Paeds · paediatric-dermatology
Approach to rash in infants and children
Also known as Paediatric rash · Childhood exanthem · Skin eruption in children · Neonatal rash · Approach to exanthem · Rash assessment in children
A morphology-first, distribution-aware and red-flag-driven fellowship approach to any rash from the neonate to the adolescent: classify the lesion, map the pattern, weigh age, fever, itch and mucosa, and separate benign and self-limiting eruptions from the emergencies - meningococcaemia, Stevens-Johnson syndrome/toxic epidermal necrolysis, staphylococcal scalded skin syndrome, necrotising fasciitis, Kawasaki disease and neonatal sepsis or herpes simplex.
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- Non-blanching purpura or petechiae in an unwell or febrile child (presumed meningococcaemia until proven otherwise)
- A child who looks unwell, is irritable or lethargic, or has abnormal vital signs with any rash
- Rapidly spreading, painful erythema with systemic features (cellulitis or necrotising fasciitis)
- Widespread blistering, skin tenderness or peeling, especially with mucosal involvement (SJS/TEN, staphylococcal scalded skin syndrome)
- Fever for five days or more with rash and mucocutaneous features (Kawasaki disease)
- Any unwell neonate with a vesicular, pustular or bullous eruption (neonatal HSV, staphylococcal infection, sepsis)
- Angioedema with airway compromise or anaphylaxis features
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- General and Community Paediatrics
- Common presentations and skin assessment
- Renewed curriculum for first-year trainees from 2027 - Learning goal 5: Clinical assessment - essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 - Learning goal 4: Recognising and managing the deteriorating child
- Clinical Applications
- Short Cases
- Long Cases
- 4. Professional skills and knowledge: Patient management
- 8. Using the paediatric assessment to recognise and respond to the deteriorating child
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- General Pediatrics Content Outline - Dermatology
- General Pediatrics Content Outline - Infectious Diseases
- General Pediatrics Content Outline - Emergency Medicine
- Patient Care 4: Clinical Reasoning
- Medical Knowledge 2: Diagnostic and therapeutic interventions
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Medical Expert
- Pediatrics: Foundations EPA - Recognizing deteriorating and/or critically ill patients and initiating stabilization
- Pediatrics: Core EPA - Managing patients with common dermatologic presentations
A rash is one of the commonest reasons a family brings a child to see you, and it is the presentation that most often makes clinicians feel they are guessing. The mistake is to try to recognise a single disease from its colour or its overall impression. The reliable method is the opposite: describe what you actually see in a structured way, and let the morphology, the distribution and the age of the child narrow the list for you. This page gives you that method, applied from the neonate to the adolescent, and tells you exactly where the danger lies. [1]
Overview & Definition
A rash is any change in the colour, texture or surface of the skin that is widespread or patterned rather than a single isolated lesion. Two terms recur throughout paediatrics. An exanthem is an eruption on the skin surface - the classic childhood "viral rash". An enanthem is the same kind of eruption on a mucosal surface, such as the mouth (for example the Koplik spots of measles or the oral ulcers of hand-foot-and-mouth disease). The distinction matters because an enanthem is a powerful clue to the cause and to several dangerous diagnoses. [5]
What makes a rash hard is that the same disease can look different on different children and on different skin tones, while very different diseases can look alike. The defence against this is a framework rather than a mental picture: rather than asking "what is this rash?", you ask four questions in order. First, is the child sick or well - because the unwell child with a rash is an emergency regardless of what the rash looks like. Second, what is the morphology - what are the individual lesions? Third, what is the distribution and pattern - where are they and how are they arranged? Fourth, what is the context - the age, fever, itch, mucosa, contacts and the tempo. Answer those four and the differential collapses to a short list you can reason about. [1]
References12ShowHide
- [1]Jalalabadi F Common Pediatric Skin Lesions: A Comprehensive Review of the Current Literature. Seminars in plastic surgery, 2016.PMID 27478417
- [2]Chadha A Common Neonatal Rashes. Pediatric annals, 2019.PMID 30653638
- [3]Wilson JL Neonatal Dermatology. Primary care, 2025.PMID 40835282
- [4]Hartman-Adams H Impetigo: diagnosis and treatment. American family physician, 2014.PMID 25250996
- [5]Saguil A Hand-Foot-and-Mouth Disease: Rapid Evidence Review. American family physician, 2019.PMID 31573162
- [6]Meza-Romero R Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clinical, cosmetic and investigational dermatology, 2019.PMID 31239742
- [7]Thompson MJ Clinical recognition of meningococcal disease in children and adolescents. Lancet (London, England), 2006.PMID 16458763
- [8]Rife E Kawasaki Disease: an Update. Current rheumatology reports, 2020.PMID 32924089
- [9]Ramien ML Stevens-Johnson syndrome in children. Current opinion in pediatrics, 2022.PMID 35836393
- [10]Brazel M Staphylococcal Scalded Skin Syndrome and Bullous Impetigo. Medicina (Kaunas, Lithuania), 2021.PMID 34833375
- [11]Guttman-Yassky E Atopic dermatitis. Lancet (London, England), 2025.PMID 39955121
- [12]Leung AKC Henoch-Schonlein Purpura in Children: An Updated Review. Current pediatric reviews, 2020.PMID 32384035