What is causing this rash?

August 20, 2009 5:40 PM

What is this (non-itchy) rash on my toddler?

A few days ago (Monday), when I picked up my sons from daycare, I noticed that one of them (Linus) had a bit of a rash on his upper thighs and upper arms. It didn't seem to be bothering him at all, so we decided to just wait and see what happened.

On Wednesday, it hadn't gotten any better, maybe a bit worse, so I took him to the pediatrician to have it checked out. She gave me a few ideas on what it could be, but no real treatment options. (I don't want to list her ideas here, because I don't want to influence your answer.) Basically, she wanted us to take a wait and see approach, and if it isn't better in a week, we'll take him to a dermatologist.

Here are some details that might be relevant. He is an identical triplet, so one would think that anything he's exposed to, his brothers would react in the same way. But neither of the others have this rash. However, one of the others (Miles) did develop these acne-like spots on his face over a week ago. The pediatrician (who saw both of them) didn't seem to think Miles's rash was related to Linus's rash, and told us to put hydrocortisone ointment on Miles's (since it was on a smaller area of his body.)

Anyway, third triplet (Oliver) has no rash at all, so it's definitely not contagious.

The only real difference between Linus and his brothers is that he has a more severe case of asthma. He is on a daily dose of Budesonide via nebulizer, but other than that, everything's the same. (Have to admit, it's handy to have three genetically identical children in situations like this.)

(I also notice that the entry I linked to on Budesonide mentions a rash as a side effect. This is a possibility, I suppose. Linus did get a terrible rash - again, not itchy or painful - when he was on Amoxicillin as a baby, about a year ago. Not sure if that is relevant.)

We haven't changed detergents recently, I asked daycare and they haven't sprayed any chemicals or changed their detergents lately either. If it's an allergy to something environmental, I wouldn't even know where to start.

Here are a few pictures of the rash I took this evening. We can't tell if it's spreading or getting a lot worse, or if we're just noticing it a lot more. I think it's gotten a little worse, and spread some since it first popped up on Monday.

I know you're not my kid's pediatrician...just looking for some opinions from someone whose kid might have had the same kind of rash.

posted by pyjammy to health & fitness (22 comments total)

Heat rash, maybe?
posted by Sublimity at 5:47 PM on August 20

IANAD(Y), but it looks a little bit like molluscum contagiosum. Hard to tell from the photo, but that would be one of my guesses.
posted by greatgefilte at 5:51 PM on August 20

Not heat rash - it's not in the usual places and it doesn't go away when he cools off. The doctor nixed that, and I have to agree.

greatgefilte - ding ding ding! That's one of the possibilities the ped mentioned, actually. After reading your link, I really hope it's not.
posted by pyjammy at 5:57 PM on August 20

Whew, glad to know our one week of dermatology made an impression. :)
posted by greatgefilte at 6:04 PM on August 20

Could be something like folliculitis. It's a chronic (possibly inherited) condition that is not easily treated, except with common skin cream.
posted by KokuRyu at 6:06 PM on August 20

My first reaction to the photos was hand-foot-mouth disease, which my son had as a toddler. Didn't have any problem other than the skin rash. Just had to wait it out.
posted by Cool Papa Bell at 6:06 PM on August 20

My son, I should say, has it on his legs and arms.
posted by KokuRyu at 6:08 PM on August 20

Here's a photo of molluscum contagiosum lesions... It doesn't really look like what your son has.
posted by KokuRyu at 6:10 PM on August 20

I'll put on my pediatrician hat, if that's OK. Of course, I am not your pediatrician, so everything I write here is just for educational purposes and is not intended to for the diagnosis or treatment of your specific child. Plus, since I can't touch the rash or get a good close-up to see if its pustular or papular, it's hard for me to be definite. That said ...

So, it doesn't look like molluscum - too wide-spread, over too many surfaces. And it's probably not folliculitis (again, too wide-spread). It's unlikely to be hand-foot-mouth (coxsackievirus) for a number of reasons: first, no other symptoms (usually kids are pretty miserable), second you don't get coxsackievirus eruptions on your arms and thighs (otherwise, I suppose, it would be hand-arm-thigh-foot-mouth).

The fact that he's got reactive airways disease raises the suspicion that he's atopic, that is, he's susceptible to allergies. Thus, this could be eczema or atopic dermatitis. Think of it like an allergy in the skin. It can be exacerbated when it's cold/dry, or by eating certain foods, or being provoked by other things that activate the immune system. Remember, your skin is a fairly big organ, and it is littered with immune cells. The one thing arguing against this is that it's not itchy.

One thing that I can tell you is that it doesn't look particularly specific, nor does it look particularly worrisome. That is, it doesn't look infectious nor does it look like a rash associated with a truly concerning disease (e.g., meningococcemia - every pediatrician's fear). If he's had a cold or upper respiratory tract infection, I'd say that it might be a non-specific viral exanthem (a rash that occurs in association with the immune system activation due to a concomittant viral infection) and that it'll go away on its own in a few days).

There are some things I don't know about your son, which means that the history is not complete (e.g., was he fully vaccinated ... can we rule out things like measles?). But assuming that he was, I would say that this looks non-specific, possibly atopic or eczematous. If it were me in the office, and this was all of the information I had, I'd probably recommend keeping the skin moist (with moisturizer) and trying a midpotency steroid cream (I'm partial to 0.05% triamcinolone) for a few days to see if that made a difference. The 1% hydrocortisone that you get over-the-counter is pretty worthless. If it gets better with steroids, that means one of two things: either the rash was not atopic or eczematous and just got better on its own despite the fact that it was being treated, or that it was atopic or eczematous and the steroids made it better.

Drop me a note and let me know what happenes ... and by the way, I love that your son's name is Linus. It suits him ... he's very handsome.
posted by scblackman at 6:34 PM on August 20 [3 favorites]

This looks very much like the non-itchy, non-painful rashes I used to get as a child, generally related to a new soap or detergent or -- once -- when I sat in my dad's lap after he'd been fertilizing the lawn. That's how sensitive I was to irritants. I also had asthma as a child, which I've now grown out of (so, you know, sucks to my assmar).

My pediatrician called it "papular urticaria," but googling that phrase just now makes me think it's basically a no-diagnosis diagnosis. "Your skin is irritated."
posted by palliser at 7:14 PM on August 20

scblackman - Oooh, where do I start, aside from thanking you for your compliments on my sweet Linus....

A little more background...he had his MMR vax at his 18 month WBV, so he is up to date on that. He and his brothers have had an upper respiratory illness over the past week or so, so I was wondering if it might be related to that. (We're currently giving him Albuterol once or twice a day in addition to the Budesonide.)

I've been putting lotion on one of his legs, as kind of a "control" to see if it's helping. I'll keep doing that.

What if it doesn't go away? Although I suppose if it doesn't, at least we'll have an easy way to tell him apart from his brothers...
posted by pyjammy at 7:27 PM on August 20

I'm no doctor, so you should probably listen to scblackman, if anyone, but it does remind me of an allergy. I would say a mild grass allergy, which is contact-based and can also be seasonal, but since he only has it on his upper arms and upper thighs, I guess that's ruled out.

You might try bathing him in some Aveeno oatmeal baths to see how that works. Every time I've had skin problems, from chicken pox to a bout of severe psoriasis in my mid-teens, Aveeno baths and lotions have really soothed any associated pain and/or itching. It's usually removed redness, too, to some degree.

I would try this before I'd try steroid cream, particularly considering his rash is very small, and the dots are spread out. Steroid cream does thin your skin, even if only a little, and it's better to use it only on the affected areas; unfortunately, doing that on spread out little dots would be difficult, time-consuming and perhaps unnecessary.

Have you randomly introduced anything new to his diet? Of course, he might have only now begun showing signs of a food allergy he's had. If an allergy is the culprit, it would probably be a dietary one, so that somewhat narrows it down. Also, certain foods are more commonly associated with allergies than others, so if you come to the conclusion that it might be a food allergy, you probably only need to start with the most likely suspects.

P.S. - Adorable little boy. :)
posted by metalheart at 7:27 PM on August 20

It looks like it could be fifth disease. My kids had it as toddlers. It's sometimes referred to by the nickname "slapped cheeks syndrome" because of the rash's tendency to cause rosy cheeks, but my kids had it mainly on their arms, thighs and stomachs. It's viral, not dangerous at all in most cases, and pretty much goes away on its own.

Best wishes to you and your little ones.
posted by amyms at 7:49 PM on August 20

2nding fifth disease. My baby had it recently and looked just like that. He had a fever before the rash tho.

I'd post this on livejournal parenting 101. Many more people to guess.
posted by k8t at 8:05 PM on August 20

That looks similar to my Keratosis Pilaris (an inherited skin condition where too much keratin is produced in hair follicles and causes raised, non-itchy, red bumps).

Mine get redder with exertion or heat, and they have a little bit of white stuff in it when squeezed and it's common to get them on upper arms and thighs. Steroidal creams help, from what I remember of trying to treat it as a kid, but the biggest improvement I see is when I exfoliate it (frees the keratin before it builds up into huge bumps).

I've had it since I was a baby, but I don't know if I was born with it or it just developed in my infancy. It's non-itchy unless my skin's really dry or I start picking at them.

IANAD, nor have I had children. What a cutie!
posted by bookdragoness at 8:14 PM on August 20

bookdragoness - That's my husband's theory aboout what this is. I may be contacting you for more info, if that's okay.

I'm not sure about the fifth disease - wouldn't my other two have it? Plus, the rash isn't on his trunk.

Am definitely going to try the Aveeno Oatmeal bath, and am going to start keeping better track of what they're eating. (The only new food I can think that they've had lately is Froot Loops. Mom of the Year, I know.)

Thanks all, and k8t - I may check out that LJ group. Thanks for the recommendation.
posted by pyjammy at 8:20 PM on August 20

Roseola is another possibility.

Here are some photos of my own kid's roseola.
posted by k8t at 8:33 PM on August 20

Could be atopic dermatitis triggered by a mild food intolerance (and one he or they will probably grow out of). For one of our sons it's strawberries; for the other it's milk. One of them gets it on his cheeks (it looks a lot like fifth disease), the other on his chest and back. Try ruling out dairy, red fruits and nuts for a week - if the systems clear, give them one, wait a day, then another, and so on, to see if it's a cause. No go? Try again the next week with three other common allergens.

I guess I should add that I'm highly skeptical of people who claim to have 'food allergies', and subjected both our kids to pretty rigorous experimentation to conclude that their rashes were definitely food-triggered dermatitis. Don't be one of these people who goes 'ooh, they're allergic', then forbids them to eat anything that isn't canned organic pears, or one of those people who persists with dietary restrictions if you discover there's no link with the rash. Take pictures and/or notes daily about the appearance of the rash, note carefully how you treat it, and try to keep your variables to a minimum, or you'll end up with "it's either peanuts AND Pledge OR bubble bath OR bananas AND shampoo."
posted by obiwanwasabi at 8:34 PM on August 20

The fact that he's got reactive airways disease raises the suspicion that he's atopic, that is, he's susceptible to allergies

Yeah, I have asthma and I get all sorts of rashes. Poor kid.
posted by KokuRyu at 8:45 PM on August 20

Both of my kids have food allergies that are very specific, but then my mom did and I do, too, and my kids' dad has a separate one. My daughter and I react to strawberries and kiwis, like my mom. My son seems to react to coconut somewhat, like his dad. I kept a food diary, which was a challenge when they'd come back from their dad's with a rash, and I'd have to figure out what they'd eaten. Lots of non-judgmental phone calls and questions, especially when they were younger and I couldn't just ask the kids directly. For minor (and not so minor) rashes, eventually narrowing things down helped a lot, and we got it all sorted out.

Several years ago, my son had a reaction to his last MMR vaccination that looked so much like measles that my kids' babysitter insisted I get a note from the doctor. It's a pretty common reaction, and he wasn't contagious. Our biggest concern was that one of the other moms was pregnant and we didn't want to accidentally expose her to something scary.

What seems strange to me is that, if they're identical, they don't have the same allergies, but I don't know much about twins, triplets, etc.

I do know that very young children and daycare can lead to a lot of worries for parents. Even having them at home can lead to a lot of worries. If your doctor and daycare providers aren't freaking out, maybe it's something they've seen before and you can ask them?

Best wishes to you and yours. Hope it's something easy. Glad your son isn't having the dreaded itch and fussiness about it.
posted by lilywing13 at 2:30 AM on August 21

CUTE!

That looks exactly like the allergic reactions I got to grass, and, well...seemingly everything else as a child. It was always a bit itchy but I could completely ignore it.

(Obviously, I am not the expert in this thread)
posted by kathrineg at 6:09 AM on August 21

Thanks all for the answers. Hard to pick a best, so I just marked some that seemed most likely. We'll see. They're going to their grandparents' this weekend, and they'll probably stay inside the whole time, so I'm hoping to see a big improvement when we pick them up on Sunday. If not, we'll put a call into the dermatologist probably.

About allergic reactions - would they should up immediately, and would they last this long?

I'm kind of hoping it's just related to the upper respiratory issue/virus of the week they were dealing with recently, and will go away in the next few days. Fingers crossed!
posted by pyjammy at 6:34 AM on August 21