Rashes in Children (PAP 18)

Rashes in Children (PAP18)

Paediatric Acute Presentation 18
Paediatric Acute Presentation 18

Notes by Isabel Viebla

Curriculum focused:


  • Usually starts in childhood <12 months
  • Typically remits and relapses
  • Classic distribution in kids – face and neck, toddlers – extensor surfaces
  • older children/adults – flexural.


  • Mainstay is avoid trigger and use emollients
  • Step up and down treatment according to severity
  • Take into account psychosocial aspects of the disease, not sleeping, avoiding activities etc when assessing severity
  • Use lowest potency steroid possible
  • Should see response in 3-7 days with steroid if not working step up or think about infection
  • Other therapies include calcineurin inhibitors, wet wraps and phototherapy
  • Don’t routinely prescribe antihistamines but sedating option eg. Chlorphenamine good for acute flares and if itch is a predominant symptom can have a 1 month trial of non-sedating option e.g. cetirizine.

Application advice for parents – use emollients all the time. Smooth down don’t rub in. Use 1 fingertip amount of corticosteroid to cover an area of skin the size of an adults palm size.

Eczema herpeticum should be admitted and treated with acyclovir.

Bites and stings:

  • Reactions vary from local to life threatening.

Spider bites:

Black widow and brown recluse main dangerous ones (not native to UK – mainly US/Canada) treat with good wound care.

Black widow

  • can cause muscle spasms and autonomic instability                                          If necessary give benzodiazepines and beta blocker

Brown recluse

  • can cause progressive necrosis. Give Dapsone (exclude G6PD first). May need surgical referral for debridement.


Can be viewed as viral/bacterial/fungal/parasitic/tick bourne



Image attributes (click here)

  • Is it measles? UMEM Education Pearls
  • notifiable disease
  • 10 days incubation
  • fever disappears with presentation of the rash (starts on face and works down)
  • look for complications – otitis media, pneumonia, encephalitis
  • Supportive management

All you need to known about measles – LITFL

Molloscum contagiosum

Image by E van Herk – nl.wikipedia

  • smooth umbilcated papules come and go over weeks and may last 12-18 months
  • Contagious – use own towels etc.
  • Don’t need to be off school

Read the British Association of Dermatologists information leaflet


Scabies (images attributes)

recognise by itch – constant + usually a contact. Lesions can be anywhere. Look for burrows. Can do skin scraping to confirm diagnosis. Permethrin 5% 2 applications a week apart

Lyme disease:

don’t send serology unless clinically relevant. Erythema Migrans is diagnostic – give amoxicillin/doxycycline



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