you have a fever the day before or on the first days of the disease.

Picture of child with chickenpox
Chickenpox produces small fluid-filled blisters on a red base

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If the child has had chickenpox, the chickenpox virus lays dormant in the nerve cells. The immune system often keeps it in check throughout childhood. However, the virus may be reactivated. When this happens, it presents as blisters of the same type as chickenpox, but sit along a band of the skin, on one side of the body. The reactivated virus travels along a particular nerve pathway to your skin and thus produces the distinctive band shape.

Picture of shingles with red blisters in the shape of a belt along the shoulder
Shingles presents as small red blisters in a cluster and can hurt a lot

If a child gets shingles on the face, go to the medical center or to an ophthalmologist. Antiviral medicine may be required if the rash is near the eye.

Hand, foot and mouth disease

Hand, foot and mouth disease is a type of viral blisters that sit on the hands, feet and mouth. Sometimes they can hurt the mouths very much and make it difficult to eat. They often do not contain as much fluid as chickenpox blisters. Some types of hand, food and mouth blisters can cause the nails to fall off in the aftermath. There is no treatment for hand, foot and mouth disease, and they often come in epidemics in the fall.

Picture of blisters on the feet - hand, foot and mouth disease
Hand, foot and mouth blisters on the feet

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Impetigo or school sores

Impetigo, or school sores, is a bacterial infection of the skin. They often sit around the mouth or under the nose, but can be found anywhere on the body. The skin around the impetigo blisters is red, inflamed and weep. The fluid solidifies into a honey-yellow crust and they can hurt quite a bit.

Picture of a child with impetigo on their cheeks
Impetigo gives wounds with yellowish crusts on a red base.

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Hives or urticaria

Sometimes children get a rash that look like they have been burnt by stinging nettles without having been near any. They are white and raised in the middle, irregular in shape and red all around. The rash moves around the body and itches terribly.

Hives on a child's legs
Hives or urticaria are itchy red rashes that can be bright and raised in the middle and moves all over the body.

Hives commonly appear spontaneously. The second most common reason is that they are associated to an infection. Hives can also be a reaction to the heat or cold.
And sometimes the hives are due to an acute allergic reaction. Sometimes hives only affect the skin. For example, when a child, who is allergic to milk, tastes milk-containing porridge rashes may appear around the mouth. If the child is doing well, you can take a photo, wait and seek medical advice calmly to see if there is an allergy.

If, on the other hand, the child appears anxious, vomits, or has difficulty breathing, seek emergency medical care immediately, and if necessary, call an ambulance. Hives can be part of a severe acute allergic reaction, which needs to be treated in hospital.

Eczema

Another type of rash that isn’t common but may have to do with allergy, is eczema. Eczema is a small, scaly, red, rash that usually affects children who have dry skin. It is more common in children who have allergies and/or asthma.

Picture of children with eczema on their cheeks
Eczema is dry, itchy rash that feels scaly

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Scarlet fever

Scarlet fever rash is red, spreads all over the body and feels like sandpaper. It always appears in conjunction with a fever. Scarlet fever is due to a streptococcal infection. If it is in the throat, you have tonsillitis at the same time. Scarlet fever should be treated with penicillin, so seek medical attention if you suspect scarlet fever.

Picture of scarlet fever rash on a child's hands
Scarlet fever rash or scarlatina feels like rough sandpaper and is pink-red.
Borrelia

Lyme disease in children is an infectious disease caused by the borrelia bacteria spread by tick bites. It is ring-shaped and not raised. You can sometimes have several ring-shaped rashes from a single tick bite and you may not always have seen the tick.

Picture of a ring-shaped rash caused by Lyme disease
Erytema migrans, ring-shaped rash due to Lyme disease

Lyme disease should be treated with penicillin so seek a medical center if you suspect Lyme disease.

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Viral spots

Many viral diseases – colds – in children can cause nonspecific dots. Often they are small, red dots that can itch a little but not so much. Viral spots heal with the cold.

Three-day fever

Three-day fever is a very common viral infection in babies and young children. They get three days of high fever without other symptoms and after the three days, a fine-spotted rash all over the body. The children are otherwise well and recover quickly. Three-day fever does not need to be treated or controlled in any particular way.

Baby acne (Hormonal spots)

Infants often get hormonal spots or newborn rash during the first month. They look a lot like little pimples and are completely harmless.

Picture of newborn baby with plenty of hormonal spots on their face
Hormonal spots, newborn rash or baby acne are completely harmless and normal.

Mosquito bites

During the summer, most children have mosquito bites. The mosquitoes usually sting in the evening or night and the bites itch and swell. Sometimes the bites can get really big.

Picture of child with two large mosquito bites on the upper arm
Mosquito bites itch and can sometimes become large in children.
Fifth Disease

Fifth Disease is a viral infection involving a virus called Parvovirus B19. It is usually harmless to the child affected but often causes fever and rash. The rash presents as wreath-shaped or laced pattern rash over the trunk and as very red cheeks characteristically known as ‘slapped cheek’.

Picture of very red cheeks on a child with fifth disease
Children with fifth disease have very red cheeks and may have a wreath-shaped rash on their trunk

Parvovirus B19 may in rare cases transiently affect the bone marrow (the tissue which produces blood cells). As a result, children produce less blood cells for some time but this usually sorts itself out. However if your child seems extra pale, or has a little bit of bleeding under the skin, you should absolutely seek medical care. This is when blood cells will be monitored with regular blood tests.

If a pregnant woman has not previously had Fifth Disease and is exposed to the infection during pregnancy, it can be dangerous for her expectant foetus if she becomes ill. If you are pregnant and worried about being exposed to Fifth Disease, contact your midwife for advice.

Petechiae

Small, pinhead-sized dark red dots that do not disappear when pressed, may be small bleeding under the skin – petechiae. Petechiae can present on the face and neck after vomiting or severe constipation.

If the dots spread elsewhere on the body, or without signs of vomiting, the child needs to have their blood count checked, especially the platelet count (thrombocytes). Platelets play an important role in the clotting cascade that prevents bleeding. Seek medical advice on the same day for a blood test.

The most common cause of low platelet count (thrombocytopenia) is ITP, idiopathic thrombocytopene purpura, which simply means that one does not know why the child is getting this. Children with ITP are otherwise healthy and fit with the treatments available.

If the child has petechiae and at the same time seems sick, you need to admit them to the emergency ward, preferably by ambulance, even if it is at night. Some severe types of septicaemia and meningitis can cause severe bleeding under the skin during the night and must be treated immediately with intensive care and antibiotics. They often cause a fever, but not always. Children with septicaemia or meningitis are always tired, dull and can sometimes be difficult to talk to, or they can complain of a headache or pain in the neck. This disease has a rapid onset and children can deteriorate by the hour.

In conclusion…

Spots on children are often due to an infection or inflammation such as in eczema or hives. But most importantly, (as usual) it is dependant on how the child is feeling.

Read more:

Läs mer om vattkoppor hos barn – smitta, förlopp, inkubationstid

Läs mer om eksem hos barn

Läs mer om blöjeksem, svamp i rumpan och röd babystjärt

Läs mer mässling – symptom, smitta, behandling

Läs mer blåsor i munnen hos barn

Läs mer om höstblåsor hos barn – hand foot and mouth disease

Läs mer om svinkoppor (impetigo) hos barn – smitta och behandling

Läs mer om skorv hos bebisar

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