Skin Rashes in Children (cont.)
Treatment of Viral Rashes
- 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.
- People who get chickenpox vaccines can spread the vaccine-strain VZV to
others, but this is very rare.
- Three out of 100 children get a chickenpox-like rash after the first
vaccine dose, but only about 1 of 100 children get a rash after the second
- 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)
- 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
multidose vials of 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 (German Measles or "Three-Day Measles")
- 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.
- 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 healthy child is contagious only before the rash appears, children who develop the rash are free to return to day care.
- 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
- 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.
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