Skin Rashes in Children (cont.)
What Are Treatments for Life-Threatening Rashes? Is It Possible to Prevent Life-Threatening Rashes?
Fever and Petechiae
- Petechiae resolve completely in seven to 10 days without any treatment. However, a doctor should evaluate a child to determine that a serious disease process is not present.
- A child may need blood tests and X-rays to find the cause of the petechiae and fever.
- Occasionally, a child also requires a lumbar puncture (spinal tap) to be sure meningitis is not the cause.
- A child with the symptoms of meningococcemia should be brought to a hospital's emergency department immediately.
- Blood tests, including blood cultures, will be needed, as may X-rays and a spinal tap (lumbar puncture) to fully evaluate the child.
- Meningococcemia is treated in the hospital with IV antibiotics. Intensive-care therapy may also be required.
- Meningococcal sepsis is often fatal even with appropriate antibiotic therapy. Early treatment and close observation are needed.
- Vaccines exist to protect children against severe disease caused by N. meningitis, H. influenzae, and Streptococcus pneumoniae. These vaccines are part of those routinely recommended by a child's pediatrician.
Rocky Mountain Spotted Fever
- Contact a physician immediately if one suspects a child has RMSF or with any concerns of a tick-related illness.
- RMSF treatment must be started before confirmatory blood test results are available since they may not turn positive for up to 10 days after the start of the illness. Treatment must be started before this time to avoid serious complications.
- Most children are put in the hospital and given antibiotics.
- Complications of RMSF are generally rare but can include meningitis, brain damage, generalized organ failure, shock, and death.
- The most effective means to prevent Rocky Mountain spotted fever and many other tick-transmitted diseases (such as Lyme disease or ehrlichiosis) is to keep from getting bitten by ticks.
- When outdoors, dress in light colors that make it easier to see ticks if they attach themselves.
- Wear long-sleeve shirts and long pants, tucking the pant legs into the socks.
- Check for ticks on the body periodically, paying special attention to the scalp, underarms, and genital areas.
- Use an insect repellent that is effective against ticks. Both DEET and picaridin are long lasting and provide protection. Picaridin has low skin absorption and does not stain fabrics.
- Never use a concentration of DEET (N, N-diethyltoluamide) higher than 30%, and never apply DEET directly to the skin. Do not use DEET on children less than 4 months of age. Do not apply to broken skin. Avoid getting DEET into the eyes, nose, or mouth. DEET can damage synthetic fibers, so be careful applying this to clothing.
- Apply the insect repellent to the shirt collar, sleeves, and pants. There are permethrin products that can be applied only to clothing which are long lasting and effective in helping to prevent tick bites.
- RMSF may be contracted more than once. Continue to follow the precautions listed above.
- Once a tick has attached itself, it should be promptly removed. The longer the tick remains attached, the higher the likelihood of transmission of the causative bacteria.
- Gently grab the tick with tweezers close to the skin (to include the head) and apply a gentle tug. Do not crush the tick, as this usually results in leaving the microscopic mouthparts still attached. (The mouthparts may contain the salivary glands that are the reservoir for the causative bacteria.)
- Hold this gentle tension until the tick releases. This may take several minutes. Save the tick in a plastic sandwich bag since a doctor may need to use it to determine which type of bacteria is causing the child's illness.
- Cleanse the bite area with alcohol, and call a doctor immediately. Wash the hands immediately after tick removal.
- Avoid the old home remedies of applying lighter fluid, petroleum jelly, gasoline, or a lit match to kill a tick. Once the tick is dead, the mouthparts may stay in the wound and greatly increase the risk of disease.
- Ticks can also be brought into the home by pets, so be sure to have a veterinarian check pets regularly and ask about products to reduce the risk of tick attachment.
- Lyme disease should be treated promptly.
- A doctor will treat early Lyme disease with oral antibiotics. When treated early, nearly all people with Lyme disease experience rapid improvement and minimal complications. If therapy is delayed, the response to antibiotics will be slower with a higher prevalence of complications.
- A vaccine has been approved for people older than 15 years of age to prevent Lyme disease (LYMErix), but it is given only to people with significant occupational exposures to Lyme disease.
- See the Prevention section in the preceding section on Rocky Mountain spotted fever for suggestions for prevention of tick-borne illnesses.
- No test is available to diagnose this disease. The diagnosis is made by evaluating for the presence of established diagnostic criteria. Children with this disease may have an elevated platelet count and erythrocyte sedimentation rate (a test that measures the extent of inflammation). Approximately 20% of patients with Kawasaki disease will develop saclike dilatations of the coronary arteries called aneurysms. All children suspected of having Kawasaki disease should have an echocardiogram and electrocardiogram (EKG).
- Children with Kawasaki disease are admitted to the hospital and given IV gamma globulin and high-dose aspirin. Upon discharge from the hospital, they remain on low-dose aspirin and have timely follow-up with a pediatric cardiologist.
Toxic Shock Syndrome
- The source of the infection must be found and adequately treated with antibiotics. The mainstay of therapy involves supporting the circulation and thus major organs (for example, kidneys).
- Children with this disease are often admitted to the hospital for close observation and therapy in an intensive-care setting.
What Are Signs, Symptoms, and Treatments of Fungal and Parasitic Rashes?
Because children often share many things and are less likely to take hygienic precautions than adults, parasites and fungal infections can spread quickly through a day-care center or a child's class at school. Pay attention to any prolonged itching or hair loss a child might experience.
Scabies is a very itchy rash that is often worsened with bathing or at night. It is caused by a mite (Sarcoptes scabiei) that burrows beneath the top layer of skin, where is lives and lays its eggs. It is spread by close bodily contact such as sleeping together or sharing of clothing. It can also be sexually transmitted. Mites can survive for several days in clothes, bedding, and dust. It may take four to six weeks following initial exposure to develop symptoms.
- Symptoms and signs
- The itchy rash of scabies tends to be found between the fingers, in the armpits, and on the inner wrists and arms. It tends to spare the head, palms, and soles except in infants and with severe infestations. This rash is most bothersome at night. Initially the rash appears as discrete, tiny blisters. After heavy scratching, these areas commonly develop a secondary skin infection. Often only 10-20 mites have burrowed beneath the skin. The large extent of generalized itching represents an allergic type of response to the mite.
- Sometimes one can see the wavy pattern under the skin where the mite has burrowed. These are most commonly seen in areas where the skin is most delicate and thin (for example, webbing between the fingers).
- To prevent scabies, good hygiene, frequent hand washing, and not sharing clothing is important. Scabies is purely a person-to-person disease -- animals do not develop scabies.
- If a child has an intensely itchy rash that lasts for more than two to three days, he or she should be checked by a doctor.
- Prescription medications are available to kill the mites and to decrease the allergic skin reactions of swelling and itch. Treatment should occur at the same time for all family members to avoid reinfection. It may take two to four weeks after the treatment for the itching to subside. If symptoms persist for greater than four weeks, retreatment may be necessary.
- Once anyone in the family is diagnosed with scabies, everyone in the home should be treated for mite infestation.
- All clothing and bedding must be washed in hot water and the mattresses vacuumed.
Ringworm is a local infection of the skin with a fungus, usually Microsporum canis, Microsporum audouinii, or Trichophyton tonsurans. Doctors refer to these infections as tinea with several forms such as tinea corporis (ringworm on the body) and tinea capitis (ringworm of the scalp). Although the two are caused by the same organisms, they must be treated differently. Ringworm can be caught from friends (exchanging combs, brushes, or hats) or from household pets. If one thinks a child may have ringworm, see a doctor.
- Symptoms and signs
- With tinea corporis, the lesion starts as a red, slightly scaly oval that gets bigger over time. As the lesion increases in diameter, the border remains raised, slightly red, and scaly, while the central region resembles unaffected skin. The rash commonly develops one to two weeks after exposure.
- The rash may be slightly itchy.
- Tinea capitis usually starts with a round to oval area on the scalp characterized by an associated loss of hair.
- Sometimes the area of the scalp will swell and may ooze. This is called a kerion and is a reaction of the body to the tinea fungus.
- Tinea capitis may also present as normal to severe dandruff without hairless patches on the scalp. It may take six to eight weeks of effective oral therapy to resolve a kerion.
- Tinea corporis can easily be treated with topical medications available from a doctor.
- Unfortunately, it can be easily spread among family members and friends.
- Good hygiene combined with appropriate therapy can break this cycle.
- Tinea capitis requires an oral medication from a doctor.
Athlete's foot is also caused by a fungal infection of the skin. The medical term for this condition is "tinea pedis."
- Symptoms and signs
- Athlete's foot is characterized by a very itchy rash between the toes. While it may occur in young children, it is more commonly a disease of older children, teens, and adults. Toddlers and younger children may develop a non-fungal rash between the toes due to excessive dampness of the feet.
- Although athlete's foot can be treated with over-the-counter medications, other causes of rash can appear similar. It is best to have a child checked by a doctor to confirm the diagnosis if one suspects athlete's foot.
- Keeping feet dry and wearing sandals in public showers will help to control the spread of tinea pedis.
Medically Reviewed by a Doctor on 6/24/2016
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