Rash, child under 2 years

• Diaper rash ( rash in the diaper area) is a skin irritation caused by prolonged dampness and the interaction of urine and feces with the skin.
• Heat rash (caused by the blockage of the pores that lead to the sweat glands) is most common in very young children, but can occur at any age. With an increase in heat and humidity, the sweat glands attempt to provide sweat as they would normally, but because of the blockage, this sweat is held within the skin and forms little red bumps, or occasionally small blisters in young infants.
• Erythema toxicum can cause flat red splotches that appear in up to half of all babies. These blotches rarely appear after 5 days of age, are usually gone in 7 to 14 days, and are nothing to worry about.
• Baby acne is caused by exposure to the mother's adult hormones. The little white dots often seen on a newborn's nose represent an abnormal amount of normal skin oil that is a result of these hormones. Acne usually occurs between 2 and 4 weeks of age but may appear up to 4 months after birth and can last for 12 to 18 months.
• Cradle cap causes greasy, scaling , crusty patches on the scalp that appear in a baby's first 3 months. It usually goes away by itself, but some cases may require treatment with medication.
• Prickly heat causes rash or blotches during hot weather or in a hot environment.

Note: There may be other causes of a rash in a child under 2 years old. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as location, quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for a rash in a child under 2 years old, occurring alone or in combination with other problems.

Home Care:
DIAPER RASHES
Keep the skin dry. Change wet diapers as quickly as possible. Allow the baby's skin to air dry as long as is practical. Launder cloth diapers in mild soap and rinse well. Avoid using plastic pants. Avoid irritating wipes (especially those containing alcohol) when cleaning the infant.

Ointments such as Desitin or zinc oxide may help reduce friction and protect the baby's skin from irritation. Powders such as cornstarch or talc should be used cautiously, as they can be inhaled by the infant and cause lung injury.

BABY RASHES
Heat rash is best treated by providing a cooler and less humid environment for the child.

While powders do not harm the child, they are unlikely to help the condition. Powders should be stored out of reach of the infant to prevent accidental inhalation. Avoid ointments and creams because they tend to keep the skin warmer and block the pores.

Normal washing is usually all that is necessary. Avoid acne medicines used by adolescents and adults.

OTHER SKIN PROBLEMS
For skin problems caused by pityriasis alba , patches may come and go for years; but between ages 20 and 30, they will disappear completely. Use sunscreen or protective clothing to prevent sunburn in affected areas. Use topical (applied to a localized area of the skin) steroids as directed by the doctor.

For skin problems caused by allergic purpura , the condition usually lasts between 1 and 3 weeks. Warm soaks in the bathtub may help relieve joint pain . Otherwise, follow prescribed therapy.

For skin problems caused by eczema , the keys to reducing rash are to avoid scratching, and keep the skin moisturized. Keep the fingernails short and consider putting soft gloves on small children at night to minimize scratching. Drying soaps and anything that has caused irritation in the past (including foods) should be avoided. Apply a moisturizing cream or oil immediately after baths to avoid drying. Hot or long baths, or bubble baths, may be more drying and should be avoided. Loose, cotton clothing will help absorb perspiration . Consult a doctor if these measures do not control the eczema, or if the skin begins to appear infected. While the majority of children with eczema will outgrow it, many will have sensitive skin as adults.

For skin problems caused by prickly heat or sweat retention, remove excess clothing and consult your doctor if the rash lasts longer than 24 hours or the child seems ill.

For cradle cap , use half-strength coal-tar cream on affected areas. The pharmacist can provide this without a prescription. Cradle cap usually disappears by 18 months. If it does not disappear or becomes infected, or if it is resistant to over-the-counter treatment, consult a health care provider.

Call Your Healthcare Provider If:

• there are any blisters or small red patches beyond the diaper area.
• the rash is worse in the skin creases.
• the rash extends beyond the diaper area.
• there is no improvement after 3 days of home treatment.
• there is a fever , or other unexplained symptoms associated with the rash.
• there is a rash, spots, blister , or discoloration in an infant 3 months or younger.

What to Expect:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting your symptom in detail may include:

• type of rash
  • Does it look like pinpoint red spots ( petechiae )?
  • Does it look like small red areas ( purpura )?
  • Does it look like bruises ( ecchymoses )?
  • Has it occurred more than once without known cause (recurrent)?
  • Does it look like hives ?
  • Does it look like blisters ?
    • Are they filled with yellow or honey-colored fluid?

  • Does it look like ulcerations?
  • Does it look like dry, tough skin growth (keratosis)?
    • Is it associated with overexposure to sunlight ( actinic keratosis )?

  • Is the rash scaling or crusting?
  • Does it look like small, solid, red, elevated bumps ( papule )?
  • Does it look like both a macule (flat area) and papule (small bump)?
  • Is it a slightly elevated flat lesion (plaque)?
  • Does it have characteristics of acne rosacea ?

• location
  • Is it in the diaper area only?
  • Is it on the rectum?
  • Is it on the scalp or face?
  • Is it on the trunk?
  • Is it on the lower extremities (legs or feet)?
  • Is it over the muscles that straighten the leg (extensor surfaces)?
  • Is it on the upper extremities (arms or hands)?
    • Is it over the muscles used to straighten the arm (extensor surfaces)?

  • Is it on the genitals?

• distribution
  • Is the rash spreading to other areas?
  • Does the amount of skin area affected increase over time (enlarging)?
  • Is the number of skin lesions increasing over time?
  • Is it at the site of a skin injury (cut, scrape, etc.)?
  • Is it at a site of chronically damaged skin (e.g., burn )?
  • Do lesions affect one side of the body (unilateral) or both sides (bilateral)?
  • Did the rash begin on hands or feet ( distal extremities)?
  • Have the sores gradually increased in size over months to years?
  • Are the lesions on exposed skin?
    • On sun exposed areas only?
    • Did the lesions begin at the site of an exposure?

• quality or color
  • Is the skin darkening ( hyperpigmentation ) or thickening?
  • Is the skin red (erythematous) or is it flesh colored?

• shapes and borders
  • Do the lesions have sharp, distinct borders?
  • Do the lesions have a bulls eye shape (irisated)?

• time pattern
  • Did the rash begin suddenly (within hours) or slowly and gradually?
  • How long did the rash last?
  • Are there short-lasting episodes of rashes (transient)?
  • Does the same type of rash occur repeatedly (recurrent)?
    • How often does the rash occur?

  • Did symptoms begin at birth or in infancy? What age?
  • Has the rash been long standing ( chronic )?
  • Did symptoms begin after a fever occurred and was relieved?
  • During which months does the rash usually occur?
  • Did you have a vesicle that disappeared after a number of weeks? How many?

• aggravating factors
  • Is it worse after taking a bath (or other exposure to water)?
  • Is it worse when you are stressed?
  • Does it occur after cold exposure ?
  • Is it worse after you use skin softening or smoothing agents (emollients)?
  • Is it worse after an exposure to the sun?

• relieving factors
  • Does the rash get better after you use skin softening or smoothing agents?

• changes over time
  • Did you have red cheeks followed within 2 days by a red spotty rash?
  • Was the rash of a brief duration and then went away (evanescent)?
  • Did the lesion change from a vesicle to an ulcer ?
  • Did the lesion change from an indurated nodule to a "beefy" red ulcer?

• other
  • What other symptoms are also present?
  • Is there itching ?
  • Is there pain?
  • Is there drainage? What kind?

The baby's skin will be thoroughly examined to determine the extent and type of the rash.

Diagnostic tests that may be performed include:

• allergy skin tests
• blood studies (e.g., CBC , blood differential )
• microscopic examination of a sample of the affected skin
• urinalysis

Intervention:
Nystatin cream may be prescribed for diaper rash caused by yeast. If the rash is severe, a corticosteroid cream may be recommended. Oral antibiotics may be prescribed if a bacterial infection is diagnosed.

For eczema , the doctor may prescribe ointments containing coal and tar or cortisone drugs to decrease inflammation. Antihistamines may be recommended to decrease itching.

Once in a while, a sedative or tranquilizer may need to be prescribed.

After seeing your health care provider:
If a diagnosis was made by your health care provider related to your baby's rash, you may want to note that diagnosis in the personal medical record.


This is a severe case of diaper dermatitis. Diaper dermatitis was more common before the advent of disposable diapers, which keep the skin very dry. Most diaper dermatitis is associated with infection from the yeast Candida. Other causes are ammonia burns from the bacterial action of urine, and environmental conditions from too infrequent diaper changes. This is a photograph of candidal dermatitis. The small red lesions on the tummy, just above the red diaper area, are referred to as "satellite lesions" (lower right side of the picture). (Courtesy of the Centers for Disease Control.)