Infant rashes are a source of extreme stress in new and experienced parents alike. Even in twins, the same rash can appear completely different. What’s worrisome, and what’s not? How do I avoid seeing the doctor every time my child develops a rash?

Though most infant rashes are benign, many can be signs of serious conditions. Stomach up and keep reading to learn more about the types of rashes that should take you to the pediatrician and those that should keep you at home.

Non-concerning Rashes

typical viral rash, non-concerning

Let’s start by talking about the most common source of a rash- viral infections. When your child has symptoms of an upper respiratory infection such as runny nose, congestion and maybe even a cough, rashes aren’t unusual. They are typically red and can be raised or flat, and can be found anywhere on the body. Sometimes they start at the feet and work their way up, while others might do the opposite. Some specific viral rashes come up suddenly after high fevers and then quickly resolve. They aren’t typically symptomatic (as in they aren’t usually itchy or painful). They also don’t typically blister.

Another common and non-concerning rash is associated with a specific viral infection: hand foot and mouth disease, or HFM. As could be expected, this rash typically involves these areas and can sometimes be severe enough to cause children to not drink resulting in dehydration. The rash itself, however frightful it may appear, isn’t concerning and self-resolves. It can blister and can sometimes be painful.

particularly nasty hand foot and mouth lesions on the toes

Diaper rashes are another common infant-specific problem, and are usually multifactorial. Yeast and irritation are two common culprits with slightly different appearances, though there is overlap. For most diaper rashes, barrier creams (I recommend Boudreaux’s Original Butt Paste, myself) and dryness are your two curative agents. Other common remedies are as simple as vaseline, while some other options are Desitin and A&D ointment.

Sometimes, though, anti-fungal creams such as Nystatin are needed (available via prescription). Dryness can be encouraged by “airing out” after diaper changes and by limiting time your infant spends in soiled diapers. Cloth diapers, because they are less absorbent, can sometimes cause increased irritation but they have other benefits (like saving tons of money!) Less commonly, infant diaper rashes are bacterial in nature. These look intensely red and painful.

Aside from these infectious causes, some infants have sensitivities to certain materials in disposable diapers and different brands can help offer relief. While some infants struggle with diaper rashes, others coast through infancy without a single one.  Every baby is unique!

fungal diaper rash that would require treatment

Concerning Rashes

In general, rashes that are painful, blistering, crusting and/or weeping require more urgent evaluation from your pediatrician or healthcare provider. Painful rashes can be a sign of serious infection, and blistering (outside of a burn) can be a sign that your body is attacking your skin from the inside. Crusting and weeping are also signs of infection and generally warrant an “eyes on” check from a knowledgeable provider.

Another serious rash isn’t painful, raised, or blistered. Instead, it looks like flat red spots that don’t disappear when you press on them. They are called “petechiae”. This can be a sign of low platelets secondary to a life threatening infection in your bloodstream, so if you or your child has this rash have them seen right away.

Petechiae on the the face

General Rash Care

There are many other types of rashes and many factors affect whether or not they are concerning. Your pediatrician is vital in helping making these distinctions. How you treat your rash heavily depends on what it is and what symptoms you have, but we can simplify some of the common treatments here:

Itchy Rashes: In general, we avoid recommending topical Benadryl for itchy rashes (outside of isolated bug bites) and instead opt for oral antihistamines such as Zyrtec (cetirizine), Claritin (loratadine), or Allegra (fexofenadine). These are basically newer forms of Benadryl (diphenhydramine) that don’t make kids as sleepy but help with itching. For dosing, i’d recommend consulting your pediatrician.

Painful Rashes: The solution for painful rashes lies in treating the source, most commonly an infection. Oral tylenol (acetaminophen)/motrin (ibuprofen), if recommended by your pediatrician, can be extremely helpful for these types of rashes in alleviating pain. There are topical numbing creams, but these are not commonly recommended or prescribed as they can be absorbed into the body.

All Rashes: Time. Some rashes come and go like the wind, but most take their time going away. It takes an average of 4 weeks for the living cells at the base of the skin to make it to the top, so don’t expect quick changes with any rash! Occasionally you may be left with a slightly lighter or darker area where the rash was. Rest assured, this is a common occurrence and usually resolves on its own over the course of a few months.

Post-inflammatory hypopigmentation

What happens if your provider can’t diagnose your rash? Depending on its appearance, they may try a combination of approaches such as topical steroids, anti-fungals, or even topical antibiotics along with a tincture of time. If those don’t work, a referral to Dermatology might be indicated.

Rashes can be a headache but remember, most don’t require treatment and are self-limiting. When in doubt, get it checked out!

TW

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