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What’s that spot? 10 types and tips for parents

Tags: allergy , children

skin

Are your child’s spots just itchy and sore or a symptom of something more sinister? Here, midwife and nurse, Jackie Hall, who leads our team of Health at Hand nurses gives you the lowdown on which spots to worry about.

“Any new parent will tell you that spots can make them anxious, and even the more experienced ones can still have sleepless nights over unusual rashes.

It’s not easy for parents to know whether a rash or skin changes indicate a serious medical problem and whether further medical assessment is needed,” says Jackie. “A rash can give a clue to the type of illness but other signs/symptoms are just as important in determining how serious an illness may be.”

What are viral rashes?

Watch for tiny, pinprick, red spots on the chest, abdomen and limbs which disappear easily when you press on them (or glass test negative). They can accompany common cough/cold/sore throat /tummy bug illnesses.

Many viral infections that cause rashes are self-limiting i.e. they resolve themselves within several days without the need for treatment. Nevertheless, though there aren’t any cures, symptoms can be managed from home with help of your pharmacist. For example, encouraging fluid intake to prevent dehydration and paracetamol to aid pain relief and fever control.

Always consult a doctor if you are worried about a rash on your child or complications that follow, such as ear infections. This is especially important with children who are under 12 months old, who have very high fevers or who are refusing to take fluids.

Viral rashes are the result of an underlying infection and their duration is only a period of the total duration of infection. Furthermore, it is this underlying viral infection that can be transmitted between children and not the rash itself. The “incubation period” – the time between contracting the virus, to developing the symptoms - will vary between viruses. As a general rule, people are most infectious in the days prior to rash outbreak, continuing until a few days post-rash outbreak.

If spots are accompanied by any of the following symptoms and your child appears to be more unwell then seek urgent medical attention.

  • Drowsiness
  • Unresolving high temperature/fever
  • Floppy body tone (your child looks and feels like a rag doll when you pick them up)
  • Confusion/difficulty awakening
  • Severe/worsening headaches
  • Very pale skin
  • Seizures, fits (convulsions)
  • Shortness of breath
  • A sharp chest pain that feels worse with breathing
  • Coughing up blood

Go to your nearest accident and emergency department or call 999 for an ambulance if you or your child develops any of these symptoms.

Here Jackie lists some of the most common spots and rashes to watch out for:

1. Meningitis

This is the scary one every parent dreads. Remember though, a rash is often one of the last signs of meningitis or septicaemia, so do see a doctor if you are concerned about any of these symptoms:

What to look for

“A child with meningitis would normally be very unwell with reddish/purple spots which look a little like tiny fresh bruises on the skin – the key is that these do not blanch in colour when you press on them. The glass test is a very useful way to check,” explains Jackie. “This is if you press the side of a clear glass firmly against the skin and the rash doesn’t fade, it’s a sign of blood poisoning (septicaemia) and you should seek medical attention immediately. The rash may be harder to see on darker skin so check for spots on the paler areas, such as the palms of the hands, soles of the feet or the abdomen.”

How to treat it

If meningitis is suspected then the child must go immediately to an Accident and Emergency Department.

Is it contagious?

Bacterial meningitis can be contagious and you will be advised by the professionals looking after your child of actions that need to be taken.

2. Slapped cheek syndrome


What to look for

This is caused by parvovirus and causes a bright red rash on the cheeks. It is accompanied by slight fever and the child will feel mild/moderately unwell but get better after a few days.

How to treat it

Slapped cheek syndrome is usually mild and should clear up without specific treatment. If you or your child is feeling unwell, you can try the following to ease the symptoms:

  • Rest and drink plenty of fluids - babies should continue their normal feeds. Dehydration poses the greater risk, particularly in the young.
  • For a fever, headaches or joint pain you can take painkillers, such as paracetamol or ibuprofen. Aspirin should not be given to children under 16 years old.
  • To reduce itchiness, oral antihistamines can be taken and/or emollients used – some antihistamines are not suitable for young children, so check with your pharmacist first.
  • Those who should contact a GP include: pregnant women exposed to anyone with slapped cheek syndrome or who have symptoms of the infection, those who have a blood disorder, a weakened immune system or those with symptoms of severe anaemia, such as very pale skin, shortness of breath, extreme tiredness or fainting.

Is it contagious?

The virus is spread by inhaling droplets that are sneezed or coughed out by someone infected or by touching a contaminated surface or object and then touching your mouth or nose. It’s very difficult to prevent slapped cheek syndrome because people who have the infection are most contagious before they develop any obvious symptoms. However, making sure that everyone in the household washes their hands frequently may help stop the infection from spreading.

Someone with slap cheek syndrome is infectious during the period before the rash develops. Once the rash appears, the condition can no longer be passed on. Unless you or your child is feeling unwell, there’s no need to stay away from school or work once the rash has developed. It is however a good idea to notify your child’s school about the infection, so children who develop early symptoms can be spotted quickly and vulnerable people can be made aware that they may need to get medical advice.

3. Chicken pox


What to look for

At first your child will seem a bit off-colour, they may be off their food and quite lethargic for a few days. Then a few, itchy, red, raised spots on the neck, face, chest or back or other body parts will start to appear. These turn into little fluid-filled blisters, which can be itchy and painful. The child can be infectious for several days before spots appear and for 5 days or more after spots become visible. forming .

How to treat it

Chickenpox is usually mild and can be self-managed from home. Most people feel better within a week or so. But some people can become more seriously ill and need to see a doctor. There’s no cure but the treatment below can help relieve the symptoms while the body fights the infection.

  • Rest and drink plenty of fluids to avoid dehydration.
  • For a fever, painkillers can help, such as paracetamol. Ibuprofen shouldn’t be given to children with chickenpox as it can make them very ill and do not give aspirin to children under 16.

IMPORTANT: Always read the packet or leaflet that comes with the medicine to check it’s suitable and how much to take. Speak to a pharmacist or your GP if you’re unsure.  

You can buy topical preparations to apply directly onto the rash or administer an oral antihistamine to help reduce itching and soothe the skin– some antihistamines are not suitable for young children, so check with your pharmacist first.

An antiviral medicine called Aciclovir may be recommended if there is a risk of severe chickenpox and you already have symptoms. It ideally needs to be started within 24 hours of the rash appearing.

Is it contagious?

Chickenpox is highly contagious and can make some people very ill, so it’s important to try and avoid spreading it to others. If you or your child has chickenpox, stay away from nursery, school or work until all of the blisters have dried up and scabbed over. This usually happens five or six days after the rash first appears. You may continue to have spots on your skin for another week or two, but you’re no longer contagious if the spots are dry and scabby.

Certain people are at a higher risk of becoming seriously ill if they become infected with chickenpox. These include:

  • Pregnant women
  • Newborn babies
  • People with weakened immune systems
  • People in these groups should avoid contact with people with chickenpox and consult their GP if there is a risk that they have become infected.

Chicken pox can be spread through contact with objects that have been contaminated with the virus, such as toys, bedding or clothing. You can prevent it spreading by cleaning any objects or surfaces with a disinfectant and wash any infected clothing or bedding regularly.

4. Measles

Measles is a highly infectious, unpleasant viral illness that has some characteristic features to distinguish it from other viruses. Furthermore, it has the potential to cause serious complications.

What to look for

A mass of red spots break out around the neck, behind the ears and face but can appear elsewhere too, including the inside of the mouth. Measles can result in serious complications but, thanks to vaccination programmes, the incidence of outbreaks is low.

Initial symptoms of measles can include:

  • A runny or blocked nose
  • Sneezing
  • Watery eyes
  • Swollen eyelids
  • Sore, red eyes that may be sensitive to light
  • A fever
  • Small greyish white spots in the mouth
  • Aches and pains
  • Cough
  • Loss of appetite
  • Tiredness, irritability and a general lack of energy

How to treat it

You should contact your GP as soon as possible if you suspect that you or your child has measles. Its best to phone before your visit as your GP surgery may need to make some arrangements to reduce the risk of spreading the infection to others. There’s no specific treatment for measles, but the condition usually improves within 7 to 10 days. If the symptoms of measles are causing discomfort for you or your child, there are some things you can do to treat these while you wait for your body to fight off the virus.

  • Rest and drink plenty of fluids to avoid dehydration.
  • Paracetamol or ibuprofen can be used to reduce a fever and relieve any aches or pains if you or your child is uncomfortable. (Aspirin should not be given to children under 16). Speak to your pharmacist if you are not sure which medications are suitable for you child.

Is it contagious?

Stay away from work or school for at least four days from when the measles rash first appears to reduce the risk of spreading the infection. It’s important to avoid contact with people who are more vulnerable to the infection, such as young children and pregnant women.

You can avoid catching measles by having the measles, mumps and rubella (MMR) vaccine. Measles is unlikely in people who are fully immunised or who have previously contracted the infection. Vaccination with one dose of the combined measles, mumps, and rubella (MMR) vaccine should provide about 90% immunity. However, vaccination with two doses of the MMR vaccine, as indicated by the UK Childhood Immunisation Programme, is thought to provide close to 100% lifelong immunity.

Data suggests that the people most likely to present with measles are younger people who have not received the MMR vaccine and who have not been previously exposed to the virus. In the past, there has been measles endemic, but since the introduction of the MMR vaccination, this has become relatively rare. However, in recent years, the infection has become more prevalent due to a failure of uptake of vaccination.

5. German measles (rubella)


What to look for

This is usually a mild illness with small red spots appearing on the face at first and then spreading to other parts of the body. Other symptoms include swollen glands and a cold-like illness. It’s rarely seen nowadays in the UK, thanks to routine vaccination. It is, however, of serious concern if a pregnant woman catches the virus in the first 16 weeks of pregnancy because it can cause birth defects in her baby.

Both measles and rubella are viral, however, the infection with rubella is usually mild by comparison, (symptoms include a rash and swollen lymph glands) but the likelihood of developing complications is rare. The main risk is contracting rubella in pregnancy.

How to treat it

You should always contact your GP if you suspect rubella. It’s best to phone before your visit as your GP surgery may need to make some arrangements to reduce the risk of spreading the infection to others. There’s no specific treatment for rubella. The condition is usually mild and improves without treatment within 7 to 10 days. If the symptoms of rubella are causing discomfort for you or your child, there are some things you can do while you wait for the infection to pass.

  • Rest and drink plenty of fluids to avoid dehydration.
  • Paracetamol or ibuprofen can be used to reduce a fever and relieve any aches or pain. (Aspirin should not be given to children under 16). Speak to your pharmacist if you are not sure which medications are suitable for you child.

Is it contagious?

While you have rubella, it’s important to reduce the risk of spreading the infection to others. If you or your child has the condition, you should avoid work or school for four days from when you first develop the rubella rash.

In rare cases, rubella can cause serious problems in an unborn baby, so you should also try to avoid contact with pregnant women for four days from the start of the rash. If your pregnant and develop a rash or have been in contact with someone who has a rash, contact you GP or midwife immediately.

6. Impetigo


What to look for

This often begins as a red patch of skin often around the nose or mouth but can occur anywhere on the body. The red patches then become a crusty/brownish colour after a few days.

It is caused by overgrowth of skin bacteria and can easily be cleared by antibiotics, although spreads easily if left untreated.

Speak to your GP if you think you or your child may have symptoms of impetigo. Impetigo isn’t usually serious, but it can sometimes have similar symptoms to more serious conditions such as cellulitis so it’s important to get the correct diagnosis.

How to treat it

Impetigo usually gets better without treatment in a few weeks. However, treatment is often recommended because it can reduce the length of the illness to around 7 to 10 days and can reduce the risk of spreading the infection to others.

Hygiene measures alone even for small, localised lesions are not recommended. The main treatments prescribed are antibiotic creams or oral antibiotics and duration of treatment is usually one week.

Is it contagious?

During treatment it’s important to take precautions to minimise the risk of impetigo spreading to other people or to other areas of the body. Most people are no longer contagious after 48 hours of treatment or once their sores have dried and healed. It’s important to stay away from school or work until then.

To help prevent the risk of infection spreading:

  • Don’t share flannels, bedding or towels with anyone who has impetigo.
  • Wash and loosely cover the sores.
  • Avoid touching or scratching the sores.
  • Avoid contact with new born babies, preparing food, playing contact sports, or going to the gym – until the risk of infection has passed.
  • Wash your hands frequently
  • Washable toys should be washed – thoroughly wipe no washable toys.

7. Eczema


What to look for

Dry /inflamed patches of skin typically form on creases of elbows and behind knees, but can occur anywhere on the body.

How to treat it

Treating eczema fundamentally involves breaking the scratch-itch cycle and replenishing the moisture content of the skin. It will normally respond well to the regular use of emollients/moisturisers and topical steroid preparations for flare ups. It is not possible to “overdose” on moisturisers and what may work for one person, may not for another. Steroid preparations are useful in managing flare-ups but should be used as prescribed. There are also specific bath additives/shower gels/soaps that are targeted to help manage eczema.

Is it contagious?

Eczema is not contagious. It is a chronic skin condition, most prevalent in childhood.

8. Molluscum


What to look for

Little crops of raised, fluid-filled blisters can occur anywhere on the body or limbs. These spots are harmless and the child will not be unwell but they are contagious and spread by person to person contact.

How to treat it

It can take up to 18 months for these to clear. Usually no treatment is needed as they clear on their own.

Is it contagious?

Resolution is spontaneous but it is contagious. It can be spread through close direct contact. If you become infected by the virus and spots appear on your skin, the virus can also spread to other areas. It is not known how long someone with molluscum is contagious for, but it is thought the contagious period may last up until the last spot has completely healed.

9. Allergic wheals


What to look for

These are blistery, reddish, raised blotches to the skin which can appear rapidly on different parts of the body. They tend to be itchy and are usually due to exposure to an allergen e.g. animal hair/dander, grasses or foods/additives.

How to treat it

Antihistamines such as Piriton can be helpful in reducing symptoms and progression. Most often the rash settles quickly over 24 hours but if there is associated swelling of the face, lips or any breathing problems, call 999.

Is it contagious?

Allergic wheals are not contagious. This is because allergic reactions are a result of the unique response of each individual's immune system to certain triggers. Substances that cause a reaction in one person may not cause a reaction in someone else.

10. Neonatal heat spots


What to look for

These small red spots with a tiny white pimple on top appear on the face, neck and upper chest. They are the result of immature sweat glands becoming blocked when the baby gets hot. They are very common and usually of no concern and will disappear after a few months.

Find out more about the child health care options available to your family. You can also discover more information in our pregnancy and childcare centre or if you have a specific question, you can ask our experts.

Further reading

Meningitis

Skin rashes in children

Rashes in babies

Allergies

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