Learn about what you can do if your kids have keratosis pilaris.
Keratosis pilaris is one of the more common rashes kids get that you have probably never actually heard of.
“Keratosis pilaris (KP) is a common inherited disorder of follicular hyperkeratosis. It is characterized by small, folliculocentric keratotic papules that may have surrounding erythema.”
Keratosis Pilaris: A Common Follicular Hyperkeratosis
Keratosis pilaris develops when hair follicles fill up with dead skin cells and scales instead of exfoliating normally. That doesn’t mean that kids with KP are doing something wrong though.
What Keratosis Pilaris Looks Like
Children with keratosis pilaris will have small, scaly, red or flesh colored bumps on both cheeks, upper arms, and/or thighs. It can even occur on a child’s back and buttocks.
Although it can occur year round, it is often worse in the winter, when a child’s skin will feel rough and dry with small red bumps.
Keratosis pilaris feels rough, like sandpaper, but it typically isn’t itchy, making this mostly a cosmetic issue.
Keratotis Pilaris Treatments for Kids
Treatment isn’t always necessary, but if you want to try and get rid of your child’s keratosis rash, it may help to very regularly (every day) use an exfoliating moisturizer, like Eucerin Roughness Relief Lotion for Extremely Dry, Rough Skin (contains urea and lactic acid) or over-the-counter strength Lac-Hydrin lotion (contains 5% lactic acid).
It can also help to:
use a soap substitute, like Dove or Cetaphil, instead of a harsh soap
wash with an exfoliating sponge, exfoliator brush, or exfoliating gloves
use a humidifier, especially if it very dry in your home
avoid long hot baths or showers, which seem to make it worse
get a higher strength Lac-Hydrin 12% lotion
get a prescription for a topical retinoid cream, such as Retin-A or Tazorac
get a prescription for a topical steroid cream if the rash is very red, rough, and bumpy
Even with proper treatment, which might include some combination of the above prescription creams, you can expect your child’s rash to come back at times.
Fortunately, keratosis pilaris does seem to eventually go away when kids get older, especially in their late teens.
What To Know About Keratosis Pilaris
Keratosis pilaris is a common rash that is hard to treat and lasts a long time.
Since it is mostly cosmetic and may eventually go away on its own, you probably don’t have to go overboard trying to treat it.
Why are some kids still getting sick if they are have been our of school and stuck in the house for weeks because of COVID-19?
COVID-19 has kept most kids out of school for some time now. Many are also out of daycare. And few are out playing with friends.
So why are some still getting sick? What else is going on with kids stuck at home while we are all social distancing to flatten the curve.
Why Are Social Distancing Kids Still Getting Sick?
The first thought of some parents and pediatric providers upon reading this might be, wait, what, kids are still getting sick?
Flu activity is low in most of the United States.
And that’s because it does seem that in addition to flattening the COVID-19 curve, staying home from school and daycare, washing hands, and general social distancing techniques has worked to keeps from getting sick with the flu and most other contagious diseases!
So while pediatric providers are available to do telemedicine appointments, it certainly isn’t business as usual, even as their days have gotten quite unusual.
Some kids are still getting sick though, and while we know what you are thinking, most probably don’t have COVID-19.
Why?
It might be because:
they aren’t social distancing as well as they think they are, keeping in mind that with many diseases, people can be contagious for a few days before they show symptoms and you can sometimes catch germs from touching fomites, or objects that a sick person has recently touched. That still doesn’t mean that they have COVID-19 though. If they have contact with others, they could catch almost anything.
they caught something from someone who had a disease a few weeks or months ago and is still shedding. For example, some infants can shed RSV for as long as 4 weeks after they get better. And they can shed the virus that causes hand, foot and mouth disease (HFMD) for almost two months! Human parainfluenza viruses (HPIV), a common cause of colds and croup (seal bark cough), can also shed for many months.
they caught something from someone who had a viral disease that causes a lifelong latent infection with periodic reactivation and shedding. Wait, what? While herpes (cold sores) is the main disease you might think of as causing a lifelong latent infection, there are others. You may not realize this, but after getting roseola (causes a high fever for a few days, followed by a rash after the fever breaks), HHV-6 (human herpes virus-6) kind of does the same thing. The big difference is that while you shed HHV-6 in your saliva from time to time, you don’t have any symptoms. You can get other folks sick though, especially older infants, once they lose the passive immunity they got from maternal antibodies.
they have a sore throat caused by a virus, allergies, or reflux, but have tonsil stones and a positive strep test because they are a strep carrier. Nearly 20% of kids are thought to be carriers of strep, which means that every time they get tested, they will be positive, whether or not they actually have strep throat. That means that you don’t have to worry about testing the dog to see if they are carrying strep…
they were exposed to a disease with a long incubation period. While the incubation period (the time between getting exposed to something to when you get sick) is just a few days for many diseases, it can be several weeks or months for others. In fact, your child might not get sick until 30 to 50 days after being exposed to someone with mono!
they had a virus a few weeks ago and now have Gianotti Crosti syndrome (GCS), a post-viral rash on a child’s legs, arms, and buttocks. Although GCS might linger for weeks or months, it eventually goes away on its own. Another rash, this one likely caused by reactivation of the virus that causes roseola, might have you thinking your child is covered in ringworm (how would they get that if they haven’t left the house??). Instead, they likely have pityriasis rosea.
their symptoms are caused by a non-contagious infectious disease that is spread from an animal or insect and not from another person – think Lyme disease (ticks), Cat scratch disease (cats), and West Nile virus (mosquitoes), etc.
they got sick (bacteria, virus, or parasite) from contaminated lake or well water, which can cause diarrhea – giardiasis, Crypto, shigellosis, norovirus,
they got sick (bacteria, virus, or parasite) from eating raw or contaminated food – giardiasis, shigellosis, norovirus, E. coli, salmonellosis
their symptoms are caused by a non-infectious disease, which could be anything from allergies and asthma to poison ivy or herpes zoster (shingles).
It is also possible that their symptoms are being caused by anxiety, fear, and stress, which is not unexpected as they see schools closed, people getting sick and wearing masks, and are likely unsure about what’s coming next.
Has your child been sick recently?
Do you have a pet turtle or chickens in your backyard? They could be a source for Salmonella…
Do you understand why now?
Now call your pediatric provider if you have questions and need help getting them well, especially if they seem anxious or have extra stress from being home all of the time and away from school and their friends.
You especially want to call if you think that they might actually have COVID-19. While most kids have mild symptoms or are asymptomatic, if your child has a fever, cough, and difficulty breathing, you should call your pediatric provider or seek medical attention.
There are a lot of different rules that dictate when kids can go to daycare or school when they are sick.
Kids don’t always have to stay home from daycare or school when they are sick.
The actual rules of your daycare or school are the ones that you are likely most familiar with, but there are also recommendations from the American Academy of Pediatrics and the CDC, in addition to state-specific regulations.
Can Your Sick Child Still Go to Daycare or School?
Most people know to stay home when they are sick.
“Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness. Avoid close contact with people who are sick.”
CDC on Information for Schools & Childcare Providers
But what exactly does it mean to be “sick” and how long are you supposed to stay home and avoid other people?
“Most minor illnesses do not constitute a reason for excluding a child from child care, unless the illness prevents the child from participating in normal activities, as determined by the child care staff, or the illness requires a need for care that is greater than staff can provide.”
Recommendations for Inclusion or Exclusion (Red Book)
In general, your child does not need to be kept home and out of daycare or school if they are able to participate in routine activities, do not need extra care, and have:
a cold (unless they have a fever) or other upper respiratory infection, even if they have a green or yellow runny nose
diarrhea that can be contained in a diaper or the child can make it to the bathroom without having an accident, as long as they aren’t having more than 2 stools above their usual or stools that contain blood or mucus
a rash without fever – most skin rashes won’t keep your kids out of school, like if they have poison ivy, hives, or even molluscum contagiosum and warts
Fifth disease – interestingly, you aren’t contagious once you have the characteristic Fifth disease rash
head lice – why not keep kids out of school if they have lice? It doesn’t stop them from spreading. They can get them treated at the end of the day.
pinworms – like lice, keeping kids out of school with pinworms isn’t going to stop them from spreading, although kids should be treated
pink eye – if caused by an infection, in general, should be able to stay or return if is improving, but keep in mind that most experts now think that kids with pink eye do not need to be excluded from daycare or school at all
oral lesions and are able to contain their drool (unless they have a fever), which would include hand foot mouth disease
skin lesions that can be covered, and if they can’t, then they can return after they have been on antibiotics for 24 hours (impetigo) or have started treatment (ringworm)
strep throat and have been fever free and on antibiotics for 24 hours
scabies – if you have started treatment
a sore throat (unless they have a fever)
Why don’t you have to keep your kids home when they have RSV or many of these other common childhood diseases?
In addition to the fact that some kids would never get to go to daycare or school, since these diseases are so common, many kids continue to be contagious even after their symptoms have gone away. So excluding them doesn’t really keep the illnesses from spreading through the daycare or school.
So why not just send them when they have a fever or really don’t feel well?
In addition to the possibility that they might be a little more contagious at those times, it is because the typical daycare or school isn’t able to provide the one-on-one care that your child would likely need when feeling that sick, as your child probably isn’t going to want to participate in typical group activities.
Policies that are overly strict at excluding children from daycare and school may also lead to antibiotic overuse, as parents rush their kids to the doctor for and push for a quick cure because they need to go back to work.
Exclusion Criteria for Vaccine Preventable Diseases
While the exclusion criteria for many diseases simply extends to when your child is fever free, starts treatment, or feels well enough to return to daycare or school, for many now vaccine-preventable diseases, you will be excluded (quarantined) for much longer:
hepatitis A virus infection – exclusion for one week after illness starts
measles – exclusion until four days after start of rash
mumps – exclusion until five days after start of parotid gland swelling
pertussis – exclusion until completes five days of antibiotics or has had cough for at least 21 days
rubella – exclusion until seven days after start of rash
chicken pox – exclusion until all lesions have crusted
diphtheria – if survives having respiratory diphtheria, would likely be excluded until finishes treatment and has two negative cultures at least 24 hours apart
rotavirus – as with other diseases that causes diarrhea, children should be excluded until “stool frequency becomes no more than 2 stools above that child’s normal frequency” as diarrhea is contained in the child’s diaper or they aren’t having accidents
tetanus – if survives having tetanus, wouldn’t be excluded, as tetanus is not contagious
Unfortunately, kids are often contagious with many of these diseases, especially measles and chicken pox, even before they have obvious symptoms, which is why large outbreaks used to be so common.
Children will often be excluded from daycare or school if they are unvaccinated or not completely vaccinated and they are exposed to a vaccine-preventable disease.
More on Sending Your Sick Child to Daycare or School
You can probably spot poison ivy if you were looking out for it, right?
Leaves of three, let it be…
You know the problem though, right? Most of the time, you aren’t actually looking out for it.
Spotting Poison Ivy
It would be nice if we got a warning anytime we were going to be around poison ivy.
Our local YMCA used to have a sign warning kids to stay out of the surrounding woods.
Or if someone was nearby to point it out to us.
Poison ivy won’t always be this easy to spot.
That’s not usually going to happen, so you need to learn how to spot poison ivy if you want to avoid it.
What’s the first step in learning how to spot poison ivy? Understanding where poison ivy is likely to be growing.
Any “wild” area, especially along tree lines and fences, just off paths and trails, and around ponds and lakes, are likely places you will find poison ivy.
Whether it is a tree line, fence, or edge of a path, you will likely find poison ivy growing nearby.
Yup, there it is on one of the posts.
Looks like a great place to go fishing… and get exposed to poison ivy if you aren’t careful.
If you really want to avoid getting a poison ivy rash when you are outside in an area that might have poison ivy plants, it is likely a good idea to wear long pants, a shirt with long sleeves, gloves, and boots. There are also products, like IvyX, that you can apply to your skin that are supposed to protect you from poison ivy oils.
Identifying Poison Ivy
While it is a good rule of thumb that you might run into poison ivy in a wild area, in some parts of the country, you might even encounter poison ivy in your own backyard. That’s why learning how to identify poison ivy plants is so important, especially if you or your kids have severe reactions to these plants.
This poison ivy plant is growing out of the edge of a lawn. Photo by CDC/ Dr. Edwin P. Ewing, Jr..
What’s the key to identifying poison ivy? That’s right – think of the old adage – leaves of three, let it be.
Birds eat the poison ivy berries and poop out the seeds, which is why you find these plants growing along tree lines… or in your garden.
Poison ivy plants use aerial roots to grab on to trees and fences.
There is a little more to it than that though. After all, other plants have three leaves. If you really want to be a pro at identifying poison ivy, you also need to know that with poison ivy:
The dead poison ivy plants clinging to this tree could still trigger a reaction.
the middle leaflet has a longer stalk (petiole) than the other two
leaflets are fatter near their base, but are all about the same size, are green in the summer, and can be red in the fall
you can sometimes find poison ivy plants with clusters of green or white berries
their stems don’t have thorns, but do have aerial roots, which help them cling to trees and fences
Most importantly, understand that even a dead poison ivy plant or a plant without leaves can trigger a reaction.
Thinking about burning poison ivy? Don’t! Inhaling the smoke from a burning poison ivy plant can be deadly.
What about poison oak and poison sumac?
They look very similar (well, except poison sumac, which has 7-13 compound leaflets, instead of just 3), but unlike poison ivy, which grows as a vine, these other plants that can cause the same type of reaction grow as a low shrub (poison oak) or a tall shrub/small tree (poison sumac).
Avoiding Poison Ivy Rashes
If your kids are active and adventurous, it is likely going to be a little harder to avoid poison ivy than for kids who rarely go outside.
And even if they get good at spotting poison ivy, the next time they spot it, might be when they are climbing down a tree that is covered in it.
What can you do if your child is exposed to poison ivy?
You can quickly cleanse the exposed areas with rubbing alcohol. How quickly? You have about 10 to 15 minutes to prevent a poison ivy reaction after an exposure.
Next, rinse the exposed areas with cool water. Don’t use soap, since soap can move the urushiol around your body and actually make the reaction worse. It is the urushiol oil from the poison ivy that actually triggers your poison ivy rash.
Don’t forget to scrub under your nails with a brush.
Now, take a shower with soap and warm water.
Lastly, put on disposable gloves and wipe everything you had with you, including shoes and tools, etc., with rubbing alcohol and water. And wash the clothes you were wearing. It is possible that urushiol that remains on these things could trigger another reaction if you touch them later.
Instead of rubbing alcohol, several over-the-counter products are available, like Zanfel, IvyX Cleanser Towelettes, and Tecnu Extreme Poison Ivy Scrub or Cleanser.
You could even use a degreasing soap (dishwashing soap, like Dawn). One group of dermatologists has suggested that you could prevent a poison ivy rash after getting exposed by using a damp washcloth and liquid dishwashing soap, washing for three minutes with “repetitive, high-pressure, single-direction wipes under hot, running water.” Repeat this full body wash two more times within one to two hours of your exposure.
If these methods don’t work and your child gets a poison ivy rash, look for treatments to control the itching and inflammation, which will likely mean visiting your pediatrician for a prescription for an oral steroid (tapered over two to three weeks to prevent a rebound rash) and a steroid cream. In addition, other anti-itch treatments and home remedies can be helpful, including an oral antihistamine, calamine lotion, oatmeal baths, cold, wet compresses made with Domeboro powder packets (modified Burow’s Solution), etc.
Keep in mind that without treatment, poison ivy rashes typically linger for about three weeks. Fortunately poison ivy isn’t contagious, so you wouldn’t have to keep your child our of school for that long, but except for very mild cases, see your pediatrician for treatment if they have poison ivy.
What to Know About Poison Ivy
Learn to avoid poison ivy, so that you can avoid getting a poison ivy rash.
While poison ivy isn’t contagious, it can make you miserable if you don’t learn to avoid it and treat poison ivy rashes properly with anti-itch creams and steroids.
It is better to learn to avoid poison ivy than to get a rash and have to get it treated. Photo by Vincent Iannelli, MD
It is usually not hard to identify a child with a poison ivy rash, especially a classic case of poison ivy, which might include a child with a known exposure to poison ivy after a camping trip, hike in the woods, or day at the lake, who a few days later develops a red, itchy rash all over his body.
The problem is that many parents don’t remember the “known exposure,” especially if it is the child’s first poison ivy rash.
The Poison Ivy Rash
Aerial roots on the stems can help you identify poison ivy, and yes, they can trigger a rash too. Photo by Vincent Iannelli, MD
After exposure to the leaves, stems, or roots of a poison ivy plant, children develop symptoms of poison ivy within 8 hours to a week or so, including:
an intensely itchy rash
red bumps that often may be in a straight line or streaks, from where the poison ivy plant had contact with your child’s skin
a rash that appears to spread, mostly because the rash appears at different times depending on how big or small a dose of the urushiol oil that area of skin got, with the rash appearing first on the spots that got exposed the most
vesicles and blisters that are filled with fluid
Keep in mind that children exposed to poison sumac and poison oak, other members of the genus Rhus or Toxicodendron, can get these same symptoms that we generically refer to as poison ivy symptoms.
(Using medical terminology, these children develop rhus dermatitis or allergic contact dermatitis, an intensely pruritic, linear, erythematous, papulovesicular rash after exposure to the urushiol oil in poison ivy.)
Treating Poison Ivy
It seems like everyone has their favorite treatments for poison ivy.
These basic treatments for poison ivy are usually going to help control the itch, and might include:
oral antihistamines (Benadryl or Atarax)
modified Burow’s Solution
Calamine lotion
Aveeno oatmeal baths
over-the-counter or prescription topical steroid creams
Is that all you need?
While these treatments might provide temporary relief and might be enough for very mild reactions, those with more moderate or severe symptoms will likely require systemic steroids.
Does that mean a steroid shot?
That might be what your doctor suggests or what some parents request, but keep in mind that it might wear off too soon, leading your child’s poison ivy symptoms to flare up again (rebound rash). That’s why most experts recommend a longer, tapering course of oral steroids instead of a single shot. A steroid dose pack is also often avoided as treatment for poison ivy, as the dose might be too low and it typically doesn’t last long enough.
Since the poison ivy rash might not go away for as long as three weeks, getting treated with systemic steroids can be an especially good idea if you have a moderate or severe case.
Avoiding Poison Ivy
A classic poison ivy plant in the ‘leaves of three, let it be’ configuration. Photo by Vincent Iannelli, MD
Since very few people are actually immune to poison ivy, it is best to learn to avoid getting exposed to it in the first place.
You can start with the old adage, ‘leaves of three, let it be,’ but you really have to look at a lot pictures of poison ivy to get good at avoiding it. And to be safe, learn to avoid the places where poison ivy grows – along tree lines, around lakes and ponds, along trails, and in wooden or wild areas, etc.
Or at least do your best to avoid the plants by wearing long pants, a shirt with long sleeves, and gloves, etc., to avoid skin contact even if you are around poison ivy while hiking, playing along a creek, or fishing near a lake.
What can you do if you have been exposed to poison ivy? If you can rinse the exposed area with rubbing alcohol, like within 10 minutes, then you might avoid a reaction. After that, the oil in poison ivy, urushiol, will likely be stuck and trigger a rash. Of course, you don’t want to be applying rubbing alcohol to a large area of your child’s skin though or allow your child to use it if they will be unsupervised. And be sure to wash it off afterwards.
Commercial products might be more useful (and safer) to help you avoid poison ivy reactions and include:
Ivy Block – was an over-the-counter barrier lotion that was supposed to prevent poison ivy, but unfortunately, it isn’t being made anymore
Tecnu Original Outdoor Skin Cleanser
Tecnu Extreme Poison Ivy & Oak Scrub
Zanfel Poison Ivy Wash
Although it is best to use the products immediately, within 10 to 30 minutes after exposure to poison ivy, if used anytime before you get a rash, you might decrease your symptoms. And if you get lucky, you might not get any symptoms at all.
Myths and Facts About Poison Ivy
Would you recognize this as poison ivy? It will still trigger a rash… Photo by Vincent Iannelli, MD
As common as poison ivy is, there are many myths and misconceptions about it, including that:
poison ivy is contagious (false) – scratching doesn’t spread poison ivy, although it may seem that way as the rash spreads to new areas over the days and weeks after being exposed. That’s only because some areas of a child’s skin that had less exposure to the poison ivy plant than others will get the rash later, not that they are continuing to spread it by scratching.
you can get poison ivy from your dog (true) – although not as common as direct contact with a plant, indirect contact, like if you touch the oil from poison ivy that got on your dog’s fur or on your clothing, could trigger a reaction
it is easy to spot poison ivy (false) – poison ivy plants are often found growing among other plants, can trigger reactions year round, even when they don’t have any leaves (the stems and roots can trigger a reaction too), and even dead poison plants can trigger a reaction, which can make it extremely hard to simply use the ‘leaves of three, let it me’ advice to spot plants.
birds help spread poison ivy (true) – ever wonder why poison plants grow along tree lines? Birds and small mammals eat the poison ivy berries and then poop out the seeds, allowing new plants to grow wherever the birds commonly hang out, including tree lines, around lakes and ponds, and your garden.
it’s easy to get rid of poison ivy plants (false) – poison ivy plants are very persistent and can be hard to get rid of
goats like to eat poison ivy (true) – well, goats like to eat everything, but a goat in your yard will likely eat up all of the poison ivy plants.
it is easy to identify poison ivy (false) – many other plants mimic the ‘leaves of three, let it be’ pattern, like Virginia creeper and Boxelder
burning poison ivy plants is dangerous (true) – the oil that triggers the poison ivy rash can vaporize, meaning exposure to the smoke from a burning plant can cause severe reactions.
And remember that your pediatrician can be helpful if you think your child has poison ivy. (true)
What To Know About Hard to Control Poison Ivy
While poison ivy isn’t contagious, it can make you miserable if you don’t learn to avoid it and treat poison ivy rashes properly with anti-itch creams and steroids.
Roseola is a common viral infection that most kids get in early childhood.
Roseola is a very common childhood infection.
It was first described in the journal Pediatrics in 1910 by J. Zahorsky.
Also called roseola infantum or exanthem subitum (sixth disease), it is caused by human herpes virus type 6 and 7. That fact wasn’t discovered until 1986 though.
Roseola is best known for causing a high fever for about three to five days, but even more characteristically, roseola often causes a rose-pink or red rash on your child’s trunk once the fever breaks.
Infections can also be asymptomatic.
There are no treatments and it rarely causes complications. Even febrile seizures that can be triggered by roseola, which happens commonly, are not thought to be serious.
Roseola, even reactivation of an old infection, can be a serious for children or adults with immune system problems though, especially those who have had a stem cell transplant.
What To Know About Roseola
Roseola is a common viral infection that most kids get in early childhood. The biggest problem when having roseola is that by the time you get diagnosed, because the fever is gone and your child has a rash, it is basically over.
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