Friday, October 14, 2005

Photoquiz: Rash in a Toddler


(click the picture for a larger image)

This photoquiz is only for non members of the CC to answer because most of them already know of my boy's recent malady. He is one year old and was unusually cranky and needy for about 2 days, then was noted to have felt hot at different times by his mother and I on the same day, but his temperature was not measured. He continued to be uncharacteristically pissy for another two days, but without anymore signs of fever, before finally developing this rash, which was when all the pieces of the puzzle fell into place. If you have an infant or toddler, know this one. It could help you avoid giving your child antibiotics unnecessarily, and subsequently branding your child as "allergic" to amoxicillin (or whatever antiobiotic your doctor gives when he/she doesn't have a good diagnosis and you don't want to leave the office emptyhanded).

UPDATE: The answer is in the comments, it is kind of long and preachy. alternative points of view are welcome.

posted by Clay @ 10/14/2005 09:32:00 PM   30 comments

30 Comments:

At 12:25 PM, Blogger Alice H said...

My first guess was heat rash or yeast, but neither of those would show up later, I don't think. And I can't imagine how a baby would get yeast on its

Your Google Ads are about jock itch - are they trying to tell us something?

 
At 3:59 PM, Blogger joe said...

poor baby !

 
At 12:03 AM, Anonymous Anonymous said...

I had that rash once. What is it???

 
At 10:14 PM, Blogger Clay said...

This is fairly typical case of roseola, aka Exanthem subitum . Usually a child will initially experience high fever, irritability, and poor appetite for a couple of days, then when the child begins to improve and the fever resolves, the rash comes, spreading from the trunk to the extremities. Complications are not common, but sometimes the child may experience febrile seizures due to the high fever. The treatment for roseola is supportive-fluids and tylenol or ibuprofen. Since it is a viral illness, antibiotics are of no use, but sometimes when a child has a fever and the doctor isn't sure what the cause is and/or the parent feels that something MUST be done, antibiotics are prescribed. Then, a couple of days later when the rash comes, the parent and/or doctor mistakenly proclaims that the child is allergic to that antibiotic. That is one reason why I do my best to advocate judicious use of antibiotics. Although this situation really irritates me, I have been guilty of the same thing.

I believe I witnessed a case exactly like this at a birthday party this weekend. Now that my wife has seen one case of roseola, she is an expert. She saw a sixteen month old girl with a rash just like the one above and said to the mom, "that looks like roseola". The mom said "She had an allergic reaction to some medicine". Here is her case. The girl was cranky, not eating and had fever up to 104 for 2 days. She went to her doctor, who gave her an injection of rocephin for "a bad sinus infection" and started her on her on augmentin. One or two days later she improved but the rash erupted so she took the girl back to her doctor who told her it was an allergic reaction and told her to stop the meds.

My point:
Obviously, if a young child has fever and is not acting well, then a visit to the doctor to is certainly in order, because there are many, more serious illnesses that need to be ruled out, and the same goes for rashes after taking medicines. However being open to this possibility or even suggesting it may save some expense, unnecessary antibiotic use, and false allergic reations.

 
At 7:29 AM, Blogger joe said...

You KNOW how I feel!!
Great case, well done!

One add, when I think it is roseola, I try to tell the parents so they call look it up on the net. I used to get pictures of the rash to show the parents so they will believe me. I ask them to call the office if the rash isn't evident in 48 hrs. Also this is almost always under 2 yrs of age.

And your wife is doing a great service by putting the correct word out on the grapevine.

 
At 12:54 AM, Blogger Sam the Blogger said...

Suck up!
You know boss man is infatuated with Roseola.

on another note---look at the gut on Henry!
How much beer are you giving him?

 
At 6:00 AM, Blogger joe said...

Sam, now you are being the COO.

 
At 1:48 PM, Anonymous Peggy said...

"Rash in a Toddler" reminds me that when my oldest son was a toddler and climber, he fell, was cranky and I took him to the doc. Turned out he had fractured his collar-bone. Oddly, he also had a very light rash across the collar-bone area. Many years later, a neighbor's toddler took a fall, not a bad one, but I noticed a light rash over the collar-bone area and suggested she take him to the doc. She did, the kid had a fractured collar bone. Neither of the kids had fever or any symptoms other than crankiness and the very light rash. Why the rash? The docs dismissed it as unrelated, but I've wondered.

 
At 9:16 PM, Blogger overactive-imagination said...

Is there any relation to this rash and pityriasis? My daughter recently had a rash that itched her terribly and looked awful. It came on quickly and I don't think she ever had a fever with it (she is 13). I was also told that it was viral and no antibitics were necesary but that it could take a month or more to go away. She used Selsun Blue shampoo as a shampoo and bodywash(at the Dr's suggestion)and it cleared up within about 6 days. Just curious. Thanks.
Dawn

 
At 8:06 AM, Blogger Clay said...

Peggy, I can't really say much about the rash with the broken collar bone, unless it was related to the trauma that caused the fracture or local inflammation associated with the fracture.

 
At 8:53 PM, Blogger Clay said...

Overactive-The main comparison between pityriasis and roseola in my view, is that they are both viral and generally benign afflictions. Roseola is known to be caused by HHV-6. It has been suggested that pityriasis has been caused by HHV-7 but to my knowledge that is not well agreed upon. My sources also tell me that the rash may take over a month or two to get better. I am very willing to tell my patients that, so that when it gets better sooner they are pleased rather than mad because it has lasted longer than expected. I am sure Joe would agree with that approach. Here is more on Pityriasis rosea.

 
At 11:50 PM, Blogger overactive-imagination said...

Thanks for the link and the info Clay.
Dawn

 
At 7:41 PM, Blogger joe said...

I agree P. rosea is a great dx, the pt never dies, you just must convince them that they don't have a problem. However,the rash of secondary syphilis is impossible to tell from P.rosea, and when I had it as a medical student they made me get a VDRL(it was negative,Sam, but thanks for asking).

P.rosea is not supposed to itch, but does sometimes and a little topical steroid gives the pt something to do.

 
At 10:59 PM, Anonymous mamax6 said...

Thank-you thank-you for the picture. My son also had the classic symptoms desscribed in text as Roseola, however the pictures that I found showed a much more dense clustering of spots. My son has a very light rash all over his body looking exactly like this picture. I have been second guessing and somwwhat panicky today as this is day two of the rash and he is still very uncharacteristically grumpy. I have worried that I missed something.

 
At 6:11 PM, Anonymous Anonymous said...

What about Fifth Disease? A doctor told us that my son may have that,he will be 3 in March, and he spiked a high fever of 103-104 (lasted only 1 night), then had a rash that developed all over his body the next day. It looks just like the baby's picture on this site. We will go to the doctor's office tomorrow to confirm.

 
At 11:20 AM, Anonymous Anonymous said...

Is it possible for a toddler to have roseola with little or no fever? What if the rash is mostly on his legs? My son is 16 mths and certainly fits the grumpy factor the last few days:), then this speckled rash apeared rather guickly, mostly on his lower half.

 
At 10:52 PM, Anonymous Anonymous said...

Thanks for the picture and comments on this. Helped ease our concern. Our 18 month daughter started out very cranky, febrile, no apetite few days ago that have since resolved and now we just noticed this macular papular rash on her trunk. Looks just like the one in the picture.

 
At 9:06 PM, Anonymous Anonymous said...

I also wonder about the link between this roseola and the Pityriasis as my 2 1/2 year old son from what I can figure has roseola.

The funny thing is I had Pityriasis when I was 13 and am one of the 3% who get it again. I've gotten it on a very light scale maybe 5 times since then ( I'm Now 35). And I have just gotten over an outbreak in the past week.

We frequent a family drop in at a community centre that I am sure is as bad as a preschool for germs, so it is not unbelievable to imagine that we would have come into contact with the virus that causes either or both.

My son has also contracted Rubella (I assume from the same place) about a month ago... as he is only selectively vaccinated. That rash looks much the same as this but much more concentrated, initially itchy and lasts for about a week.

 
At 7:07 AM, Blogger The Smith Reporth said...

I have been searching for something like this....I will probably sound like the patient who tells the pharmacist, "the BLUE one! I take the BLUE pill with the little word inscribed on the side! You know which one that is!" But seriously, my daughter has a rash just like this. Only, I am like one of your other contributors, whereas, she hasn't had much in the way of fever, except for like, once or twice (99, then 100.4)....And after frequently, and disbelievingly taking her temp, after looking at her Cherry Red, and scorchingly hot cheeks and legs, I thought my thermometer must be broken. But the doctor's office found no temp either. She started out by refusing her nap on Thursday and Friday, eating poorly, being more clingy, and protesting everything in general. Then Friday night at bedtime, Saturday morning, Poof! Tiny little red bumps everywhere! The doc's office said "viral infection," which I thought...okay....yeah, chicken pox is viral, so "what up?!" They said they didn't know "which" virus, but asked me to remember that every virus she comes into contact with now, is a new virus for her body and could potentially have a reaction like this! I left the office feeling no better about her situation than when I went in there. It is now Tuesday, and the red bumps have subsided into bumpy, almost non-visible, but raised blistery skin to the touch, and I even began to wonder if I had her outside too long in the wind.....It reminds me of Chillblains from running in the mornings at Fort Drum, NY in 20 below temperatures. But, I didn't have her outside in extreme weather, and besides, her body was completely covered in overalls when we went to the playground on Friday...so the texture and effect of this rash were equal on her belly, as on her back, as on her legs, arms, and face. Now, the red color is almost waned to nothing, except on her face, which is still bright red, and all of her skin is very bumpy, like touching a rough orange peel. Also, she is sleeping very poorly, tossing and turning, and ever reaching for mommy, to seek out my face, and assure that I am still right next to her. Thanks for the article, it gives me something to think about...I was even afraid to give her the ibuprofin or tylenol, since I couldn't be sure what effect it would have on her, since I didn't know "exactly" what she has. She doesn't seem to be in any pain, or itchy...she's not scratching at all. Thanks, ya'll. Shelly, in Glen Burnie, MD

 
At 3:13 PM, Anonymous Anonymous said...

Can someone please email me at lifeisgood76@msn.com about this. My daughter has mysteriously been getting a rash just like this. We are doing tons of bloodtests, but it looks just like this!

 
At 8:25 PM, Anonymous Anonymous said...

My 11 month old son was diagnosed with Roseola about a month ago. He had a fever that went to 103 and a runny nose. Went to the doctor and he also had double ear infections and roseola. He had antibiotics for two weeks and still has the rash. Does anyone know if this is normal? My two year old had it in the spring but much worse of a rash and his lasted about two and a half weeks. I am just wondering what to do.

 
At 3:55 PM, Anonymous Anonymous said...

Sounds like Roseola. My daughter had the same thing a month ago. The temp and crankiness come first for anywhere from 2 to 5 days they once you seem out of the woods the rash shows. The rash is a sign that the viral infection known as Roseola is gone and the babies body is getting back to normal. Look it up I am sure you will find everything you need.

 
At 5:23 PM, Anonymous Anonymous said...

Okay - I am very confused here. My 2 1/2 yr old toddler had some chest & nose congestion then a week later became irritable, not eating well, came down w/103 fever for 2 days dr gave scrip for amoxicillin. 2nd day into amoxicillin fever broke and this similar looking rash appeared on her trunk (stomach & back) only. Took her to dr, he said "roseola" stop the antibiotic so we did. 2 days later she had 101.7 fever AGAIN we were told go back on the amoxicillin. AGAIN 2 days later rash broke out this time all over her entire body, incl her face bright red cheeds w/bumpy, rash is worse. Next dr saw rash & ruled out 5th, roseola - said it's either allergic reaction to antibiotic OR ?Mono?! which is different in toddlers than in hschoolers. Dr said to give Zyrtec & if it's allergy to antibiotic rash would go away in 1 hr. Rash didn't go away w/Zyrtec or Benadryl but everyone whos seen rash & had similar experience, incl a friend who is an ER nurse w/small kids, says it is allergic reaction to amoxicillin. HELP! I am so fed up with trying to figure out what is wrong with my toddler!
Kelly

 
At 5:16 PM, Anonymous cookiedahl said...

Thanks so much for posting the photo. My daycare provider mentioned this virus when I called my daughter in sick for daycare and said she had a fever followed by a rash. I looked up rashes and most sites had very severe photos of this condition, and as my 28 month old (who had spiking temps and soft bm's and little appetite for the last 2 days)had a rash that didn't resemble most of the photos I saw, I nearly ruled it out till I saw yours. Hers is exactly the same and the symptoms all match. Thanks again.

 
At 5:06 PM, Anonymous Anonymous said...

And 5 years later...THANK YOU!!!!!!!!!!!!! We have been worried sick about our little guy, and this explains it. I was so worried (we lost our daughter to SIDS, makes us hyper-sensitive to his ailments). I will rest easier tonight. Thank you!

 
At 5:48 PM, Anonymous worried mom said...

I know this thread is from years ago but just want to try to see if anyone can give me some suggestions. My 4 month old baby son has been sick for 7 days. He came down with with a fever of 99.3 last Wednseday night, it became 101 on Thursday, 103.5 on Friday, and 104.6 on Saturday. I've been giving him tylenol and ibprophen alternately, it only helped temperarily. After the medication wear out, the fever came back and it was always over 102. He was admited to hospital on Saturday, they checked his blood, urin, stool but everything came back negative. The doctors had nothing to tell us, and nurses just kept giving him tylenol. On monday I found rash on his legs and arms, he continued to get more of them, now I can find rash on his bottom as well. But high fever did not go away. Can anyone please give me some clue about what's going on?

 
At 3:15 PM, Anonymous Anonymous said...

My son has this!!! should i take him to the hospital or wait it out??

 
At 8:37 PM, Blogger Mumof5 said...

my son has that exact rash. He has had four days of mid to high fevers, no appetite and has been tired. I put the glass to his rash and it doesn't appear which is a good sign. I was just about to book into the Dr but will not give him some ibruprofen and see if that help. Thanks for that.

 
At 10:27 AM, Anonymous Anonymous said...

Hi,
Wonderin if yu can help,
My son has a rash that look like that,
He's had it for 4 days,
Its al over his body and on the parms ov his hands and feet aswell,
Took him the docs and they said it can either b,
Hand foot and mouth or scabes,
But I've researched them both and it does not look like what he has,
He's not long had an ear infection with a temp ov 80/90

 
At 5:07 PM, OpenID stacybuckeye said...

My son is almost and a half and is recovering from roseola. His rahs is almost gone but he still have decreased appetite and is cranky.

 

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