When a rash suddenly appears in a normally healthy child, the first thing you should do is step back, take a deep breath, and objectively assess the situation. If the rash is spreading rapidly or showing up all over the body, or if your child is experiencing progressive symptoms such as wheezing or shortness of breath, increasingly high temperature, weakness, lethargy, or intense headache, joint aches, or muscle pains, then you are dealing with a serious situation and should immediately seek medical assistance. Any rash that doesn’t go away after a week or two also warrants professional help.

If you’ve decided that the situation is not urgent, then you can apply some detective skills by gathering clues about the physical characteristics and location of the rash and the sequence of events prior to its appearance. Even if you are unable to determine the cause, answering these questions will help describe the situation to your healthcare provider: Is the rash confined to one area, or is it widespread? Does it come and go, or does it stay in the same place? Does it have small spots, large blotches, or a diffuse redness? Is it flat, raised, or blistered? Is it pink, red, purple, etc.? Do the affected areas itch or burn? Is it scaly, crusty, or weeping?

The most important step is to try to figure out whether the rash has been caused by an infection or an allergic reaction, since each of these categories will lead to an entirely different course of action. For example, if the rash is from an infection, then your child may be contagious. If systemic symptoms such as a fever, sore throat, swollen lymph nodes, muscle aches, diarrhea, or abdominal pain preceded the rash, then you would suspect a virus (measles, roseola, chicken pox), bacteria (scarlet fever from streptococcus), or bacteria-like organisms (Lyme disease, Rocky Mountain spotted fever). Recent exposure to any of these illnesses or a recent tick bite may be a tip-off.

The most dangerous rash that you could encounter in this context is from bacterial meningitis. In its initial stages, bacterial meningitis may resemble a bad cold or flu, but then things get suddenly worse with a high fever, severe headache, and joint aches. The rash is actually the result of small areas of bleeding called petechiae that occur under the skin and in the mucous membranes and the eyes. It typically begins in one region and then spreads all over the body, thus signaling a life-threatening situation.

Rashes from superficial infections may result from fungi (ringworm, athlete’s foot, diaper rash), viruses (herpes), bacteria (impetigo), or parasites (scabies and mites). Each of these rashes has a unique appearance and typical time course. An important clue is whether the child’s playmates or family members have experienced any similar problems. Recent travel or camping trips may lead you to suspect a fungal or parasitic infection.

Allergic reactions can be topical or internal. Rashes from topical exposures include reactions to plants (poison ivy), chemicals (detergents, fabric softeners, dyes), rubber, or metals. They tend to be itchy, scaly, and wet, especially after scratching, and commonly occur on the hands or legs. Systemic reactions typically result in hives, which are intensely itchy pink or red bumps that can appear anywhere on the body. In most cases they resolve within a day or two after the child stops eating the offending food or drug.

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