Itchy Rash

Dear Lisa,

My daughter's skin has been having these weird bumps. They spread faster than anything I've seen. They itch her incredibly and scratch all the time. They are red and once they go away, they leave scars, big black scars. I don't know how to help her get rid of them. I have been to the doctor with her, and they gave her an ointment that worked just a little bit, unfortunately after a few weeks or months, it would spread all over her body again.

She also has a wedding to go to in a few months and she can't even show her legs in the dress she wants. I'm hopeless and have no idea how to help her. Lisa, what should I do?

“bday4life111”

Dear “bday41ife111”,

Unfortunately without physically examining your daughter I cannot tell you the cause of her rash. I can tell you about itchy rashes that commonly occur in childhood. These rashes include Atopic Dermatitis or Eczema, Scabies, Bed bugs and Chicken Pox.

Atopic dermatitis (AD) or Eczema is a hereditary skin condition that is commonly found in the pediatric population. It is a chronic, relapsing inflammatory skin rash that tends to occur in allergic individuals. The main symptom of eczema includes itching, which in some cases can be so intense that it wakes a child at night. The incidence of AD or Eczema is on the rise in Western and developing countries worldwide. The prevalence of Atopic Dermatitis is 15 to 20 % in school children in the United States and Western Europe which reflects a two to threefold increase in the past 30 years.(1)

Outbreaks of Eczema can be triggered by psychological stress, weather changes, humidity, texture of fabrics, contact irritants, excessive bathing and food. In younger children, food allergy is a common trigger with eggs, milk, soy and wheat being the most likely candidates.(2,3,4)

Scabies is a rash that is caused by a hypersensitivity to a parasitic mite. The symptoms of Scabies include intense itching which occurs especially at night. (5) The rash is very similar to a wide spread case of contact dermatitis and many times is mistaken for Eczema. In older children the rash is typically found on the skin between the fingers, around the belly button area, the wrists, the buttocks, the belt line, thighs and the penis. Infants younger than two years old typically do not present with the classic “Scabies” rash. The rash on younger children appears more like vesicles and is likely to occur on the head, neck, palms of the hands and soles of the feet.

Occasionally, 2-5 mm red-brown nodules can be found that persist for weeks or even months after a person is treated. These nodules are formed in response to the dead mites that remain on the skin after treatment. Scabies is spread through close personal contact with people who have the condition and is usually found in more than one person in the family. Once a family member is diagnosed with Scabies measures should be taken to prevent the spread of the condition to other members in the household.

There has been a recent resurgence of “Bed Bugs” or Cimex Lectularius Cimicidae. “Bed bugs” are flat wingless bugs that tend to be found in people’s mattresses. Their size ranges from the size of a poppy seed to ¼ inch in length. They live off of the blood of warm blooded animals and tend to bite humans in their bed at night when they are sleeping. Their color ranges from nearly white (just after molting) or a light tan to a deep brown or burnt orange. (6)

A child bit by “Bed Bugs” can develop a hypersensitivity reaction to the bug’s saliva. This allergic response is quite itchy and looks like a flea or mosquito bite. The rash usually occurs 1 ½ days after the bite occurs. The location of the bites from “Bed Bugs” include the parts of the body that are exposed during sleep, as opposed to flea bites which tend to occur on the ankles. (7)

Chicken Pox is another skin condition that causes a child to develop itchy skin lesions. Chicken Pox is an acute illness caused by the Varicella Zoster virus. The symptoms include a one to three day prodrome in which the exposed person experiences a fever, respiratory symptoms and a headache. Following this three day period a rash develops. At first the rash appears as red flat lesions which then erupt into dew dropped shaped, fluid filled sacs on top of a red base.(1)

The rash typically spreads throughout the entire body including the torso, extremities, face, scalp and in some cases the mucosal surfaces(inside the mouth).(8) Chicken Pox lesions can cause intense pruritis (itchiness) and lead a patient to have uncontrollable scratching. Once scratched, the lesions form a scab and once healed may leave scarring. New crops of lesions erupt each day, leaving a patient with a rash consisting of lesions at all different stages.

Once the rash develops, Chicken Pox lasts for approximately five days but may last for more than a week especially in immunocompromised patients. Since you described your daughter’s rash to occur for a few weeks and then reoccur weeks or months later, it does not fit the description of a Chicken Pox rash.

The best way to determine the cause of your daughter’s skin condition and the proper treatment course is to have her evaluated by a Pediatric Dermatologist. In most cases a diagnosis can be made through your child’s history and direct examination. In some cases a biopsy may need to be performed to determine the cause of a rash. A Dermatologist will also be able to recommend special make-up to cover up the scars on your daughter’s legs if they have not faded in time for the wedding.

I hope your daughter finds relief from her symptoms and enjoys the wedding.

For more information about topics discussed, read the following Pediatric Advice Stories:

Scabies

Norwegian Scabies

Eczema Treatment

Bed Bugs

Chicken Pox

References:
(1)Dohil M, Eichenfield L. A Treatment Approach for Atopic Dermatitis. Pediatric Annals. 2005. 34(3):201-210.
(2)Rosenthal M. Pediatricians treating more patients with atopic dermatitis. Infectious Diseases in Children. 2006. April:56.
(3)Photo Quiz. Blame the Family Pet for These Rashes? Consultant for Pediatricians. 2006. May:308.
(4)Nassif A, Chan SC, Storrs FJ, Hanifin JM. Abnormal skin irritancy in atopic dermatitis and in atopy without dermatitis. Arch Dermatol. 1994. 130(11):1402-1407.
(5) American Academy of Pediatrics. Scabies. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:387-390:468-470.
(6) Harvard School of Public health. Available at: http://www.hsph.harvard.edu/bedbugs/#examined. Accessed April 2007.
(7) University of Kentucky Entomology. Available at: http://www.uky.edu/Ag/Entomology/entfacts/struct/ef636.htm. Accessed April 2007.
(8)Pang M. Spot the Rash. Infectious Diseases in Children. 2006. March:90.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Parents