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What’s That Rash?

A question I’m asked frequently at school, “Nurse, what’s this rash from?” is honestly a tough one to answer. There are so many different kind of rashes, some are contagious, some are bug bites, and some are just random “nothing” rashes. I’ll tell you from the start, I have no idea what bug bit you. Unless you saw the bug or captured the bug in action then it’s only a guess. They don’t teach us that in nursing school.

Disclaimer: The school nurse can not diagnose a rash or an illness. They can only be aware of the signs and symptoms of various things and give an assessment. If they suspect a contagious or treatable condition, the child has to see a doctor for diagnosis and treatment.

It is important to have a basic understanding of some different rashes and conditions that are encountered at school so we know when they need to be treated or not.

Bedbug Bites https://kidshealth.org/en/parents/bedbugs.html?ref=search : Bedbug bites look like small, itchy red bumps all over. Sometimes they look like little blisters with fluid inside them. Typically they are small like pimples, not as big as mosquito bites. It helps to know if there are bedbugs where the person has been sleeping/living. There is no treatment to get rid of them but you can treat the symptoms with anti-itch creams (Hydrocortisone) and antihistamine medicine (Benadryl). The most important thing for dealing with bed bug bites is to eliminate the bedbugs from the home which should be done by calling a professional exterminator who manages bedbug infestations. If you are living in a shelter or place you don’t have control over like a hotel then report the issue to management. If bedbugs are seen in a school building then the maintenance staff will see that the exterminator handles the situation.

Bedbug Bites

Ringworm https://kidshealth.org/en/parents/fungal-ringworm.html?ref=search : Ringworm is a fungal skin infection. It usually looks like a reddish circle on the skin with a clear center, or sometimes whitish in the center. It can be itchy. Often you will see just one spot but sometimes there are multiple areas of infection. frequently it is in the hair/scalp but can show up anywhere on the body. It is highly contagious by contact with the rash so it must be treated as soon as it is seen and covered with a bandage if possible. Your child can not come back to school until they have been treated for at least 24 hours. Ringworm is treated with a prescription antifungal cream and sometimes an oral antifungal medicine.

Tinea corporis (ringworm) SOURCE: Basil J. Zitelli, et al (2002). Atlas of Pediatric Physical Diagnosis, 4th Ed. “Ch. 8 Dermatology,” Page 272, Figure 8-33. 2) Thomas B. Fitzpatrick, et al (2001). Color Atlas & Synopsis of Clinical Dermatology, 4th Ed. “Tinea Corporis,” Pg. 696, Figure 21-9.

Scabies https://kidshealth.org/en/parents/scabies.html?ref=search : Scabies are little skin mites that burrow under your skin. The bites usually look like small blister-like pimples in clusters, often with grayish or red lines in between them. They burrow under the skin and travel leaving the lines on the skin (I know, I know, I’m itchy now too!) Scabies is very contagious and needs to be treated by a doctor as soon as possible. Usually the treatment is a prescription lotion that is spread over the entire body and left on for several hours before rinsing it off. It is recommended that anyone who has been in close physical contact with that person should also be treated.

Scabies

Infection/Abscess https://kidshealth.org/en/parents/mrsa.html?ref=search : Usually something that is infected will be very red, painful, feel hot in the area where there is infection and likely have drainage (pus). The person sometimes will get a fever or red lines on the skin going away from the area. The infection could be anything from picking at a fingernail or a bug bite that got scratched open, to any cut or wound that gets a bacteria in it. Some infections are contagious such as MRSA (Methicillin Resistant Staph Aureus) but most of the time we just have bacteria everywhere and it gets in a wound. This is why we need to keep wounds clean and avoid infection. These must be seen by a doctor and treated – usually with antibiotics.

Eczema https://kidshealth.org/en/parents/eczema-atopic-dermatitis.html?ref=search : A very common skin disorder, usually has red/pink itchy scaly patches on the skin. It can be genetic, or associated with some allergies (food, seasonal). It is not contagious. Eczema is usually treated with various creams – over the counter moisturizing creams and sometimes prescription steroid cream or allergy medicine. People who have frequent flare ups may learn what the triggers are for their flare ups and learn to avoid them.

Eczema

Measles https://kidshealth.org/en/parents/measles.html?ref=search : Usually starts out with a high fever, cough, runny nose and red watery eyes. After a few days the rash appears looking like tons of red spots, some flat and some raised, so many that the spots join together. The rash usually starts in the hairline and face and spreads downward. Measles is extremely contagious and can be very dangerous for some people to be exposed to. In order to attend school all students should be vaccinated against it with two doses of the vaccine.

Measles

Chickenpox https://kidshealth.org/en/parents/chicken-pox.html?ref=search : Chickenpox usually starts out kind of like the flu – fever, cough, achy, swollen glands, etc. The rash looks like raised fluid filled blisters that are very itchy. They can show up anywhere but most often on the abdomen and back. It is very contagious – so much so that most doctors do NOT want you to come to the office and expose everyone there. Again, in order to attend school students should have two doses of the vaccine or have had chickenpox already so they are immune. There is no treatment but waiting for the virus to pass and treating the symptoms (cream for itchies, Motrin for fevers)

Chickenpox

Bug bites: does your kid have random red bumps here and there? Probably itchy? Maybe hurts a little? Otherwise well appearing and feeling? It’s probably a bug bite but who knows what bug it was? Certainly not me! It could be mosquitoes, fleas, or maybe spiders. We can put on some Hydrocortisone and hope for the best.

Scarlet Fever https://kidshealth.org/en/parents/scarlet-fever.html?ref=search : Scarlet fever gets a bad rap. It is literally strep throat that causes a rash in some people. Scarlet fever rash looks like tiny red dots on the chest, belly and back (but can spread all over) and the rash feels like sand on the skin if you feel it. It is usually accompanied by strep symptoms like sore throat, fever, stomachache, headache, or vomiting. Scarlet fever/strep is treated with antibiotics.

Measles vs Scarlet Fever

There are so many more rashes and conditions I could get into but these are some fairly common ones we encounter in a school population.

Look at your child’s overall condition to decide what to do. Are they feverish? Are they sick appearing? What other symptoms do they have, if any? If in doubt, don’t be afraid to call the doctor and see what they have to say.

This is an article all about rashes from Kidshealth.org that is really helpful too: https://kidshealth.org/en/parents/rashes-sheet.html?ref=search

Published by Emme Mauer M.Ed., BSN, RN, CSN

Mom to two preemies, anxiety sufferer, postpartum depression survivor, and school nurse extraordinaire.

2 thoughts on “What’s That Rash?

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