Skin Rashes
Skin rashes in infants and young children are not usually serious and can have various causes.
Diaper rash (diaper dermatitis) is a bright red rash caused by irritation from prolonged skin contact with urine or stool anywhere beneath a child's diaper. Typically, the areas of the skin that touch the diaper are most affected. Diaper rash can also be caused by infection with the fungus Candida, typically causing a bright red rash in the creases of the skin and small red spots. Less often, diaper rash is caused by bacteria. Diaper rash does not always bother the child. It can be prevented or minimized by using diapers with absorbent gel, by avoiding restrictive plastic diapers or pants that trap moisture, and by frequent changing of diapers when they are soiled. Breastfed babies tend to have fewer diaper rashes because their stools contain fewer enzymes and other substances that can irritate the skin.
The main treatment for diaper rash is frequent removal or change of a child's diapers. The child's skin should be washed gently with mild soap and water. Often the rash improves with these measures alone. Use of a skin moisturizer and barrier ointment, such as zinc, petroleum jelly, or vitamin A & D cream, may help. Antifungal cream may be necessary if the doctor diagnoses a Candida infection. Antibiotic cream can be used if the rash is caused by bacteria.
Eczema (atopic dermatitis) is a red, scaly, dry rash that tends to appear in patches, and comes and goes. Although the cause is unknown, eczema tends to run in families and in many cases is thought to be due to an allergy. Most children outgrow eczema, but for others eczema is a life-long condition. Children with severe cases may develop infections intermittently of some particularly affected areas. Treatment includes use of skin moisturizers, gentle soaps, humidified air, corticosteroid creams, and anti-itch drugs. Efforts to control dust mites and other triggers of a child's allergies may occasionally improve the condition.
Cradle cap (seborrheic dermatitis) is a red and yellow scaling, crusty rash that occurs on an infant's head and occasionally in the skin folds. The cause is not known. Cradle cap is harmless and disappears in most children by 6 months of age. Cradle cap can be treated by regularly shampooing and massaging mineral oil into the scalp. The scales may be worked off with a fine comb. Cradle cap that does not improve with these measures may need further treatment, such as selenium shampoo or corticosteroid creams.
Tinea is a fungal infection of the skin. In children, infections of the scalp (tinea capitis) and body (tinea corporis, or "ringworm") are most common. The diagnosis and treatment of tinea are the same in children and adults (see Section 18, Chapter 212). Some children have an inflammatory reaction to the fungal infection that leads to a scalp mass (kerion), which may require additional treatment.
Molluscum contagiosum is a cluster of flesh-colored pearly pimples or bumps caused by a viral skin infection (see Section 18, Chapter 213) that usually disappears without treatment.
Milia are small pearly cysts on the face of newborns caused by the first secretions of the child's oil glands. Like newborn acne (see Section 23, Chapter 264), milia require no treatment and disappear soon after birth.
Other skin rashes in young children are often caused by viral infections. Rashes caused by roseola and erythema infectiosum (fifth disease) are harmless and generally improve without treatment (see Section 23, Chapter 273). Rashes caused by measles, rubella, and chickenpox are becoming less common or rare because children are receiving vaccines.
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