Rash - Child Under 2 Years

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What to Expect at your Health Care Provider's Office

The health care provider will perform a physical examination and ask questions such as the following:

• Type of rash
  • Does it look like pinpoint red spots?
  • Does it look like small red areas?
  • Does it look like bruises?
  • Has it occurred more than once without known cause (recurrent)?
  • Does it look like hives (red welts that come and go on different parts of the body and are very itchy)?
  • Does it look like blisters? Are they filled with yellow or honey-colored fluid?
  • Does it look like ulcerations (craters in the skin)?
  • 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)?
• 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?
  • Do the spots come and go, or do they always stay in the same place?
  • 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 (blister) that appeared 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?
• 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 hard bump (nodule) to a "beefy" red ulcer?
• Cther
  • What other symptoms are also present?
    • Is there fever?
    • Is there itching?
    • Is there pain?
    • Is there drainage? What kind?
  • What laundry detergent do you use? How long have you used it?
  • What kind of soap do you use? How long have you used it?
  • Do you put anything on the skin (creams, lotions, oils, perfumes, etc)?
  • Is your child taking any medications? How long has he/she taken them?
  • Has your child eaten any new foods recently?
  • Has your child been in contact with grasses/weeds/trees recently?
  • Has your child had a recent illness?
  • Does your child have any allergies?
  • Do allergies run in your family?
  • Do any skin problems run in your family?
  • Does asthma run in your family (many times asthma and eczema are associated)?

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

Diagnostic tests are seldom required but may include the following:

• Allergy skin tests
• Blood studies (such as CBC, blood differential)
• Microscopic examination of a sample of the affected skin

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 cortisone drugs to decrease inflammation. Antihistamines may be recommended to decrease itching.

For hives, antihistamines may be recommended to decrease itching.