Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Many childhood diseases have viral or bacterial causes and include a rash of some type. As additional vaccines become available, these diseases become less of a threat to your child's long-term health. A rash of any kind should be taken seriously, however, and may require a trip to the doctor's office for evaluation. Examples of viral or bacterial rashes include several common childhood illnesses.
A virus called varicella-zoster causes this very contagious disease. The disease is not harmful to most children. The symptoms generally last
two weeks and can make the child very uncomfortable. Chickenpox can be a serious illness in people with weak immune systems such as newborns, people on chemotherapy for cancer, people taking steroids, pregnant women, or those with HIV/AIDS. A safe and effective vaccine is now available to children aged 1 year or older to prevent chickenpox. The symptoms
of chickenpox generally appear 10-21 days after exposure.
Symptoms
The earliest symptoms of chickenpox are fever, sore throat, and feeling tired. This is followed, usually within a day, by the appearance of the classic, intensely itchy rash that typically begins on the head and torso and then spreads outward to the arms and legs. The total duration of the rash is
seven to 10 days.
The rash begins as an area of redness with a small, superficial
blister in the center. After one to two days, the blister ruptures and the lesion will form a crusty scab that will fall off in
two to three days. This entire evolution takes four to five days.
Thus, children with chickenpox will have new outbreaks of the initial lesions as older crusted lesions are resolving. They characteristically will have both new and older lesions present at the same time.
Treatment
The virus is spread primarily from nasal and oral secretions of the child, but the
rash itself is also contagious. The child remains contagious and cannot go to
school or day care until the last lesion to appear has fully crusted over.
There is no "cure" for chickenpox once it has begun, but there is a vaccine that is very effective in preventing the disease. If a child contracts chickenpox, a physician can prescribe treatments to help control the itching and make your child more comfortable.
The chickenpox vaccine, called the "varicella vaccine" was added to the U.S. routine childhood immunizations in 1995. It is given in two doses. The first dose is given at 12 to 15 months of age. The second dose is recommended between 4 and 6 years
of age. The vaccine is both safe and effective. The vaccine can cause mild tenderness and redness at the site for a few days. While the vaccine will protect most children, some children (3%) who are later exposed to chickenpox can develop a mild chickenpox case usually without fever and with very few lesions. A new combination vaccine against measles, mumps, rubella, and chickenpox was introduced in 2005. It has been shown to work as well as the separate MMR and chickenpox vaccines. Because of a higher frequency of febrile seizures with the MMRV vs. separately administered MMR and Varicella vaccines, children below 2 years of age receive a split vaccine protocol. The febrile seizure side effect has not been shown in children over 2 years of age.
The varicella vaccine cannot cause chickenpox in either the vaccine recipient or any close contact.
Contraindications to receiving the vaccine include having a suppressed immune system, pregnancy, a current moderately severe illness, recent blood or blood product transfusion, or recent recipient of antiviral medications (for
example, Acyclovir or Tamiflu).
Never give aspirin to a
child with chickenpox. A deadly disease called
Reye syndrome has been associated with children taking aspirin, especially
if they have chickenpox. Be sure to check any other
over-the-counter medications for the ingredients aspirin or salicylates because these are often found mixed
with over-the-counter cold medications.
Chickenpox can occasionally affect the cornea, the clear front portion of the eye. If your child develops chickenpox on the tip of the nose or in the eyes, or if the child develops a red, irritated eye, you should see your doctor immediately.
Measles ("Regular" or "Hard" Measles)
A Paramyxovirus causes measles. A safe and
effective vaccine is available to prevent this disease, but outbreaks in people
who have not been fully vaccinated still occur.
Symptoms
Initial symptoms generally appear 10-12 days after exposure to this highly contagious virus.
The disease usually begins with nasal congestion and cough, eye redness without discharge, and moderate fever (102
F-103 F).
The child will generally look sick, with decreased appetite and activity level.
On the third or fourth day of the illness, a higher fever (104 F-105 F) develops and the child will develop a brown rash on the face, along the hairline, and behind the ears. The rash then spreads down the body to the thighs and feet. After approximately a week, the rash fades in the same pattern as it developed.
Treatment
Once the disease begins, no medication is available to treat measles.
Children who have measles appear quite ill and are miserable, but the
illness usually gets better without lasting ill effects.
You can prevent your child from getting measles by making sure they receive the recommended vaccines. The measles vaccine is part of the MMR (measles, mumps, rubella) vaccine given at age 12-15 months and repeated at age 4-6 years. In the past, some parents would elect to skip this vaccine because of concerns of association between vaccines and autism. Multiple international studies have shown the vaccine to be safe and definitely not associated with autism or any other behavioral abnormality. Safety concerns also focused on the vaccine preservative, thimerosal, which contains mercury. The studies on thimerosal have shown it to be safe, and its use is still endorsed by the World Health Organization (WHO). However, the MMR vaccine and the DTaP vaccines in the United States have been thimerosal-free since 1995. Since 2001, with the exception of the adult influenza (flu) vaccines, thimerosal has not been used as a preservative in routinely recommended childhood vaccines in the U.S.
Approximately 20% of those who develop measles may experience a complication. These may include ear infection, pneumonia and bronchitis, encephalitis, pregnancy problems, and a low platelet count (platelets are necessary for effective blood clotting).
Rubella is a much milder disease than "regular" measles and is also caused by a virus (Rubivirus).
Symptoms
Rubella is purely a disease of humans and is spread by virus in nasal and oral secretions.
Following an incubation period of 14-21 days following viral exposure, the infected child will develop a pink or light red rash on the face
that then spreads to the body. The rash does seem to itch to a mild degree. Other symptoms, which improve in three days, include low-grade temperature (100 F), headache, mild joint pains, conjunctivitis without discharge, and swollen lymph nodes in the neck and especially behind the ears.
Generally children do not appear to be very ill especially when compared to those suffering from measles.
Rubella can be very serious to an unborn child if the mother develops rubella early in her pregnancy. All women of childbearing age should have their immune status verified. Complications include congenital rubella syndrome. Congenital rubella syndrome occurs when intrauterine infection occurs during the
first trimester. Complications involving the brain, heart, vision, hearing, and liver of the infant may be life threatening.
Treatment
There is no specific treatment other than supportive care. Generally rubella is a short term, mild disease.
Rubella is easily prevented with an effective vaccine (the MMR) generally administered at 12-15 months with a booster dose at 4-6 years of age.
Scarlet fever is simply strep
throat with a rash. The throat infection is caused by the bacteria group A
Streptococcus pyogenes. It is most commonly seen in school-aged children in the winter and early spring, but it can occur in individuals of any age and in any season. It is very contagious, and the risk of transmission can be decreased with good hand washing. Strep infection may also occur around the anus or in the vaginal region.
The rash is not serious or contagious, but serious complications can occur from the
underlying infection, strep infection. The most worrisome of these is
rheumatic fever, a serious disease that can damage the
heart valves and cause long-term
heart disease.
Symptoms
The child's symptoms begin acutely with sore throat (which can be mild), moderate fever (101
F-103 F), headache, upset stomach, and swollen glands (lymph nodes) in the neck region.
After one to two days of these symptoms, the child develops a rash on the body that is red and has a sandpaper-like roughness. The classic medical description paints an accurate picture
-- "sunburn on skin with goose bumps." The rash usually spares the palms and soles.
The cheeks may look very flushed with a thin ring of normal skin around the mouth.
Symptoms of perianal or vaginal strep infection are those of moderate redness (without discharge) of the area associated with itching and often pain with passing stool or urine.
Treatment
Streptococcal sore throat can be treated with
antibiotics.
Have your child seen by your doctor immediately if you suspect he or she has
strep throat or scarlet fever.
Your child will require a full course of antibiotics, which should be
finished even if your child is better before completion.
Your child may return to school or day care in 24 hours if the fever has resolved and he
or she is feeling better.
Fifth disease, also
known as erythema infectiosum
or "slapped cheeks" disease, is caused by a virus (parvovirus
B19). This infection tends to occur more commonly in the winter and spring but can occur year-round. Infection tends to occur after an incubation period of
four to 14 days.
Symptoms
Parvovirus B19 infection is strictly human-to-human in nature. While there are animal parvovirus infections, these do not affect humans. Most people with a parvovirus B19 infection will have no symptoms. Only one in four will develop
fifth disease. The vast majority of infections occur during childhood, and infection conveys lifelong immunity.
Fifth disease often starts as a " cold" -- nasal congestion with slight cough, headache, mild sore throat, and low-grade fever. The rash only appears immediately after the symptoms of the viral illness are over and the child is no longer contagious.
The earliest specific sign of the disease is often bright red cheeks, inspiring the name "slapped cheeks disease."
After one to two days, as the slapped cheek appearance fades, and a lacy,
red rash spreads throughout the body and is most commonly found on the arms. The rash appears to fade when the skin is cool, but with a warm bath or with activity, the rash becomes more pronounced.
Occasionally the child may have sore joints with the rash. Adults who contract Parvovirus B-19 infection are more likely to report soreness of the joints of the hands, knees, and elbows.
Once the rash appears, the child is no longer
contagious.
Treatment
While there is no specific therapy other than comfort measures, several points are significant.
Fifth disease is not serious in otherwise healthy children but can pose a
serious problem for children with
sickle cell anemia, leukemia,
or HIV/AIDS.
The disease can also cause problems for pregnant women who have not already had Parvovirus B-19 infection prior to the pregnancy. The woman should consult her obstetrician to discuss laboratory studies that will help determine risk factors.
Because the child is contagious only before the rash appears, children who
develop the rash are free to return to day care.
Roseola is also called exanthem subitum and is a common childhood illness caused most commonly by human herpes virus 6. Human herpes virus 7 is less commonly the cause of this disease. A great majority of individuals who contract this disease are children between 6 months and 2 years of age. There is no seasonal variation.
Symptoms
The classic symptom sequence of roseola is that of an abrupt onset of a high, spiking fever for two to five days without other significant respiratory or intestinal symptoms. The fever breaks and is quickly followed by the onset of a rash.
The rash consists of small, pink, flat, or slightly raised lesions that appear on the trunk and spread to the extremities.
The rash is not bothersome and resolves quickly, usually only lasting one to two days.
Treatment
No curative therapy is currently available to treat roseola.
Despite the worrisome fever, the disease is not harmful and gets better
without specific therapy. Acetaminophen
(Tylenol) may be used if desired.
The fever associated with roseola can occasionally cause a
seizure. Simple febrile seizures are not associated with long-term neurological side effects.
Coxsackieviruses and Other Enteroviruses
The enteroviruses, including the coxsackieviruses,
are a very common cause of fever and rash in children. Two common diseases
caused by coxsackieviruses are
hand foot and mouth disease and herpangina.
Coxsackievirus infections are more common in the summer and autumn. All childhood age ranges are susceptible.
Symptoms
In hand foot and mouth disease, children develop a moderate fever for one or two days and then a characteristic rash. The rash includes tender blisters in the mouth and tongue as well as on the palms and soles of the hands and the feet. Occasionally the rash will also occur on the buttocks or the genital area. Young children have a general feeling of being ill (malaise) and are often cranky with a depressed appetite. The incubation period following exposure is
five days.
Herpangina causes a fever, headache, sore throat, and painful blisters or ulcers in the back of the mouth. It typically occurs during the summer months and is most commonly seen in children between 3-10 years of age. A diminished appetite is common as a consequence of mouth pain. The incubation period is
seven days.
Treatment
No specific treatment is available except
acetaminophen or ibuprofen
(Advil) for fever and discomfort. A diet of soft and cold items (for example, yogurt, ice cream) is generally well tolerated.
The diseases are not harmful but can be prevented with good hand washing and
not eating off of someone else's plate or sharing straws.
Impetigo is a superficial skin infection caused by streptococcal or staphylococcal bacteria. It is often found around the nose and mouth but can occur anywhere. The rash is more common in the warmer months. It can also occur as a secondary infection in skin that has been damaged, such as with insect bites, poison ivy, eczema, or abrasions.
Symptoms
Impetigo begins as small superficial blisters that rupture, leaving red, open
patches of skin.
Often a honey-colored crust forms over this rash.
The rash may be quite itchy.
Impetigo is highly contagious. A child can spread the infection to other parts of the body by scratching himself or to other people by person to person (non respiratory) contact.
Impetigo is rarely a serious disease but is generally treated to cure the patient, reduce the risk of complications, and lessen the likelihood of transmission to others.
Treatment
This infection of the skin is easily treated with topical or oral
antibiotics.
Your child usually is no longer contagious after one to two days of therapy.
The rash begins to heal in three to five days.
If the rash does not show signs of healing by the third day of treatment,
your child needs to be seen by a doctor.
If itching is intense, your child's doctor can recommend anti-itch medications.
A prototypical example of irritant contact dermatitis, diaper dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations.
