SKIN DEEP
From measles and eczema to meningitis – can you spot the deadly kids’ rashes from the ‘harmless’ ones?
Plus when you should take your child straight to A&E
CHILDREN’S rashes can be concerning for any parent.
And with a measles outbreak larger than any for over a decade, it’s good to get clued up about what symptoms to look out for.
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But winter bugs and viruses can also develop as rashes in young people, as can conditions that stick long-term.
So when do we need to take action?
Sun Health spoke to some dermatologists to help you determine what rash your child has and when to seek medical help.
Measles
With cases of measles on the rise, parents need to know what symptoms to look out for when their child develops a worrying rash.
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Dr Stuart Sanders, GP at , says: “Measles is not a trivial infection like many other childhood illnesses.
“It can affect unvaccinated children and adults as well and, in some cases, can be a serious illness.”
LOOKS LIKE: Dr Sanders adds: “Symptoms include a temperature, cough, sore throat and a flat red rash starting on the face and chest and progressing to the rest of the body.
“Small white spots also usually occur in the mouth, inside the cheeks or on the palate.”
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HOW TO TREAT: If you think your child may have measles, it’s vital to call your GP.
“But be sure to isolate your child, make sure they’re drinking plenty of fluids and give them paracetamol to bring down the fever,” says Dr Sanders.
Your child can be protected from measles by vaccination before they start school. A single dose is given at the age of one, and at three years four months.
“Measles is a nasty illness for most children and for some can be serious, but it is completely preventable,” adds Dr Vanessa Saliba, UKHSA consultant epidemiologist.
“Vaccination is the best way to protect yourself and your children.
“If you or your child are not up to date with your two doses of MMR vaccine please contact your GP to catch up now.”
Eczema
One of the most common rashes in children is eczema, which can affect them from as young as the day they’re born.
Dr Adam Friedmann, consultant dermatologist at , explains that atopic eczema is the most common type in children, and it can be related to other conditions such as asthma and hay fever.
It occurs on what are known as flexor surfaces - like the inside of the elbow, the back of the knee, the front of the neck, the inside of the wrists.
Allergic contact dermatitis, which is a type of eczema, is caused by a reaction to something like perfume, and irritant contact eczema is caused by a chemical irritating the skin, such as soap or disinfectants.
LOOKS LIKE: Dr Friedmann says: “Eczema is inflammation of the skin characterised by redness, swelling, itching and scratch marks.”
When eczema is flaring - the skin is angry and worsening - the eczema will be red, itchy and swollen.
Due to scratching, the eczema may bleed and then weep.
As it heals, the eczema will be dry and scabby, which can still cause it to be itchy.
Dr Philippa Kaye, a GP, says: "Red, raised, sore skin which can look very cracked and dry."
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HOW TO TREAT: If your child’s eczema looks very sore and painful, a GP can prescribe steroid creams which work quickly and effectively.
But eczema is a cycle that is hard to break, as the scratching causes it to worsen. It is necessary to prevent flare-ups in the first place.
Dr Friedmann says: “Regular application of an emollient several times every day, to the whole face and body will help the epidermis of the skin to function better as a barrier to the environment.
“The drier the skin, the more frequently moisturiser should be applied and the best moisturiser to use is the greasiest.
“Also wash with a moisturiser instead of soap, avoiding fragranced products and even bubble bath.
“Children can be sensitised to allergens through cracked, dry skin, so also avoid natural products such as essential oils.”
Hives
Hives are another common rash in children and usually surface when the immune system releases histamine into the skin.
Lots of children come up in hives when their body is fighting something such as an infection or allergic reaction.
LOOKS LIKE: Hives generally look like a raised area of skin, like a bump or patch of varying sizes. They can look like mosquito bites.
Symptoms include swelling and itching of the skin. The raised bumps can look red, but this is harder to see on darker skin, or skin-coloured.
“Hives usually last from minutes to hours but often disappear without a trace within 24 hours,” explains Dr Friedmann.
“They’re usually very itchy and in chronic cases, the symptoms are often worse in the evenings which can affect sleep.”
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HOW TO TREAT: You can get treatment for hives in a pharmacy.
Dr Friedmann says: “Most cases of hives, also called acute urticaria, get better without treatment and the symptoms can be effectively treated with antihistamines.
“If the symptoms don’t go, however, always go to your GP.”
Impetigo
Although very contagious, impetigo can be treated quickly and is rarely serious. It’s the most common bacterial skin infection in the UK.
LOOKS LIKE: The rash starts as tiny blisters that burst and leave the skin red and weepy. These turn into crusted sores.
It usually comes up around the mouth and nose before moving down the body.
Despite not looking great and often feeling quite itchy, your child should hopefully not feel too poorly with impetigo.
However, warn them not to scratch or touch the sores to avoid spreading the infection.
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HOW TO TREAT: Dr Friedmann says: “Although impetigo usually clears up on its own after a few weeks, because of the contagious nature of the infection, sufferers will usually be treated with antibiotics.
“So if you think your child has it then give the GP a call.
“While the infection is healing, gently wash the skin daily with clean gauze and antiseptic soap and to prevent spreading, cover infected areas with gauze bandages or loose clothing.”
Usually, if a case of impetigo hits a school or nursery children are asked to stay off for between three and 10 days from the first time they’re exposed to the infection.
Make sure everyone in the household is regularly hand washing and ensure to clean any bedding, towels or clothes your child has worn or used.
Intertrigo
This is a rash that forms in damp areas that are in the flexures, such as behind the ears, between the buttocks or generally anywhere where there is a fold or crevasse.
It's an umbrella term, therefore it could be that there is eczema there, or thrush or athletes foot, for example.
In babies, it is seen as a result of nappy-wearing or dribbling.
LOOKS LIKE: If you notice red, raw and weeping skin in a fold on your child’s body - such as under the chin, armpits or around the nappy - they might have intertrigo.
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HOW TO TREAT: Dr Friedmann says: “The surface of the affected skin is very delicate and painful. It needs to be treated very gently.
“Even washing it with water can be painful. Using emollients such as aqueous cream to clean the skin may be gentler.
“Don’t rub the skin. Pat it dry carefully, and often.
“A weak cortisone mixed with antifungal ingredients such as Daktacort is usually effective.
“Moisturising with greasy moisturisers such as Vaseline helps also.”
Slapped cheek syndrome
Dr José Costa, a senior paediatric allergy consultant at, says: “Slapped cheek syndrome is a benign skin condition caused by a virus called parvovirus B19.
“It's most often seen in children from four to 10 years of age, although it can appear at any age.”
LOOKS LIKE: This rash is exactly what it sounds like - a red rash on the cheek that can look like the aftermath of a slap. Ouch!
“Initially, it presents with flu-like symptoms, including a fever and a bright red facial rash that then progresses to the rest of the body,” Dr Costa says.
Once the cheeks are red, a light pink rash appears on the body, usually the stomach, arms and thighs, and the skin is often itchy and raised.
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HOW TO TREAT: Dr Costa says: “The best way to manage it is to give your child plenty of fluids, rest, and medication to decrease their temperature and to help with headaches or joint pains.”
Slapped cheek syndrome is contagious - others can become infected during the initial stages of the infection from coughs and sneezes or a contaminated surface.
By the time the rash appears, the person is no longer contagious.
Chickenpox
Most of us will have come across chickenpox at some point in our lives, and anyone who’s had it will know how uncomfortable and itchy it can be.
LOOKS LIKE: Chickenpox has three stages. It starts with small spots that can be anywhere on the body, either widespread or in one area.
The small spots fill with fluid and become blisters that may burst, and in the final stage, become scabs. If scratched, the blisters usually leave a scar.
Dr Costa says: “Often chickenpox starts around the face, neck or back, spreading to the rest of the body afterwards.”
The rash may be accompanied by a fever, aching muscles, a headache, feeling sick, a sore throat, tiredness, a stomach ache, loss of appetite and generally feeling unwell.
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HOW TO TREAT: Dr Costa says: “In most cases, it is not serious and resolves on its own over a period of two weeks.
“Sometimes it can be more severe, seek the help of your doctor if your child becomes unwell.”
Hand foot and mouth
The hand foot and mouth rash usually only affects children under the age of seven - although anyone of any age can get it - and is quite common.
LOOKS LIKE: It normally presents as raised red bumps on the hands, in the mouth and on the feet which may spread to the thighs and bottom. Later, these spots can turn into blisters.
Dr Costa says: “Often blisters come up between the fingers or toes.
“It’s very common and contagious and can be uncomfortable for your child - usually involving a mild fever and a painful mouth due to shallow ulcers.”
Your child may not want to eat and have a high temperature.
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HOW TO TREAT: Dr Costa says: “Keep your child well hydrated and give them pain medication to help symptoms and it usually resolves within ten days.
“Complications with this virus are rare.”
A pharmacist can help with treatments if you are worried for your child.
Hand foot and mouth disease is easily passed, so make sure towels, clothes, bedding, cups or cutlery your child has used are not shared.
Keep them off school and generally away from other kids, or you could be dealing with more than one case in the home.
Scarlet fever
Scarlet fever might sound like a Victorian disease but it’s still very much around.
There have been several warnings in the past year about an unusual surge in cases of this disease.
It can make your child very poorly, even leading to death in some cases.
LOOKS LIKE: Dr Costa warns: “If your child has a sudden onset of high temperature, sore throat, headache, tummy and muscle pain and swollen neck glands, it’s important to see your doctor urgently.”
The first symptoms are flu-like, and the rash - which may be harder to see on darker skin - does not appear until at least 12 to 48 hours later.
Dr Costa says: “A few days later, you can also see a red blanching rash [covering most of the skin] that feels like sandpaper and a white coating on the tongue, which often can be misdiagnosed as a fungal infection.
“As this white coating disappears, it evolves into a red rash called strawberry tongue.”
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HOW TO TREAT: You must take your child to a GP if they have the symptoms of scarlet fever, or are feeling unwell after being in contact with someone who has it.
A GP can prescribe antibiotics, which will also reduce the risk of spread and complications of the virus.
These include an ear infection, sinusitis, pneumonia, meningitis and in very rare cases, invasive Group A strep (iGAS), which can tragically cause death.
Ringworm
Despite the horrific name, this rash has nothing to do with worms.
It’s a fungus that lives in the skin and feeds on dead skin, hair and nails.
Dr Costa says: “It is common in children from two to 10 years old and can be spread by direct contact, either between humans or from pets to humans.”
LOOKS LIKE: As the name suggests, the ringworm rash is ring-shaped.
Dr Costa says: “From a small red dot, it progresses to a red, itchy, and raised rash on its outside, with the centre becoming healed, with normal skin.”
Sometimes the singular ring, less visible on darker skin, can spread into a rash.
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HOW TO TREAT: Dr Costa says: “The most common way of treating is by the use of antifungal creams.
“If not well treated, sometimes it might lead to a bacterial infection, requiring antibiotics.”
The rash is contagious so it’s vital to keep items such as bedsheets and towels clean.
Scabies
This horrible rash is caused by parasites nibbling on the skin.
Although we can’t see them, the idea of these little mites burrowing under the skin is enough to give anyone nightmares.
Sadly, they’re very common and spread easily between kids in school or nursery settings.
LOOKS LIKE: The rash shows up as small, weepy spots that can look swollen and red - similar to how eczema looks. It is itchy.
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HOW TO TREAT: All that’s needed is a medicated cream from the GP.
However, the rash can continue for weeks or months after the eggs on the skin have been killed.
Scabies can be hell to try to clear from a home if people keep reinfecting each other.
It is spread by prolonged skin-to-skin contact, but scabies can also survive for two to three days away from the skin and on furnishings.
Keep the home clean by vacuuming furniture and carpets in the room of an infected person.
Items such as bedding, clothing, and towels used by a person with scabies can be decontaminated by machine-washing in hot water and drying using the hot cycle, or by dry-cleaning.
Meningitis
It’s the one thing parents dread the most when they see a rash form on their child’s skin.
Meningitis is an infection affecting the brain, usually caused by bacteria or viruses.
LOOKS LIKE: Dr Sanders says: “Symptoms usually start with a high temperature, headache, neck stiffness, photophobia (dislike of light), nausea and sometimes vomiting.”
There may be a fine skin rash that characteristically does not fade on compression with a drinking glass.
Confusion, sleepiness or convulsions can also occur.
Dr Sanders says: “The infecting organism usually lives in the nose and/or the throat.
“So, the infection is spread by coughing, sneezing or close contact.”
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HOW TO TREAT: If you’re worried about your child’s symptoms, Dr Sanders explains that you need to go straight to the hospital.
Blood tests, throat swabs and a lumbar puncture can examine the spinal fluid.
“Then intravenous antibiotics are given urgently as soon as immediate tests for infection have been completed,” Dr Sanders says.
The NHS warns: “Trust your instincts and do not wait for all the symptoms to appear or until a rash develops.
“Someone with meningitis or sepsis can get a lot worse very quickly.”
Meningitis can lead to sepsis and organ failure, or life-long side effects that affect the brain or nerves.
Dr Kaye says: "It's important not to miss the rash. It's a tiny pinprick rash of red, purple or even black or brown dots on darker skin.
";When you put a glass on it, the rash does not go away.
"That needs urgent, urgent medical care."
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Dr Sanders says: “Meningococcus, pneumococcus and Haemophilus vaccines are advised as an integral part of the NHS infant and children vaccination program.”
These vaccines can help protect against some of the strains of meningitis.
When to see a doctor and call 999
MOST of the time, rashes in babies and children aren't anything too serious.
But if you little one's rash is accompanied by any of the following symptoms, they need urgent medical help and you must call 999 or take them to A&E immediately:
- A stiff neck
- Bothered by light
- Confusion
- A high temperature
- Difficulty breathing (e.g. grunting noises, tummy sucking under their ribs, breathlessness etc.)
- A rash that looks like small bruises under the skin and does not fade when you press a glass against it
- Pale, blue, grey or blotchy skin, lips or tongue
Source: NHS
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