Pediatric Common Skin Disorders

Skin fungi live in the top layer of skin cells in moist areas of the body, such as between the toes or in the groin and diaper area. Sometimes, the normal balances that keep fungi in check are upset, resulting in an infection.

Some fungal infections cause only a small amount of irritation, while other types penetrate deeper and can cause itching, swelling, blistering or scaling.

In some cases, fungal infections can cause reactions elsewhere on the body. A child can develop a rash on the finger or hand associated with an infection of the scalp or foot, for instance.

What is ringworm (tinea infection) in children?

Ringworm is a type of skin infection caused by a fungus. It looks like a red skin rash that forms a ring around normal-looking skin. There are several types of ringworm.

What causes ringworm in a child?

A ringworm infection is not caused by an actual worm. It is caused by fungi on the skin, hair and nailbeds called dermatophytes. Different types of dermatophytes affect different parts of the body. They cause different types of symptoms.

Which children are at risk for ringworm?

Children may be at risk for ringworm if they:

• Use shared bathrooms or locker rooms
• Play contact sports, such as wrestling
• Live in a warm climate
• Have contact with other children or pets that have ringworm
• Have a weak immune system because of illness or medicines
• Have poor hygiene
• Are malnourished

What are the symptoms of ringworm in a child?

The symptoms of ringworm vary depending on which part of the body is affected. The most common types of ringworm are listed below.

Athlete's foot

This problem mostly affects teenage boys and men. It usually doesn’t affect children before puberty. Things such as sweating, not drying the feet well after swimming or bathing, wearing tight socks and shoes, and warm weather can play a part in this problem. Symptoms may include:

• Whitening of the skin between the toes
• Scaling of the feet
• Itchy rash on the feet
• Blisters on the feet

Jock itch

This problem is also more common in males. It happens more often during warm weather. It is very rare in females. Symptoms of jock itch may include:

• Red, ring-like patches in the groin area
• Itching in the groin area
• Pain in the groin area

It does not usually involve the scrotum.

Scalp ringworm

Scalp ringworm is highly contagious, especially among children. It happens mainly in children between ages 2 and 10. It rarely happens in adults. Symptoms may include:

• Red, scaly rash on the scalp
• Itchy scalp
• Hair loss on the scalp
• Rash elsewhere on the body

Bad cases of ringworm of the scalp can also develop into a kerion. A kerion is a thick, pus-filled area on the scalp. It can also cause a fever. This can be caused by an overly active response of the immune system or an allergic reaction to the fungus. It may cause a rash elsewhere on the body and tender lymph nodes in the neck.

Nail infection

This type of ringworm causes the nails to become thickened and deformed. This problem affects the toenails more often than the fingernails. It happens more often in adolescents and adults rather than young children. Symptoms may include thickening of the ends of the nails and yellowing of the nails.

• Thickening of the ends of the nails
• Yellow color to the nails

Body ringworm

This skin infection is a ring-like rash that appears anywhere on the body or face. It happens in people of all ages, but it is more common in children. It is also more common in warmer climates. The symptoms may include:

• Red, ring-like rash with raised edges
• The middle of the rash may become less red as the lesion grows
• Itching of the affected area

Ringworm may look like many skin problems. Make sure your child sees their health care provider for a diagnosis.

How is ringworm diagnosed?

Ringworm is usually diagnosed based on a health history and physical exam of your child. The ringworm rash is unique. This makes it easy to diagnose with a physical exam. In addition, your child's healthcare provider may order a culture or skin scraping of the rash to confirm the diagnosis.

How is ringworm treated in a child?

Fungi can live indefinitely on the skin, so ringworm is likely to come back. Treatment may need to be repeated. Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment for scalp ringworm may include:

• Antifungal medicine taken by mouth for four to eight weeks. Some children may need longer treatment.
• Special shampoo to help get rid of the fungus. Shampoos can't replace the oral medicine, but you can use shampoo in addition to them.

If your child has a kerion or a secondary sore (abscess) or bacterial infection, the healthcare provider may order additional medicines to help reduce the swelling. These may include steroids.

Treatment for ringworm of the body, groin and foot is usually an antifungal cream or pill to take by mouth. The length of the treatment depends on the location of the ringworm.

Ringworm of the nails can be difficult to cure. It is usually treated with antifungal medicine taken by mouth.

Good handwashing is critical to managing ringworm. Scrub your hands for at least 20 seconds before and after treating your child's ringworm. Teach your child how and when to wash their hands as well.

If the ringworm is from an animal, it will need treatment too.

What are possible complications of ringworm in a child?

Ringworm rarely has serious complications. 

What can I do to prevent ringworm in my child?

Ringworm can be prevented by:

• Having good hygiene
• Frequent handwashing
• Not wearing other people's hats or clothing
• Keeping feet dry
• Staying away from someone who has ringworm

When should I call my child's health care provider?

Most types of ringworm can be treated with over-the-counter medicines. But ringworm of the scalp and nails requires taking an antifungal medicine by mouth. This medicine must be prescribed by your health care provider. If you are unsure if your child has ringworm or if your child has a weakened immune system, call your child's health care provider.

What is tinea versicolor?

Tinea versicolor is a common fungal skin infection characterized by lighter or darker patches on the chest or back. This infection, which prevents the skin from tanning evenly, occurs most often in adolescence and early adulthood.

What are the symptoms of tinea versicolor?

Typically the only symptom of tinea versicolor is white or light brown patches. The patches may scale slightly, but they rarely itch or hurt. Other common characteristics of the infection include:

• White, pink, or brown patches
• Infection only on the top layers of the skin
• Rash on the trunk
• No rash on the face
• Patches worsen in the heat or humidity
• Patches worsen if the child is on steroid therapy or has a weakened immune system
• Patches are most noticeable in the summer

The symptoms of tinea versicolor may resemble other skin conditions. Always consult a physician for diagnosis.

How is tinea versicolor diagnosed?

Tinea versicolor is usually diagnosed based on a medical history and physical examination of the child. The patches are unique, and usually a diagnosis can be made on physical examination. The physician may also use an ultraviolet light to see the patches more clearly or take skin scrapings of the lesions to confirm the diagnosis.

What is the treatment for tinea versicolor?

Treatment usually includes the use of dandruff shampoo on the skin as prescribed by the physician. The shampoo is left on the skin overnight and washed off in the morning, and may be required for several nights.

Tinea versicolor usually recurs, requiring additional treatments, and sometimes improves temporarily. The physician may prescribe topical creams, oral antifungal medications, or monthly shampoo treatments.

This infection can also cause a change in skin color, which can take several months to return to normal.

Many childhood viral infections are called viral exanthems. Exanthem means rash or skin eruption. Childhood viral exanthems include the following:

• Measles or rubeola
• Rubella
• Varicella (or chickenpox)
• Fifth disease
• Roseola

Three main groups of viruses cause the majority of viral skin infections, including the following:

• Human papillomavirus
• Herpes simplex virus
• Poxvirus

What is herpes zoster (shingles)?

Herpes zoster, or shingles, is a reactivation of the varicella-zoster virus (chickenpox). The virus causes a painful rash of small blisters on a strip of skin anywhere on the body. On some occasions, the pain may continue for a prolonged period of time even after the rash is gone.

After a person has had chickenpox, the virus lies dormant in the nerves. If the virus reactivates, however, it causes shingles. Herpes zoster is more common in people with depressed immune systems or over the age of 50. It is very rare in children, and the symptoms are mild compared to what an adult may experience.

Children who have weakened immune systems may experience the same, or more severe, symptoms as adults, however.

What are the symptoms of herpes zoster?

Herpes zoster most often occurs on the trunk and buttocks, but can also appear on the arms, legs or face. Each child may experience the symptoms differently. The most common symptoms may include:

• Skin hypersensitivity in the area where the herpes zoster appears
• Mild rash, which appears after five days and first looks like small, red spots that turn into blisters
• Blisters that turn yellow and dry
• Rash which usually goes away in one to two weeks
• Rash localized to one side of the body

The symptoms of herpes zoster may resemble other skin conditions. Always consult a physician for a diagnosis.

How is herpes zoster diagnosed?

Diagnosis usually involves obtaining a medical history of the child and performing a physical examination. Diagnosis may also include:

• Skin scrapings (gently scraping the blisters to determine if the virus is shingles)
• Blood tests

What is the treatment for herpes zoster?

Specific treatment for herpes zoster will be determined by a physician based on:

• The child's age, overall health, and medical history
• Extent of the condition
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Child or parent’s opinion or preference

Medication may help alleviate some of the pain, but the condition has to run its course. Immediate treatment with antiviral drugs may help lessen some of the symptoms. Use of medication will be determined by a physician based on the age of the child and the severity of the symptoms.

What is pityriasis rosea?

Pityriasis rosea is a mild, common rash. It causes the skin to be scaly, pink and inflamed. The rash can last from one to three months and often leaves no lasting marks. This rash is not thought to be contagious.

What causes pityriasis rosea?

Experts don’t know what causes pityriasis rosea. It is believed to be caused by a virus. It is usually seen in children, teens, and young adults. Some children may have a cold before the rash. The rash is more common in spring and fall.

What are the symptoms of pityriasis rosea?

The rash often starts with a large pink or tan oval area on the chest, stomach, or back. This patch (herald patch) is often followed by smaller pink or tan patches elsewhere on the body. They often show up on the back, neck, arms, and legs. The scaly rash often begins to heal on its own in 4 to 6 weeks and will go away by 14 weeks.

Below are other common symptoms of pityriasis rosea. But each child may experience symptoms differently. Symptoms may include:

• Severe tiredness (fatigue)
• Aches
• Itching

The symptoms of pityriasis rosea may look like other skin conditions or health problems. Always talk with your child’s health care provider for a diagnosis.

How is pityriasis rosea diagnosed in a child?

The rash is fairly unique. Pityriasis rosea is often diagnosed based on a health history and physical exam of your child. Your child may also need blood tests to rule out other conditions that might look like pityriasis rosea.

What is the treatment for pityriasis rosea?

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

The goal of treatment for pityriasis rosea is to ease symptoms such as itching. The rash will go away on its own. Treatment will be decided by your child’s healthcare provider based on how bad the rash is. Treatment may include:

• Medicated lotions and creams
• Medicines taken by mouth
• Cool baths with or without oatmeal
• Ultraviolet exposure
• Cool compresses

When should I call my child’s health care provider?

• Your child becomes very sick.
• The rash doesn't get better or gets worse.
• Itching or other symptoms cause your child a lot of discomfort.
  Your child gets a secondary bacterial infection from scratching the rash.

What are warts?

Warts are non-cancerous skin growths caused by the papillomavirus. Warts are more common in children than adults, although they can develop at any age.

Warts are contagious, and can spread to other parts of the body or to other people. There are many different types of warts, due to the fact that there are more than 60 types of the papillomavirus. Warts are typically not painful, except when located on the feet, and most warts go away without treatment over an extended period of time.

What are the common types of warts?

The more common types of warts include the following:

• Common warts are growths around nails and the back of hands; usually have a rough surface; grayish-yellow or brown in color.
• Foot warts are located on the soles of feet (plantar warts) with black dots (clotted blood vessels that once fed them); clusters of plantar warts are called mosaic. These warts may be painful.
• Flat warts are small, smooth growths that grow in groups up to 100 at a time; most often appear on children's faces.
• Genital warts grow on the genitals, are occasionally sexually transmitted; are soft and do not have a rough surface like other common warts.
• Filiform warts are small, long, narrow growths that usually appear on eyelids, face or neck.

What is the treatment for warts?

The specific treatment for warts will be determined by a physician based on:

• The child's age, overall health and medical history
• Extent of the growths
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the growths
• Child or parent’s opinion or preference

Warts in children often disappear without treatment. Treatment of warts depends on several factors, including:

• Length of time on the skin
• Location
• Type
• Severity

Treatment for more stubborn or recurring warts may include:

• Application of salicylic and lactic acid (which softens the infected area)
• Freezing with liquid nitrogen
• Electrodesiccation (using an electrical current to destroy the wart)
• Immunotherapy
• Laser surgery

What is molluscum contagiosum?

Molluscum contagiosum is a viral disease of the skin that causes small pink- or skin-colored bumps on the skin of your child. It is not harmful and usually does not have any other symptoms. The virus lives inside the bumps and is mildly contagious. The bumps usually clear up without treatment over six to nine months.

What causes molluscum contagiosum?

Molluscum contagiosum is caused by a virus called the poxvirus. It is most common in children and adolescents, although it can also affect adults.

What are the symptoms of molluscum contagiosum?

The bumps are small and are usually pink- or skin-colored. Over time, the bumps may develop a small, sunken center. Children usually develop between two and 20 lesions, often in clusters. They are not harmful, but may cause some cosmetic concern for the child if they appear on the face or other visible areas.

How is molluscum contagiosum diagnosed?

Molluscum contagiosum is usually diagnosed based on a medical history and physical examination of the child. The lesions are unique and usually are diagnosed on physical examination.

What is the treatment for molluscum contagiosum?

Specific treatment for molluscum contagiosum will be determined by the physician based on:

• The child's age, overall health, and medical history
• Extent of the condition
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Child or parent’s opinion or preference

In most cases, the lesions will heal without treatment over six to nine months. Additional treatment options may include:

• Removal of the lesions
• Use of topical medications (to speed up healing)

The most common childhood viral exanthems include the following:

• Measles
• Mumps
• Rubella
• Chickenpox

Immunizations have decreased the number of cases of measles, mumps, rubella, and chickenpox, but all viral skin infections require clinical care by a physician or other healthcare professional. Each of the viral exanthems listed here have a distinct pattern, which can aid in the diagnosis.

What is measles in children?

Measles (rubeola) is a respiratory illness caused by a virus. It causes a red, blotchy rash. It is also known as 10-day measles or red measles. It's a very contagious illness.

The measles virus lives in the mucus in the nose and throat. It's spread from one child to another through contact with fluid from the nose and throat. It is also spread by an infected child coughing and sneezing.

What causes measles in a child?

Measles is caused by a virus. It is mostly seen in the winter and spring.  

Which children are at risk for measles?

Children are more at risk for measles if they have not had the measles vaccine and are in contact with anyone who has measles. A person is contagious about four days before the rash breaks out, so a child may have contact with the virus without knowing it.  

What are the symptoms of measles in a child?

It may take seven to 14 days for a child to develop symptoms of measles after contact with the virus. A child is contagious about four days before the rash breaks out and four days after the rash develops. A child may pass the virus to others before you know they have it.

The early phase of the illness lasts between one and four days. Symptoms are like those of an upper respiratory infection. The most common symptoms include:

• Runny nose
• Hacking cough
• Pink eye (conjunctivitis) 
• Fever

After two or three days of the above, other symptoms include:

• Severe diarrhea 
• Small spots with white centers (Koplik spots) on the inside of the cheek
• Deep, red, flat rash that starts on the face and spreads down to the torso, arms, legs and feet

The red rash starts as small lesions that combine into one big rash. After three to seven days, the rash will start to go away. It will fade in the same order it appeared. It then leaves a brown-colored area and peeling skin.

The symptoms of measles can be like other health conditions. Make sure your child sees their health care provider for a diagnosis.

How is measles diagnosed in a child?

The health care provider will ask about your child's symptoms and health history. They may also ask about your family's health history. They will give your child a physical exam. The physical exam will include looking at the rash. The measles rash is different from other rashes. Your child may also have tests such as blood or urine tests to confirm the diagnosis.

How is measles treated in a child?

Treatment will depend on your child's symptoms, age and general health. It will also depend on how severe the condition is. Antibiotics are not used to treat this illness.

The goal of treatment is to help ease symptoms. Treatment may include:

• Making sure your child drinks more fluids
• Giving acetaminophen or ibuprofen for fever and discomfort

Your child's health care provider may tell you to give your child vitamin A in two doses to help prevent eye damage and blindness. If your child is younger than 1 year old or admitted to the hospital with respiratory problems, your child's health care provider may recommend an antiviral treatment called ribavirin.

Talk with your health care providers about the risks, benefits and possible side effects of all medicines. Don't give ibuprofen to a child younger than 6 months old unless your health care provider tells you to. Don't give aspirin to children. Aspirin can cause a serious health condition called Reye syndrome.

If your child was exposed and has not had a measles vaccine, your child's health care provider may give the MMR vaccine within 72 hours. Or the provider may give immune globulin (IG) within six days of measles exposure. These are to help prevent the disease.

Talk with your child's health care provider about the risks, benefits and possible side effects of all medicines.

What are possible complications of measles in a child?

The most serious complications from measles include:

• Ear infection
• Lung infection (pneumonia)
• Croup
• Inflammation of the brain (encephalitis)
• Blindness

How can I help prevent measles in my child?

The measles vaccine is usually given as part of a combination vaccine with mumps and rubella. It's called the MMR vaccine. The MMR vaccine is very safe and works well. It's given in two doses. The first dose is given between ages 12 months to 15 months. A second dose is given between ages 4 and 6 years. The second dose needs to be given at least four weeks after the first dose. During an outbreak, your child may need another booster shot.

Other ways to prevent the spread of measles include:

• Keeping children home from school or daycare for four days after the rash appears
• Checking that all of your child's friends and caregivers have been vaccinated

When should I call my child's health care provider?

Call the health care provider if your child has:

• Symptoms that don't get better or get worse
• New symptoms

What is rubella (German measles)?

Rubella is a viral illness that causes a rash on the skin. It is spread from one child to another through direct contact with discharge from the nose and throat.

Warning

Pregnant women who have been exposed to rubella need to seek medical attention immediately.

Infants and children who develop the disease usually only have a mild case of the rash and side effects. However, children who contract rubella from their mother while she is pregnant can have severe birth defects and consequences. It is also very dangerous for pregnant women to come in contact with someone who has rubella, because it can cause a miscarriage.

What causes rubella?

Rubella is caused by a virus called a Rubivirus. It can be spread from a pregnant mother to the unborn child, or from secretions from another infected person. It is most prevalent in late winter and early spring. Rubella is preventable by proper immunization.

The rubella vaccine is usually given in combination with the measles and mumps vaccine. It is called the MMR vaccine and is usually administered when the child is 12 to 15 months old, and then again between 4 and 6 years of age.

What are the symptoms of rubella?

The disease itself does not have any long-term consequences. The biggest concern is to prevent an infected child from infecting a pregnant woman. Take note of the following facts:

• It can take between 14 to 21 days for a child to develop signs of rubella after coming in contact with the disease
• Children are most contagious when the rash is erupting
• A child can be contagious beginning 7 days before the onset of the rash and 14 days after the rash has appeared
• Children may be contagious before they even know they have rubella.

The following are the most common symptoms of rubella. However, each child may experience symptoms differently.

Childhood rubella

• Rubella may begin with a period of not feeling well, a low-grade fever and diarrhea. This may last one to five days.
• The rash then appears as a pink rash with areas of small, raised lesions.
• The rash begins on the face and then spreads down to the trunk, arms and legs.
• The rash on the face usually improves as the rash spreads to the arms and legs.
• The rash usually fades by the third to fifth day.
• Lymph nodes in the neck may also become enlarged.
• Older children and adolescents may develop some soreness and inflammation in their joints.

Congenital rubella

Rubella that is present at birth where the child contracted it from the mother while in utero, can result in many problems, including the following:

• Cataracts in the eyes
• Heart problems
• Mental retardation
• Growth retardation
• Enlarged liver and spleen
• Skin lesions
• Bleeding problems

The symptoms of rubella may resemble other skin conditions or medical problems. Always consult a physician for the proper diagnosis.

How is rubella diagnosed?

Rubella is usually diagnosed based on a medical history and physical examination of the child. The lesions of rubella are unique, and usually the diagnosis can be made on physical examination. In addition, the child's physician may order blood or urine tests to confirm the diagnosis.

What is the treatment for rubella?

Specific treatment for rubella will be determined based on:

• The child's age, overall health and medical history
• Extent of the disease
• The child's tolerance for specific medications, procedures or therapies
• Expectations for the course of the disease
• Child or parent’s opinion or preference

Since it is a viral infection, there is no cure for rubella. The goal of treatment for rubella is to help prevent the disease, or decrease the severity of the symptoms. Treatment may include increased fluid intake or rest.

Other ways to prevent the spread of rubella:

• Children should not attend school for seven days after the onset of the rash.
• Children who are born with rubella are considered contagious for the first year of life.
• Check that a child's contacts have been properly immunized.

What is roseola?

Roseola is a contagious viral illness that is marked by a high fever and a rash that develops as the fever decreases.

What causes roseola?

Roseola is likely caused by more than one virus, but the most common cause is the human herpesvirus 6 (HHV-6). Roseola occurs mostly in children under the age of 3, and occurs more often in the spring and fall.

What are the symptoms of roseola?

It can take between five and 15 days for a child to develop symptoms of roseola after being exposed to the disease. Children are most contagious during the period of high fever, before the rash occurs.

The following are the most common symptoms of roseola. However, each child may experience symptoms differently.

• High fever that starts abruptly
• Fever (may last three to four days)
• Irritability
• Swelling of the eyelids
• Rash (as the fever decreases, a pink rash, with either flat or raised lesions, starts to appear on the trunk and then spreads to the face, arms, and legs.)

What are the complications of roseola?

The most serious complication of roseola is febrile seizures. As the child's temperature rises, there is a chance that the child will have a seizure.

The symptoms of roseola may resemble other skin conditions or medical problems. Always consult a physician for the proper diagnosis.

How is roseola diagnosed?

Roseola is usually diagnosed based on a medical history and physical examination of your child. The rash of roseola that follows a high fever is unique, and often the diagnosis is made simply on physical examination.

What is the treatment for roseola?

The specific treatment for roseola will be determined based on:

• The child's age, overall health, and medical history
• Extent of the disease
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Child or parent’s opinion or preference

Since it is a viral infection, there is no cure for roseola. The goal of treatment for roseola is to help decrease the severity of the symptoms. Treatment may include increased fluid intake or acetaminophen for fever (DO NOT GIVE ASPIRIN).

What is fifth disease in children?

Fifth disease is a viral illness that causes a rash (exanthem). Fifth disease is also called erythema infectiosum. And it's known as "slapped cheek" disease. This is because the rash can cause a child's cheeks to become very red. Fifth disease is spread from one child to another through direct contact with fluid from the nose and throat. It can also be spread through contact with infected blood. It is somewhat contagious.

What causes fifth disease in children?

Fifth disease is caused by human parvovirus B19. It occurs most often in the winter and spring.

Which children are at risk for fifth disease?

It is most common in young, school-age children. Children often get it at school or other places where children gather. Adults can get fifth disease, too, but most infections are in children. 

What are the symptoms of fifth disease in a child?

Symptoms usually show up 4 to 14 days after a child is exposed to the disease. About 4 in 5 infected children have very mild symptoms for about a week before getting the rash. About 1 in 5 will have no symptoms at all before the rash appears. Children are most contagious before the rash occurs, before they know they have the disease.

Early symptoms are usually very mild. These may include:

• Low fever
• Headache
• Runny nose
• Sore throat
• Itching
• Nausea or vomiting
• Diarrhea

A rash is usually the main symptom of fifth disease. The rash:

• Starts on the cheeks and is bright red
• Spreads to the trunk, arms, and legs, and lasts 2 to 4 days. It often has a "lacey" appearance. 
• May come back when the child is exposed to sunlight, heat or cold, or injury to the skin. This may continue for several days.

The symptoms of fifth disease can be like other health conditions. Make sure your child sees their health care provider for a diagnosis.

How is fifth disease diagnosed in a child?

The health care provider will ask about your child's symptoms and health history. They will give your child a physical exam. The physical exam will include inspecting the rash. The rash is unique to fifth disease and may be enough to diagnose your child. In some cases, your child may also have blood tests.

How is fifth disease treated in a child?

Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is. The illness is caused by a virus. Antibiotics won't help your child.

The goal of treatment is to help ease symptoms. Treatment may include:

• Having your child drink plenty of fluids
• Giving acetaminophen or ibuprofen for fever and discomfort
• Giving an antihistamine medicine for itching 

Talk with your child's health care providers about the risks, benefits and possible side effects of all medicines. Don't give ibuprofen to a child younger than 6 months old unless your health care provider tells you to. Don't give aspirin to children. Aspirin can cause a serious health condition called Reye syndrome.

What are possible complications of fifth disease in a child?

Fifth disease is usually a mild illness. In some cases, it may cause acute severe anemia in a child with sickle cell disease or a weak immune system. In a pregnant woman with fifth disease, there is a small risk of death of the baby in the womb.

How can I help prevent fifth disease in my child?

The best ways to keep fifth disease from spreading include:

• Washing hands well with soap and warm water
• Covering the mouth and nose when coughing or sneezing

When should I call my child's health care provider?

Call the health care provider if your child has:

• Symptoms that don't get better, or get worse
• New symptoms

What is chickenpox?

Chickenpox is a highly infectious disease, usually associated with childhood. By adulthood, more than 95% of Americans have had chickenpox.

The disease is caused by the varicella-zoster virus (VZV), a form of the herpes virus. Transmission occurs from person-to-person by direct contact or through the air.

Chickenpox most commonly occurs in children between the ages of 5 and 9. In the US, in areas with a large number of children in daycare settings, chicken pox in children between the ages of 1 and 4 is common.

What is the chickenpox vaccine?

Since 1995, a chickenpox vaccine has been available for children 12 months of age and older. Adolescents and adults who have never had chickenpox can also get the vaccine. The vaccine has proven very effective in preventing severe chickenpox.

The Center for Disease Control & Prevention’s Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians recommend that all children be vaccinated with the chickenpox vaccine between 12 and 18 months of age.

A booster vaccination is recommended again between 11 and 12 years of age. Many schools now require vaccination prior to entry into preschool or public schools.

What are the symptoms of chickenpox?

Symptoms are usually mild among children, but may be life threatening to infants, adults and people with impaired immune systems.

The following are the most common symptoms of chickenpox. However, each child may experience symptoms differently. Symptoms may include:

• Fatigue and irritability one to two days before the rash begins
• Itchy rash on the trunk, face, under the armpits, on the upper arms and legs, and inside the mouth
• Fever
• Feeling ill
• Decreased appetite
• Muscle and/or joint pain
• Cough or runny nose

The symptoms of chickenpox may resemble other skin problems or medical conditions. Always consult a physician for a diagnosis.

How is chickenpox spread?

Once infected, chickenpox may take 10 to 21 days to develop. Chickenpox is contagious for one to two days before the appearance of the rash and until the blisters have dried and become scabs, which usually happens within four to five days of the onset of the rash.

Children should stay home and away from other children until all of the blisters have scabbed over. Family members who have never had chickenpox have a 90 percent chance of becoming infected when another family member in the household is infected.

How is chickenpox diagnosed?

Chickenpox is usually diagnosed based on a complete medical history and physical examination of the child. The rash of chickenpox is unique, and usually a diagnosis can be made from a physical examination.

What is the treatment for chickenpox?

The specific treatment for chickenpox will be determined based on:

• The child's age, overall health, and medical history extent of the condition
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition child or parent’s opinion or preference

The treatment for chickenpox may include:

• Acetaminophen for fever (DO NOT GIVE ASPIRIN)
• Antibiotics for treating bacterial infections
• Calamine lotion (to relieve itching)
• Antiviral drugs (for severe cases)
• Rest
• Increased fluid intake (to prevent dehydration)
• Cool baths with baking soda or Aveeno (to relieve itching)

Children should not scratch the blisters, as this can lead to secondary bacterial infections. Keep the child's fingernails short to decrease the likelihood of scratching.

What is immunity from chickenpox?

Most individuals who have had chickenpox will be immune to the disease for the rest of their lives. However, the virus remains dormant in nerve tissue and may reactivate, resulting in herpes zoster (shingles) later in life.

Occasionally a secondary case of chickenpox does occur. Blood tests can confirm immunity to chickenpox in people who are unsure if they have had the disease.

What complications are commonly associated with chickenpox?

Complications can occur from chickenpox. Those most susceptible to severe cases of chickenpox are infants, adults, pregnant women (unborn babies may be infected if the mother has not had chickenpox prior to pregnancy), and people with impaired immune systems. Complications may include:

• Secondary bacterial infections
• Pneumonia
• Encephalitis (inflammation of the brain)
• Cerebellar ataxia (defective muscular coordination)
• Transverse myelitis (inflammation along the spinal cord)
• Reye syndrome (a serious condition which may affect all major systems or organs)
• Death

Skin parasites are small insects or worms that burrow into the skin to live there or lay their eggs.

There are many types of parasitic skin infections that require clinical care by a physician or other health care professional.

What is scabies?

Scabies is an infestation of mites (tiny insects) characterized by small red bumps and intense itching. This highly contagious infection often spreads from person to person while they are sleeping together in the same bed or have close personal contact.

The itching is caused by the mites burrowing into the skin where they lay eggs that hatch a few days later. Scabies can affect people of all ages. Scabies occurs mostly in children and young adults.

What are the symptoms of scabies?

It may take between 4 to 6 weeks for a child to develop symptoms of scabies after coming in contact with an infected person.

In children younger than 2 years of age, the lesions caused by the mites tend to occur on the head, neck, palms, and soles. In older children, the lesions are usually between the fingers, on the hands or wrists, along the belt line, on the thighs or belly button, in the groin area, around the breasts, and in the armpits.

The following are the most common symptoms of scabies. However, each child may experience symptoms differently. Symptoms may include:

• Itching, usually severe
• Rash, with small pimples or red bumps
• Scaly or crusty skin (with advanced conditions)

How is scabies diagnosed?

In diagnosing scabies, the skin and skin crevices are examined by a physician. A sample of skin, obtained by scraping the skin, may be examined under a microscope to confirm the presence of mites.

What is the treatment for scabies?

Scabies is treatable and usually all members in a family are treated at the same time. Specific treatment will be determined based on:

• The child's age, overall health, and medical history
• Extent of the infestation
• The child's tolerance for specific medications, procedures or therapies
• Expectations for the course of the infestation
• Child or parent’s opinion or preference

Treatment may include:

• Applications of prescription creams and lotions, such as permethrin and lindane solutions
• Oral antihistamine medication (to help relieve itching)
• In some cases, topical ointments are recommended

In addition, it is important to wash all clothes and bedding in hot water and dry in a hot dryer in order to kill the mites. Clothing and other objects that cannot be washed (i.e., pillows, stuffed animals) should be placed in a plastic bag for at least one week.

Also, the itching may continue for many weeks after the initial treatment of the scabies.

What are lice?

Lice are tiny insects that can infest the skin anywhere on the body. Lice infection is characterized by intense itching.

Lice are highly contagious, spreading from person to person by close body contact, shared clothes, and other items (such as hats, hairbrushes, and combs). There are three types of human lice:

Head lice

• Head lice are seen mostly in child-care settings and among school-aged children
• The child usually has itching in the head area
• Lice, or the eggs (called nits), can usually be seen on the hair, behind the ears, and on the neck

Body lice

• Body lice are usually seen in people with poor hygiene
• Body lice are rare in children
• Body lice cause severe itching, which is often worse at night
• In some cases, lice and eggs can be found in the seams of clothes

Pubic lice

• Pubic lice are very contagious and can be transmitted through sexual contact or by contaminated items such as towels and clothes
• Pubic lice can affect the pubic hair, but also can cause infections of the hair on the chest, abdomen, thighs and eyebrows
• Itching of the affected area is a common symptom of pubic lice

How are lice diagnosed?

The eggs laid by lice are usually visible to the naked eye, making it easy for a child's physician to diagnose. Pubic lice leave small brown spots on the parts of clothing that come into contact with the genitals or anus.

What is the treatment for lice?

The specific treatment for lice will be determined based on:

• The child's age, overall health and medical history
• Extent of the infestation
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the infestation
• Child or parent’s opinion or preference

Lice are very treatable. Treatment may include:

For head lice and pubic lice:

Application of a medicated cream rinse or shampoo is usually an effective treatment for head and/or pubic lice. The specific instructions need to be followed. Examples of medicated cream rinses or shampoos include the following:

• Permethrin or Nix® cream rinse
• Lindane
• Kwell® shampoo
• Pyrethrins or RID® gel
• Nits need to be removed from the hair with a fine-tooth comb.

Combs and brushes should be soaked in hot water with the shampoo for at least 15 minutes.

Children can return to school or daycare the day following their first treatment for head lice.

For body lice:

• Medications are usually not needed to treat body lice
• Treatment for body lice usually consists of improving hygiene and washing clothes
• Bed sheets and blankets should be washed in hot water and dried in a hot dryer

Skin fungi live in the top layer of skin cells in moist areas of the body, such as between the toes or in the groin and diaper area. Sometimes, the normal balances that keep fungi in check are upset, resulting in an infection.

Some fungal infections cause only a small amount of irritation, while other types penetrate deeper and can cause itching, swelling, blistering or scaling.

In some cases, fungal infections can cause reactions elsewhere on the body. A child can develop a rash on the finger or hand associated with an infection of the scalp or foot, for instance.

What is ringworm (tinea infection) in children?

Ringworm is a type of skin infection caused by a fungus. It looks like a red skin rash that forms a ring around normal-looking skin. There are several types of ringworm.

What causes ringworm in a child?

A ringworm infection is not caused by an actual worm. It is caused by fungi on the skin, hair and nailbeds called dermatophytes. Different types of dermatophytes affect different parts of the body. They cause different types of symptoms.

Which children are at risk for ringworm?

Children may be at risk for ringworm if they:

• Use shared bathrooms or locker rooms
• Play contact sports, such as wrestling
• Live in a warm climate
• Have contact with other children or pets that have ringworm
• Have a weak immune system because of illness or medicines
• Have poor hygiene
• Are malnourished

What are the symptoms of ringworm in a child?

The symptoms of ringworm vary depending on which part of the body is affected. The most common types of ringworm are listed below.

Athlete's foot

This problem mostly affects teenage boys and men. It usually doesn’t affect children before puberty. Things such as sweating, not drying the feet well after swimming or bathing, wearing tight socks and shoes, and warm weather can play a part in this problem. Symptoms may include:

• Whitening of the skin between the toes
• Scaling of the feet
• Itchy rash on the feet
• Blisters on the feet

Jock itch

This problem is also more common in males. It happens more often during warm weather. It is very rare in females. Symptoms of jock itch may include:

• Red, ring-like patches in the groin area
• Itching in the groin area
• Pain in the groin area

It does not usually involve the scrotum.

Scalp ringworm

Scalp ringworm is highly contagious, especially among children. It happens mainly in children between ages 2 and 10. It rarely happens in adults. Symptoms may include:

• Red, scaly rash on the scalp
• Itchy scalp
• Hair loss on the scalp
• Rash elsewhere on the body

Bad cases of ringworm of the scalp can also develop into a kerion. A kerion is a thick, pus-filled area on the scalp. It can also cause a fever. This can be caused by an overly active response of the immune system or an allergic reaction to the fungus. It may cause a rash elsewhere on the body and tender lymph nodes in the neck.

Nail infection

This type of ringworm causes the nails to become thickened and deformed. This problem affects the toenails more often than the fingernails. It happens more often in adolescents and adults rather than young children. Symptoms may include thickening of the ends of the nails and yellowing of the nails.

• Thickening of the ends of the nails
• Yellow color to the nails

Body ringworm

This skin infection is a ring-like rash that appears anywhere on the body or face. It happens in people of all ages, but it is more common in children. It is also more common in warmer climates. The symptoms may include:

• Red, ring-like rash with raised edges
• The middle of the rash may become less red as the lesion grows
• Itching of the affected area

Ringworm may look like many skin problems. Make sure your child sees their health care provider for a diagnosis.

How is ringworm diagnosed?

Ringworm is usually diagnosed based on a health history and physical exam of your child. The ringworm rash is unique. This makes it easy to diagnose with a physical exam. In addition, your child's healthcare provider may order a culture or skin scraping of the rash to confirm the diagnosis.

How is ringworm treated in a child?

Fungi can live indefinitely on the skin, so ringworm is likely to come back. Treatment may need to be repeated. Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment for scalp ringworm may include:

• Antifungal medicine taken by mouth for four to eight weeks. Some children may need longer treatment.
• Special shampoo to help get rid of the fungus. Shampoos can't replace the oral medicine, but you can use shampoo in addition to them.

If your child has a kerion or a secondary sore (abscess) or bacterial infection, the healthcare provider may order additional medicines to help reduce the swelling. These may include steroids.

Treatment for ringworm of the body, groin and foot is usually an antifungal cream or pill to take by mouth. The length of the treatment depends on the location of the ringworm.

Ringworm of the nails can be difficult to cure. It is usually treated with antifungal medicine taken by mouth.

Good handwashing is critical to managing ringworm. Scrub your hands for at least 20 seconds before and after treating your child's ringworm. Teach your child how and when to wash their hands as well.

If the ringworm is from an animal, it will need treatment too.

What are possible complications of ringworm in a child?

Ringworm rarely has serious complications. 

What can I do to prevent ringworm in my child?

Ringworm can be prevented by:

• Having good hygiene
• Frequent handwashing
• Not wearing other people's hats or clothing
• Keeping feet dry
• Staying away from someone who has ringworm

When should I call my child's health care provider?

Most types of ringworm can be treated with over-the-counter medicines. But ringworm of the scalp and nails requires taking an antifungal medicine by mouth. This medicine must be prescribed by your health care provider. If you are unsure if your child has ringworm or if your child has a weakened immune system, call your child's health care provider.

What is tinea versicolor?

Tinea versicolor is a common fungal skin infection characterized by lighter or darker patches on the chest or back. This infection, which prevents the skin from tanning evenly, occurs most often in adolescence and early adulthood.

What are the symptoms of tinea versicolor?

Typically the only symptom of tinea versicolor is white or light brown patches. The patches may scale slightly, but they rarely itch or hurt. Other common characteristics of the infection include:

• White, pink, or brown patches
• Infection only on the top layers of the skin
• Rash on the trunk
• No rash on the face
• Patches worsen in the heat or humidity
• Patches worsen if the child is on steroid therapy or has a weakened immune system
• Patches are most noticeable in the summer

The symptoms of tinea versicolor may resemble other skin conditions. Always consult a physician for diagnosis.

How is tinea versicolor diagnosed?

Tinea versicolor is usually diagnosed based on a medical history and physical examination of the child. The patches are unique, and usually a diagnosis can be made on physical examination. The physician may also use an ultraviolet light to see the patches more clearly or take skin scrapings of the lesions to confirm the diagnosis.

What is the treatment for tinea versicolor?

Treatment usually includes the use of dandruff shampoo on the skin as prescribed by the physician. The shampoo is left on the skin overnight and washed off in the morning, and may be required for several nights.

Tinea versicolor usually recurs, requiring additional treatments, and sometimes improves temporarily. The physician may prescribe topical creams, oral antifungal medications, or monthly shampoo treatments.

This infection can also cause a change in skin color, which can take several months to return to normal.

Many childhood viral infections are called viral exanthems. Exanthem means rash or skin eruption. Childhood viral exanthems include the following:

• Measles or rubeola
• Rubella
• Varicella (or chickenpox)
• Fifth disease
• Roseola

Three main groups of viruses cause the majority of viral skin infections, including the following:

• Human papillomavirus
• Herpes simplex virus
• Poxvirus

What is herpes zoster (shingles)?

Herpes zoster, or shingles, is a reactivation of the varicella-zoster virus (chickenpox). The virus causes a painful rash of small blisters on a strip of skin anywhere on the body. On some occasions, the pain may continue for a prolonged period of time even after the rash is gone.

After a person has had chickenpox, the virus lies dormant in the nerves. If the virus reactivates, however, it causes shingles. Herpes zoster is more common in people with depressed immune systems or over the age of 50. It is very rare in children, and the symptoms are mild compared to what an adult may experience.

Children who have weakened immune systems may experience the same, or more severe, symptoms as adults, however.

What are the symptoms of herpes zoster?

Herpes zoster most often occurs on the trunk and buttocks, but can also appear on the arms, legs or face. Each child may experience the symptoms differently. The most common symptoms may include:

• Skin hypersensitivity in the area where the herpes zoster appears
• Mild rash, which appears after five days and first looks like small, red spots that turn into blisters
• Blisters that turn yellow and dry
• Rash which usually goes away in one to two weeks
• Rash localized to one side of the body

The symptoms of herpes zoster may resemble other skin conditions. Always consult a physician for a diagnosis.

How is herpes zoster diagnosed?

Diagnosis usually involves obtaining a medical history of the child and performing a physical examination. Diagnosis may also include:

• Skin scrapings (gently scraping the blisters to determine if the virus is shingles)
• Blood tests

What is the treatment for herpes zoster?

Specific treatment for herpes zoster will be determined by a physician based on:

• The child's age, overall health, and medical history
• Extent of the condition
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Child or parent’s opinion or preference

Medication may help alleviate some of the pain, but the condition has to run its course. Immediate treatment with antiviral drugs may help lessen some of the symptoms. Use of medication will be determined by a physician based on the age of the child and the severity of the symptoms.

What is pityriasis rosea?

Pityriasis rosea is a mild, common rash. It causes the skin to be scaly, pink and inflamed. The rash can last from one to three months and often leaves no lasting marks. This rash is not thought to be contagious.

What causes pityriasis rosea?

Experts don’t know what causes pityriasis rosea. It is believed to be caused by a virus. It is usually seen in children, teens, and young adults. Some children may have a cold before the rash. The rash is more common in spring and fall.

What are the symptoms of pityriasis rosea?

The rash often starts with a large pink or tan oval area on the chest, stomach, or back. This patch (herald patch) is often followed by smaller pink or tan patches elsewhere on the body. They often show up on the back, neck, arms, and legs. The scaly rash often begins to heal on its own in 4 to 6 weeks and will go away by 14 weeks.

Below are other common symptoms of pityriasis rosea. But each child may experience symptoms differently. Symptoms may include:

• Severe tiredness (fatigue)
• Aches
• Itching

The symptoms of pityriasis rosea may look like other skin conditions or health problems. Always talk with your child’s health care provider for a diagnosis.

How is pityriasis rosea diagnosed in a child?

The rash is fairly unique. Pityriasis rosea is often diagnosed based on a health history and physical exam of your child. Your child may also need blood tests to rule out other conditions that might look like pityriasis rosea.

What is the treatment for pityriasis rosea?

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

The goal of treatment for pityriasis rosea is to ease symptoms such as itching. The rash will go away on its own. Treatment will be decided by your child’s healthcare provider based on how bad the rash is. Treatment may include:

• Medicated lotions and creams
• Medicines taken by mouth
• Cool baths with or without oatmeal
• Ultraviolet exposure
• Cool compresses

When should I call my child’s health care provider?

• Your child becomes very sick.
• The rash doesn't get better or gets worse.
• Itching or other symptoms cause your child a lot of discomfort.
  Your child gets a secondary bacterial infection from scratching the rash.

What are warts?

Warts are non-cancerous skin growths caused by the papillomavirus. Warts are more common in children than adults, although they can develop at any age.

Warts are contagious, and can spread to other parts of the body or to other people. There are many different types of warts, due to the fact that there are more than 60 types of the papillomavirus. Warts are typically not painful, except when located on the feet, and most warts go away without treatment over an extended period of time.

What are the common types of warts?

The more common types of warts include the following:

• Common warts are growths around nails and the back of hands; usually have a rough surface; grayish-yellow or brown in color.
• Foot warts are located on the soles of feet (plantar warts) with black dots (clotted blood vessels that once fed them); clusters of plantar warts are called mosaic. These warts may be painful.
• Flat warts are small, smooth growths that grow in groups up to 100 at a time; most often appear on children's faces.
• Genital warts grow on the genitals, are occasionally sexually transmitted; are soft and do not have a rough surface like other common warts.
• Filiform warts are small, long, narrow growths that usually appear on eyelids, face or neck.

What is the treatment for warts?

The specific treatment for warts will be determined by a physician based on:

• The child's age, overall health and medical history
• Extent of the growths
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the growths
• Child or parent’s opinion or preference

Warts in children often disappear without treatment. Treatment of warts depends on several factors, including:

• Length of time on the skin
• Location
• Type
• Severity

Treatment for more stubborn or recurring warts may include:

• Application of salicylic and lactic acid (which softens the infected area)
• Freezing with liquid nitrogen
• Electrodesiccation (using an electrical current to destroy the wart)
• Immunotherapy
• Laser surgery

What is molluscum contagiosum?

Molluscum contagiosum is a viral disease of the skin that causes small pink- or skin-colored bumps on the skin of your child. It is not harmful and usually does not have any other symptoms. The virus lives inside the bumps and is mildly contagious. The bumps usually clear up without treatment over six to nine months.

What causes molluscum contagiosum?

Molluscum contagiosum is caused by a virus called the poxvirus. It is most common in children and adolescents, although it can also affect adults.

What are the symptoms of molluscum contagiosum?

The bumps are small and are usually pink- or skin-colored. Over time, the bumps may develop a small, sunken center. Children usually develop between two and 20 lesions, often in clusters. They are not harmful, but may cause some cosmetic concern for the child if they appear on the face or other visible areas.

How is molluscum contagiosum diagnosed?

Molluscum contagiosum is usually diagnosed based on a medical history and physical examination of the child. The lesions are unique and usually are diagnosed on physical examination.

What is the treatment for molluscum contagiosum?

Specific treatment for molluscum contagiosum will be determined by the physician based on:

• The child's age, overall health, and medical history
• Extent of the condition
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Child or parent’s opinion or preference

In most cases, the lesions will heal without treatment over six to nine months. Additional treatment options may include:

• Removal of the lesions
• Use of topical medications (to speed up healing)

The most common childhood viral exanthems include the following:

• Measles
• Mumps
• Rubella
• Chickenpox

Immunizations have decreased the number of cases of measles, mumps, rubella, and chickenpox, but all viral skin infections require clinical care by a physician or other healthcare professional. Each of the viral exanthems listed here have a distinct pattern, which can aid in the diagnosis.

What is measles in children?

Measles (rubeola) is a respiratory illness caused by a virus. It causes a red, blotchy rash. It is also known as 10-day measles or red measles. It's a very contagious illness.

The measles virus lives in the mucus in the nose and throat. It's spread from one child to another through contact with fluid from the nose and throat. It is also spread by an infected child coughing and sneezing.

What causes measles in a child?

Measles is caused by a virus. It is mostly seen in the winter and spring.  

Which children are at risk for measles?

Children are more at risk for measles if they have not had the measles vaccine and are in contact with anyone who has measles. A person is contagious about four days before the rash breaks out, so a child may have contact with the virus without knowing it.  

What are the symptoms of measles in a child?

It may take seven to 14 days for a child to develop symptoms of measles after contact with the virus. A child is contagious about four days before the rash breaks out and four days after the rash develops. A child may pass the virus to others before you know they have it.

The early phase of the illness lasts between one and four days. Symptoms are like those of an upper respiratory infection. The most common symptoms include:

• Runny nose
• Hacking cough
• Pink eye (conjunctivitis) 
• Fever

After two or three days of the above, other symptoms include:

• Severe diarrhea 
• Small spots with white centers (Koplik spots) on the inside of the cheek
• Deep, red, flat rash that starts on the face and spreads down to the torso, arms, legs and feet

The red rash starts as small lesions that combine into one big rash. After three to seven days, the rash will start to go away. It will fade in the same order it appeared. It then leaves a brown-colored area and peeling skin.

The symptoms of measles can be like other health conditions. Make sure your child sees their health care provider for a diagnosis.

How is measles diagnosed in a child?

The health care provider will ask about your child's symptoms and health history. They may also ask about your family's health history. They will give your child a physical exam. The physical exam will include looking at the rash. The measles rash is different from other rashes. Your child may also have tests such as blood or urine tests to confirm the diagnosis.

How is measles treated in a child?

Treatment will depend on your child's symptoms, age and general health. It will also depend on how severe the condition is. Antibiotics are not used to treat this illness.

The goal of treatment is to help ease symptoms. Treatment may include:

• Making sure your child drinks more fluids
• Giving acetaminophen or ibuprofen for fever and discomfort

Your child's health care provider may tell you to give your child vitamin A in two doses to help prevent eye damage and blindness. If your child is younger than 1 year old or admitted to the hospital with respiratory problems, your child's health care provider may recommend an antiviral treatment called ribavirin.

Talk with your health care providers about the risks, benefits and possible side effects of all medicines. Don't give ibuprofen to a child younger than 6 months old unless your health care provider tells you to. Don't give aspirin to children. Aspirin can cause a serious health condition called Reye syndrome.

If your child was exposed and has not had a measles vaccine, your child's health care provider may give the MMR vaccine within 72 hours. Or the provider may give immune globulin (IG) within six days of measles exposure. These are to help prevent the disease.

Talk with your child's health care provider about the risks, benefits and possible side effects of all medicines.

What are possible complications of measles in a child?

The most serious complications from measles include:

• Ear infection
• Lung infection (pneumonia)
• Croup
• Inflammation of the brain (encephalitis)
• Blindness

How can I help prevent measles in my child?

The measles vaccine is usually given as part of a combination vaccine with mumps and rubella. It's called the MMR vaccine. The MMR vaccine is very safe and works well. It's given in two doses. The first dose is given between ages 12 months to 15 months. A second dose is given between ages 4 and 6 years. The second dose needs to be given at least four weeks after the first dose. During an outbreak, your child may need another booster shot.

Other ways to prevent the spread of measles include:

• Keeping children home from school or daycare for four days after the rash appears
• Checking that all of your child's friends and caregivers have been vaccinated

When should I call my child's health care provider?

Call the health care provider if your child has:

• Symptoms that don't get better or get worse
• New symptoms

What is rubella (German measles)?

Rubella is a viral illness that causes a rash on the skin. It is spread from one child to another through direct contact with discharge from the nose and throat.

Warning

Pregnant women who have been exposed to rubella need to seek medical attention immediately.

Infants and children who develop the disease usually only have a mild case of the rash and side effects. However, children who contract rubella from their mother while she is pregnant can have severe birth defects and consequences. It is also very dangerous for pregnant women to come in contact with someone who has rubella, because it can cause a miscarriage.

What causes rubella?

Rubella is caused by a virus called a Rubivirus. It can be spread from a pregnant mother to the unborn child, or from secretions from another infected person. It is most prevalent in late winter and early spring. Rubella is preventable by proper immunization.

The rubella vaccine is usually given in combination with the measles and mumps vaccine. It is called the MMR vaccine and is usually administered when the child is 12 to 15 months old, and then again between 4 and 6 years of age.

What are the symptoms of rubella?

The disease itself does not have any long-term consequences. The biggest concern is to prevent an infected child from infecting a pregnant woman. Take note of the following facts:

• It can take between 14 to 21 days for a child to develop signs of rubella after coming in contact with the disease
• Children are most contagious when the rash is erupting
• A child can be contagious beginning 7 days before the onset of the rash and 14 days after the rash has appeared
• Children may be contagious before they even know they have rubella.

The following are the most common symptoms of rubella. However, each child may experience symptoms differently.

Childhood rubella

• Rubella may begin with a period of not feeling well, a low-grade fever and diarrhea. This may last one to five days.
• The rash then appears as a pink rash with areas of small, raised lesions.
• The rash begins on the face and then spreads down to the trunk, arms and legs.
• The rash on the face usually improves as the rash spreads to the arms and legs.
• The rash usually fades by the third to fifth day.
• Lymph nodes in the neck may also become enlarged.
• Older children and adolescents may develop some soreness and inflammation in their joints.

Congenital rubella

Rubella that is present at birth where the child contracted it from the mother while in utero, can result in many problems, including the following:

• Cataracts in the eyes
• Heart problems
• Mental retardation
• Growth retardation
• Enlarged liver and spleen
• Skin lesions
• Bleeding problems

The symptoms of rubella may resemble other skin conditions or medical problems. Always consult a physician for the proper diagnosis.

How is rubella diagnosed?

Rubella is usually diagnosed based on a medical history and physical examination of the child. The lesions of rubella are unique, and usually the diagnosis can be made on physical examination. In addition, the child's physician may order blood or urine tests to confirm the diagnosis.

What is the treatment for rubella?

Specific treatment for rubella will be determined based on:

• The child's age, overall health and medical history
• Extent of the disease
• The child's tolerance for specific medications, procedures or therapies
• Expectations for the course of the disease
• Child or parent’s opinion or preference

Since it is a viral infection, there is no cure for rubella. The goal of treatment for rubella is to help prevent the disease, or decrease the severity of the symptoms. Treatment may include increased fluid intake or rest.

Other ways to prevent the spread of rubella:

• Children should not attend school for seven days after the onset of the rash.
• Children who are born with rubella are considered contagious for the first year of life.
• Check that a child's contacts have been properly immunized.

What is roseola?

Roseola is a contagious viral illness that is marked by a high fever and a rash that develops as the fever decreases.

What causes roseola?

Roseola is likely caused by more than one virus, but the most common cause is the human herpesvirus 6 (HHV-6). Roseola occurs mostly in children under the age of 3, and occurs more often in the spring and fall.

What are the symptoms of roseola?

It can take between five and 15 days for a child to develop symptoms of roseola after being exposed to the disease. Children are most contagious during the period of high fever, before the rash occurs.

The following are the most common symptoms of roseola. However, each child may experience symptoms differently.

• High fever that starts abruptly
• Fever (may last three to four days)
• Irritability
• Swelling of the eyelids
• Rash (as the fever decreases, a pink rash, with either flat or raised lesions, starts to appear on the trunk and then spreads to the face, arms, and legs.)

What are the complications of roseola?

The most serious complication of roseola is febrile seizures. As the child's temperature rises, there is a chance that the child will have a seizure.

The symptoms of roseola may resemble other skin conditions or medical problems. Always consult a physician for the proper diagnosis.

How is roseola diagnosed?

Roseola is usually diagnosed based on a medical history and physical examination of your child. The rash of roseola that follows a high fever is unique, and often the diagnosis is made simply on physical examination.

What is the treatment for roseola?

The specific treatment for roseola will be determined based on:

• The child's age, overall health, and medical history
• Extent of the disease
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Child or parent’s opinion or preference

Since it is a viral infection, there is no cure for roseola. The goal of treatment for roseola is to help decrease the severity of the symptoms. Treatment may include increased fluid intake or acetaminophen for fever (DO NOT GIVE ASPIRIN).

What is fifth disease in children?

Fifth disease is a viral illness that causes a rash (exanthem). Fifth disease is also called erythema infectiosum. And it's known as "slapped cheek" disease. This is because the rash can cause a child's cheeks to become very red. Fifth disease is spread from one child to another through direct contact with fluid from the nose and throat. It can also be spread through contact with infected blood. It is somewhat contagious.

What causes fifth disease in children?

Fifth disease is caused by human parvovirus B19. It occurs most often in the winter and spring.

Which children are at risk for fifth disease?

It is most common in young, school-age children. Children often get it at school or other places where children gather. Adults can get fifth disease, too, but most infections are in children. 

What are the symptoms of fifth disease in a child?

Symptoms usually show up 4 to 14 days after a child is exposed to the disease. About 4 in 5 infected children have very mild symptoms for about a week before getting the rash. About 1 in 5 will have no symptoms at all before the rash appears. Children are most contagious before the rash occurs, before they know they have the disease.

Early symptoms are usually very mild. These may include:

• Low fever
• Headache
• Runny nose
• Sore throat
• Itching
• Nausea or vomiting
• Diarrhea

A rash is usually the main symptom of fifth disease. The rash:

• Starts on the cheeks and is bright red
• Spreads to the trunk, arms, and legs, and lasts 2 to 4 days. It often has a "lacey" appearance. 
• May come back when the child is exposed to sunlight, heat or cold, or injury to the skin. This may continue for several days.

The symptoms of fifth disease can be like other health conditions. Make sure your child sees their health care provider for a diagnosis.

How is fifth disease diagnosed in a child?

The health care provider will ask about your child's symptoms and health history. They will give your child a physical exam. The physical exam will include inspecting the rash. The rash is unique to fifth disease and may be enough to diagnose your child. In some cases, your child may also have blood tests.

How is fifth disease treated in a child?

Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is. The illness is caused by a virus. Antibiotics won't help your child.

The goal of treatment is to help ease symptoms. Treatment may include:

• Having your child drink plenty of fluids
• Giving acetaminophen or ibuprofen for fever and discomfort
• Giving an antihistamine medicine for itching 

Talk with your child's health care providers about the risks, benefits and possible side effects of all medicines. Don't give ibuprofen to a child younger than 6 months old unless your health care provider tells you to. Don't give aspirin to children. Aspirin can cause a serious health condition called Reye syndrome.

What are possible complications of fifth disease in a child?

Fifth disease is usually a mild illness. In some cases, it may cause acute severe anemia in a child with sickle cell disease or a weak immune system. In a pregnant woman with fifth disease, there is a small risk of death of the baby in the womb.

How can I help prevent fifth disease in my child?

The best ways to keep fifth disease from spreading include:

• Washing hands well with soap and warm water
• Covering the mouth and nose when coughing or sneezing

When should I call my child's health care provider?

Call the health care provider if your child has:

• Symptoms that don't get better, or get worse
• New symptoms

What is chickenpox?

Chickenpox is a highly infectious disease, usually associated with childhood. By adulthood, more than 95% of Americans have had chickenpox.

The disease is caused by the varicella-zoster virus (VZV), a form of the herpes virus. Transmission occurs from person-to-person by direct contact or through the air.

Chickenpox most commonly occurs in children between the ages of 5 and 9. In the US, in areas with a large number of children in daycare settings, chicken pox in children between the ages of 1 and 4 is common.

What is the chickenpox vaccine?

Since 1995, a chickenpox vaccine has been available for children 12 months of age and older. Adolescents and adults who have never had chickenpox can also get the vaccine. The vaccine has proven very effective in preventing severe chickenpox.

The Center for Disease Control & Prevention’s Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians recommend that all children be vaccinated with the chickenpox vaccine between 12 and 18 months of age.

A booster vaccination is recommended again between 11 and 12 years of age. Many schools now require vaccination prior to entry into preschool or public schools.

What are the symptoms of chickenpox?

Symptoms are usually mild among children, but may be life threatening to infants, adults and people with impaired immune systems.

The following are the most common symptoms of chickenpox. However, each child may experience symptoms differently. Symptoms may include:

• Fatigue and irritability one to two days before the rash begins
• Itchy rash on the trunk, face, under the armpits, on the upper arms and legs, and inside the mouth
• Fever
• Feeling ill
• Decreased appetite
• Muscle and/or joint pain
• Cough or runny nose

The symptoms of chickenpox may resemble other skin problems or medical conditions. Always consult a physician for a diagnosis.

How is chickenpox spread?

Once infected, chickenpox may take 10 to 21 days to develop. Chickenpox is contagious for one to two days before the appearance of the rash and until the blisters have dried and become scabs, which usually happens within four to five days of the onset of the rash.

Children should stay home and away from other children until all of the blisters have scabbed over. Family members who have never had chickenpox have a 90 percent chance of becoming infected when another family member in the household is infected.

How is chickenpox diagnosed?

Chickenpox is usually diagnosed based on a complete medical history and physical examination of the child. The rash of chickenpox is unique, and usually a diagnosis can be made from a physical examination.

What is the treatment for chickenpox?

The specific treatment for chickenpox will be determined based on:

• The child's age, overall health, and medical history extent of the condition
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition child or parent’s opinion or preference

The treatment for chickenpox may include:

• Acetaminophen for fever (DO NOT GIVE ASPIRIN)
• Antibiotics for treating bacterial infections
• Calamine lotion (to relieve itching)
• Antiviral drugs (for severe cases)
• Rest
• Increased fluid intake (to prevent dehydration)
• Cool baths with baking soda or Aveeno (to relieve itching)

Children should not scratch the blisters, as this can lead to secondary bacterial infections. Keep the child's fingernails short to decrease the likelihood of scratching.

What is immunity from chickenpox?

Most individuals who have had chickenpox will be immune to the disease for the rest of their lives. However, the virus remains dormant in nerve tissue and may reactivate, resulting in herpes zoster (shingles) later in life.

Occasionally a secondary case of chickenpox does occur. Blood tests can confirm immunity to chickenpox in people who are unsure if they have had the disease.

What complications are commonly associated with chickenpox?

Complications can occur from chickenpox. Those most susceptible to severe cases of chickenpox are infants, adults, pregnant women (unborn babies may be infected if the mother has not had chickenpox prior to pregnancy), and people with impaired immune systems. Complications may include:

• Secondary bacterial infections
• Pneumonia
• Encephalitis (inflammation of the brain)
• Cerebellar ataxia (defective muscular coordination)
• Transverse myelitis (inflammation along the spinal cord)
• Reye syndrome (a serious condition which may affect all major systems or organs)
• Death

Skin parasites are small insects or worms that burrow into the skin to live there or lay their eggs.

There are many types of parasitic skin infections that require clinical care by a physician or other health care professional.

What is scabies?

Scabies is an infestation of mites (tiny insects) characterized by small red bumps and intense itching. This highly contagious infection often spreads from person to person while they are sleeping together in the same bed or have close personal contact.

The itching is caused by the mites burrowing into the skin where they lay eggs that hatch a few days later. Scabies can affect people of all ages. Scabies occurs mostly in children and young adults.

What are the symptoms of scabies?

It may take between 4 to 6 weeks for a child to develop symptoms of scabies after coming in contact with an infected person.

In children younger than 2 years of age, the lesions caused by the mites tend to occur on the head, neck, palms, and soles. In older children, the lesions are usually between the fingers, on the hands or wrists, along the belt line, on the thighs or belly button, in the groin area, around the breasts, and in the armpits.

The following are the most common symptoms of scabies. However, each child may experience symptoms differently. Symptoms may include:

• Itching, usually severe
• Rash, with small pimples or red bumps
• Scaly or crusty skin (with advanced conditions)

How is scabies diagnosed?

In diagnosing scabies, the skin and skin crevices are examined by a physician. A sample of skin, obtained by scraping the skin, may be examined under a microscope to confirm the presence of mites.

What is the treatment for scabies?

Scabies is treatable and usually all members in a family are treated at the same time. Specific treatment will be determined based on:

• The child's age, overall health, and medical history
• Extent of the infestation
• The child's tolerance for specific medications, procedures or therapies
• Expectations for the course of the infestation
• Child or parent’s opinion or preference

Treatment may include:

• Applications of prescription creams and lotions, such as permethrin and lindane solutions
• Oral antihistamine medication (to help relieve itching)
• In some cases, topical ointments are recommended

In addition, it is important to wash all clothes and bedding in hot water and dry in a hot dryer in order to kill the mites. Clothing and other objects that cannot be washed (i.e., pillows, stuffed animals) should be placed in a plastic bag for at least one week.

Also, the itching may continue for many weeks after the initial treatment of the scabies.

What are lice?

Lice are tiny insects that can infest the skin anywhere on the body. Lice infection is characterized by intense itching.

Lice are highly contagious, spreading from person to person by close body contact, shared clothes, and other items (such as hats, hairbrushes, and combs). There are three types of human lice:

Head lice

• Head lice are seen mostly in child-care settings and among school-aged children
• The child usually has itching in the head area
• Lice, or the eggs (called nits), can usually be seen on the hair, behind the ears, and on the neck

Body lice

• Body lice are usually seen in people with poor hygiene
• Body lice are rare in children
• Body lice cause severe itching, which is often worse at night
• In some cases, lice and eggs can be found in the seams of clothes

Pubic lice

• Pubic lice are very contagious and can be transmitted through sexual contact or by contaminated items such as towels and clothes
• Pubic lice can affect the pubic hair, but also can cause infections of the hair on the chest, abdomen, thighs and eyebrows
• Itching of the affected area is a common symptom of pubic lice

How are lice diagnosed?

The eggs laid by lice are usually visible to the naked eye, making it easy for a child's physician to diagnose. Pubic lice leave small brown spots on the parts of clothing that come into contact with the genitals or anus.

What is the treatment for lice?

The specific treatment for lice will be determined based on:

• The child's age, overall health and medical history
• Extent of the infestation
• The child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the infestation
• Child or parent’s opinion or preference

Lice are very treatable. Treatment may include:

For head lice and pubic lice:

Application of a medicated cream rinse or shampoo is usually an effective treatment for head and/or pubic lice. The specific instructions need to be followed. Examples of medicated cream rinses or shampoos include the following:

• Permethrin or Nix® cream rinse
• Lindane
• Kwell® shampoo
• Pyrethrins or RID® gel
• Nits need to be removed from the hair with a fine-tooth comb.

Combs and brushes should be soaked in hot water with the shampoo for at least 15 minutes.

Children can return to school or daycare the day following their first treatment for head lice.

For body lice:

• Medications are usually not needed to treat body lice
• Treatment for body lice usually consists of improving hygiene and washing clothes
• Bed sheets and blankets should be washed in hot water and dried in a hot dryer