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What Causes Recurring Rash On Face Of A 4 Year Old?
Question: My 4 year old daughter started getting a weird rash on her face about 6 months ago. This rash regularly comes and goes and now shows on her wrists and sometimes ankles as well. I have celiac disease, so we had her tested for TTG last summer and it was negative. It seemed like she broke out worse after eating certain things and the only common link I could find was corn. Took her to an allergist and had her scratch tested for probably 30 different things and all were negative. The allergist ran his pen across her arm to see if it was just sensitive skin reacting but nothing happened. He asked us to come back for more testing for autoimmune diseases.
I can't find any autoimmune diseases that match her symptoms and I don't want to put her through unnecessary testing if she has something common and normal that she will grow out of. I also don't want to ignore something serious and put her health at risk.
I can't find any autoimmune diseases that match her symptoms and I don't want to put her through unnecessary testing if she has something common and normal that she will grow out of. I also don't want to ignore something serious and put her health at risk.
Brief Answer:
a possibility of Atopic eczema
Detailed Answer:
Hello. Thank you for writing to us at healthcaremagic
I have gone through your query and I have also reviewed the Images.
I can see that there is involvement of face as well as dorsum of both hands with red rashes.
I would like to know specifically whether she itches over them?
I would keep a likely possibility of childhood atopic dermatitis.
Atopic dermatitis is an eczematous skin condition in which skin has reduced water retention capacity and is therefore dry.
Dry skin of atopics is prone to rashes. The skin may develop itchy, red rashes on various body sites like cheeks, arms and legs.
There is considerable itching in atopic eczema.
If I was the treating doctor I would suggest that you use an intensive moisturizer for her, all over, at least twice daily.
You have been using Aquaphor. Aquaphor is good and I suggest you to continue with it regularly, twice daily, even after the rashes resolve.
Make sure that you apply a moisturizer immediately after a bath to trap moisture into skin.
Specifically for the rashes I would suggest a moderately potent topical steroid e.g fluticasone propionate 0.05% twice daily, over and above the moisturizer.
Topical steroids are rapidly effective in atopic dermatitis.Topical steroids may be stopped once the skin clears, usually 2 weeks.
Syp cetrizine once daily would provide symptomatic relief from itching.
However, atopic rashes may recur specially in cold, dry weather in winters.
Milder involvement can be effectively treated with topical immunomodulators like pimecrolimus or tacrolimus rather than topical steroids.
These (topical steroids and topical immunomodulators) are all prescription medications and therefore I suggest that you talk to your doctor for the needful.
Since atopic ezcema tends to flare in winters, therefore general measures would include using moisturizers regularly and avoiding woollens directly on to the skin Or wearing cotton lined woolens.
Soaps should be avoided. You may use a gentle cleanser for her e.g cetaphil cleansing lotion.
Regards
a possibility of Atopic eczema
Detailed Answer:
Hello. Thank you for writing to us at healthcaremagic
I have gone through your query and I have also reviewed the Images.
I can see that there is involvement of face as well as dorsum of both hands with red rashes.
I would like to know specifically whether she itches over them?
I would keep a likely possibility of childhood atopic dermatitis.
Atopic dermatitis is an eczematous skin condition in which skin has reduced water retention capacity and is therefore dry.
Dry skin of atopics is prone to rashes. The skin may develop itchy, red rashes on various body sites like cheeks, arms and legs.
There is considerable itching in atopic eczema.
If I was the treating doctor I would suggest that you use an intensive moisturizer for her, all over, at least twice daily.
You have been using Aquaphor. Aquaphor is good and I suggest you to continue with it regularly, twice daily, even after the rashes resolve.
Make sure that you apply a moisturizer immediately after a bath to trap moisture into skin.
Specifically for the rashes I would suggest a moderately potent topical steroid e.g fluticasone propionate 0.05% twice daily, over and above the moisturizer.
Topical steroids are rapidly effective in atopic dermatitis.Topical steroids may be stopped once the skin clears, usually 2 weeks.
Syp cetrizine once daily would provide symptomatic relief from itching.
However, atopic rashes may recur specially in cold, dry weather in winters.
Milder involvement can be effectively treated with topical immunomodulators like pimecrolimus or tacrolimus rather than topical steroids.
These (topical steroids and topical immunomodulators) are all prescription medications and therefore I suggest that you talk to your doctor for the needful.
Since atopic ezcema tends to flare in winters, therefore general measures would include using moisturizers regularly and avoiding woollens directly on to the skin Or wearing cotton lined woolens.
Soaps should be avoided. You may use a gentle cleanser for her e.g cetaphil cleansing lotion.
Regards
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
I thought with atopic dermatitis the rashes would be more persistent. These come and go rapidly. Some of the pictures I sent you were taken yesterday. This morning her wrists and face were clear. After breakfast, her wrists began showing redness. By the time I pick her up from school today she will likely have red marks on her face.
This started in the summer, so I don't think the weather is affecting it. Plus I run cool mist humidifiers throughout the house and keep level humidity. It seems like she breaks out more often after eating, but I can't pinpoint a certain food. I can sit and watch her eat a fruit cup and she will slowly develop rashes as she is eating it. Within an hour, the rashes are often gone. She can eat the exact same type of fruit cup the next day and have no reaction at all.
After looking through pictures for a while last night, I realized that this all began after she spent a week at her dad's house and he sprayed so much sun screen on her that her face was swollen for days. She has gotten the rashes regularly since then. You can literally watch them come and go if you stare at her long enough.
The allergist gave us hydroxyzine and cetirizine. It's hard to tell if they do anything because the rashes come and go so quickly anyway.
I occasionally see her rub her skin as if it itches, but she never scratches or complains. She is usually unaware of the rashes until I ask her about them.
Could this still be atopic dermatitis? Is there any possibility of autoimmune or allergy? If it is not atopic dermatitis, what are some other possibilities?
This started in the summer, so I don't think the weather is affecting it. Plus I run cool mist humidifiers throughout the house and keep level humidity. It seems like she breaks out more often after eating, but I can't pinpoint a certain food. I can sit and watch her eat a fruit cup and she will slowly develop rashes as she is eating it. Within an hour, the rashes are often gone. She can eat the exact same type of fruit cup the next day and have no reaction at all.
After looking through pictures for a while last night, I realized that this all began after she spent a week at her dad's house and he sprayed so much sun screen on her that her face was swollen for days. She has gotten the rashes regularly since then. You can literally watch them come and go if you stare at her long enough.
The allergist gave us hydroxyzine and cetirizine. It's hard to tell if they do anything because the rashes come and go so quickly anyway.
I occasionally see her rub her skin as if it itches, but she never scratches or complains. She is usually unaware of the rashes until I ask her about them.
Could this still be atopic dermatitis? Is there any possibility of autoimmune or allergy? If it is not atopic dermatitis, what are some other possibilities?
Brief Answer:
Allergic urticaria
Detailed Answer:
Hi.
Thank you for additional information.
Another possibility that I would like to keep is of urticaria because they are not persistent and are actually evanescent.
Urticaria usually presents with red, raised welts and some times as just flat red rashes with no welts. The rashes in urticaria are evanescent and may last just a few hours.
Atopics do have a higher probability of developing urticaria, specially allergic urticaria.
Various allergens that may be implicated are:
Certain foods like fish and prawns, milk, nuts (peanuts), cheese, tomatoes, pineapple, carrots, spices, rice, bananas, apples and oranges, food preservatives e.g canned food and drinks etc
Besides certain inhalants like pollens, animal dander, moulds and spores and house dust may also be causing these in her.
The cause may get identified by testing for specific antibodies in the serum for some antigens like suspected food allergens.
There may be no identifiable cause in at least 50-60% of cases with urticaria.
Surely, antihistamines would be going to help her and I would suggest the same for her.
Regards
Allergic urticaria
Detailed Answer:
Hi.
Thank you for additional information.
Another possibility that I would like to keep is of urticaria because they are not persistent and are actually evanescent.
Urticaria usually presents with red, raised welts and some times as just flat red rashes with no welts. The rashes in urticaria are evanescent and may last just a few hours.
Atopics do have a higher probability of developing urticaria, specially allergic urticaria.
Various allergens that may be implicated are:
Certain foods like fish and prawns, milk, nuts (peanuts), cheese, tomatoes, pineapple, carrots, spices, rice, bananas, apples and oranges, food preservatives e.g canned food and drinks etc
Besides certain inhalants like pollens, animal dander, moulds and spores and house dust may also be causing these in her.
The cause may get identified by testing for specific antibodies in the serum for some antigens like suspected food allergens.
There may be no identifiable cause in at least 50-60% of cases with urticaria.
Surely, antihistamines would be going to help her and I would suggest the same for her.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your help. I have one last question. Is it possible that a yeast overgrowth could cause her symptoms? I noticed what appears to be a vaginal yeast infection last night. She eats a lot of fruit, gluten free noodles and breads, and has a cup of apple juice every day.
Brief Answer:
Vaginal yeast infections are implicated in urticaria
Detailed Answer:
Hi
Yes certainly, candidal vaginal infections can give rise to urticaria.
Infections are one of the many causes of urticaria. Dental, vaginal, streptococcal sore throat infections etc are all implicated.
Regards
Vaginal yeast infections are implicated in urticaria
Detailed Answer:
Hi
Yes certainly, candidal vaginal infections can give rise to urticaria.
Infections are one of the many causes of urticaria. Dental, vaginal, streptococcal sore throat infections etc are all implicated.
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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