Introduction to Rashes

For all those non-medics out there, parts of this topic are quite technical. You may find it easier to first download the Parent Information Leaflet attached to the bottom of this page. This is written in plain English and avoids technical jargon.

Dr Tina Newton will guide you through this topic, rashes. Rashes are a common reason for children to present to a health care provider. Whether they are new onset or chronic, rashes cause significant anxiety to carers.

Learning Outcomes

• Understand the common causes of rashes
• Be able to spot the different features of different types of rash
• Be able to spot potentially serious rashes
• Understand what initial treatment is required

As in all of the sessions in this MOOC, the first question I would like you to ask yourself is, ‘Does the child look ill or do they look well?’. Of course well looking children can rapidly become very unwell but the child who runs past you and has to be caught by a parent to show you the rash, is unlikely to have a life threatening disease. On the other hand the child whose rash is part of a severe allergic reaction will look unwell from the outset.

In this session we are looking more at sudden onset rashes as these are more likely to prompt a call to the emergency services. Common chronic rashes such as eczema in children are more likely to present to health care services because the parents are at the end of their tether managing them, rather than because of a life threatening complication. But that said, children can become ill with any long term rash if, for example repeated scratching leads to infection or if they pick up another co incidental infection like chicken pox. But thinking about acute rashes, the common presentations we see will be rashes due to infection, rashes due to a reaction to something, or rashes that are a marker of something else going on in the body.

All rashes can be described in terms of the appearance of the lesions on the skin. The terms are used to describe the rash and not necessarily point to the diagnosis.

The commonest terms that we use are macular (flat lesions), papular (raised lesions), vesicular (fluid filled blisters), urticaria (hives), petechiae (dark red spots that do not temporarily disappear when the skin is stretched or pressed on) and purpura (bruises).

Of all of these, the rash that tends to strike fear into parents and health workers alike is the non-blanching, petechial rash as this may be a sign of meningococcal disease (the meningitis bug). But remember that there are a lot of other causes of this rash and in a child who is otherwise well and who doesn’t have a fever, these should all be considered. A child who has vomited repeatedly and has petechiae only on the upper body may well have them because of the increased pressure in the superior vena cava caused by vomiting. A child with widespread petechiae and/or bruising may have idiopathic thrombocytopenia purpura (ITP); in many cases a benign disease. But the child with petechiae and fever needs to be looked at in a different light. These children need to be assessed rapidly and taken to somewhere they can receive urgent intervention.

Take a look at the following simulation and use the questions posed to help you to learn a little more about rashes in children.

The 999 Call

Let’s have a look at this potentially emergency situation. A frantic mum calls 999. She is hysterical, her 5 year old daughter has been unwell today with a high temperature. She has come out in a rash over her whole body. She looks really unwell. Mum begs for someone to come quickly and help.

A paramedic team is dispatched.
What will they need to consider on they way?
What do you think their priorities will be?

Discuss below with the group.