Frequent rashes in children: causes and investigations

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What is a skin rash?

Rash is a medical term used to describe a series of changes in the color and texture of the skin (integument) which includes:

• patches
• Papules
• Pustule
• Plaques and vesicles specific to a varied number of dermatological or infectious pathologies.

The most common rashes in children

Among the most common causes of rashes in children are:

Rashes in viral infections

Viral rashes in children are usually caused by viral pathogens involved in childhood diseases:

• Varicella zoster virus
• Rubella virus
• The measles virus
• Herpes virus 6 (causes roseola infantum)
• Parvovirus B19 (which causes erythema infectiosum)
• Coxsackie virus A16 (responsible for hand, mouth, foot disease).

Learn more about childhood diseases

The disposition of the rashes and their characteristic appearance may vary depending on the viral agent involved, but as a rule, childhood diseases are accompanied of:

• Febrile syndrome
• Altered general condition of the child
• Pruritus (itching of the skin).

The periods of incubation, contagiousness and evolution of the eruptions may show small variations for each individual pathology, but, as a rule, the viral pathogens involved in the occurrence of childhood diseases spread easily both through the respiratory tract (in the case of viruses with respiratory tropism) and and through direct contact with the lesions of the little one (herpetic virus).

Rashes in children’s food allergies

The most common food allergies in children are due to the consumption of eggs, cow’s milk and peanuts, followed by wheat flour, soy and fish. These foods contain protein allergens which can generate a series of skin manifestations due to their ability to generate a specific response from the child’s immune system.

Skin manifestations associated with food allergies can be presented in the form of:

• Edema rash (reddening of the skin)
• Urticaria that appears 2-3 hours after the ingestion of the allergen
• Blisters or blisters on the knees, elbows, shoulders, buttocks and scalp.

The child’s digestive symptomatology accompanied by this type of skin changes should direct the parents to the allergist’s office for clinical examination and diagnostic investigations.

The investigations recommended for the diagnosis of the child’s food allergies can include allergy skin testing, the determination of specific IgE antibodies and the performance of a food challenge test in the hospital under the strict supervision of the allergist.

Rashes caused by allergies to pet hair and insect bites

The most frequently encountered pet allergies are those in dogs and cats, but autoimmune reactions can be clinically evident in people who own hamsters, guinea pigs, exotic birds or farm animals.

Among the skin allergic manifestations to anime can also be found dermatitis, urticaria and itching (itching of the skin).

The bites of ants, mosquitoes, wasps and spiders can cause allergic skin manifestations that cause redness and swelling of the skin at the level of the sting along with intense local itching. Certain insect venoms contain serotonin, bradykinin, histamine and other inflammatory mediators that can cause the appearance of skin lesions such as papules and vesicles, the evolution of which can be complicated by the appearance of skin infections.

The tick bite can be manifested by the appearance of lesions in the form of a bumpy red ring with a characteristic bull’s-eye appearance or Rocky Mountain spotted fever, which involves the appearance of a rash in the form of reddish spots, initially on the ankles and wrists, with a tendency of generalization at the level of the whole body.

Skin tests (prick test) and serological tests for determining specific IgE to certain allergens of animal origin are the main investigations used to diagnose allergies to pets and insect bites.

Skin diseases in children

Seborrheic dermatitis of the newborn, diaper dermatitis, heat erythema (skin irritation caused by heat), vulgar warts present especially at the palmo-plantar level caused by HPV infection, dermatophytoses, acne and pityriasis versicolor are other dermatological conditions that can be found in the pediatric population apart from eruptions associated with childhood diseases.

• Seborrheic dermatitis of infants and children it is manifested by erythematous lesions with a tendency to scale on the scalp, face and anterior thorax which can extend to the posterior thorax, armpits and inguinal area.
• Pityriasis versicolor it represents a self-limited, exenthematous, pruritic dermatological condition that begins with an eruption in the form of a round plaque of 2-5 cm, well-defined oval, of salmon pink color, located on the trunk or neck. Within 3-14 days, lesions with a similar appearance of smaller sizes appear on the trunk and the proximal areas of the extremities, which are arranged in the form of a “Christmas tree”.
• Dermatophytosis it is a dermatological condition caused by fungal infections with different locations. Tinea pedis (located on the soles), cruris (affects the genital area), capitis, barbae or manum, is manifested by the appearance of irritated red skin with a cracked appearance and a tendency to exfoliate or ring-shaped rashes at 4-14 days after infectious contact.
• Acne occurs especially in adolescents and is manifested by skin lesions that can vary depending on the severity of the condition, including comedones, papules, pustules, nodules or cysts, located especially on the face, anterior chest, posterior, armpits, buttocks and inguinal area .

Autoimmune diseases and skin manifestations

Juvenile dermatomyositis, juvenile systemic lupus erythematosus and psoriasis are some of the autoimmune pathologies that can affect children, generating changes in the skin. These pathologies are not transmissible and are due to an aberrant immune response directed against the body’s own cells, including those in the skin.

Red plaques with a scaly appearance accompanied by itching are specific to psoriasis, periorbital edema, heliotrope rash (purple-pink discoloration of the eyelids) and malar rash (redness in the cheeks) are found in the evolution of juvenile dermatomyositis, while red infiltrated spots , sometimes with scales arranged in the form of butterfly wings on the nose and cheeks are characteristic of systemic lupus erythematosus.

Dermatologist he is the one who establishes the cause that favors the appearance of these skin changes and, if necessary, can recommend an additional specialized examination depending on the characteristics of each individual case.

Complications of skin rashes in children

The main complication associated with the child’s rashes is represented by infection with bacterial germs favored by the production of grating injuries (scratching). The itchy nature that accompanies most of the child’s integumentary eruptions determines grating through which continuity solutions are created at the skin level, which facilitates the penetration of bacterial/fungal agents with the appearance of infections.

In certain situations, grating injuries are followed by a long healing period involving the formation of unsightly scar tissue.

The skin is a complex organ that performs numerous functions in the body, representing the first defense barrier against external aggression factors. The immune system develops progressively from birth until the age of 11-12 years through the interaction with external viral, bacterial and parasitic pathogens. The most vulnerable period from the point of view of the body’s immunity is between 3 and 6 months of the infant’s life and is due to the disappearance of maternal antibodies (acquired from the mother). This characteristic is the main factor that predisposes children to the appearance of dermatological manifestations on the background of low immunity.

References:

• A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases, PE Beattie, MS Lewis‐Jones | British Journal of Dermatology
• Atopic dermatitis: Kids are not just little people, Smita Awasthi, Marti Jill Rothe, Lawrence F. Eichenfield
• Common pediatric and adolescent skin conditions, Angela M Sanfilippo, Victoria Barrio, Carol Kulp-Shorten, Jeffrey P Callen
• Cutaneous infectious diseases: Kids are not just little people, Shehla Admani, Sphoorthi Jinna, Sheila Fallon Friedlander, Brett Sloan
• Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne, American Academy of Pediatrics (AAP)