A Three-Step Approach to Pediatric Rashes

Written by on August 1, 2014 in Practice tips - No comments

One thing that parents and many physicians have in common is their dislike, even fear of, rashes and skin conditions. As a pediatrician with experience with pediatric dermatology, when I am working with other providers and a patient presents with a rash, they are usually relieved that I am there to take on the problem. Rashes can be mysterious at times. They don’t always fit into an easy diagnosis. Often, they don’t present the way that they are “supposed to”.

RashWEBA wonderful pediatric dermatologist, when faced with a rash that didn’t have an easily determined diagnosis, would often give the same speech. He would tell the family that the cause of the rash was unknown, but there were basically only three things we could do for a rash: “Leave it alone, cut it out, or rub a cream on it.” He would then make his recommendation for treatment, and the family would usually leave satisfied. Now, there are actually many more things you can do to diagnose or treat a rash. You can obtain lab tests, prescribe systemic medications, apply a chemical, or even perform a laser or light treatment. But that isn’t really the point. The point is that it isn’t always important to know the specific name or even cause of the rash, as long as you provide an effective treatment. And many times the treatment is doing nothing.

Seeing that this dermatologist, who practiced in a tertiary care pediatric dermatology department, didn’t always know the diagnoses and didn’t always do a lot to determine it, relieved a lot of my own anxiety when faced with an unknown rash. If the expert didn’t know or need to know, then surely I didn’t always have to. In time, I developed my own three-step approach to rashes.

  1. First, if I can give the rash a specific diagnosis or a name, then everyone is happy. A rash with a name is a little less mysterious. It is something that can be defined and, therefore, usually treated. I provide the family with the name of the condition and encourage them to look it up. Even better, I will often show the family a picture of the rash in the office. Once they see it, they can see that I actually do know what I’m talking about. We will then discuss treatment options, and the visit should be a success.
  2. If I am unable to uncover the specific cause of the rash, my next goal is to determine if the rash is dangerous or not. Unlike adults, who may have a fairly high incidence of serious skin conditions or malignancies, most rashes in children are not dangerous. They may be unsightly, itchy, or annoying, but they are usually pretty harmless. There are a few things that I need to look for such as serious infections, malignancies, allergic reactions, or rashes that are a sign of an underlying serious medical condition. Once I inform the family that their child’s rash is not one that worries me, most of the anxiety about the rash is relieved.
  3. Finally, if I cannot determine the name or cause of the rash, and I do not find it to be dangerous, I try to give the family a treatment plan that will make the rash go away or at least relieve the symptoms until it goes away on its own. Many pediatric rashes will resolve with time.  Even without a specific diagnosis, I can often tell enough about the rash to know which treatments may be effective.  For example, many rashes are the result of inflammation or dermatitis; irritation; bacterial, viral, or fungal infection; or contact or allergic reactions.  I then tailor the treatment to the most likely cause.  If I feel that further evaluation or treatment is required, or the rash does not respond to treatment, I will refer the patient to a pediatric dermatologist where, often, the treatment is still to “Leave it alone, cut it out, or rub a cream on it”!

By Laura E. Marusinec, MD, Urgent Care Pediatrician
Children’s Hospital of Wisconsin

 Laura Marusinec is a board-certified pediatrician with experience in general pediatrics, pediatric dermatology, and pediatric urgent care. She has supported an electronic health record implementation and optimization and is pursuing further medical writing education and opportunities.

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