Common Skin Rashes in Children
Considerations include the appearance and location of the rash; the clinical course; and associated symptoms, such as pruritus or fever.
- Fever is likely to occur with roseola, erythema infectiosum (fifth disease), and scarlet fever.
- Pruritus sometimes occurs with atopic dermatitis, pityriasis rosea, erythema infectiosum, molluscum contagiosum, and tinea infection.
- The key feature of roseola is a rash presenting after resolution of a high fever, whereas the distinguishing features in pityriasis rosea are a herald patch and a bilateral and symmetric rash in a Christmas tree pattern.
- The rash associated with scarlet fever usually develops on the upper trunk, then spreads throughout the body, sparing the palms and soles.
- Impetigo is a superficial bacterial infection that most commonly affects the face and extremities of children.
- Erythema infectiosum is characterized by a viral prodrome followed by the “slapped cheek” facial rash.
- Flesh-colored or pearly white papules with central umbilication occur with molluscum contagiosum, a highly contagious viral infection that usually resolves without intervention.
- Tinea is a common fungal skin infection in children that affects the scalp, body, groin, feet, hands, or nails.
- Atopic dermatitis is a chronic, relapsing inflammatory skin condition that may present with a variety of skin changes.
Key Recommendations for Practice
- Potassium hydroxide testing can be a helpful diagnostic tool to distinguish pityriasis rosea from tinea or other rashes with a scale.
- Pityriasis rosea usually resolves spontaneously in two to 12 weeks without active treatment.
- Rapid antigen tests have a sensitivity of 86% for diagnosing group A beta-hemolytic streptococcal pharyngitis.
- Although impetigo is often self-limited, antibiotics are commonly prescribed to prevent complications and spread of the infection.
- The use of emollients is recommended for children with atopic dermatitis.
- Atopic lesions that do not respond to traditional therapies should be biopsied or cultured if there is concern for infection.
Distinguishing Characteristics of Common Childhood Rashes
- Roseola infantum (exanthema subitum): Rash in Trunk, spreads peripherally. Macular to maculopapular. High fever, usually greater than 102°F (39°C), precedes the rash; child is otherwise well-appearing. No pruritus. Can be confused with measles; measles rash begins on the face, and the child is usually ill-appearing. Duration: 1 to 2 days
- Pityriasis rosea: Rash in Trunk, bilateral and symmetric, Christmas tree distribution. Herald patch on the trunk may present first, followed by smaller similar lesions; oval-shaped, rose-colored patches with slight scale. No fever. Ppruritus occurs in up to one-half of patients, Often confused with tinea corporis; pityriasis rosea is typically widespread, whereas tinea corporis usually causes a single lesion. Duration: 2 to 12 weeks
- Scarlet fever: Rash in Upper trunk, spreads throughout body, spares palms and soles. Erythematous, blanching, fine macules, resembling a sunburn; sandpaper-like papules. Fever occurs 1 to 2 days before rash develops. Usually no pruritus. Petechiae on palate; white strawberry tongue; test positive for streptococcal infection. Duration: Several weeks
- Impetigo: Rash in Anywhere; face and extremities are most common. Vesicles or pustules that form a thick, yellow crust. Usually no fever. No pruritus. May be a primary or secondary infection; bullous form is typical in neonates, and nonbullous form is more common in preschool- and school-aged children. Duration: Usually self-limited but often treated to prevent complications and spread of the infection
- Erythema infectiosum (fifth disease): Rash in Face and thighs. Erythematous “slapped cheek” rash followed by pink papules and macules in a lacy, reticular pattern. Fever: Low grade. Pruritus: Yes. May be confused with scarlet fever; the slapped cheek rash can differentiate erythema infectiosum. Duration: Facial rash lasts 2 to 4 days; lacy, reticular rash may last 1 to 6 weeks
- Molluscum contagiosum: Rash in Anywhere; rarely on oral mucosa. Flesh-colored or pearly white, small papules with central umbilication. No fever. Pruritus: Yes, if associated with dermatitis. Usually resolves spontaneously without treatment. Duration: Months or up to 2 to 4 years
- Tinea infection: Rash in Anywhere. Alopecia or broken hair follicles on the scalp (tinea capitis), erythematous annular patch or plaque with a raised border and central clearing on the body (tinea corporis). No fever. Pruritus: Yes. Often confused with pityriasis rosea; potassium hydroxide microscopy can help confirm diagnosis. Usually requires antifungal treatment.
- Atopic dermatitis: Rash in Extensor surfaces of extremities, cheeks, and scalp in infants and younger children; flexor surfaces in older children. Erythematous plaques, excoriation, severely dry skin, scaling, vesicular lesions. No fever. Pruritus: Yes. Emollients and avoidance of triggers are the mainstay of treatment; topical corticosteroids may be needed for flare-ups. Duration: Chronic, relapsing
Let’s try some cases
Fig 1. Herald patch of pityriasis rosea (arrow).
Fig. 2 Sandpaper-like papules associated with scarlet fever.
Fig. 3 Impetigo. Note the yellow crusting
Fig. 4 Erythematous “slapped cheek” facial rash associated with erythema infectiosum.
Fig. 5 Flesh-colored papules with central umbilication characteristic of molluscum contagiosum.
Fig. 6 Tinea capitis. Alopecia with broken hair follicles.
Fig. 7 Tinea corporis. Note the annular patch with central clearing and raised border.
Fig. 8 Erythematous plaques and papules of atopic dermatitis. Excoriations on the flexor surfaces are common.
Figure 1. Herald patch of pityriasis rosea (arrow).
Figure 2. Sandpaper-like papules associated with scarlet fever.
Figure 3. Impetigo. Note the yellow crusting.
Figure 4. Erythematous “slapped cheek” facial rash associated with erythema infectiosum.
Figure 5. Flesh-colored papules with central umbilication characteristic of molluscum contagiosum.
Figure 6. Tinea capitis. Alopecia with broken hair follicles.
Figure 7. Tinea corporis. Note the annular patch with central clearing and raised border.
Figure 8. Erythematous plaques and papules of atopic dermatitis. Excoriations on the flexor surfaces are common.