What’s causing that itchy rash?


Determining the cause of a child's rash is important to proper diagnosis and management. Allergic contact dermatitis and eczema are 2 of most common causes.

Most children will have a rash at least once in their childhood, but that commonness doesn’t make them any less irritating, especially when the child and family don’t know what’s causing them. Two common causes are eczema and allergic contact dermatitis, but a correct diagnosis is key to proper treatment.

Dr. JiaDe Yu, MD, FAAD, director of occupational and contact dermatitis clinic and assistant professor of adult and pediatric dermatology at Massachusetts General Hospital in Boston discussed offered an overview of both for the 2022 American Academy of Dermatology annual meeting in Boston.

Eczema is frequently characterized by intense itching, which can damage the skin and make the rash worse. Atopic dermatitis is the most common form and typically presents early in life, with most children who have it developing the condition before their 5th birthday. Eczema can appear differently on skin of color, which is important to know because Black and Asian American children develop atopic dermatitis more often than their white counterparts and Black children can potentially have eczema that is more severe or itchy.

Eczema may go away as a child grows up, but 50% of children will still have it when they reach adulthood. Although there’s no way to know if the condition will persist, early diagnosis and treatment can prevent severe disease, which can be harder to treat and is more likely to continue into adulthood.

Although it can be confused for eczema, allergic contact dermatitis can generate symptoms such as rash, tenderness, burning, or blisters. Metals like nickel and cobalt, which can be found in toys, accents to clothes, and costume jewelry, are the allergens children are most likely to be allergic to. Soaps, shampoo, and laundry detergents can be a source for 2 other common allergens: fragrance and preservative. Chemicals and dyes used to treat fabrics can also generate a reaction. Dr. Yu noted, “Dermatologists are seeing two emerging allergens affecting children —adhesive allergens, which are commonly used in wearable blood glucose monitors, and an allergen from a chemical used in shin guards.”

Knowing the location of the rash and getting a thorough family history of skin conditions can help differentiate the 2 conditions. Allergic contact dermatitis typically occurs in unusual locations, whereas eczema has certain areas where it frequently presents such as the wrist and back of knees. Because allergic contact dermatitis can actually make eczema worse, children who are diagnosed with eczema should avoid common allergens when possible.


American Academy of Dermatology. What’s causing your child’s itchy rash? Published March 25, 2022. Accessed March 26, 2022. https://www.aad.org/news/cause-childrens-itchy-rash

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