Common Childhood Rashes

chicken-poxringwormimpetigohead-lice

 

Chickenpox                                                                                    

Chickenpox is caused by varicella zoster virus. It presents with fever, aches, headache and itchy red spots all over the body. This is an illness of the under 10 age group. The rash usually peaks after 48 hours but new lesions can develop for up to 5 days. There are several stages to the spots. First they blister then the blisters burst, next they dry and crust over. Blisters can develop in the mouth and around the eyes. If this occurs, you should see your GP.

Most children are better in a week. Very young children or those with a weakened immune system should see the GP urgently. It is very important to keep children hydrated. They should be given plenty of fluids, eg water, milk, juice, ice lollies. Calpol can be given for pain relief and to manage temperatures. It is a very itchy rash. Scratching should be avoided, as possible, to prevent infection developing as this can result in scarring. Dress the child in light cotton clothes. Keep fingernails short. Gloves or socks over the hands at night can prevent scratching. Aveeno moisturizer absorbs well and helps to soothe the lesions. A sprinkle of oatmeal or a small cup of baking soda in the bath can also help with itch. Note however that the oatmeal can make the bath slippery for your child. An anti-histamine at night such as piriton can help with itch also.

There are several complications of chickenpox. You should go to see the GP if you are concerned about your child. Look for signs such as the child becoming drowsy, is feeling weak, has breathing problems, is not drinking, if the rash bruises or bleeds or if the child is complaining of a headache which is not responding to paracetamol.

If there is a case of chickenpox in a class, it is very likely to spread to other children. Chickenpox is contagious from a few days prior to the rash developing, hence it is difficult to avoid passing it on. A child should be excluded from school from the onset of the rash until day 6 of the illness. Chickenpox usually only occurs once but in rare cases it can recur. A varicella zoster vaccine is available to prevent the virus

Reactivation of the virus in later life causes shingles. If a non-immune person, usually a child who has never had chickenpox, is in contact with shingles, they are at risk of developing chickenpox. However, it does not work the other way around i.e. you cannot get shingles from chickenpox and you cannot get shingles from a person with shingles.

About 90% of women are immune to chickenpox. This immunity is also passed on to a foetus. Therefore, if you are pregnant and you have been exposed to someone with chickenpox but you yourself have had chickenpox in the past you do not need to worry.

If, however a woman is exposed to chickenpox and she has never had chickenpox, this does pose a risk to both her and to the unborn baby. She should receive an injection to strengthen the immune system as soon as possible. A mother can develop complications such as a varicella pneumonitis, which is inflammation of the lungs, this can be life threatening. There is a risk of the baby developing a varicella syndrome, which can be a very serious illness. The risk is higher if the exposure is before 20 weeks. However, most women who do develop chickenpox during pregnancy, recover from it and give birth to healthy babies.

Head lice

These are blood feeding insects called Pediculus capitis. They are extremely common. They often present with an itchy scalp, especially at the nape of the neck or behind the ears. They are spread by direct head to head contact. The female lice lay eggs (nits) on the hair shaft. Head lice can be treated with fine tooth combing. You can buy a special comb in the pharmacy. It is best to wet the hair and apply a lot of conditioner. Detangle with an ordinary brush or comb first. Then use the fine-tooth comb. Start very close to the scalp and pull the comb all the way to the end of the hair.  Comb the hair over the sink or white paper so the lice can be easily seen. The hair should be combed two to three times per week until the lice are cleared.

Head lice have become resistant to many chemical treatments. Malathion, also known as Derbac M, is still considered effective in the treatment of head lice although resistance is occurring with this too. It can be bought over the counter in pharmacies. It should be applied twice, with 7 days in between applications. Apply to dry hair and leave on the hair overnight. Do not use a hairdryer after application as it is a flammable substance. Wash the hair with shampoo the next morning. Use a fine-tooth comb again after rinsing to remove any dead lice. Non-chemical products such as Hedrin or Full Marks are also popular. They work by suffocating the lice. Full Marks solution should not be used under 2 years or in those with underlying skin conditions such as eczema.

Parents should check their own hair too. All affected family members should be treated at the same time. Children who are being treated for head lice can still attend school. It is a good idea to tie girls’ hair up if they are being treated for lice or if there is a breakout in the class.

Ringworm

This is a common skin rash in children. It is caused by a fungus, not by a worm. It starts as a red bump and develops into a ring, which is usually mild to moderately itchy. It is contagious and is spread by skin-to-skin contact or by sharing sports equipment and towels. It is treated with an anti-fungal cream.

Impetigo

This is a bacterial infection of the skin. It can occur on healthy skin or on broken skin such as eczema or psoriasis or even a graze.

It starts as small blisters which burst and scab over. The patches are classically a golden colour and moist. It can occur anywhere but the face is the most commonly infected site.   A small area is treated with an antibiotic cream but a larger area may need oral antibiotics.

It is a contagious rash. It is important not to touch the infected area and to wash your hands if you do touch it. You should avoid sharing towels/sports equipment.

Children should be excluded from school until there is no more crusting or until 48 hours after antibiotic treatment has been started.

Dr Ciara Aherne

The Grove Medical Centre, Ballincollig, Co. Cork

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