Poison Ivy and Poison Oak

Skin reactions to poison ivy or poison oak are very uncomfortable, itchy, and unsightly. They can make a child miserable.

About half of the children who come in contact with either poison ivy or poison oak have an allergic reaction. Typically, the skin becomes reddened, swollen, and blistered, with the rash shaped like streaks or in patches. The children experience severe itching and burning sensations. The rash usually appears one to four days after your child is exposed. Then blisters form and soon rupture, fluid oozes out of them, and they eventually become crusty.

As with all allergies, preventing exposure to the offending agent is most important. Particularly if your child spends time in forests and fields, make sure she knows what the poison ivy and poison oak plants look like. Poison ivy is a red-stemmed, three-leafed plant whose shiny green leaves turn bright red in the fall. Poison oak has green shiny leaves that also grow three to a stem. You might teach your child the poem: “Leaves of three, let them be.” Particularly when you have younger children, inspect the parks they play in for any poison ivy or oak, and have the plants removed.

The skin reactions to poison ivy and poison oak are not contagious and cannot be transmitted from one child to another. But if your youngster comes in contact with the plants themselves, she should wash immediately with soap and water to remove as much of the sap or oil as possible. This will keep its absorption—and the ensuing inflammation—to a minimum. Pets playing in yards with poison ivy and poison oak can be a source of exposure to family members.

The rash will heal within about two weeks, although your doctor may suggest some treatment to relieve the symptoms. For instance, to ease both the itching and oozing, have your child soak the affected area in cool water for a few minutes, or rub it gently for ten to twenty minutes, several times a day, with an ice cube; then let the skin air-dry. A hydrocortisone cream might also be helpful. To discourage scratching and further damage to the skin, keep your child’s fingernails trimmed. If your youngster cannot sleep at night because of the itching, you may give her an antihistamine. While mild cases can be treated at home, consult a doctor if your child is especially uncomfortable, if the rash is severe, if it has erupted on your child’s face or groin, or if it shows signs of infection (fever, redness, and swelling beyond the poison ivy or oak lesions).


Pityriasis Rosea

The inflammatory skin disorder pityriasis rosea peaks in incidence during adolescence and young adulthood. It typically begins as a large (three-quarters of an inch to two inches in diameter) pink rash on the chest or back. This is called a “herald patch,” because it is indeed a harbinger of what is to follow.

Within one to two weeks, the youngster breaks out in dozens, if not hundreds, of smaller faint-pink rashes. The trunk, arms, legs and neck may be affected, but rarely the face. Parents often confuse pityriasis rosea with ringworm, a fungal infection. Pityriasis rosea’s cause isn’t known, but it is not a fungal infection and therefore isn’t helped by antifungal medications. One way to recognize the disorder is to examine the chest or back for the distinctive Christmas-tree-shaped pattern of its flat, oval-shaped lesions.

Pityriasis rosea presents differently in African Americans, who tend to develop raised patches on their face and extremities more so than on their torsos. The color usually differs, too: light-brown instead of pink, and with a coarse, granular center.

Symptoms That Suggest Pityriasis Rosea May Include:

Large pink patch, typically on the torso, followed by:

  • Multiple smaller rashes
  • Mild fatigue
  • Mild itching

How Pityriasis Rosea Is Diagnosed

Physical examination and thorough medical history, plus KOH prep, in which a tiny sample of tissue from one of the spots is scraped off and examined under a microscope to rule out fungal infection.

How Pityriasis Rosea Is Treated

Pityriasis rosea is not contagious and does not pose any danger, usually running its course within three to nine weeks. Expect new spots to erupt during that time. Until the rashes fade and disappear—leaving no scars, happily—your pediatrician will focus on controlling symptoms. For example, lotions or antihistamines may be prescribed to relieve the itching. Exposure to sunlight or ultraviolet light treatments are sometimes recommended to hasten resolution of the rashes.

Helping Teenagers Help Themselves

Youngsters with symptomatic pityriasis rosea may wish to avoid strenuous physical activity, which can exacerbate existing rashes. Bathing in lukewarm water, not hot water, is also recommended.



Fortunately, the most common type of worm infesting children, the pinworm, is essentially harmless. The pinworm is unpleasant to look at and may cause itching and, in girls, vaginal discharge, but it is not responsible for more serious health concerns. Pinworms cause more social concern than medical problems.

Pinworms are spread easily from one child to another by the transfer of eggs. Often an infected child scratches himself, picking up an egg, and then transfers it to the sandbox or a toilet seat where another child unknowingly picks up the egg and later transfers it to his mouth. The eggs are swallowed, later hatch, and the pinworm makes its way to the anus to again deposit its eggs. Pinworms usually present with itching around your child’s behind at night. Girls may also have vaginal itching. If you take a look at the skin around the anus you may see the adult worms which are whitish gray and threadlike, measuring about 1⁄4 to 1⁄2 inch (0.63–1.27 cm) long. Your pediatrician might collect some of the worms and eggs by applying the sticky side of a strip of clear cellophane tape to the skin around the anus. The tape can be examined under a microscope to confirm the presence of the parasite.


Pinworms can be treated easily with an oral prescription drug, taken in a single dose and then repeated in one to two weeks. This medication causes the mature pinworms to be expelled through bowel movements. Some pediatricians may advise treating the other family members, as well, since one of them may be a carrier without having any symptoms. This medication is not recommended for use in children under two years of age. Also, when the infection is resolved, the child’s underclothes, bedclothes, and sheets should be washed carefully to reduce the risk of reinfection.


It is very difficult to prevent pinworms, but here are some hints that might be helpful.

  • Encourage your child to wash her hands after using the bathroom.
  • Encourage her sitter or child care provider to wash the toys frequently, particularly if pinworms have been detected in one or more of the children.
  • Encourage your child to wash her hands after playing with a house cat or dog, since these pets can carry the eggs in their fur.

What Causes Acne?

Although a number of factors contribute to acne, the initiating event is hormonal stimulation of the sebaceous glands beneath the skin. “The sebaceous glands produce sebum, the oily substance that gets transmitted onto the skin’s surface,” explains Dr. Eichenfield. Each bulb-shaped gland leads to a narrow duct called a follicle; each follicle contains a strand of hair.

“Once kids reach puberty,” he continues, “not only do the glands become more active, but the chemical composition of the sebum changes.” Ordinarily, a follicle’s inner lining sheds dead cells into the sebum, which gets deposited onto the skin, waiting to be scrubbed away.

For reasons that aren’t clear, in acne the cells clump together and plug the opening, or pore. This prevents the oil from escaping. It also forces bacteria that normally reside in the skin (called Propionibacterium acnes, or P. acnes), to proliferate inside the narrow follicle. Eventually the sebum seeps out of the opening. If chemicals produced by P. acnes inflame the skin, a reddish pusfilled pimple begins to grow there.

Acne, whiteheads and blackheads are all by-products of the same process. Acne refers to an enlarged follicle that protrudes from the surface of the skin; whitehead describes a plugged follicle that remains just beneath the surface. When the follicle opens partially to reveal a black speck the size of a pinhead, it is called a blackhead. Contrary to popular myth, “the discoloration is pigment, not accumulated dirt,” stresses Dr. Eichenfield. “Blackheads are just another type of acne.” Still other acne lesions include:

  • Paranasal erythema: an early form of acne commonly seen in kids on the cusp of puberty.
  • Papule: an inflamed, small, pink bump that is tender to the touch.
  • Nodule: a large, solid lesion lodged far below the skin’s surface; is frequently painful.
  • Cyst: another painful deep-seated lesion. Cysts, however, are inflamed and contain pus. They can also leave scars. Only one in twenty cases of acne are this severe.


Warts are tiny, firm bumps on the skin caused by viruses from the human papillomavirus (HPV) family. Warts are contagious and commonly found in school-aged children. They rarely occur in children younger than 2 years.

Signs and Symptoms

Skin warts are dome shaped with a rough appearance and a yellow, tan, black, brown, or gray coloring. They can appear anywhere on the body, but most often they are found on the hands, including near or under the fingernails; toes; face; and around the knees.

Warts also can occur on the soles of the feet, where they are often flat and painful. Your child may say she feels like she is walking on a pebble. Doctors refer to these manifestations as plantar warts. They may have tiny black dots on them, which are actually tiny, clotted blood vessels.

Human papillomaviruses are spread by close physical contact. The virus often gets into the body through breaks in the skin. Swimming in public pools may increase your child’s risk of developing plantar warts.

When warts occur on the genitals, they are considered a sexually transmitted disease caused by a type of HPV. They are spread during genital, oral, and anal sex with a partner who is infected.

When to Call Your Pediatrician

Let your pediatrician know if your child develops a wart on her face or genitals. If warts persist or spread or if they are painful, ask your pediatrician for medical advice.

How Is the Diagnosis Made?

Most warts, including genital warts, are diagnosed by their appearance. Genital warts can be identified by performing a biopsy that is sent to the laboratory for confirmation of an HPV infection.


While warts will go away on their own without treatment, they can become painful if they are bumped, and some children are embarrassed by them. Your pediatrician may suggest applying an over-the-counter medicine containing salicylic acid to the warts. Prescription-strength chemicals are also available for removing them. Recently, duct tape has been shown to work against warts! If your child has multiple warts or they keep coming back, your doctor may recommend removing them surgically by scraping, cauterizing (cutting away the warts), or freezing them (with liquid nitrogen). There is a good success rate with the use of surgery, but it sometimes leaves scars.

If your teenaged girl has genital warts, she should have a Pap smear to be sure there are no changes in the cells of the cervix. There is a link between genital warts and cancer of the cervix. Warts in the airways are also difficult to treat and often require referral to a specialist.

What Is The Prognosis?

Many warts last for months or years and then go away on their own or in response to treatment. The earlier the treatment is given, the greater the chances are of completely getting rid of the warts.


There is no way to effectively prevent warts.


Treatment For Warts

Warts are caused by a virus—the human papillomavirus (HPV). These firm bumps (although they also can be flat) are yellow, tan, grayish, black, or brown. They usually appear on the hands, toes, around the knees, and on the face, but can occur anywhere on the body. When they’re on the soles of the feet, doctors call them plantar warts. Although warts can be contagious, they appear infrequently in children under the age of two.


Your pediatrician can give you advice on treating warts. Sometimes he will recommend an over-the-counter medication that contains salicylic acid or even treat them in the office using a liquid nitrogen–based solution or spray. If any of the following are present, he may refer you to a dermatologist.

  • Multiple, recurring warts
  • A wart on the face or genital area
  • Large, deep, or painful plantar warts (warts on the soles of the feet)
  • Warts that are particularly bothersome to your child

Some warts will just go away by themselves. Others can be removed using prescription or nonprescription preparations. However, surgical removal by scraping, cauterizing, or freezing is sometimes necessary with multiple warts, those that continue to recur, or deep plantar warts. Although surgery usually has a good success rate, it can be painful and results in scarring. Laser treatment may help. The earlier the warts are treated, the better the chance of permanent cure, although there is always the possibility that they will recur even after treatment that is initially successful.

If a wart comes back, simply treat it again the way you did the first time, or as directed by your pediatrician. Don’t wait until it becomes large, painful, or starts to spread.


Molluscum Contagiosum

Molluscum contagiosum is a common skin infection in children that is caused by a poxviruse, named molluscum virus. It produces harmless, noncancerous growths in the skin’s top layers. The disease is spread by direct contact with the skin of an infected person or sharing towels with someone who has the disease. Outbreaks have occasionally been reported in child care centers.


Molluscum contagiosum causes a small number, usually between 2 and 20, of raised, dome-shaped bumps or nodules on the skin. They tend to be very small and flesh-colored or pinkish, with a shiny appearance and an indentation or dimple in their center. They are found most often on the face, trunk, and extremities, but may develop anywhere on the body except the palms of the hands and soles of the feet. They are painless and may last for several months to a few years.

The incubation period varies between 2 and 7 weeks, although it is sometimes much longer (up to 6 months).

When to call the doctor

If you notice bumps or nodules on your child that fit this description, call your child’s doctor.


Your child’s doctor can make the diagnosis by visual examination of the bumps. If the diagnosis is unclear, the doctor can perform a skin biopsy or send you to a dermatologist for a biopsy.


Most often, molluscum nodules go away on their own without treatment. This means that children with just one or a few widely scattered lesions do not need any special care. However, if you and your child choose, these lumps can be removed by a scraping procedure with a sharp instrument (curette) or by using peeling agents or freezing techniques (with liquid nitrogen). These methods are painful and in very rare situations, there may be scarring after the infection has healed.


A molluscum contagiosum infection tends to go away over a period of several months to years. In children who have suppressed immune systems, the infection can remain or even spread to another part of the body.


Keep your youngster from having skin-to-skin contact with another child or adult with molluscum contagiosum lesions.  


Impetigo Care

Impetigo is a contagious bacterial skin infection that often appears around the nose, mouth, and ears. More than 90 percent of impetigo cases are caused by staphyloccus, or “staph,” bacteria, while the rest are caused by streptococcus bacteria (which also are responsible for “strep” throat and scarlet fever). If staph bacteria are to blame, the infection may cause blisters filled with clear fluid. These can break easily, leaving a raw, glistening area that soon forms a scab with a honey colored crust. By contrast, infections with strep bacteria usually are not associated with blisters, but they do cause crusts over larger sores and ulcers.


Impetigo needs to be treated with antibiotics, either topically or by mouth, and your pediatrician may order a culture in the lab to determine which bacteria are causing the rash. Make sure your child takes the medication for the full prescribed course, or the impetigo could return.

One other important point to keep in mind: Impetigo is contagious until the rash clears, or until at least two days of antibiotics have been given and there is evidence of improvement. Your child should avoid close contact with other children during this period, and you should avoid touching the rash. If you or other family members do come in contact with it, wash your hands and the exposed site thoroughly with soap and water. Also, keep the infected child’s washcloths and towels separate from those of other family members.


The bacteria that cause impetigo thrive in breaks in the skin. The best ways to prevent this rash are to keep your child’s fingernails clipped and clean and to teach him not to scratch minor skin irritations. When he does have a scrape, cleanse it with soap and water, and apply an antibiotic cream or ointment. Be careful not to use washcloths or towels that have been used by someone else who has an active skin infection.

When certain types of strep bacteria cause impetigo, a rare but serious complication called glomerulonephritis can develop. This disease injures the kidney and may cause high blood pressure and blood to pass in the urine. Therefore, if you notice any blood or dark brown color in your child’s urine, let your pediatrician know so he can evaluate it and order further tests if needed.



Impetigo is a bacterial skin infection. It can develop in any skin injury, such as an insect bite, cut, or break in the skin. It can develop as a result of irritation caused by a runny nose.

A child can spread the infection to other parts of his body by scratching. He can spread the germs to others in close contact by directly touching them. He can spread the germs by touching a surface that another child touches.

Impetigo can occur anytime. It is most common in warm weather when cuts and scrapes from outdoor play are more likely.

What to Look For: 

  • Red pimples 
  • Fluid-filled blisters 
  • Oozing rash covered by crusted yellow scabs

What You Should Do: 

Parents or primary caregiver should

  1. Call child’s medical provider for a treatment plan. 
  2. Clean infected area with soap and water. Try to gently remove crusty scabs.
  3. Cover infected area loosely. The scabs need airflow for healing. Covering also helps prevent contact that would spread the infection to others or to other parts of the child’s body.
  4. Keep sores covered until they are healed.
  5. Wash hands well after treating sores.
  6. Try to keep your child from scratching.
  7. Trim the child’s fingernails.
  8. Do not permit sharing of towels or face cloths.
  9. Observe the rash. Notice whether it improves or gets worse.

Other Caregivers Should:

  • Tell parents if you notice a child has signs of impetigo.
  • If the child cannot be picked up promptly, wash the affected area with soap and water. Then cover any exposed sores until the parents can arrange to remove the child for treatment. 
  • In the event that more than one child in a group has been infected, contact the health department about control measures. The problem could involve antibiotic-resistant staphylococcal bacteria.

When A Child May Return to School or Child Care:

  • Twenty-four hours after treatment is started with an antibiotic ointment or oral antibiotic medicine. 
  • The child may return when he feels well enough to do regular activities. If your child needs special care, the staff should decide if they can provide the care while still taking care of the other children in the group.

Human Herpes Virus 6

Roseola, also called exanthem subitum and sixth disease, is a common, contagious viral infection caused by the human herpesvirus (HHV) 6. This strain of the herpes virus is different than the one that causes cold sores or genital herpes infections.

Roseola occurs most often in children aged 6 to 24 months. Youngsters typically have a high fever (greater than 103°F or 39.5°C) for 3 to 7 days. After the fever disappears, a rash will develop on the torso and spread to the arms, legs, back, and face. This rash usually only lasts for hours, but in some cases persists for several days. Some children have seizures associated with the high fever, but more often the fever is accompanied by a decrease in appetite, a mild cough, and a runny nose. This pattern of a high fever followed by a rash will help your pediatrician make the diagnosis of this infection. However, HHV-6 can also cause fever without rash or rash without fever.

Human herpes virus 6 is spread from person to person via secretions from the respiratory tract. You can reduce the chances of your child becoming infected by making sure that he washes his hands thoroughly and frequently. There is no specific treatment for roseola, and it usually goes away without causing any complications. If your child’s fever makes him uncomfortable, ask your pediatrician about lowering his temperature with acetaminophen.

Similar symptoms are associated with another herpesvirus infection caused by HHV-7. Many children infected with HHV-7 have only a mild illness. Human herpes virus 7 may be responsible for second or recurrent cases of roseola that were originally caused by HHV-6. Like all of the viruses in the herpes family, these viruses will stay within the body for life. If a person’s immune system becomes weakened by disease or medicines, the virus can reappear to cause fever and infection in the lungs or brain.