Skin Infections & Rashes

Impetigo (im-peh-TY-go) is one of the most common skin infections among kids. It often affects preschool and school-age children, causing blisters or sores on the face, neck, hands, and diaper area.

Kids can be more likely to develop the infection when the skin is already irritated by another problem, such as eczema, poison ivy, insect bites, and cuts or scrapes. Scratching a sore or a rash is a common cause — for example, poison ivy can get infected and turn into impetigo. Making sure that kids wash their hands and faces well can help prevent it.

Impetigo is contagious, so can spread from one person to another. It’s usually caused by one of two bacteria: Staphylococcus aureus or Streptococcus pyogenes (also called group A streptococcus, which also causes strep throat). Methicillin-resistant Staphylococcus aureus (MRSA) is also becoming an important cause of impetigo.

In most cases, doctors can diagnose impetigo based on how the rash looks. Occasionally, they may need to take a sample of fluid from blisters. Impetigo is typically treated with antibiotics, either as an ointment or a medicine taken by mouth.

Signs and Symptoms

Impetigo may affect skin anywhere on the body, but is most common around the nose and mouth, hands, and forearms, and in young children, the diaper area.

The two types of impetigo are non-bullous (crusted) and bullous (large blisters):

1. Non-bullous or crusted impetigo is most common. It’s usually caused by S. aureus but also can be due to infection with S. pyogenes. Non-bullous begins as tiny blisters that eventually burst and leave small wet patches of red skin that may weep fluid. Gradually, a yellowish-brown or tan crust covers the affected area, making it look like it has been coated with honey or brown sugar.
2. Bullous impetigo is nearly always caused by S. aureus, which releases toxins that trigger the formation of larger fluid-containing blisters that appear clear, then cloudy. These blisters are more likely to stay longer on the skin without bursting.

Contagiousness

Because impetigo is contagious, it can spread to anyone who touches infected skin or items that have been touched by infected skin (such as clothing, towels, and bed linens). It can be itchy, so kids also can spread the infection when they scratch it and then touch other parts of their body.

Treatment

When it just affects a small area of the skin (and especially if it’s the non-bullous form), impetigo is treated with antibiotic ointment. But if the infection has spread to other areas of the body or the ointment isn’t working, the doctor may prescribe an antibiotic pill or liquid to be taken for 7–10 days.

Once antibiotic treatment begins, healing should start within a few days. It’s important to make sure that your child takes the medicine as prescribed. Otherwise, a deeper and more serious skin infection could develop.

While the infection is healing, gently wash the skin with clean gauze and antiseptic soap every day. Soak any areas of crusted skin with warm soapy water to help remove the layers of crust (it is not necessary to completely remove all of it).

To keep your child from spreading impetigo to other parts of the body, the doctor or nurse will probably recommend covering infected areas with gauze and tape or a loose plastic bandage. Keep your child’s fingernails short and clean to prevent scratching that could lead to infection.

Prevention

Keeping skin clean can help prevent impetigo. Kids should wash their hands well and often and take baths or showers regularly. Pay special attention to skin injuries (cuts, scrapes, bug bites, etc.), areas of eczema, and rashes such as poison ivy. Keep these areas clean and covered.

Anyone in your family with impetigo should keep their fingernails cut short and the impetigo sores covered with gauze and tape.

Prevent impetigo infection from spreading among family members by making sure everyone uses their own clothing, sheets, razors, soaps, and towels. Separate the infected person’s bed linens, towels, and clothing, and wash these items in hot water. Keep the surfaces of your kitchen and household clean.

When to Call the Doctor

Call the doctor if your child has signs of impetigo, especially if he or she has been exposed to a family member or classmate with the infection.

If your child is already being treated for impetigo, keep an eye on the sores and call the doctor if the skin doesn’t begin to heal after 3 days of treatment or if a fever develops. If the area around the rash becomes red, warm, or tender to the touch, call the doctor right away.

Caring for pets is a great learning experience for kids, teaching them responsibility, gentleness, and respect for other living beings. Like adults, kids can benefit from the companionship, affection, and relationships they share with their pets.

But animals and pets can spread infections to humans, especially kids. So if you’re thinking about buying a pet, or already have one, it’s important to know how to protect your family from infections.

How Pets Spread Infections

Like people, all animals carry germs. Illnesses common among housepets — such as distemper, canine parvovirus, and heartworms — can’t spread to humans.

But pets also carry certain bacteria, viruses, parasites, and fungi that can cause illness if transmitted to humans. Humans get these animal-borne diseases when they’re bitten or scratched or have contact with an animal’s waste, saliva, or dander.

These diseases can affect humans in many ways. They’re of greatest concern to young children, infants, pregnant women, and people whose immune systems have been compromised by illness or disease. Infants and kids younger than 5 years old are at risk because their immune systems are still developing, and some infections that might make an adult just mildly sick can be more serious for them.

Healthy Family, Healthy Pets

But you don’t have to give up your family’s furry friends either. Pets can enrich your family life, and taking a few precautions can protect your kids from getting sick.

Protecting your family from pet-related infections begins before bringing a pet home. For instance, reptiles and amphibians should not be allowed as pets in any household with infants and young children.

Also consider the health and age of your kids before getting a pet. A pet that would require frequent handling is not recommended for any immunocompromised child (such as a child who has HIV, has cancer and is undergoing chemotherapy, or uses prednisone frequently). Kids with eczema should probably avoid aquariums.

Dogs and Cats

Dogs and cats are popular pets but can carry infections such as:

• Campylobacter infection: can be spread by household pets carrying Campylobacter jejuni bacteria, which cause diarrhea, abdominal pain, and fever in people. The bacteria may be in the intestinal tract of infected dogs, cats, hamsters, birds, and certain farm animals. A person can become infected through contact with contaminated water, feces, undercooked meat, or unpasteurized milk.

  More than 2 million cases of campylobacter infection happen each year in the United States, and C. jejuni is now the leading cause of bacterial gastroenteritis. These infections are contagious, especially among members of the same family and kids in childcare or preschools. Infection is treated with antibiotics.

• Cat scratch disease: can happen when a person is bitten or scratched by a cat infected with Bartonella henselae bacteria. Symptoms include swollen and tender lymph nodes, fever, headaches, and tiredness, which usually ease without treatment. However, a doctor may prescribe antibiotics if the infection is severe. Cat scratch disease rarely causes long-term complications.
• Rabies: a serious illness caused by a virus that enters the body through a bite or wound contaminated by the saliva from an infected animal. Animals that may carry the rabies virus include dogs, cats, raccoons, bats, skunks, and foxes. Widespread immunization of dogs and cats has decreased the transmission of rabies in these animals and in people. Human rabies is rare in the United States, and a vaccine is available for treatment following a bite from a potentially rabid animal.
• Rocky Mountain spotted fever (RMSF): spread by ticks infected by the Rickettsia ricketsii bacteria. These ticks are frequently carried by dogs. Symptoms include high fever, chills, muscle aches, and headaches, and a rash that may spread across the wrists, ankles, palms, soles, and trunk of the body. RMSF, which can be treated with antibiotics, is most common in the south central and the mid-south Atlantic regions of the United States.
• Ringworm: also called tinea; a skin infection caused by several types of fungi found in the soil and on the skin of humans and pets. Kids can get ringworm from touching infected animals such as dogs and cats. Ringworm of the skin, or tinea corporis, usually is a dry, scaly round area with a raised red bumpy border and a clear center. When the scalp is affected, the area may be flaky, red, or swollen. Often there are bald patches. Ringworm is treated with antifungal medicines including shampoo, cream, or oral medicine.
• Toxocariasis: an illness caused by the parasitic roundworm Toxocara, which lives in the intestines of dogs and cats. The eggs from the worms are passed in the feces of dogs and cats, often contaminating soil where kids play. When a child ingests the contaminated soil, the eggs hatch in the intestine and the larvae spread to other organs, an infection known as visceral larva migrans. Symptoms include fever, cough or wheezing, enlarged liver, rash, or swollen lymph nodes. Symptoms may clear up on their own or a doctor may prescribe drugs to kill the larvae. When the larvae in the intestine make their way through the bloodstream to the eye, it is known as ocular toxocariasis, or ocular larva migrans, which may lead to a permanent loss of vision.
• Toxoplasmosis: contracted after contact with a parasite found in cat feces. In most healthy people, toxoplasma infection causes no symptoms. When symptoms do happen, they may include swollen glands, tiredness, muscle pain, fever, sore throat, and a rash. In pregnant women, toxoplasmosis can cause miscarriage, premature births, and severe illness and blindness in newborns. Pregnant women should avoid contact with litter boxes. People whose immune systems have been weakened by illnesses such as HIV or cancer are at risk for severe complications from toxoplasmosis infection.
• Dog and cat bites: may become infected and cause serious problems, particularly bites to the face and hands. Cat bites tend to be worse, partly because they are deeper puncture wounds. Significant bites should be washed out thoroughly. Often these bite wounds require treatment in a doctor’s office or emergency room; antibiotics are sometimes necessary.

Birds

Pet birds, even if they are kept in a cage, may transmit these diseases:

• Cryptococcosis: a fungal disease contracted when someone inhales organisms found in bird droppings, especially from pigeons, that can cause pneumonia. People with weakened immune systems from illnesses such as HIV or cancer are at increased risk of contracting this disease and developing serious complications, such as meningitis.
• Psittacosis: also known as parrot fever, a bacterial illness that can happen from contact with infected bird feces or with the dust that builds up in birdcages. Symptoms include coughing, high fever, and headache. It is treated with antibiotics.

Reptiles and Amphibians

Reptiles (including lizards, snakes, and turtles) and amphibians (including frogs, toads, and salamanders) put kids at risk for:

• Salmonellosis: Reptiles and amphibians shed Salmonella in their feces. Touching the reptile’s skin, cage, and other contaminated surfaces can lead to infection. Salmonellosis causes symptoms such as abdominal pain, diarrhea, vomiting, and fever. Young children are at risk for more serious illness, including dehydration, meningitis, and sepsis (blood infection).

Other Animals

Handling and caring for rodents — including hamsters and gerbils — as well as fish can place kids at risk for:

• Lymphocytic choriomeningitis virus (LCMV): People can get LCMV by inhaling particles that come from urine, feces, or saliva from infected rodents, such as mice and hamsters. LCMV infection can cause flu-like symptoms — fever, tiredness, headaches, muscle aches, nausea, and vomiting — and may even lead to meningitis (an inflammation of the membrane that surrounds the brain and spinal cord) and encephalitis (an inflammation of the brain). As with most viruses, there is no specific treatment, but some patients might need to be hospitalized. Like toxoplasmosis, LCM may be passed from an infected pregnant woman to her fetus.
• Mycobacterium marinum: This infection may happen in people exposed to contaminated water in aquariums or pools. Although mycobacterium marinum infections are generally mild and limited to the skin, they can be more severe in people with HIV or weakened immune systems.

Precautions When Adopting or Buying a Pet

If you’re adopting or buying a pet, make sure the breeder, shelter, or store has a good reputation and vaccinates all of its animals. A reputable breeder should belong to a national or local breeding club, such as the American Kennel Club. Contact the Humane Society of the United States or your veterinarian for information about animal shelters in your area.

As soon as you choose a family pet, take it to a local veterinarian for vaccinations and a physical exam. Don’t forget to routinely vaccinate your pet on a schedule recommended by your vet — this will keep your pet healthy and reduce the risk that infections will spread to your kids.

You’ll also want to regularly feed your pet nutritious animal food (ask your vet for suggestions) and provide plenty of fresh water. Avoid feeding your pet raw meat because this can be a source of infection, and do not allow your pet to drink toilet water because infections can be spread through saliva, urine, and feces.

Limit young kids’ contact with outdoor pets that hunt and kill for food because a pet that ingests infected meat may get an infection that can be passed to people.

Safely Caring for Your Pet

Here are some tips to help your family safely care for pets:

• Always wash your hands, especially after touching your pet, handling your pet’s food, or cleaning your pet’s cage, tank, or litter box. Wear gloves when cleaning up after an animal’s waste, and if you have a bird, wear a dust mask over your nose and mouth when cleaning the cage to prevent inhaling urine or fecal particles. Don’t have kids clean cages or litter boxes unless there is supervision or until they know how to do this safely and responsibly (and again, hands should be washed afterward).
• Avoid kissing or touching your pet with your mouth because infections can spread through saliva. Also, don’t share food with your pet.
• Keep your pet’s living area clean and free of waste. If your pet eliminates waste outdoors, pick up waste regularly and don’t allow kids to play in that area.
• Don’t allow pets in areas where food is prepared or handled, and don’t bathe your pet or clean aquariums in the kitchen sink or bathtub. Wash your pet outdoors or talk to your veterinarian about professional pet grooming.
• Avoid strange animals or those that appear sick. Never adopt a wild animal as a pet.

Watch kids carefully around pets. Small children are more likely to catch infections from pets because they crawl around on the floor with the animals, kiss them or share food with them, or put their fingers in the pets’ mouths and then put their dirty fingers in their own mouths. Also, if kids visit a petting zoo, farm, or a friend’s house where there are animals, make sure they know the importance of hand washing.

For your pet’s comfort and for your family’s safety, control flea and tick problems in your pet. Fleas and ticks can carry diseases that may be easily passed to kids. Oral and topical medicines are available for flea and tick control; avoid using flea collars because kids can handle them and become sick from the chemicals they contain. Check your pet regularly for fleas and ticks, as well as bites and scratches that may make them more open to infection. Keep your pet leashed when outdoors and keep it away from animals that look sick or may be unvaccinated.

And, finally, spay or neuter your pet. Spaying and neutering may reduce your pet’s contact with other animals that may be infected, especially if your pet goes outdoors.

Lyme disease is often associated with heavily wooded or grassy areas where mice and deer live. It’s most common in the Northeast, the Pacific Northwest, and the northern Midwest states.

About Lyme Disease

Lyme disease is caused by the bacterium Borrelia burgdorferi, which is found in small animals like mice and deer. Ixodes ticks (also called black-legged or deer ticks) that feed on these animals can then transmit Borrelia burgdorferi to people through tick bites.

Ticks are small and can be hard to see. Immature ticks, or nymphs, are about the size of a poppy seed; adult ticks are about the size of a sesame seed.

It’s important to know and watch for symptoms of Lyme disease because ticks are hard to find and it’s easy to overlook a tick bite — in fact, many people who get Lyme disease don’t remember being bitten. The good news is that most tick bites don’t result in Lyme disease.

Signs and Symptoms

Lyme disease can affect different body systems, such as the nervous system, joints, skin, and heart. Symptoms are often described as happening in three stages (although not everyone experiences all three):

1. A circular rash at the site of the tick bite, typically within 1-2 weeks of infection, often is the first sign of infection. Although a rash is considered typical of Lyme disease, many people never develop one.The rash sometimes has a characteristic “bull’s-eye” appearance, with a central red spot surrounded by clear skin that is ringed by an expanding red rash. It also can appear as an expanding ring of solid redness. It is usually flat and painless, but sometimes can be warm to the touch, itchy, scaly, burning or prickling. The rash may appear and feel very different from one person to the next, and it might be more difficult to see on people with darker skin tones, where it can look like a bruise. It expands over the course of days to weeks, and eventually disappears on its own. Along with the rash, a person may have flu-like symptoms such as fever, fatigue, headache, and muscle aches.
2. Left untreated, symptoms of the initial illness may go away on their own. But in some people, the infection can spread to other parts of the body. Symptoms of this stage of Lyme disease usually appear within several weeks after the tick bite, even in someone who has not developed the initial rash. A person might feel very tired and unwell, or have more areas of rash that aren’t at the site of the bite.

   Lyme disease can affect the heart, leading to an irregular heart rhythm, which can result in dizziness or heart palpitations. It can also spread to the nervous system, causing facial paralysis (Bell’s palsy), or meningitis.

3. The last stage of Lyme disease can occur if the early stages were not detected or appropriately treated. Symptoms of late Lyme disease can appear anytime from weeks to years (average of 6 months) after an infectious tick bite, and in children is almost always in the form of arthritis, with swelling and tenderness particularly in the knee or other large joints.

   Having such a wide range of symptoms can make Lyme disease difficult for doctors to diagnose, although certain blood tests can be done to look for evidence of the body’s reaction to Lyme disease.

When to Call the Doctor

If you think your child could be at risk for Lyme disease or has been bitten by a tick, call your doctor. Although other conditions can cause similar symptoms, it’s always wise to contact your doctor. This is especially true if your child develops a red-ringed rash, flu-like symptoms, joint pain or a swollen joint, or facial paralysis. That way your child can get further evaluation and treatment, if necessary, before the disease progresses too far.

Prevention

There’s no surefire way to avoid getting Lyme disease. But you can minimize your family’s risk.

Be aware of ticks in high-risk areas like shady, moist ground cover or areas with tall grass, brush, shrubs, and low tree branches. Lawns and gardens may harbor ticks, too, especially at the edges of woods and forests and around old stone walls (areas where deer and mice, the primary hosts of the deer tick, thrive).

If you or your kids spend a lot of time outdoors, take precautions:

• Wear enclosed shoes or boots, long-sleeved shirts, and long pants. Tuck pant legs into shoes or boots to prevent ticks from crawling up legs.
• Use an insect repellent containing 10% to 30% DEET (N,N-diethyl-meta-toluamide).
• Wear light-colored clothing to help you see ticks more easily.
• Keep long hair pulled back or tucked in a cap for protection.
• Don’t sit on the ground outside.
• Check for ticks regularly — both indoors and outdoors. Wash clothes and hair after leaving tick-infested areas.

If you use an insect repellent containing DEET, always follow the recommendations on the product’s label and don’t overapply it. Place DEET on shirt collars and sleeves and pant cuffs, and only use it directly on exposed areas of skin. Be sure to wash it off when you go back indoors.

No vaccine for Lyme disease is currently on the market in the United States.

Treatment

Lyme disease is usually treated with a 2- to 4-week course of antibiotics. Cases that are diagnosed quickly and treated with antibiotics almost always have a good outcome. A person should be feeling back to normal within several weeks after beginning treatment.

Contagiousness

Lyme disease is not contagious, so it can’t spread from person to person. But people can get it more than once from ticks that live on deer, in the woods, or travel on pets. So continue to practice caution even if you or your child has already had Lyme disease.

If You Find a Tick

You should know how to remove a tick just in case one lands on you or your child. First, don’t panic. The risk of developing Lyme disease after being bitten by a tick is only about 1% to 2%. On top of that, it takes at least 24 to 48 hours for the tick to transmit the bacteria that cause Lyme disease. (To be safe, though, you’ll want to remove the tick as soon as possible.) This is why a daily tick check is a good idea for people who live in high-risk areas.

If you find a tick:

• Use tweezers to grasp the tick firmly at its head or mouth, next to the skin.
• Pull firmly and steadily on the tick until it lets go of the skin. If part of the tick stays in the skin, don’t worry. It will eventually come out — although you should call your doctor if you notice any irritation in the area or symptoms of Lyme disease.
• Swab the bite site with alcohol.
• Put the tick in a sealed container to preserve it. Then, call your doctor, who might want to see the tick to determine if it’s the type that can carry Lyme disease.

  One note of caution: Don’t use “folk remedies” like petroleum jelly or a lit match to kill and remove a tick. These methods don’t get the tick off skin and might just cause the insect to burrow deeper and release more saliva (which increases the chances of disease transmission).

Tick bites don’t generally hurt — that’s part of the difficulty in knowing whether someone has Lyme disease because pain usually helps to call attention to problems. So be on the lookout for ticks and rashes, and call your doctor if you’re at all concerned.

About Measles

Measles, also called rubeola, is a highly contagious respiratory infection that’s caused by a virus. It causes a total-body skin rash and flu-like symptoms, including a fever, cough, and runny nose. Though rare in the United States, 20 million cases happen worldwide every year.

Since measles is caused by a virus, there is no specific medical treatment for it and the virus has to run its course. But a child who is sick should drink plenty of fluids, get lots of rest, and be kept from spreading the infection to others.

Signs and Symptoms

While measles is probably best known for its full-body rash, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and red eyes. Children who get the disease also may have Koplik’s spots, small red spots with blue-white centers that appear inside the mouth.

The measles rash breaks out 3-5 days after symptoms start, and can coincide with high fevers up to 104°F (40°C). The red or reddish-brown rash usually first shows up as flat red spots on the forehead. It spreads to the rest of the face, then down the neck and torso to the arms, legs, and feet. The fever and rash gradually go away after a few days.

Contagiousness

Measles is highly contagious — 90% of people who haven’t been vaccinated for measles will get it if they are near an infected person. Measles spreads when people breathe in or have direct contact with virus-infected fluid, such as the droplets sprayed into the air when someone with measles sneezes or coughs. A person who is exposed to the virus might not show symptoms until 8-10 days later.

People with measles are contagious (can spread the disease) from 4 days before the rash appears until about 4 days after it does, and are most contagious while they have a fever, runny nose, and cough. Those with weakened immune systems due to other conditions (like HIV and AIDS) may be contagious until they recover from measles.

Recent Outbreaks

Measles is very rare in the United States. Before measles vaccination became available in the 1960s, more than 500,000 cases were reported every year. Back then, about 500 people died of the disease each year, and around 4,000 people a year had encephalitis (swelling of the brain) from the disease.

Due to widespread immunizations, the number of U.S. measles cases declined steadily to a low of 37 people in 2004. From 2000 to 2007, only about 63 cases per year were reported.

But recent years have seen spikes in measles outbreaks, including 131 cases in the first half of 2008 and 644 cases in 2014. Most U.S. outbreaks begin with people who were infected outside of the country, with the disease spreading quickly in areas where too few people have received the vaccine. About 85% of people infected with measles were not immunized or their immunization status was unknown, although they were eligible to receive the vaccine.

The people at highest risk of getting measles during these outbreaks are infants (who aren’t old enough to get the vaccine), pregnant women, and people with poor nutrition or weakened immune systems.

Exposure

During a measles outbreak, an injection of measles antibodies (called immune globulin) can help protect people who haven’t been vaccinated if they come into contact with an infected person (called “exposure”). The injection is most effective if it’s given within 6 days of exposure. These antibodies can either prevent measles or make symptoms less severe.

For women who are not pregnant and people not in one of the other at-risk groups, the measles vaccine may offer some protection if given within 72 hours of measles exposure.

Unvaccinated people who are exposed to measles and show symptoms of the virus should seek medical care. Otherwise, they should stay home and not return to childcare, school, or work until 21 days after they were exposed.

Prevention

The most important thing you can do to protect your kids from measles is to have them vaccinated according to the immunization schedule prescribed by your doctor.

Older kids are usually immunized against measles according to state and school health regulations. For most, measles protection is part of the measles-mumps-rubella vaccine (MMR) or measles-mumps-rubella-varicella vaccine (MMRV) given when they’re 12 to 15 months old and again when they’re 4 to 6 years old.

Infants are generally protected from measles for 6 months after birth due to immunity passed on by their mothers. Measles vaccine usually is not given to infants younger than 12 months old. But if there’s a measles outbreak, or a child will be traveling outside the United States, the vaccine may be given when a child is 6-11 months old, followed by the usual MMR immunization at 12-15 months and 4-6 years of age.

The measles vaccine sometimes causes side effects in kids who don’t have underlying health problems. The most common reactions are fever 6-12 days after vaccination (in about 15% of kids vaccinated) and a measles-like rash, which isn’t contagious and fades on its own (in about 5% of vaccinated kids).

As with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information about vaccine recommendations.

The measles vaccine should not be given to these at-risk groups:

• pregnant women
• kids with untreated tuberculosis, leukemia, or other cancers
• people whose immune systems are weakened for any reason
• kids who have a history of severe allergic reaction to gelatin or to the antibiotic neomycin, as they could have serious reactions to the vaccine

Because certain people cannot receive the measles vaccine for health reasons, it’s all the more important to make sure that children who can get the vaccine get it on schedule. At-risk children depend on “herd immunity.” This means a high percentage of people have been immunized against a disease, which prevents the disease from spreading in a population and helps prevent outbreaks.

Treatment

There is no specific medical treatment for measles. To help manage symptoms, which usually last for about 2 weeks, give your child plenty of fluids and encourage extra rest. If a fever is making your child uncomfortable, you can give a non-aspirin fever medicine, such as acetaminophen or ibuprofen.

Remember, you should never give aspirin to a child who has a viral illness, as its use in such cases has been associated with the development of Reye syndrome.

Kids with measles should have their condition closely monitored by a doctor. In some cases, measles can lead to other complications, such as otitis media, croup, diarrhea, pneumonia, and encephalitis, which may require antibiotics or hospitalization.

In developing countries, vitamin A has been found to decrease complications and death associated with measles infections. In the U.S., vitamin A supplementation should be considered for children between 6 months and 2 years old who are hospitalized with measles and its complications.

Also, all kids over 6 months old with certain risk factors — such as vitamin A deficiency, a weakened immune system, or malnutrition — might benefit from vitamin A supplementation.

Children with measles should be quarantined for 4 days after their rash appears. If they have a weakened immune system, they should stay in isolation until they make a full recovery and all symptoms are gone.

When to Call the Doctor

Call the doctor immediately if you suspect that your child has measles. Also, it’s important to get medical care after measles exposure, especially if your child:

• is an infant
• is taking medicines that suppress the immune system
• has tuberculosis, cancer, or a disease that affects the immune system

Most important: remember that measles, a once common disease, is preventable through routine childhood immunization.

Although molluscum contagiosum is a common skin rash in kids, many parents have never heard of it. The most important thing to know is that for most children, the rash is no big deal and goes away on its own over time.

About Molluscum Contagiosum

Molluscum contagiosum is a viral infection that causes a mild skin rash. The rash looks like one or more small growths or wart-like bumps (called mollusca) that are usually pink, white, or skin-colored. The bumps are usually smooth and shiny or pearly-looking, and may have an indented center.

Infection is most common among kids between 1 and 12 years old, but also affects:

• athletes who have close skin-to-skin contact, such as wrestlers, or athletes who share equipment, such as gymnasts
• people whose immune systems have been weakened by conditions such as HIV, cancer treatment, or long-term steroid use

As you might guess by its name, this skin disorder is contagious, and can be passed from one person to another. It is unknown how long the rash and virus might be contagious.

Causes

Molluscum contagiosum is caused by the molluscum contagiosum virus (MCV), a member of the poxvirus family. This virus thrives in warm, humid climates and in areas where people live in close quarters.

Infection with MCV happens when the virus enters a small break in the skin’s surface. Many people who come in contact with the virus have immunity against it, and do not develop any growths. For those not resistant to it, growths usually appear 2 to 7 weeks after infection.

Kids can get molluscum contagiosum in a few different ways. It spreads easily, and most commonly, through direct skin-to-skin contact, but kids can get it by touching objects that have the virus on them, such as toys, clothing, towels, and bedding.

Once someone has molluscum contagiosum, it can be spread from one part of the body to another by scratching or rubbing the bumps and then touching another part of the body.

Molluscum contagiosum also can be spread between sexual partners.

Signs and Symptoms

Because it is a skin infection, the only real sign or symptom of molluscum contagiosum are the small round pink, white, or skin-colored mollusca on the skin. These bumps are filled with a white, waxy core that contains the virus, and might have a shiny or “pearly” look.

Each molluscum starts out as a very small spot about the size of a pinhead and grows over several weeks into a larger bump that might become as large as a pea or pencil eraser. A tiny dimple (indentation) often develops on the top of each molluscum.

The mollusca can appear alone as a single bump or in groups, clusters, or rows. They can show up almost anywhere on the skin, but in kids are most commonly found on the chest, stomach, arms (including the armpits), legs, groin, genital area, and face.

In sexually active teens and adults, the bumps are usually located in the genital area or the inner thighs. Rarely, the bumps can happen around the eyes or around the mouth.

Most people develop between 1 and 20 mollusca. They’re usually painless, but can become itchy, red, swollen, sore, and infected, especially if scratched.

Diagnosis

A doctor is likely to recognize molluscum contagiosum just by looking at the rash. The doctor might refer you to a dermatologist, a doctor who specializes in skin diseases.

Treatment

In many cases, molluscum contagiosum is left to go away on its own without treatment. Each individual molluscum typically disappears in about 2-3 months. However, new growths generally appear as old ones are going away, so it usually takes 6-18 months (and can take as long as 4 years) for molluscum contagiosum to go away completely.

Sometimes, doctors use treatments to remove the growths or help them go away more quickly, such as:

• removing the contagious center by squeezing the bumps with a scalpel or tweezers
• removing growths by freezing them (cryotherapy) or scraping them off with a sharp instrument (curettage)
• applying a chemical agent or cream, such as salicylic acid, tretinoin, cantharidin, or other wart medicine
• giving a medicine by mouth called cimetidine

Although these treatments can sometimes help the disease resolve more quickly, many doctors do not use them on kids because they can be painful and burn, blister, discolor, or scar the skin. The use of treatment sometimes depends on the location and number of lesions. Some people request it if the rash is embarrassing or causes other problems, such as itching or other discomfort.

Treatment works best when started early because there are usually only a few growths. Your child’s doctor will talk with you about the advantages and disadvantages of treatment and help you decide whether treatment is necessary. Be sure to talk with the doctor before trying any at-home remedies, including removing the bumps yourself.

Complications

Molluscum contagiosum generally causes no long-term problems, and the growths usually leave no marks. However, treatments might scar the skin, and some people develop a secondary infection, which can be treated with antibiotics.

People with weakened immune systems can sometimes get a more serious form of molluscum contagiosum. They typically have more mollusca, especially on the face. The growths are larger, look different, and usually are more difficult to treat. In these cases, doctors might prescribe medicines that help strengthen the immune system.

Preventing the Spread of Molluscum Contagiosum

Because molluscum contagiosum is contagious and can spread to other parts of the body, someone who’s infected should follow these precautions:

• Do not touch, scratch, or rub growths.
• Wash hands often with soap and water.
• Keep areas with growths clean.
• Try to cover each growth with clothing or a watertight bandage, especially before participating in activities in which equipment is shared or skin contact can occur, like swimming and wrestling.
• Change each bandage daily or when it becomes dirty.
• Do not shave over areas that have bumps.
• Moisturize the skin if dry.

As long as they follow these precautions until all of the bumps are gone, kids with molluscum contagiosum can still go to school or daycare, participate in sports, and play with other children. They can even go swimming in public swimming pools, as long as they keep their towels and water toys to themselves.

A person can get molluscum contagiosum again through contact with someone who’s infected, but this is rare.

To avoid infection, have your kids follow these tips:

• Wash hands often with soap and water.
• Do not share towels, clothing, and other personal items.
• Do not share kickboards and other water toys at swimming facilities.
• Do not touch or scratch bumps or blisters on your skin or other people’s skin.

About Oral Thrush

Oral thrush is a very common infection in infants that causes irritation in and around a baby’s mouth. It is caused by the overgrowth of a yeast (a type of fungus) called Candida albicans.

Most people (including infants) naturally have Candida in their mouths and digestive tracts, which is considered normal growth. The amount of this fungus in the body is controlled by a healthy immune system and some “good” bacteria.

If the immune system is weakened (due to an illness or medicines like chemotherapy), or if the immune system is not fully developed as is the case in infants, the Candida in the digestive tract can overgrow and lead to an infection. Candida overgrowth also causes diaper rash and vaginal (yeast) infections.

Candida overgrowth (or candidiasis) can happen after a baby has received antibiotics for a bacterial infection because antibiotics can kill off the “good” bacteria that keep the Candida from growing. Similarly, it can happen after the use of steroid medicines.

Symptoms

Oral thrush can affect anyone, although it’s most common in babies younger than 6 months of age and in older adults.

A baby with oral thrush might develop cracked skin in the corners of the mouth or whitish patches on the lips, tongue, or inside the cheeks that look a little like cottage cheese but can’t be wiped away. Scraping the white patches off can cause some bleeding.

Many babies don’t feel anything at all, but some may be uncomfortable when sucking. Some babies may not feed well because their mouth feels sore.

Babies can have oral thrush and a diaper rash due to the same yeast at the same time.

Prevention

Even though oral thrush is a common infection in infancy, you can help prevent it: If you are formula-feeding your baby or using a pacifier, it’s important to thoroughly clean the nipples and pacifiers in hot water or dishwasher after each use. That way, if there’s yeast on the bottle nipple or pacifier, your baby doesn’t continue to get re-infected. Storing milk and prepared bottles in the refrigerator prevents yeast from growing.

If you are breastfeeding and your nipples are red and sore, there’s a chance you may have a yeast infection on your nipples, and that you and the baby are passing it back and forth. If so, you may want to talk to the doctor about using an antifungal ointment on your nipples while the baby is being treated with the antifungal solution.

Changing diapers often also prevents fungal diaper rashes.

Treatment

See your doctor if you think your baby may have thrush. Some cases go away without medical treatment within a week or two, but the doctor may prescribe an antifungal solution for your baby’s mouth. This medicine is usually applied several times a day by “painting” it on the inside of the mouth and tongue with a sponge applicator.

And depending on your baby’s age, the doctor might suggest adding yogurt with lactobacilli to your child’s diet. The lactobacilli are the “good” bacteria that can help eliminate the yeast in your child’s mouth.

If your baby keeps getting oral thrush, especially if he or she is older than 9 months of age, talk with your doctor because this might be a sign of another health issue.

Paronychia Basics

Paronychia is an infection of the skin around a fingernail or toenail. The infected area can become swollen, red, and painful, and a pus-filled blister (abscess) may form.

Most of the time, paronychia is not serious and can be treated at home. In rare cases, the infection can spread to the rest of the finger or toe and lead to a deeper infection that may require a doctor’s help.

It’s unlikely that your child will get paronychia in a toe (unless he or she has an ingrown toenail). But fingernail paronychia is one of the most common hand infections.

Causes

Paronychia usually happens when the skin around a person’s nail is irritated or injured. When the skin is damaged like this, germs can get in and cause an infection. These germs may be bacteria (causing bacterial paronychia) or fungi (fungal paronychia).

Kids and teens can develop paronychia from:

• biting or pulling off a hangnail
• frequent sucking on a finger
• clipping a nail too short or trimming the cuticle
• getting manicures
• having hands in water a lot (as from a job washing dishes in a restaurant)

Kids with diabetes also have a higher chance of getting paronychia infections.

Symptoms

Chances are, if your child has paronychia, it will be easy to recognize. You’ll probably see an area of red, swollen skin around a nail. The area will be painful, warm, and tender to the touch, and there could be a pus-filled blister.

Bacterial paronychia usually appears very suddenly, while fungal paronychia may take longer to become apparent. Fungal paronychia may cause less obvious symptoms than bacterial paronychia, but it can be a chronic condition, meaning it can last for a long time.

Chronic paronychia can cause changes in the affected nail. It might turn a different color or look as though it is detached or abnormally shaped.

In rare cases, if the paronychia is especially severe and goes untreated, the infection can spread beyond the area of the nail.

Diagnosis

If your child has paronychia that doesn’t get better with treatment or if the infection seems to be spreading, call a doctor.

Usually, a doctor or nurse practitioner will be able to diagnose paronychia just by examining the infected area. In some cases, the doctor may take a pus sample and have it examined in a laboratory to determine what type of bacteria or fungus is causing the infection.

Treatment

Treating paronychia depends on how severe the infection is and whether it has started to spread. Often, just soaking the infected nail in warm water for 20 minutes a few times a day will help it heal on its own in a few days.

If an abscess (a pus-filled blister) forms, it may need to be drained by a doctor. In rare cases, part of the nail may have to be removed. This should never be attempted at home, as it could increase the risk of serious complications. The doctor also might prescribe antibiotic medications to treat the infection.

Usually, once an abscess is treated, the affected finger or toe heals quickly with no long-term complications.

For fungal paronychia, the doctor may prescribe antifungal creams, lotions, or oral medications to help treat the underlying cause of the condition.

Prevention

Have kids follow these tips to minimize their risk of paronychia:

• Don’t bite or pick nails.
• Trim fingernails and toenails with clippers or manicure scissors, and smooth the edges with an emery board or nail file. The best time to do this is after a bath or shower, when nails are softer.
• Don’t push cuticles back or trim them and don’t use cuticle remover. Damaging cuticles can let bacteria get into the skin and cause an infection.
• Have your child wear rubber gloves if there’s a chance his or her hands might come into contact with harsh detergents or chemicals.
• If your child has diabetes, make sure it is well controlled.

As much as possible, have kids try to avoid injuring their nails and the skin around them. Nails grow very slowly, so any damage to them can last a long time and increase the risk of paronychia.

Imagine this: your son shows you a raised patch of skin on his chest. He says it doesn’t really hurt, so you decide to see what happens and don’t call the doctor. About a week later, the patch is joined by lots of smaller, oval-shaped spots. What’s going on?

Chances are your son has a harmless condition called pityriasis rosea, which usually goes away on its own without treatment. Still, it’s important to get it checked out by the doctor to make sure that’s exactly what it is, and to rule out other unlikely conditions.

About Pityriasis Rosea

Pityriasis rosea (pit-uh-RYE-uh-sis ROW-zee-uh) is a temporary skin condition that’s common in older kids and teens. This pink or gray scaly skin rash can last for 4 to 8 weeks — or, sometimes, months. The rash usually starts with one big patch on the chest, abdomen, thighs, or back.

As the rash spreads, the original patch is joined by a number of smaller spots that spread out across the torso. In some cases, the spots spread to the arms and legs (however, it usually doesn’t appear on the palms or soles). The spots can be slightly itchy.

Pityriasis rosea is not contagious. Although sometimes the spots take a while to fade completely, most kids have no lasting traces of the rash after it’s healed.

Causes

Doctors aren’t really sure what causes pityriasis rosea. Some think it’s caused by a virus, but this hasn’t been proved.

Pityriasis rosea is more likely to show up in the spring and fall.

Symptoms

Most kids and teens who get pityriasis rosea have no warning signs. Sometimes kids have flu-like symptoms, a sore throat, swollen glands, and headaches, and feel tired a few days before the rash appears.

The rash itself usually starts with one large spot, called the herald patch or “mother” patch, which can appear anywhere on the skin but usually is on the chest, abdomen, back, or thighs. This patch can be raised and may feel scaly. In people with light skin, the patch is pink or red. People with darker skin can see a variety of colors, from violet to brown to gray.

The herald patch might be the only sign of this condition for up to 2 to 3 weeks. As the rash grows, however, smaller spots (called “daughter” spots) can appear across the torso and on the arms and legs. The spots look almost identical on both sides of the body. These small patches are are usually oval shaped and often form a pattern on the back that looks like a Christmas tree.

Diagnosis

To diagnose pityriasis rosea, the doctor will examine your child’s skin to look for the telltale signs of the rash. Sometimes doctors gently scrape off a few scales from the rash to examine under the microscope to rule out other possible causes, like ringworm or psoriasis.

Treatment

Most cases of pityriasis rosea go away in 1 to 2 months without any treatment. Some cases can be as short as 2 weeks, while others can last for 3 months or longer.

When pityriasis rosea does need treatment, it’s usually just to control the itching. Over-the-counter itch creams or allergy syrups can help, and so can oatmeal baths.

In some cases, just getting a moderate amount of sunlight can help improve the rash and the itching. If your child uses this form of therapy, make sure he or she is protected from sunburn, which can sometimes make a rash worse.

Light therapy might be prescribed for cases where the itching is really bothersome. Usually, this involves ultraviolet B (UVB) therapy and is done by a dermatologist.

About RMSF

Rocky Mountain spotted fever (RMSF) is a bacterial infection that’s transmitted to people by tick bites. It occurs most often in the spring and summer, during months when ticks are active — between April and early September.

Although RMSF is most common in the southeastern part of the United States (Virginia, Georgia, and the Carolinas), it occurs in other states as well. It’s relatively rare (about 250 to 2,000 cases per year in the United States), but can be a serious disease if not treated properly.

The bacteria Rickettsia rickettsii that causes RMSF is transmitted by the dog tick (Dermacentor variabilis) in the eastern United States and by the wood tick (Dermacentor andersoni) in the Rocky Mountain states. On the West Coast, the lone star tick (Amblyomma americanum) also can transmit the bacteria.

RMSF gets its name from the trademark rash it causes — small red spots and blotches that begin on the wrists, ankles, palms, and soles. In addition to the rash, the infection can cause fever, chills, muscle aches, vomiting, and nausea. Typically, RMSF is treated with antibiotics and patients recover without any complications. But with late or no treatment, RMSF can cause serious health problems.

If your child has fever, achiness, stiff neck, or rash and has or may have been bitten by a tick, it’s important to talk with your doctor.

Signs and Symptoms

The symptoms of RMSF typically develop within 1 week of a tick bite but can take up to 2 weeks to appear. In many cases, the person doesn’t even remember being bitten by a tick.

Symptoms of RMSF usually begin suddenly. There is a high fever — often 103°-105°F (39°-40°C) — with chills, muscle aches, and a severe headache. Eyes can become red, muscles may feel tender, and there may be abdominal pain, nausea, vomiting, poor appetite, and fatigue.

The trademark rash of this infection can begin anytime up to 10 days after the fever and headache start, but it most often appears on the third to fifth day. The rash looks like small red spots or blotches that begin on the wrists, ankles, palms, and soles. It spreads up the arms and legs toward the trunk.

As the RMSF infection progresses, the original red spots might start to look more like bruises or bloody dots or patches under the skin.

Diagnosis and Treatment

Doctors usually diagnose Rocky Mountain spotted fever based on enough symptoms to indicate infection. Test results for RMSF can take a while to be sent to the doctor, so treatment often starts before the results are available.

RMSF is typically treated with oral or IV antibiotics, depending on the severity of the infection. Complications may require prolonged treatment.

If untreated, RMSF can lead to serious health problems, so it’s important to call your doctor promptly if you notice any symptoms of RMSF, such as:

• high fever
• headache
• chills
• muscle aches
• red eyes
• rash

Without antibiotic treatment, RMSF can lead to health problems that involve the heart, lungs, and brain. In an extremely severe case, it can be fatal.

If your child is recovering from RMSF at home, follow the doctor’s instructions for giving antibiotics. Allow your child to rest in bed until the fever and other symptoms are gone.

Prevention

RMSF can be prevented by avoiding tick-infested areas, like woods and tall grasses, brush, shrubs, and low tree branches, and by taking precautions when spending time outdoors.

When they’re playing outdoors, have kids wear light-colored clothing that makes ticks more visible and, if it’s practical, long-sleeved shirts and long pants. Use an insect repellant that fends off ticks, being careful to follow the label instructions. Be sure to use a repellent that contains 10% to 30% concentration of DEET (look for N,N-diethyl-meta-toluamide).

Not all ticks carry the RMSF bacteria, but it’s wise to remove any immediately. The longer a tick stays attached to the skin, the greater the chance of infection. It usually takes several hours for a tick to transmit the bacteria that cause RMSF once it has become attached to the skin.

To remove a dog tick, use tweezers to grasp it by the head (not just the body) as close to the skin as possible. Pull steadily until the tick dislodges. Without touching the tick, preserve it in a jar or plastic bag until you can show it to your doctor. Disinfect the bite area with alcohol, wash your hands, and call your doctor.

Since pets also can bring ticks into your home, check their skin and fur for ticks whenever they have been playing in tick-infested areas. Follow your veterinarian’s advice about collars and other products that can be used to keep your pet tick-free.

If you have any concerns, talk with your doctor.

About Roseola

Roseola (also known as sixth disease, exanthem subitum, and roseola infantum) is a viral illness that most commonly affects young kids between 6 months and 2 years old.

It is usually marked by several days of high fever, followed by a distinctive rash just as the fever breaks.

Two common, closely related viruses can cause roseola, human herpesvirus (HHV) type 6 and type 7. These viruses belong to the same family as the better-known herpes simplex viruses (HSV), but do not cause the cold sores and genital herpes infections that HSV can cause.

Signs and Symptoms

Most children with roseola develop a mild upper respiratory illness, followed by a high fever (often higher than 103°F or 39.5°C) for up to a week. During this time, a child might be fussy or irritable, not eat as much as usual, and may have swollen lymph nodes (glands) in the neck.

The high fever often ends abruptly, and at about the same time a pinkish-red flat or raised rash starts on the trunk. The rash’s spots turn white when touched, and individual spots may have a lighter “halo” around them. The rash usually spreads to the neck, face, arms, and legs.

This fast-rising fever can trigger febrile seizures (convulsions caused by high fevers) in about 10% to 15% of young children who have roseola. Signs of a febrile seizure include:

• unconsciousness
• 2 to 3 minutes of jerking or twitching in the arms, legs, or face
• loss of control of the bladder or bowels

Contagiousness

Roseola is contagious. The infection spreads when a child with roseola talks, sneezes, or coughs, sending tiny droplets into the air that others can breathe in. The droplets also can land on surfaces; if other children touch those surfaces and then their nose or mouth, they can become infected.

Roseola may be contagious during the fever phase, but does not spread by the time the rash breaks out.

Prevention

There is no known way to prevent roseola. But because it affects young kids rather than adults, it’s thought that a bout of roseola in childhood may provide some lasting immunity to the illness. Repeat cases of roseola can happen, but are uncommon.

Duration

The fever of roseola lasts from 3 to 7 days, followed by a rash lasting from hours to a few days.

Professional Treatment

To make a diagnosis, a doctor will take a medical history and do a thorough physical examination. A diagnosis of roseola is often uncertain until the fever drops and the rash appears, so the doctor may order tests to make sure that the fever is not caused by another type of infection.

Roseola usually does not require professional treatment. When it does, most treatment is focused on lowering the high fever. Antibiotics can’t treat roseola because viruses, not bacteria, cause it.

Home Treatment

Acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin) can help to ease your child’s fever. Never give aspirin to a child who has a viral illness because its use in such cases has been associated with Reye syndrome, which can lead to liver failure and death.

While some parents use lukewarm sponge baths to lower fever, there is no evidence that this really works. In fact, sponge baths can make children uncomfortable. Never give your child an icy or cold bath or alcohol rubs.

To prevent dehydration from the fever, encourage your child to drink clear fluids such as water with ice chips and children’s electrolyte solutions. Breast milk and formula can help prevent dehydration as well.

When to Call the Doctor

Call the doctor if your child is lethargic or won’t drink or breastfeed. If your child has a seizure, seek emergency care immediately.