Scott Webb (Host): Childhood rashes are common, and for the most part treatable. But some rashes are an indication that our kiddos need to be seen by a provider. And joining me today to explain rashes and the various causes and treatment options is Dr. Lauren Strelitz. She's a pediatrician with Stanford Medicine Children's Health.

This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb.

Doctor, it's nice to have you back on the podcast today. Today we're talking rashes and trying to understand childhood rashes, and of course I had kids and they had rashes, and we all want to understand them. So great to have you back. And let's just start there. Like, what are the most common rashes in children?

Lauren Strelitz, MD: One of the most common rashes in children is eczema. Another common rash in children would be a viral exanthem. So a rash caused by a virus, you can also get urticaria or hives. And then rashes that are allergies to things, skin sensitivities, contact dermatitis, but there are wide variety of rashes.

Host: Yeah, that's the thing. And yeah, it's a very broad topic. There's lots of types of rashes and sure if maybe your kids were outside sometimes it's obvious, right? But, in general, because there are so many types of rashes, are there some symptoms that maybe lead to the rash?

Lauren Strelitz, MD: Depends on what the rash is being caused by, right? Rash is just a change in texture or color of the skin. And so some rashes have no symptoms and it's just something you see and other rashes can be itchy or painful. So there are lots of rashes that kids may not need to or don't come to the doctor for.

Things you would worry about would be a rash that's getting worse. A rash with blisters, a rash that's painful, a rash that's itchy. And then of course some viral rashes are from viruses that are more benign and not going to cause any long-term risk, such as roseola, and hand, foot mouth.

And then there are other rashes that can be from more serious illnesses that can have high rates of hospitalization and even death, such as chickenpox and even more potentially fatal, measles. Making sure your children are immunized on the schedule and being aware of your child's immunization status is also something that can really help determine whether your child has a rash that is just going to resolve on its own, or a rash that could be part of a disease that has more risk of what we call morbidity, which is long-term consequences or mortality, which is death.

Host: It's not easy being a parent. We've established that and it's definitely not easy being a pediatrician. So there's different types of rashes depending on the severity. And you know, presumably parents know whether or not their children have been immunized against things like measles.

So a lot to consider there. And can you just give us a sense, like what causes a rash? Like how does a rash happen?

Lauren Strelitz, MD: Well, you know, again, there are many different causes and I'll give you an example of one very common rash, eczema. So eczema is caused by the skin not making the oil barrier it needs. So it becomes dry, it becomes irritated. It becomes inflamed. The more you scratch it, the worst the rash gets.

So that's one type of rash. Another type of rash, hives is caused by a allergic response to something. Or it can also be a spontaneous what we call idiopathic, which we don't know what the cause is. Viruses can also cause hives, and there are treatments for eczema. There are treatments for hives.

Then there are other rashes for which there are no treatments, but it's not dangerous, such as the rash that is caused by the Roseola virus. So Roseola is a really common viral illness that younger kids get where they will have a high fever for three to five days, and then the fever goes away, and then they get this rash all over their body.

And for parents, sometimes when they see the rash, they get really worried, right? Like, why does my child have this big rash? What's going on? But there are no other associated symptoms with the rash, and it goes away on its own, and it's not dangerous at all, versus, the rash from eczema, which if it's not treated, first of all, it's extremely uncomfortable, but, there are also these little micro tears in the skin that can lead to infection.

Or the rash from the urticarial rash, the hives, which, if it's a sign of an allergic reaction, then you'd want to figure that out because potentially that could be associated with anaphylaxis, the severe allergic reactions. Some rashes you don't need to do anything and other rashes, you really should see a doctor to talk about and get a diagnosis and see if there is a treatment or if more evaluation needs to be

Host: Right. Yeah. I know in our medicine cabinet we have a full array, Doctor of things, hydrocortisone cream, Benadryl, you know, I could go through the whole list of things that we've used over the years, whether it's been a reaction to something, as you say, an allergic reaction. And then of course that sets in the whole other, alright is it just the skin reaction or could there be a bigger reaction like, as you say, anaphylaxis, that, that kind of thing. So just in general, when you advise patients and their parents, of course, what do you recommend that we do to treat rashes? What's our frontline first line treatment and where do we go from there?

Lauren Strelitz, MD: For an itchy rash, an over the counter hydrocortisone twice a day for a few days. If it's not getting better, you should see the doctor. Vaseline is really helpful at repairing the oil barrier of the skin and also protecting that rash from other irritants and infections.

You mentioned Benadryl. I actually really don't recommend anybody take Benadryl anymore. Benadryl is a first generation antihistamine and because it's a first generation antihistamine, it actually has a lot of potential side effects. It can cross the blood brain barrier.

And that's why it makes people sleepy. But it can also cause something called anticholinergic side effects, which can be things like having a hard time peeing, confusion, even hallucinations. It can be a really dangerous medication. And so, I know when we were kids that was like the go-to, right Benadryl, but now even the allergists are moving really away from Benadryl and towards some of the later generation antihistamines.

Cetirizine is the generic name is a really effective antihistamine. It can be used in kids over six months old for hives, and that's what I would go for an allergic reaction versus Benadryl. It actually is faster acting and more effective anyway, but you should see a doctor if you're worried your child's having an allergic reaction as well.

I mean, give the cetirizine, but see a doctor also.

Host: Yeah. As you say, there are some things that we can try at home. Give it a couple of days. When in doubt when we're worried, obviously, if we have to, we could go to the ED, I suppose, but we could also make an appointment to see someone like yourself. And I guess that's my natural follow up here is like, when do we worry? When is it time to do something?

Lauren Strelitz, MD: Most rashes don't need to be evaluated in the ED. But you should see a doctor if it's not going away after a few days, if it's getting worse, if it's itchy or painful. Certainly if there's a very painful rash that's rapidly getting worse, especially with like blisters and associated fevers, that might be a reason to go to the ED, especially at nighttime or weekend or holiday. But any rash that's just not getting better on its own or is getting worse and having any associated symptoms, fever, pain, itchiness, you should see a doctor for that.

Host: Yeah. Right. And I think we've all been there, all of us parents where it's like, I'm using air quotes now, doctor, but some rashes kind of seem normal, right? And it's pretty obvious what to do. And then within a day or two it's gone. And then, there's the one that you know, I'm not a doctor, but this one just doesn't look right and it doesn't seem to be getting better on its own.

And maybe that's how you want to finish today, is like just encouraging parents. Maybe like when it doesn't feel right, that's the time to go.

Lauren Strelitz, MD: Absolutely. When it doesn't feel right, when you're worried, when there's pain, when there's itchiness, when the home remedies aren't working after a few days, or if it's getting worse, that's a reason to be seen. I think over the counter hydrocortisone is great for short term, but if things aren't getting better, it's been three to five days, that's a time to see a doctor because there may be other treatments that are going to improve the symptoms faster as well.

Host: So, you know, Doctor, I'm thinking about the summer months, right? And kids going hiking and playing outside. At least that's what I did when I was a kid, and all the things we touched and rolled around in. And maybe you can just give us a sense of the types of rashes or reactions that kiddos might have, just being outside, being kids.

Lauren Strelitz, MD: Some of them can just be allergic reactions to grasses and things like that or skin sensitivities to grasses or things like that, that are more self-limited. But one thing you would want to worry about more would be poison oak. And that's a rash that is a later reaction from the oils, from those plants. What you really want to do, if you think the child has been exposed to poison oak, is when you get them home, you want to take off all the clothes, you want to wash them so that they're not using them again and again, like a hat that has something on it that they put to their skin again, or shoes.

And then there's a product called Tecnu that you can take a shower with that actually decreases the risk of developing the rash. If they do have a poison oak rash, those are rashes that tend to just keep getting worse and in some cases can be pretty severe. And so topical hydrocortisone that you find over the counter isn't really gonna do it.

And it would be important to see a doctor to consider whether they need a stronger topical prescription strength steroid or even an oral steroid in some severe cases.

Host: Well, it's great to have you on. It's always a pleasure to hear your voice and get your expertise, so thank you so much.

Lauren Strelitz, MD: Oh, you're so welcome. Thanks for having me for this.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.