Rashes are a common reason for people to visit local emergency departments. Many of these can easily be treated at home while others can be suggestive of true emergencies. On this week’s On Call for All Kids, Joe Perno, M.D., pediatric emergency medicine physician and vice president of medical affairs at Johns Hopkins All Children’s Hospital, shares information for parents about dealing with a variety of rashes.What is eczema?

Eczema is a common pediatric rash that presents with very dry, itchy, scaly skin. It most commonly affects younger children although some people suffer their entire lives. It is believed to be triggered by an over-active immune system response. It is very common in people with allergies or asthma. There is no cure, but treatment is focused on moisturizing the dry skin with lotions and treating the itching with steroid creams or oral anti-histamines. Eczema is rarely an emergency; however, the skin can become infected with bacteria such as MRSA, which would then require prompt treatment.

What is contact dermatitis?

Contact dermatitis is a local reaction of the skin to a foreign substance. Good examples of this include poison ivy, reactions to perfume or lotions, laundry detergents, bubble baths, etc. The rash is usually localized to the area of contact with the substance. The skin may be red, blistering or even develop raised bumps or hives. Often the area is very itchy. Treatment consists of removing the offending agent and treating the itching with oral antihistamines such as Benadryl. The reaction can last days to weeks. Contact dermatitis can become an emergency if the itching becomes very severe or it is not resolving.

What causes hives and when is it an emergency?

Hives or urticaria is usually triggered by an allergic reaction to food, airborne allergens or even viral infections. Typically hives are raised, red blotchy areas that are extremely itchy. The hives may come and go and move around the body. The main treatment of hives is with oral antihistamines. Hives can become a significant emergency if they are associated with difficulty breathing or swallowing. If a patient is wheezing, short of breath, has swollen lips or cannot swallow, he or she should seek immediate medical attention either in an emergency department or via 911. In the emergency department, we have other treatments to reverse a severe allergic reaction. People with known severe allergies to food or insect bites should carry an Epi-pen, which is a device to deliver epinephrine, which immediately reverses a severe allergic reaction.

What are the common types of rashes we see?

Many viral illnesses can cause rashes; in particular the viruses that are most common in the summertime. Viral rashes usually consist of small red bumps scattered over the body. Typically, they are not itchy and do not bother the child. They often only bother the parents who are upset that the child is now covered in red spots. Some viruses cause rashes to develop after the fever has resolved (roseola) while others will be present while the child is ill. Viral rashes typically do not require any therapy. Chickenpox (varicella) can require more precautions and treatment, but it typically is rare with vaccination.

While rare, symptoms of multisystem inflammatory syndrome in children (MIS-C) related to COVID-19 has occurred in children. Call your family doctor or pediatrician right away if your child experiences a fever of 100.4 or more, lasting more than 24 hours, and at least one of these symptoms:

• Unusual weakness or fatigue
• A red rash
• Abdominal (belly) pain
• Vomiting and diarrhea
• Red, cracked lips
• Red eyes
• Swollen hands or feet

When is a rash dangerous and should parents rush to the Emergency Center? 

Any rash that is associated with difficulty breathing or swallowing should be treated as an emergency. Certain rashes with fever can be dangerous. If the child has fever and a flat bright red rash that looks like someone made small dots with a red magic marker, the child should be seen immediately. Also, if the child has a purple, blotchy rash that almost looks like bruising the child should be seen right away. If the child develops a rash with significant peeling of the skin or involvement inside the mouth, nose or eyes, the child should also be seen immediately. Identifying rashes can be very difficult, so anytime the parent has any concerns, the child should be seen by a pediatrician or local emergency department.