Rashes Part 3 – Bacteria & Fungi

In the previous two blogposts we have discussed the general causes and management of red rashes, as well as the different types of viral rashes that could appear on your child’s skin. Supportive measures will mostly be enough to comfort and care for those rashes. However sometimes you need more help in the form of specific medical ointments or oral treatments. Today we will discuss rashes caused by bacteria and fungi.

Bacterial Skin infections:

Bacterial rashes are mostly caused by Staphylococcus Aureus and some strains of Streptococcal bacteria which are normally found on your skin as part of your microbiome. When the healthy balance is disturbed or when there is overgrowth of one type, it can lead to infections of the skin as described below:

  • Impetigo

Mostly seen in children 2-5 years old it is a very contagious superficial infection that can affect healthy skin or infect lesions such as insect bites, scrapes or eczema secondarily.

Symptoms:

Lesions begin as a red rash that changes to blisters, fills with puss and then breaks down to form a honey-coloured crust with redness of the surrounding skin. Mostly affects the face, hands and feet. It can also present with large, wobbly blisters filled with a yellowish fluid that is mostly on the body.

Impetigo is usually caused by Staph Aureus, but if it is caused by the Strep-bacteria, there is a small risk of the development of heart (Rheumatic fever) and kidney (Post-Streptococcal Glomerulonephritis) complications.

Management:

Wash the crusted lesions gently with warm soapy water. Cover draining wounds with a clean gauze and bandage. Prevent further spread of the bacteria by keeping the nails short and washing hands regularly. Children can go back to school within 24hours after starting antibiotic treatment.

Treatment:

Mupirocin (Bactroban) ointment applied 3 times a day for 5 days if there are limited lesions.

Oral antibiotics (Cephalexin or Cloxacillin) is indicated for extensive lesions and should be taken for 7 days.

Sometimes the Staph Aureus can be resistant to the Methicillin part of the antibiotics (then called MRSA). If the lesions do not respond after one course of antibiotic treatment your doctor needs to investigate further for this super-bug, and then you need a different group of antibiotics.

  • Erysipelas:

Infection of a break in the skin with Streptococcus Group A.

Symptoms:

Your child may first have fever, headache and feel tired for a few hours before the rash appears. The skin in the area is warm, swollen and red with a clear line between the infected area and healthy tissue. (This can also be called cellulitis). There can be a red rash, blisters or areas of bleeding under the skin (called petechiae). The lymphnodes in the area can also be swollen.

Sometimes the infected area can form an abscess in the skin, causing a painful, red, warm bump that can fluctuate (you can move the fluid around in the bump).

If left untreated these infections can spread to the blood causing sepsis / infection of the valves of the heart (infective endocarditis) / joints (septic arthritis), but this is rare.

Management:

Antibiotics are always needed when your child has erysipelas. Depending on the type of lesion and the usual bugs found in your area your doctor can prescribe Amoxycillin, Cephalexin or Cloxacillin.

If there are any signs of an abscess, your doctor will have to drain the puss with an incision. This procedure will reduce the pain immediately and ensure a quick recovery.

Lord my God, I called to you for help, and you healed me.

Psalm 30:2

Fungal skin infections:

  • Dermatophytes:

Fungi that live on the keratin in the skin, nails and hair can cause this rash and is better known as “ring worms”. It is classified according to the site of the infection. We will only discuss Tinea corporis (infection of the skin all over the body) today, although it is common to have simultaneous infections of the scalp and hair follicles, the feet or the nails.

Tinea infections are contracted from direct contact with another child or animal that is infected.

Symptoms:

The rash starts as a round / oval red bump that can be quite itchy and can have some scaling of the skin. As the bump gets bigger the centre starts to heal while the edges stay red and raised, causing a “ring-like” picture. Luckily there is no real association with worms!

Management:

Infection of the skin responds well to an anti-fungal ointment (which you can usually buy over the counter from your pharmacist).

Apply the ointment once / twice per day (as instructed) and only stop when there is no more redness / raised edges. This can take anything from 1-3weeks. Do not combine the ointment with a steroid ointment as there is a chance that the infection can get worse / will not respond to the treatment.

  • Candida:

The other very common fungal rash that all babies have at some point in their lives, is Candida. It is also a normal part of your microbiome that causes infection when the balance is disturbed, or conditions change in favour of the fungal growth.

Symptoms:

It usually starts in the nappy area, but this rash can also present in other warm, moist areas such as around the thighs, in the armpits, in the neck or around the mouth of a drooling baby. It starts as a fine red rash with some scaling of the edges of the rash, as well as some “satellite” lesions (small groups of red spots a little further away). It can cause some burning/stinging/itching and can make baby very uncomfortable.

Management:

An antifungal ointment (eg Nystatin or Canesten) is necessary to get the infection under control, but will not work if the area stays moist. It is very important to keep the area dry by exposing it to air (keep the nappy off for as long as possible or change it frequently). Apply the antifungal ointment underneath a barrier cream containing zinc frequently during the day.

“Inside, I found three things: a silver mirror, a silk handkerchief, and a glass flask of ointment. These items will help you on your journey. use them when need be. If you ever lose faith in yourself, the mirror will show your inner beauty. In case your reputation is stained, the handkerchief will remind you of how pure your heart is. As for the balm, it will heal your wounds, both inside and outside.” 

Elif Shafak, The Forty Rules of Love

I hope you now have some more tools in your mom-survival-kit to use when you see those first few red spots on your child’s skin. In collaboration with MedicineMommy I will publish a post on eczema soon (another reason for itchy, red skin), so be sure to follow us on Instagram to read more about this pesky condition.

*** Photos by :  Tamas Kolossa on Unsplash, WebMD, Dermnet NZ.

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