While I could try to review the most common or the most serious skin disorders, I don’t think that is really as helpful as trying to develop a process for determining which rashes need immediate attention. So here are a few rules.

1. A rash associated with a high fever should be brought to the attention of your pediatrician. Some of these are less common today because we have immunizations that protect us. Measles and chicken pox come to mind. Some, like scarlet fever, may lead to serious consequences if not treated. The parents’ job is not to identify the rash. The parents’ job is to recognize the urgency.
2. A rash that is painful or associated with discomfort is usually a sign of a serious illness. Bacterial infections like cellulitis may have tender red areas or streaking along a limb. Erythema multiforme is another disease with painful red blotches that should be seen by your doctor. Do you have to know what erythema multiforme is? Of course not. But you should pay attention to blotchy conditions all over the body that are uncomfortable or painful.
3. Even localized areas that are red and painful need attention. Red swelling around a fingernail or toenail usually will not go away without treatment. Tender red swellings like boils, especially just below the tailbone, need special treatment.
4. Chronic conditions associated with hair loss or skin pigment should be seen. Your pediatrician may refer you to a dermatologist (skin specialist). Vitiligo, alopecia, and ringworm are included in this group.
5. Parents call everything in the diaper area a diaper rash. Pediatricians know there are a dozen different causes of rashes in the diaper area. If your home treatment is not working, don’t be shy about getting professional advice.
6. A word about acne. Adolescents hate acne. Please do not take their concerns lightly. My most important advice about acne is to treat it as soon as possible. There are effective over-the-counter treatments, but getting factual information is a very good idea. WebMD, Mayo Clinic, and other sites that you can count on for that information are easily accessible on the internet. It is important to realize that acne treatment is a slow process. It may take six weeks before the new, clearer skin begins to show up. There are no dietary changes that make any significant difference. If your child seems to be developing acne before puberty, you need to see a dermatologist. And emphasize to your child that picking the lesions may lead to scars that never go away.
7. Eczema, specifically atopic dermatitis, is extremely common. Treatments have come a long way in the last 20 years. The location of these itchy, crusty or sticky red lesions may be different in young children and older children and adolescents. If your child can’t stop scratching, you are probably dealing with eczema. Scratching will not alleviate the itch. You need to see your pediatrician or a dermatologist with experience in treating this condition. Persistent scratching often leads to infection.
8. Finally, there are a host of lumps and bumps, almost all of which are not serious, but which should be identified. However, a mole that has changed size or shape or has started bleeding should be seen immediately. Other lesions which have been unchanged for months usually can wait for the next time you’re in the doctor’s office.

While we’re on the subject of skin and it’s almost summer, remember to apply sunscreen whenever your child is out in the sun with exposed skin. Cancers caused by sun exposure may not show up for decades!

 Robert B. Golenbock, MD, is currently retired. He has cared for children in the Danbury area for 43 years, including at the Center for Pediatric Medicine. The CPM is located at 107 Newtown Rd, #1D, Danbury, CT, 06810. For more information, please call (203) 790-0822 or visit https://centerforpediatricmedct.com.