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The Mysterious Rash

By Rod Moser, PA, PhDOctober 06, 2010
From the WebMD Archives

The Top 12 Reasons Kids are Excluded from School Part Six

When you think about it, the skin can only respond in one way — a rash. There are many, many causes for a rash, but when one shows up in school, teachers assume the worst. They are worried about measles, chicken pox, Lyme disease, scarlet fever, Fifth disease, impetigo, herpes simplex/zoster, hand/foot/mouth disease, MRSA or roseola, just to name a few. It is this fear of imminent contagiousness that leads to the child’s exclusion from school.

Sometimes, the skin eruption is due to allergies, such as hives, or just a worsening dry-skin condition, like eczema (atopic dermatitis). Even a cold virus (whether it’s in a cold that’s at the contagious stage or not) can cause a rash. Fortunately for all of us, most rashes that children get are not serious or contagious. I have seen children excluded for insect bites, hives, sunburns, poison oak/ivy, eczema, and even zits.

Teachers are not dermatologists, so they are not going to make the diagnosis. The school is just going to exclude the child and require a clearance note before the child can return.

I had a child excluded this week with poison oak. Poison oak is not contagious, but at least half of the people I encounter think that it is. The oleoresin of the Rhus plant is definitely contagious, but once this oil has been washed off of the contaminated skin, clothing and other objects, it can no longer cause trouble. When people see this ugly rash oozing, they assume the drainage is the “poison.” This is not true. Once the person takes a good shower and changes their clothes, they do not need to be treated like they have leprosy. (Incidentally, leprosy is not really that contagious.)

“That’s not true!” I hear from parents.

“My son got poison oak and a few days later, I had it. I did not go and play in the woods.”

The parent did not get it from the skin of the person with the poison oak eruption, but rather from picking up their contaminated clothing or shoes. The oil of this plant is quite stable and can remain on unwashed objects for a long, long time; even a year or more. Dogs can get it on their fur while running through wooded areas and then give it to you when you pet them.

Another person made her husband sleep in the garage on an army cot, and use paper plates to eat his meals, so that he would not spread his poison oak to other family members. After a long talk, backed up by some written proof, she let him back in the house again (three days later).

High school wrestlers tend to get a variety of skin infections from those contaminated mats. I see common warts, molluscum (another wart-like skin lesion), impetigo (a staph or strep skin infection), and more recently, MRSA (a potentially-serious, drug-resistant Staph infection). Of course, the wrestlers are also excluded from participation because of eczema, mosquito bites and other non-contagious skin issues. Referees and coaches are getting better in recognizing skin problems, I must say.

“It’s not measles.”

I must say this statement a dozen times a week, contradicting home diagnoses made by day care providers and grandmothers. Measles is relatively rare in the United States now. Personally, I have not seen a case in over 20 years, thanks to the effectiveness of vaccinations. Measles was such a scourge a generation or two ago that grandmothers are still looking for it. A few hundred to a few thousand cases still occur in the U.S., depending on the year, in unvaccinated individuals.

Measles is a killer and is still listed as the number two cause of death in children worldwide. It has been proven in numerous, controlled, scientific studies that measles vaccine does NOT cause autism; yet false rumors are hard to break. The English physician who made this original claim has lost his license, and a prestigious medical journal had to profusely apologize for printing his thus unsubstantiated crap, resulting in the worldwide vaccination hysteria that still smolders today.

Mosquito and flea bites can mimic early chicken pox lesions, but only for a short while. Chicken pox (varicella) looks like a “dew drop sitting on a rose petal.” It is a tiny blister on a red base which turns into a scab, followed by a tiny crater (pox) in a day or so. Although varicella-immunized children can get a mild case, it really does look different than mosquito bites. Several times a month, I am writing a note back to day care or school, contradicting an infectious-disease-expert teacher.

“It’s not chicken pox. She can go back to school.”

Chicken pox is caused by the herpes virus, so re-exposure to this disease later in life can cause a reactivation of the virus resulting in herpes zoster, also known as shingles. There is now a vaccine given to the elderly to prevent herpes zoster.

Warts are contagious, but not very much. To exclude a child from school because of warts is really unnecessary. It can take a month or more to effectively treat a case of stubborn warts, freezing them with liquid nitrogen or chemically burning them with various acids. High school wrestlers with warts can wrestle as long as they are covered by clothing or a bandage, but many are excluded from participation by an Eagle-eyed referee.

Since we all have skin and all skin will rash from time to time, decisions will need to be made. Involving your medical provider in this decision is important. If dermatology was easy, there wouldn’t be a medical specialty devoted to it.

Read more from the series:

  • Fever
  • Strep Is Always Going Around
  • The Dreaded Pink Eye
  • Colds and Influenza
  • Diarrhea, Vomiting, and Dehydration
  • The Mysterious Rash

Do you try to diagnose your child’s skin rashes? How often are you right? Post your comments on the Ear, Nose and Throat Community.

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