My child has a rash. What should I do?

My child has a rash that just appeared today. It’s spreading rapidly. Could it be chickenpox?

My baby has a rash on her cheeks and forehead. Should I put lotion on it?

Rashes are one of the most challenging diagnoses to a pediatrician. You will find that we can often tell you what the rash is not, but may not be sure what exactly it is. The reason for this is that there are hundreds of rashes, and sometimes the same cause may have different appearances from one person to the next. What pediatricians recognize very well, however, are the dangerous rashes.

Chickenpox can range from a benign to deadly illness. Once upon a time chickenpox was relatively easy to diagnose, but in this age of chickenpox vaccine the rash and overall symptoms can be so mild as to be unrecognizable. Classically the chickenpox rash starts on the forehead and scalp line, spreading to the trunk and then arms. You see a combination of pimples and blisters, which are itchy. Small infants and elderly are at highest risk for serious complications.

Probably the rash that triggers the most alarm is that from the bacteria N.meningococcus (there’s almost a yearly story about a college student who developed this, but it can happen at almost any age). Describing it on this site does not do it justice, but you can find many pictures of it on the internet, just look up “meningococcemia”.

There are many other rashes associated with dangerous conditions, but here are some simple rules to determine whether your child needs to be seen immediately or whether it can wait a day or more.

1. When you press on the rash and blanche the skin, does the rash disappear in that spot momentarily? If not, have your child seen immediately.

2. Does the rash look purple? If so, have your child seen.

3. Is your child alert and active, or does he/she appear lethargic and/or limp? If lethargic and/or limp, have your child seen immediately.

4. Does your newborn have blisters or a combination of pimples and blisters anywhere on the skin? If so, have him/her seen immediately.

5. Does your child have blisters on his skin and inside the mouth, eyes, or nostrils? Have him/her seen immediately.

6. Is the rash painful? If so, have your child seen immediately.



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