From the Guidelines
When evaluating rashes in children, a systematic approach is essential for accurate diagnosis and appropriate management, starting with a thorough history and physical examination, as emphasized by the 2017 study on critical issues in food allergy 1.
Key Considerations
- The diagnosis of atopic dermatitis, a common childhood rash, is made clinically based on historical features, morphology, and distribution of skin lesions, as outlined in the 2014 guidelines for the management of atopic dermatitis 1.
- A thorough history should include onset, duration, associated symptoms, recent illnesses, medications, and exposures, as suggested by the 2006 guide for physicians and other health-care and public health professionals on tickborne rickettsial diseases 1.
- Physical examination should assess the distribution pattern, morphology, color, and associated findings like fever or lymphadenopathy.
Common Childhood Rashes
- Viral exanthems, such as roseola, characterized by high fever followed by a blanching rash
- Atopic dermatitis, chronic, pruritic, often in flexural areas
- Contact dermatitis, localized to exposure site
- Infectious rashes, such as impetigo or tinea
Management
- For viral rashes, supportive care with antipyretics like acetaminophen and adequate hydration is typically sufficient.
- Atopic dermatitis requires regular moisturizing and topical corticosteroids applied twice daily for 7-14 days.
- Bacterial infections like impetigo need topical mupirocin for localized cases or oral antibiotics for widespread infection.
- Fungal infections respond to topical antifungals applied twice daily for 2-4 weeks.
Red Flag Symptoms
- Petechiae/purpura
- Severe pain
- Rapidly spreading rash
- Mucosal involvement
- Systemic symptoms like high fever or altered mental status The most recent and highest quality study, from 2017, emphasizes the importance of considering food allergy in the diagnosis of rashes in children, particularly in those with moderate to severe atopic dermatitis 1.
From the Research
Approach to Rashes in Children
- Rashes in children can be categorized into four broad categories based on visual and tactile characteristic patterns: petechial/purpuric, erythematous, maculopapular, and vesiculobullous 2
- A thorough history and physical examination, followed by consideration of red flags, are essential in diagnosing and managing rashes in children 2, 3
- The presence of fever and systemic signs of illness should be assessed after differentiating rashes into their respective categories 2
Common Causes of Rashes in Children
- Impetigo is a common superficial bacterial infection of the skin that affects children, with a global disease burden of greater than 140 million 4
- Impetigo can be divided into two common variants: nonbullous (70%) and bullous (30%), with principal pathogens including Staphylococcus aureus and Streptococcus pyogenes 4
- The classic appearance of distinctive honey-colored, crusted legions aids in the diagnosis of impetigo, which is most often based on clinical presentation 4
Management and Treatment of Rashes in Children
- Treatment of localized impetigo lesions can be achieved through topical antibiotics, while oral antibiotics are reserved for extensive disease 4, 5
- Antimicrobial stewardship is critical to optimize patient outcomes and prevent the development of resistance, with healthcare providers needing to be aware of local resistance patterns in impetigo to guide therapy 5
- International guidelines for the management of impetigo vary, with some recommending systemic antibiotics only for widespread lesions or failure of topical antibiotic treatment, while others recommend broad-spectrum antibiotics as first-line treatment 6