Comments on: Ack! Weird / Fast / Mysterious Rash! Itchy!!!

Question: Ack! Weird / Fast / Mysterious Rash! Itchy!!!

ZakDaddy — Sun, 12 Aug 2007 19:31:27 -0800

SeeADoctorForThisRashFilter: Which we are going to, first thing in the morning, but I'm trying to put the Missus' mind at ease.

My oldest daughter (turns 9 in November) developed a rather startling rash this morning, both in severity and speed of onset. It itches like crazy, apparently. No other symptoms (no fever, cough, nothing) and we're able to take the worst edge off the itch with liberal calamine / Benadryl / oatmeal bath application, but we can't figure out what it is. The nurse at the CVS MinuteClinic said it was very likely chicken pox, but (1) my daughter was vaccinated for that years ago, (2) she has no fever or other symptoms and (3) the rash doesn't look ... quite right for chicken pox. To wit: its distribution is odd, with hundreds of angry itchy red bumps on her trunk and extremities, most heavily where her bathing suit exposes the skin. Her back, in particular, is quite a sight. She has few to none on her face, scalp, genitals, butt, hands and feet. It's been about ... call it 20 hours since onset, and thus far none of the bumps have developed pustules. So, you know, wth? IANAD (obviously) and nothing I can find tells me whether this particular symptom set falls within the range of normal for chicken pox. Other ideas? We thought maybe Swimmer's Itch (we went swimming in her grandfolx neighborhood pool yesterday) but that apparently requires a waterborne pathogen, and presumably a chlorinated pool that's checked weekly would rule that out. Additionally, no one else in the family has any symptoms at all.

Weird, huh? Flagrant speculation and hand-waving is welcome. We'll be calling the doctor's office first thing in the morning, so we can bypass the "see a doctor" that's inevitably going to show up anyway. Thanks in advance. :)

By: ZakDaddy

ZakDaddy — Sun, 12 Aug 2007 19:33:53 -0800

I'll continue to pee in my own thread:

How bout this?

By: SassHat

SassHat — Sun, 12 Aug 2007 19:39:24 -0800

Kind of sounds like duck itch, which we used to get after swimming in the lake...maybe the pool hasn't been kept up as well as possible lately.

Does she have sensitive skin? Skin allergies can present themselves suddenly, so if she was running around in her bathing suit and came across, say, a flower or plant she was allergic to, it would present itself in a rash or hives. This has happened to me as my skin is "allergic" to things that don't cause other allergy symptoms like sneezing, etc.

By: dilettante

dilettante — Sun, 12 Aug 2007 19:46:44 -0800

Has she been out in that swimsuit earlier in the summer? Or with her back and the other affected areas exposed otherwise?

By: peep

peep — Sun, 12 Aug 2007 20:01:48 -0800

Does it look like this? Sounds like it could be pityriasis rosea.

By: LittleMissCranky

LittleMissCranky — Sun, 12 Aug 2007 20:04:49 -0800

Can you take a picture?

By: The corpse in the library

The corpse in the library — Sun, 12 Aug 2007 20:14:43 -0800

Has she been on antibiotics lately?

By: blaneyphoto

blaneyphoto — Sun, 12 Aug 2007 20:31:46 -0800

Poison Ivy? Sunscreen - perhaps one that has PABA as an ingredient?

By: loiseau

loiseau — Sun, 12 Aug 2007 20:50:41 -0800

Possibly psoriasis. My first flareup wasn't til I was 14 but it was much like that. The spots would be raised and possibly/eventually flaky.

By: rhizome

rhizome — Sun, 12 Aug 2007 20:51:23 -0800

Does the rash follow scratch lines at all?

By: whoaali

whoaali — Sun, 12 Aug 2007 20:55:19 -0800

Impetigo? Doesn't seem quite like a typical case, but it is really common in kids her age.

By: Slarty Bartfast

Slarty Bartfast — Sun, 12 Aug 2007 21:13:51 -0800

Urticaria, most likely. Benedryl. See your doctor tomorrow.

By: ZakDaddy

ZakDaddy — Sun, 12 Aug 2007 21:27:35 -0800

Pictures coming shortly; links below.

SassHat: It's a fairly hoity-toity neighborhood (the in-laws are well-off), so if the pool hasn't been well-maintained of late there will be hcek to pay, I'm sure. Pending Dr's analysis; we'll see. No plant / dermal allergens that we know of (she inherited my seasonal "hay fever," poor dear) and the pool area is quite plant-free.

dilettante: She has spent pretty much all summer outdoors in this particular swimsuit with no prior ill effects. Swimming lessons Disney World, beach time, etc. Minor sunburn in the first couple of days in Florida, no complications.

peep: 'Fraid not, although we'll read up. Thanks for the link.

LittleMissCranky: Pics linked below.

The corpse: Yes, she just finished a 10-day regimen of Keflex (sp?) for strep throat, second incidence (all three girls! Rrgh!) in six months. That's why I'm wondering about the sun allergy.

blaneyphoto: Not likely, sorry. Not been in the woods. Sunscreen brand hasn't changed all summer.

loiseau: We'll track the progress closely, but she's had 0 history of psoriasis / exczema / other skin problems to date.

rhizome: Not a bit; just sun exposure, to a certain extent.

whoaali: I don't think so. No blistering yet.

Pictures: Initial Onset, noon today (1), Initial Onset, noon today (2), Progress as of 9:00 PM tonight. The flash I had to use 'cause of my crappy, slow kit lens tends to wash out the redness and make it look about 50% less bad than it is.

We've also noticed that the bumps have lighter rings around them, which I tried to capture here. That's her right knee / lower thigh. Thoughts?

By: ZakDaddy

ZakDaddy — Sun, 12 Aug 2007 21:32:41 -0800

Slarty Bartfast: Seems to describe it the best. Looking at this Wikipedia link, I wonder what "rare" means pertaining to Solar Physical Urticaria? Anyhoo, a-doctoring we will go. Thanks, all.

By: ZakDaddy

ZakDaddy — Sun, 12 Aug 2007 21:33:14 -0800

Woops. This Wikipedia link.

By: whoaali

whoaali — Sun, 12 Aug 2007 21:46:36 -0800

If she's recently been ill don't discount the possibility that it is an allergic reaction. When you are sick you can become far more sensitive to things, this happened to me once, I was using the same skin stuff for two months with no reaction, got tonsillitis and developed a horrible rash all over my body. I developed an allergy to it and from that point on and have never been able to use it. The fact that its mostly on the parts of her body not covered by her swimsuit makes it sound like she might have developed an allergy to the sunblock you're using.

By: ZakDaddy

ZakDaddy — Sun, 12 Aug 2007 21:50:48 -0800

whoaali: Allergy to sunblock? Sounds plausible; we really slather it on. And it seems statistically more likely than, say, allergy to sun. We'll definitely bring that up with the doctor tomorrow. Thanks!

By: 26.2

26.2 — Sun, 12 Aug 2007 22:21:16 -0800

I've gotten an allergic reaction to the sun - it looked nothing like that in terms of intensity. With me I only get that reaction if I have a sudden intense exposure to sun after months of little exposure, e.g. a tropical vacation is February. Chicken pox doesn't seem correct either; generally there's a bit of time feeling sick before the papules show. It doesn't really look like a contact dermatitis either since there's no weeping, bursting or crusting. Of course, it may simply be a matter of time before that occurs.

Is she taking an oral antihistamine? I saw you mentioned Benedryl, but I'm not sure if it's topical or oral. If it's oral, remember to be very consistent to the dosing schedule. If you're late by a bit all those histamines get going again.

To me that looks like an acute hives situation, but IANAD. One thing you might want to do is draw a circle around a few hives. You want to know if the hives are getting larger, or if some disappearing and new ones are appearing. It's hard to tell from photos.

By: taff

taff — Sun, 12 Aug 2007 22:30:45 -0800

viral exanthem?

By: dancinglamb

dancinglamb — Sun, 12 Aug 2007 22:40:04 -0800

Not to freak you out, but if your daughter's rash is progressing this quickly, and it *is* an allergic reaction, it could very well be also occurring internally. Have you tried giving her oral Benadryl to counteract the hives?

I don't know that I'd be comfortable waiting till morning to see her regular Ped, but that's me. Did you call their office to speak to the on-call doc? I have to admit that if it was one of my kiddos, I'd be hightailing it to the ER just in case it gets worse in the middle of the night. Keep a very close eye on her and make sure her breathing is OK. I've seen a few too many anaphylactic reactions to blow something like this off.

One last suggestion - follow your wife's instincts. The Mom always knows. Trust me on that one.

Keep us posted.

By: croutonsupafreak

croutonsupafreak — Sun, 12 Aug 2007 22:42:03 -0800

I've had allergic reactions that look like that, contact dermatitis. She may get a steroid shot and some prescription ointment to treat it, but if it's a contact rash she'll probably have to suffer until it goes away.

By: croutonsupafreak

croutonsupafreak — Sun, 12 Aug 2007 22:42:43 -0800

I should add: contact dermatitis can sometimes manifest 30 minutes to 3 hours after initial contact.

By: dancinglamb

dancinglamb — Sun, 12 Aug 2007 22:45:36 -0800

One other thing - make sure that you're giving her the right dosage of Benadryl (assuming you are giving it to her). It's far more accurate to dose by weight rather than age.

Benadryl dosing is 0.5mg per pound of body weight every 4-6 hours. The kid chewables come in 12.5mg, and the non-chewable tablets come in 25mg.

By: amyms

amyms — Sun, 12 Aug 2007 23:33:56 -0800

Fifth Disease, so-named because it was the fifth of the identified childhood rashes. (here and here)

By: BrotherCaine

BrotherCaine — Mon, 13 Aug 2007 02:16:05 -0800

The pattern makes me think it is sun related, but make sure you rule out hot tub folliculitis.

By: dilettante

dilettante — Mon, 13 Aug 2007 03:59:51 -0800

She has spent pretty much all summer outdoors in this particular swimsuit with no prior ill effects

I'd normally say it's not a usual sun rash, then, or she'd have had it earlier this year. I've had them all my life and they usually come up with first exposure to strong sunlight on skin that's otherwise been covered. However, the Keflex could easily have caused a sun rash - although that's more likely if the Keflex is still in her system.

By: konolia

konolia — Mon, 13 Aug 2007 05:59:51 -0800

Looks like Fifth Disease to me too.

By: cass

cass — Mon, 13 Aug 2007 12:19:56 -0800

She may be allergic to sulfa-based antibiotics, if Keflex is one of those. My mom develeoped a bad rash when she was taking antibiotics for a UTI. Turned out she had an allergy to sulfa drugs. Also, some antibiotics have warnings about sun exposure.

By: The corpse in the library

The corpse in the library — Mon, 13 Aug 2007 14:02:10 -0800

I've had a rash like that. The doctors at the emergency room where I went (it was the weekend, couldn't get to my usual doctor) couldn't tell what it was. It was about a week after I'd taken my last dose of a long spell of antibiotics. Benadryl helped.

I've also had a similar rash just on my legs, while taking antibiotics. That time my doctor was certain it was an allergic reaction to the antibiotics, which were sulfa drugs. Plain old lotion helped with the itching that time. So... my money's on an allergic reaction to the antibiotics.

By: drpynchon

drpynchon — Mon, 13 Aug 2007 18:25:23 -0800

This is very likely to be urticaria, the cause of which could be anything including topical lotions, oral antibiotics, or even sun exposure. The raised lesions with halos are a hallmark of it. Please discuss this with your doctor for further details, as you reportedly may already have. Should she develop any swelling in her face, throat, tongue, or have any wheezing or difficulty breathing, I would emergently seek medical care but fortunately this doesn't appear to be the case. Treatment typically involves avoiding precipitants and using antihistamines but bad cases (of which this may be one), sometimes require corticosteroids such as prednisone. Again, talk to your doctor asap.

By: ZakDaddy

ZakDaddy — Mon, 13 Aug 2007 21:12:02 -0800

Thanks very much, all. Doctor has prescribed oral prednisone, to be taken once daily for 5 days. The rash appears to be marginally less angry tonight, although the itching is starting to really get on her nerves. (She's been an amazingly good sport the entire time, poor dear.)

I think we're calling it urticaria resulting from antibiotics / sun exposure (maybe, but much less likely, sunscreen.) Chicken pox has been definitively ruled out. Her breathing has been fine throughout; thanks for the heads-up, dancinglamb.

By: loiseau

loiseau — Mon, 13 Aug 2007 21:32:56 -0800

ZakDaddy: "loiseau: We'll track the progress closely, but she's had 0 history of psoriasis / exczema / other skin problems to date."

Yeah, well no one does, until they do. You don't know you have it until you have an attack.

It does look a lot like my first psoriasis outbreak. I really really hope that's not it!

By: dancinglamb

dancinglamb — Mon, 13 Aug 2007 22:24:16 -0800

Glad to see your daughter's on the road to recovery. Watch the prednisone, since it can have some not so nice side effects. Did the doctor recommend that she stay out of the sun as long as she's taking the prescription?

I'm assuming you took her to your normal Ped. If it doesn't start to clear up, you might want to ask for a referral to a pediatric dermatologist or allergist. Uticaria can be hard to knock out if they don't know the root cause.

Hope she feels better soon and you are able to tame the itchies.

By: ZakDaddy

ZakDaddy — Tue, 14 Aug 2007 15:50:51 -0800

dancinglamb - We took her to her normal pediatrician, so her complete history was available. We've been keeping her out of the sun pretty much no matter what, so thanks for the reminder about the prednisone.

Update - Her rash today is much less "lumpy" although still just as red, but the itching has diminished significantly, thank heavens. I think we're on our way out of the woods. Actions going forward:

1 - Never get strep throat again (wish us luck!)
2 - Use care with antibiotics / sun exposure
3 - Switch sunscreens anyway

Any other ideas for prophylactic measures?

By: Slarty Bartfast

Slarty Bartfast — Tue, 14 Aug 2007 21:37:40 -0800

Hmmm. Didn't see the pictures when I answered urticaria before. Urticaria usually has much smaller papules (bumps). If this were a question on the medical board exam, I'd probably say Pityriasis Rosea (although very atypical for her age) or a viral exanthem. Urticaria should or a viral exanthem should get better quickly, pityriasis will not (6-8 weeks on average). Use Google images to look up "pityriasis rosea" and you will see a picture of your daughter. Now I am really curious, keep us posted. Email's in the profile.