In our continuation of “What Childhood Conditions Can Cause a Skin Rash?” we’ll look at five more examples: fifth disease, scabies, miliaria, impetigo, and pityriasis rosea. As always, this information is a good starting point for identifying an unknown rash on your little one, but you should always speak with your child’s primary care physician or a dermatologist to ensure no complications. 

Fifth Disease

Fifth disease, known as “slapped cheek disease” or erythema infectiosum, is caused by the human parvovirus 19. It’s most common in children between the ages of 5 and 15. The name comes from the fact that it was the fifth skin rash illness to be identified in children, after measles, scarlet fever, rubella, and Filatow-Dukes’ disease. 

Most outbreaks occur between late winter and early summer, and it is most contagious just after infection but before the rash develops, making it particularly difficult to detect before it spreads. 

Identifying Fifth Disease

If your child has a rash caused by Fifth disease, you’ll first see it appear on their cheeks, which turn very bright red and are often compared to a slapped cheek. It’s also slightly raised and “lacy,” with intermittent spots of normally colored skin showing between the red. From there, the rash may spread to other parts of the body, down to the soles of the feet.

The breakout can be quite itchy and may come back intermittently for around two weeks after initially disappearing if your child spends time in the sun, is exposed to extreme heat or cold, or gets injured.

Gzzz, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

Other Symptoms of Fifth Disease

With fifth disease, the rash is the primary symptom, and around 20% of children don’t experience any other symptoms before the rash develops. The other 80% will have mild symptoms for around a week before you’ll see the redness on their cheeks.

These symptoms include:

  • Mild flu symptoms, including sore throat, runny nose, and low-grade fever
  • Nausea, vomiting, and diarrhea
  • Headache
  • Itching
  • Joint pain, though this is more common in adults than children

Treatment and Symptom Relief

Like many other childhood illnesses caused by a virus, the typical treatment for Fifth disease is letting the virus run its course. You can help your child feel more comfortable by addressing the symptoms with antihistamines and over-the-counter pain relievers to ease discomfort. 

Scabies

Scabies are caused by a microscopic mite (Sarcoptes scabiei var. hominis), or “human itch mite.” This species is not the same as dust mites (Dermatophagoides farinae) or one that causes mange on pets (Sarcoptes scabiei var. canis).

A scabies rash develops due to female mites burrowing under the first layer of skin to survive on dead skin cells and lay their eggs. Their offspring hatch 3-4 days later and develop into adults after 1-2 weeks, all the while continuing to burrow under the skin. Someone with scabies typically only has 10-15 individual mites, except in exceptionally severe cases called “crusted scabies.”

Identifying Scabies

The scabies rash develops due to an immune reaction to the protein in mite feces and dead bodies, but it can take your child’s body up to 2 months to respond after the initial infection, especially if they’ve never had scabies before. Once the body has experienced the allergen once, though, it is much faster to react to additional exposures. 

  • Severe, overwhelming itchiness that worsens at night
  • Tiny lines of greyish skin where the mites have burrowed
  • Pimple-like pustules

Scabies infections can be anywhere on the body, but they are most common in skin folds for older children and adults. Younger children are also more likely to get the rash on their fingers, face, scalp, palms, and soles of the feet. 

 

Other Symptoms of Scabies

Because of the nature of the infection, there are no other symptoms associated with scabies apart from the rash. However, prolonged scratching can cause complications and infections, including impetigo. 

Treatment and Symptom Relief

It is crucial to begin scabies treatment as quickly as possible, as they are highly contagious, especially in shared households with frequent skin-to-skin contact and shared linens or clothing. 

The first step is killing the parasites and their eggs with a prescribed topical cream, such as permethrin or sulfur cream. Alternatively, ivermectin pills may be prescribed for those with weakened immune systems or when infections are so severe that the lotions aren’t working. Because of how easily they spread, doctors will typically request that all family members undergo treatment even if no one else is experiencing symptoms. Unfortunately, the intense itching may continue for many weeks after the mites are dead, which antihistamines and calamine lotion can help. 

You’ll also need to deep clean your home to prevent scabies from returning, which involves washing all clothing, bedding, towels, etc., in hot water and drying them on high heat. For soft surfaces you can’t wash, including mattresses and furniture, you’ll need to use a scabies disinfectant that contains permethrin or a steam cleaner that reaches at least 140°F, followed by a vacuum cleaner to take care of any lingering eggs. Mites can also survive on hard surfaces for 2-3 days, so you’ll also need to disinfect counters, tile, flooring, furniture, toys, and the like with hot, soapy water, steam, or by isolating the items in tied-up trash bags away from your home, such as in the garage or shed. 

Miliaria

Summertime may be prime for some fun in the sun, but it can also trigger a condition called miliaria or heat rash due to blocked sweat ducts that trap perspiration underneath the skin, which causes the pores to swell and inflame. As the name implies, it is more common in hot weather when we’re more prone to sweating, but there are several reasons why heat rash occurs:

  • Poor exfoliation practices that allow dead skin cells to collect in the pores
  • Wearing clothes that don’t allow air to circulate against the skin
  • Inflamed hair follicles that swell and block nearby sweat ducts

Miliaria is particularly common in infants because their sweat glands haven’t fully developed yet and are far more likely to become clogged. Toddlers and younger children are also more likely to develop miliaria in the winter because they spend many hours bundled up in warm layers that don’t allow sweat to evaporate. Keep your children in breathable fabrics like cotton as much as possible, and remove as many layers as possible when they’re not outdoors.

Sweat from fevers can also cause miliaria to appear on the face, so be sure to keep your little one’s face cool and turn on a fan that helps with evaporation when they’re ill.

Identifying Miliaria

Heat rash appears in three forms, each of which is more severe than the last:

  1. Miliaria crystellina: Tiny, clear blisters with no inflammation, itching, or pain
  2. Miliaria rubra: Small, red blisters that cause intense itching
  3. Miliaria profunda: Caused by severe cases of miliaria in which the sweat leaks out of the blocked pores into the deepest layers of skin, resulting in hard, flesh-colored papules that look like goosebumps

Other Symptoms of Miliaria

The only symptoms of miliaria are pustules or papules, itching, and inflammation.

Treatment and Symptom Relief

Heat rash goes away on its own after a few days as long as the area stays cool and sweat-free while the ducts heal. In the meantime, you can help ease the itchiness with calamine lotion.

Impetigo

Impetigo, which is caused by Staphylococcus aureus or Streptococcus pyogenes, is the most common bacterial skin infection in preschoolers between 2 and 5 years old. Because it’s incredibly contagious, most people get it by coming into direct contact with the skin, sores, or body fluids of someone infected. However, it’s possible to get it indirectly by touching contaminated objects, especially for little ones who live in humid climates where staph thrives or those who attend a daycare program.

The bacteria tend to enter through broken skin, putting children with cuts, scratched bug bites, scabies, and eczema at greater risk, but it can also affect unbroken skin.

Identifying Impetigo

Impetigo can take on a couple of different forms:

The most common form is called non-bullous impetigo:

  1. The first symptom is a small, red, itchy sore that typically develops in areas of exposed skin, including the nose, mouth, arms, legs, scalp, or hairline.
  2. These sores break open, leaking clear fluid.
  3. As the sore heals, it develops a distinctive yellow scab that heals without scarring. The crusting scabs look similar to cornflakes and have a honey-like color.

Bullous impetigo takes the same course as non-bullous, but the symptoms tend to be more severe and are more likely to affect the torso. The blisters can be nearly an inch across, painful, and often spread before bursting. Like the first form, the area does not scar after the crusting scabs heal.

Left untreated, impetigo can escalate into a more severe condition called ecthyma, caused by the infection moving deeper into the skin layers and creating ulcers. The blisters are extremely painful, and it can lead to scarring.

Other Symptoms of Impetigo

In rare cases, bullous impetigo may cause a fever and swollen lymph nodes as the immune system fights the infection.

Treatment and Symptom Relief

Your child’s doctor will prescribe either an oral or topical antibiotic to kill the staph bacteria. You’ll need to keep the area clean and covered for 48 hours after the first treatment, at which point impetigo is no longer contagious. It’s also important to not allow your child to go to school or come into close contact with other children to prevent the spread of the infection.

Pityriasis Rosea

Known as the “Christmas tree rash,” pityriasis rosea is more likely to develop in older children above the age of 10. While doctors are still unsure what causes this condition, the theory is that another viral infection triggers it, as most children tend to have a cold before the first spot appears.

While it is non-contagious, it lasts anywhere from six weeks to three months and can be uncomfortably itchy, particularly during physical activity or when out in the heat.

Identifying Pityriasis Rosea

Pityriasis rosea starts out as an oval-shaped “herald patch” that forms on the face, back, chest, or stomach and can grow up to 4 inches across. It has a scaly texture with a darker outline that can easily be mistaken for ringworm.

After a couple of weeks, smaller spots form outwards from the herald spot, forming swooped branches that spread across the torso, back, arms, and legs.

Evanherk, CC BY-SA 3.0 <http://creativecommons.org/licenses/by-sa/3.0/>, via Wikimedia Commons

Other Symptoms of Pityriasis Rosea

Like fifth disease, many people experience flu-like symptoms (headache, fever, body fatigue, and sore throat) before the pityriasis rosea rash appears.

Treatment and Symptom Relief

Because pityriasis rosea can look similar to other conditions like ringworm and psoriasis when the herald patch develops, your child’s dermatologist may want to take a skin scraping or biopsy to rule out any other issues. While there’s no treatment, you can use calamine lotion, antihistamines, and oatmeal baths to help with the itching. The doctor may also recommend treatments like corticosteroids or oral steroids for extreme itchiness. Otherwise, the rash will disappear on its own in 6-8 weeks.

Final Thoughts

We hope any concerned parents found this resource helpful for gaining some insights into what might be the cause of your child’s skin rash, but remember that a professional diagnosis and treatment plan are always the safest options.

In most cases, skin rashes on children are treatable and, at most, uncomfortable, but you should always consult a dermatologist and/or your child’s pediatrician to ensure that there aren’t any underlying issues or complications that need to be addressed.