Taking care of skin rashes in children

Babies’ skins are delicate and prone to infections. One of the commonest problems that parents have to deal with, are skin rashes. Rashes make babies irritated and restless. In this interview with GERALDINE AKUTU, Consultant Physician, Dermatologist and Genitourinary Specialist, Lagos University Teaching Hospital, Dr. Otrofanowei Erere shed more light on skin rashes and related problems in babies and children, their treatment and management.

What causes skin rashes in children?
A RASH is any change in the human skin, which affects its colour, appearance or texture.

With that definition in mind, almost anything- from a casual or prolonged contact with the external environment to an internal response of a disease state may cause a rash.

Generally speaking, skin rashes on a child may be caused by heat, infections (bacterial, viral, fungal, parasitic), allergens, pubertal changes, immune system disorders and/or medications (whether taken orally, through the veins, as an intramuscular injection or applied topically as a cream).

There are also a few genetic conditions that some children have, so they are either born with obvious skin rashes or are easily prone to certain skin rashes.

What are the various skin rashes that affect children?
These are too many to list. One of the most common causes of skin rashes in children is itching.

Whilst a rash may cause you to scratch, scratching the skin (whether in response to an itch or not) will usually produce a rash as defined above.

It is important to note that a major reason a child will scratch the skin is as a result of dry skin.

In our environment, the other more common skin rashes include Miliaria (heat rashes); atopic dermatitis or eczema and other allergic skin diseases, such as diaper dermatitis, urticaria (hives); papular urticaria

There are also infective causes, such as bacterial e.g. impetigo, scarlet fever; fungal e.g. tinea corporis/capitis (ringworm of the body/scalp); parasitic e.g. scabies, bed bugs bites, lice and viral e.g. erythema multiforme, varicella (chickenpox), measles, warts and molluscum contagiosum to name a few. The HIV/AIDS virus can also cause skin rashes and children are not spared from it.

Steven Johnson Syndrome and toxic epidermal necrolysis are some drug related skin rashes that can affect children with resulting skin loss and some more devastating consequences.

Systemic diseases, such as meningitis, acute rheumatic fever, and cancers such as the lymphomas can all cause skin rashes.

Acne vulgaris is a common rash in teenagers and can be a great cause of anxiety, depression and other psychosocial disorders.

What are the signs and symptoms of a serious rash?
The skin has a limited way it responds to the wide array of insults it gets.

Thus, it may be difficult to judge correctly what rash is serious or not, without taking a detailed and focused history.

Whilst most rashes, which affect children are not serious and tend to disappear after a few days with the child still eating, playing and behaving as usual, some can actually be a bit more serious and the child may be withdrawn, refusing food and generally not his or her usual self.

It is important for caregivers to take any such child with rashes accompanied or not by high fever, breathing difficulties, vomiting and or stooling to the doctors.

An attempt at describing the rashes over the telephone is not adequate and may give the wrong information and delay prompt and possible life-saving action.

What is a viral rash?
A viral rash is caused by a virus. The more common viral infections that affect children are chicken pox, measles, Roseola infantum, fifth disease, Rubella and a few others.

Viral meningitis (with the triad/tetrad of fever, skin rash and seizures/neck stiffness) is an important disease to mention here because the dry season sometimes brings with it all manner of viruses that are highly contagious.

Most viral rashes tend to have a pattern of presentation, which may give the doctor clues to what disease is playing out. They are often preceded by catarrh, cold, cough and the child feels feverish and unwell. The above symptoms clearly mimic the common cold or malaria, making many caregivers to resort to “self- medication.”

The rash of measles are tiny red spots that may be blanched (the colour fades when mild pressure is applied) and start from the head and neck before spreading centrifugally to the trunk and limbs.

There may be accompanying conjunctivitis (red eyes popularly called Apollo) and Koplik’s spots in the mouth. These clearly distinguish measles from chickenpox.

The rash of Varicella (chickenpox) are usually vesicles (fluid filled) that appear in crops (groups) and are present in different stages from flat macules to early papules (solid bumps) and the characteristic vesicles before becoming crusted lesions, which fall off within four days to a week, leaving behind the typical discoloration.

It also affects the face, trunk and extremities, but it is classically highly itchy.

The above are typical presentations of measles and chickenpox in an immunocompetent child (one who has no chronic disease that may hamper the way the body attends to insults/infections).

A fully immunised child may either not develop the disease at all or have a much milder form of the disease called atypical presentation or breakthrough disease.

An immunocompromised child may have complicated cases of these viral rashes, which may result in disability and sometimes death.

This underscores the importance of immunisation with the available vaccines for many of these viral skin rashes. Public hospitals across the country provide vaccines as part of the National Programme on Immunisation, and every newborn should be vaccinated.

What skin conditions in babies need urgent attention?
Any condition that causes discomfort to a baby, such that the usual calm and playful child becomes highly irritable and listless needs urgent attention. It is better to err on the side of caution than to regret a delayed action.

What is the fastest way to get rid of a rash?
The fastest way to get rid of a rash is to leave it alone. Most rashes are innocent and the body is well equipped with its inherent immune system (the body’s Ministry of Defence) to take care of such rashes.

The simplest thing to do is moisturise the skin with bland emollients (creams) and keep cool. Simple over-the-counter antihistamines (drugs for itching) may be taken if the itch is unbearable.

Are there baby skincare mistakes parents tend to make?
In the course of my work, I have come across a few bizarre practices parents and other caregivers employ.

One of such is the notion that babies are usually born with lighter skin tones from the womb and to maintain that tone, mothers mix Shea butter or coconut oil with triple action creams, which come in tubes (tube cream for lighter shades) and apply to the baby’s skin regularly.

This is a very dangerous practice and should be thoroughly discouraged, as the increased body surface area of babies allows for enhanced skin absorption of any topically applied product.

The triple action creams have a combination of antifungal, antibiotic and anti-inflammatory ingredients, which some people promote as a complete skin panacea to all and any skin disease. They have a side effect, as well as many other issues.

There is also the practice of using medicated or antiseptic soaps purportedly made for babies.

This should also be discouraged, as they tend to be rather harsh and strip off the body’s natural commensals (normal skin bacteria) and moisture, resulting in further dryness and itching.

The popular “agbo” applied to the skin should also be discouraged, as this has been known to worsen many mild skin rashes that may have resolved spontaneously.

It is usually difficult to qualify the contents of the “agbo” applied as the concoction formula varies from one provider or ‘mixologist’ to the other.

What ingredients should be avoided when buying skin products for babies and children?
Any product with skin lightening, whitening, brightening connotations or suggestions is to be avoided generally, but even more so in babies.

Talcum powder has been touted as being dangerous in babies, but this is largely due to asbestos-based talc, as asbestos is implicated in certain cancers. Some talcum powders have asbestos-free talc and this is not dangerous.

The manner of application of the talcum powder also matters, in that if dusted rather than rubbed onto the baby’s skin, inhalation may inadvertently occur, causing some harm.

Medicated or antiseptic products, except where prescribed, should be avoided as well.

I jokingly ask my patients if they have waded in the gutter or some muddy water, otherwise why the need to scrub the intact skin with antiseptics? Washing with gentle soaps or cleansers are all that is needed to remove the sweat and grime off the skin of an adult who is out working most of the day.

There is little need for any more products for a baby, who is mostly protected from all the elements.