More Itching, More Rashes

Last week’s blog post on eczema brought to mind two other common rashes we see in the Emergency Department: hives and poison ivy.  We see hives a lot because it really does look bad, and is associated with bad allergic reactions.  When a kid is covered with itchy welts, especially when they have blotches on their face and around their eyes, parents think about other scary allergic reactions: Will my child start to wheeze and struggle to breathe?  Will his throat close up?  Will she go into shock?

The good news is that hives, or ”urticaria” in doctor-talk, by itself is not dangerous.  If your kid has had hives for an hour or two without any of that bad stuff above, rest easy.  The bad allergic reactions- throat swelling, wheezing, anaphylactic shock- happen immediately in an allergic reaction.  Hives are also quite common.  Most kids have an attack of hives sometime in their childhood, and they get over it just fine.

What causes hives?  When a kid comes in covered with itchy welts, the parents have already been racking their brains for causes.  What food did he eat?  Did we use a new washing powder?  Did she get bitten by something?  It turns out that most urticaria episodes have unclear origins.  In fact, if the kid gets allergy testing after a hives outbreak, most often all the tests are negative.  Only if the child has just taken something highly allergenic before the attack, like antibiotics or allergenic foods like peanuts, do we have a possible culprit.  For most kids though, there is no obvious cause.

How do you treat urticaria?  As you probably could guess, use good old Benadryl.  Benadryl is good for the itching, and makes the rash look better.  Tylenol is also good for itching and is safe to take with Benadryl.  If the Benadryl still is not enough to keep your kid happy, sometimes we add steroids.

More good news about urticaria is that it is short-lived.  Most kids are better in 2 to 4 days.  Rare cases last longer, and those are the few kids who need allergy testing.  Otherwise, if your kids has hives, don’t panic!  Give some benadryl, maybe some tylenol, keep them cool and their skin soft.  And don’t go too nuts trying to figure out a cause- you won’t!

Poison ivy is another common non-emergency rash that we see in the Emergency Department.  It may not be an emergency, but like hives and eczema it sure does itch like crazy, and looks awful.  It is red, streaky, and often has pustules and wet, weepy patches.  Kids commonly get it on their faces and arms and legs, since these are the places skin is exposed and brushed by the poison ivy leaves.

Poison ivy is one cause of a class of rashes we call “contact dermatitis.”  In other words, any irritant that contacts your skin can cause this rash.  Other irritants, like poison oak, poison sumac, or any other thing your kid’s skin is allergic to, can cause a break out.  Myth buster: many people think poison ivy is contagious, that you can spread the “oil” that causes the rash to others.  THIS IS WRONG!  Poison ivy and other contact dermatitises are not contagious.  It seems contagious when a kid as more and more break-outs on his own body, as if he is spreading it around by scratching.  In reality, the kid is just having later breakouts where his body got a lower dose of the allergen.

To treat poison ivy, we use steroids again.  Steroids are anti-inflammation medicines, and calm down the skin inflamed by the irritant.  Another myth-buster: steroid injection, the “cortisone shot,” does not work any better or faster than steroid pills or syrup.  Other treatment for poison ivy includes covering the really raw spots with bandages, and giving Tylenol or ibuprofen for the itch.  Poison ivy can take as long as a week to heal.

So if your kid has poison ivy, dress the worst patches and give him or her some Tylenol for the itching.  Call your doctor for a steroid prescription and tell his teachers he is not contagious.  Tell them you heard it from me!