Baby's Skin

Rash Guard: When to Worry About Baby’s Skin

By Malia Jacobson

Spring is here, and local little ones are enjoying the outdoors in strollers, baby swings and backyards. For some, though, peeling away winter’s heavy layers reveals angry, irritated skin. If your baby’s skin seems unusually irritated these days, they’re not alone. Markus Boos, M.D., Ph.D., a pediatric dermatologist with Seattle Children’s Hospital, says his infant patients are coming in with more severe cases of common rashes, most likely because families are waiting longer than usual to take children to the doctor. “I think families are delaying care because of concerns about the safety of going out in public with their infant during COVID,” he says.

Delaying care for skin irritations is understandable, particularly during the past couple of years. After all, rashes on babies are sometimes dismissed as harmless, even unavoidable, childhood nuisances. But skin rashes can sometimes signal more serious health conditions, reactions to medication or even a serious COVID-19 complication, so it’s a good idea to check in with your child’s health-care provider if a rash appears suddenly, seems painful or infected, or is accompanied by cold- or flu-like symptoms, such as fever, vomiting, changes in appetite or diarrhea. Here’s a primer on common rashes, along with information about when to worry about them and how to care for irritated skin at home.

Atopic dermatitis This hereditary form of eczema, which causes red, scaly patches near the joints and on the cheeks, is the most common condition Boos treats. Although atopic dermatitis has a genetic basis (meaning it can only be managed, not cured), certain factors make flare-ups more likely. Fragrances, harsh soaps and some chemical cleaners or detergents can result in itchy, uncomfortable rashes on babies and young children. Fortunately, the condition is often treated successfully with topical steroids, and many children outgrow it by the time they reach kindergarten age.

Heat rash As temperatures rise during spring and summer, caregivers may notice clusters of tiny pink or red bumps or water blisters on their child’s upper body, mainly the neck, chest or upper back. Caused by blocked sweat glands, heat rash can be itchy and uncomfortable, but it generally doesn’t signal an underlying illness and it is not accompanied by a fever. To treat heat rash, cool the affected skin with a damp washcloth or a cool (not freezing!) bath without soap and allow the skin to air-dry whenever possible.

Psoriasis Scaly, thickened patches of skin covering a red, inflamed rash underneath could signal psoriasis, a frustratingly persistent condition that affects babies, children and adults throughout their lives. This condition has a genetic component, and while psoriasis can’t be cured, it can be managed with treatments that include topical steroids and oral or injectable medications. Psoriasis may be a manifestation of a systemic inflammatory disorder, notes Boos, and treatment may involve working with specialists in immunology, gastroenterology and rheumatology.

Multisystem inflammatory syndrome (MIS-C) A red, bumpy rash accompanied by stomachache, fever and fatigue could be a sign of multisystem inflammatory syndrome in children (MIS-C), a condition linked to the virus that causes COVID-19. In children with MIS-C, internal organs, including the brain, lungs, skin and stomach, become inflamed. “Things to look for include conjunctival injection [bloodshot eyes], bright red cheeks, swelling and redness of the palms and around the eyes, and a nonspecific rash that can look like hives, fine bumps or just red spots and bumps. Sometimes the tongue can be bright red or white, as well,” says Boos. “In general, the skin findings occur along with or after a fever, but rarely

do the skin findings precede fever.”

Because of MIS-C’s potential effects on vital internal organs, this is a serious diagnosis, he notes, so prompt evaluation by a healthcare provider is necessary when a combination of these symptoms is noticed in babies and young children.

Hand, foot and mouth disease (HFMD) This highly contagious illness may have made the rounds in your family, day care or group of friends. Caused by an enterovirus, hand, foot and mouth disease causes small, circular red spots and blisters on the hands, feet, mouth and buttocks. Babies with HFMD may drool more than normal and have a lackluster appetite, along with a fever, according to Boos. Because HFMD spreads easily, it’s important to keep children at home until their fever subsides and their blisters scab over. And don’t worry if your child loses their fingernails the following month — this is a common HFMD aftereffect, and your baby’s nails should grow back good as new. Rashes are uncomfortable and generally no fun, especially when they make for a cranky, irritable infant. But most of the time, rashes are easily treated and shouldn’t cause alarm, Boos notes. See your child’s health-care provider if you notice any of the following:

• Rashes that involve the eyes, mouth or nose • Infections with blisters and pus • Rashes that seem painful • Rapid changes in the rash’s appearance • Rashes accompanied by fever, vomiting or lethargy ■ Malia Jacobson is a health and family journalist based in Tacoma.

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