Childhood Skin Problems

Medically Reviewed by Renee A. Alli, MD on August 30, 2020

There are a number of skin conditions seen in infants and young children, including cradle cap, molluscum, acne, roseola, and fifth disease.

Cradle cap (also called infantile seborrheic dermatitis) is a rash that begins as scaling and redness on an infant's scalp. This is not an infectious or contagious skin condition. Seborrheic dermatitis is common in infants, usually beginning in the first weeks of life and slowly disappearing over a period of weeks or months. The condition rarely is uncomfortable or itchy.

The precise cause of the rash is not known; however, it may be a result of mother’s hormonal changes in pregnancy and the influence on baby’s oil glands. 

Mild cases of cradle cap can be treated with mild shampoo. You should wash the hair more frequently than before. This, along with soft brushing, will help remove the scales. Medicated shampoos (dandruff shampoos containing sulfur and 2% salicylic acid) may loosen the scales, but these shampoos can cause irritation and should be used only after consulting a pediatrician. Remember these shampoos are not tear-free, so extra caution should be used to prevent contact with the eyes. Additional medications, such as topical steroids, may be prescribed to treat the scales and redness.

In most cases, frequent shampooing with a mild baby shampoo can prevent cradle cap from coming back once it has cleared up. A stronger medicated shampoo may be needed in some cases, but seek the advice of your doctor regarding the use of these shampoos. Most children outgrow cradle cap by the time they are 6 months old.

Roseola is a viral illness that usually affects children between the ages of 6 months and 2 years. It is typically marked by several days of high fever, followed by a pinkish-red flat or raised rash that appears on the child's trunk and spreads over the body just as the fever breaks.

Roseola can be caused by two common and closely related viruses: human herpes virus (HHV) type 6 and type 7. These two viruses belong to the same family as the herpes simplex viruses. However, HHV-6 and HHV-7 do not cause the cold sores and genital herpes infections that HSV can cause. Roseola is contagious and spreads through tiny drops of fluid from the nose and throat of infected people. Someone who has not yet developed symptoms often spreads the infection.

In most cases, a child with roseola develops a mild upper-respiratory illness, followed by a high fever (often higher than 103 degrees Fahrenheit) for three to seven days. The child may be fussy or irritable during this time, may have a weak appetite, and may have swollen glands (lymph nodes) in the neck or the back of the head.

In many cases, the high fever abruptly stops and a rash appears on the child's body at about the same time. The rash is made up of flat or raised pinkish-red spots and appears on the torso. The spots turn skin-colored (or blanches) when touched. Individual spots may have lighter areas or "halos" around them. Usually, the rash spreads to the face, legs, arms, and neck. Seizures may be a complication of roseola. 

To diagnose roseola, a doctor will take a history and do a thorough physical exam. A diagnosis of roseola is often uncertain until the fever goes down and a rash appears. As a result, the doctor may order tests to make sure that the fever is not caused by another type of infection.

In most cases, roseola does not require treatment other than trying to bring down a high fever. Antibiotics cannot treat roseola because it is caused by a virus.

Acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin) can help to reduce your child's fever. Avoid giving aspirin to a child because the use of aspirin in such cases has been associated with the development of Reye's syndrome, which can lead to liver failure. A sponge or towel soaked in cool water may help comfort the child until the fever drops. Ice, cold water, alcohol rubs, cold baths, and fans should be avoided.

Encourage your child to drink clear fluids such as water with ice chips, children's electrolyte solutions, sodas like ginger ale, or clear broth. Fluids decrease the risk of dehydration.

Call your child's doctor if your child is lethargic, not drinking, or if you cannot keep their fever down.

There is no known way to prevent the spread of roseola. The infection usually affects young children but rarely adults. Therefore, it is thought that exposure to roseola in childhood may provide some lasting immunity to the illness. Repeat cases of roseola may occur, but they are not common.

Fifth disease is a highly contagious condition caused by human parvovirus. The condition results in a facial rash that looks like the cheeks have been slapped.

Fifth disease usually affects school-aged children.

Fifth disease rarely causes harm to an unborn child, but pregnant woman should be monitored in case they haven't developed immunity to the virus.

The virus - Parvovirus B19 - that causes fifth disease is transmitted by sneezing or coughing. The disease is only contagious before the rash appears.

Most children with fifth generally have minimal symptoms, if any, other than a rash. Symptoms of fifth disease include:

  • Flu- and cold-like symptoms such as coughing, runny nose, fever, generalized aches and pains in joints and muscles, loss of appetite, and irritability
  • A facial rash that looks as if the cheeks have been slapped appears around days 7-10 of the illness; the rash is not painful but is warm to the touch. It usually goes away in about a week but can recur when hot from sweating or exercising.
  • Spreading of the rash to the thighs and arms

Aches in joints are sometimes seen in adults, rarely in children.

In most cases, a doctor can diagnose fifth disease by seeing the typical rash during a physical exam. To confirm the diagnosis, a blood test may be done to look for antibodies to parvovirus.

There is no treatment for the disease itself, but medications like Tylenol or Advil can treat the symptoms. Those who have fifth disease should drink plenty of fluids to prevent dehydration.