A “widespread rash” means it either covers the whole body or is at least relatively symmetric, like a rash on both arms, or the entire trunk, or both hands and feet, etc. (If you think you have a localized rash, follow this link instead: Localized rashes) Widespread rashes are usually due to the body’s internal response to something. This is usually one of four things: A virus, a medication/vaccination reaction, eczema, or allergic reaction/hives. Often, it can be quite challenging to tell these apart on appearance alone, so I’ll usually want you to bring them in for an exam (please leave a message on our voicemail or email the clinic for a non-urgent appointment). But first, let’s make sure it’s not the one rash that is an immediate emergency: a non-blanching rash.
Make sure your rash “blanches”
Blanching means that you can make the color leave a spot by pressing on it. Tip: If you’re having a hard time telling whether or not your rash is blanching, take a clear drinking glass and press it up against the spot such that you can see it through the glass as you are compressing it. Watch as the color leaves the spot during compression and returns when you lift the glass. If this doesn’t happen, then your rash does not blanch.
Unless your rash is isolated to only one single area of the body, a full-body rash that doesn’t blanch is a medical emergency and needs to be evaluated right away. Call 911 if your child appears unwell. Even if your child is completely well appearing, do not be falsely reassured – this can be a rapidly progressive disease and they need to be taken to the emergency room immediately.
Exception to the rule: if the non-blanching rash is isolated to just one small area of the body, like just the face, or just the left arm, etc., AND your child is well-appearing, does not have fever, and does not have other concerning symptoms, it’s OK to wait and see me the following day, just make sure the rash doesn’t progress to the whole body.
Just so we’re clear, let’s review:
Doesn’t blanch = BAD
Blanches = GOOD
Now that we have established that your rash blanches and your child is well-appearing (no shortness of breath, no distress, no vomiting, etc), there is typically no urgency to most rashes, so it can wait until the next convenient clinic day to be seen. In the meantime here are a few points to keep in mind about widespread rashes until you are able to see me:
- If the rash itself is not bothersome and the child has no symptoms, there’s no need to take any action before you see me other than taking a photograph. Sometimes giving/applying medications can make things worse. But do keep your child isolated from others until we figure out what it is.
- It’s OK if fever or cold symptoms are present, as long as the rash is blanching (see box above) and the child is otherwise not in distress. Just treat/address the other symptoms as you normally would.
- If you think it might be a medication reaction, but your child is not in any distress, simply stop the medication and send me an email or give me a call during the day so we can determine if it's safe to continue using the medication or not. Please take a good photo in case the rash is fleeting (see tip below).
- If you think it’s a vaccine reaction, send me an email so we can document it, there is usually no need to be seen unless your child is having any other symptoms.
- If your rash looks like hives (white or red medium- to large-sized flushed and often raised patches that move and fluctuate throughout the body and tend to be very itchy), it’s OK to give an antihistamine, like Benadryl, Zyrtec, Claritin, etc. Write down your child’s exposure prior to development of the hives, take a photo, and bring these in to your appointment. Note: hives are not an emergency unless your child has one of the following signs (if so, call 911):
- respiratory distress/wheezing
- mouth/lip/tongue swelling
- profuse vomiting
- ill appearance
- contact/ingestion of known product to which they have a history of life-threatening reaction.
- Eczema is a common widespread rash, with typically dry skin. Because this condition can be chronic and has very specific management needs, please come in to see me first so we can talk about it.
Common childhood viruses with widespread rashes:
- Hand foot and mouth disease (sore throat, spots on hands and feet)
- Fifth disease (red cheeks, lacy rash, fever)
- Roseola (spots all over after a fever resolves)
- Chickenpox (blistery bumps all over with fever)
- Measles (red eraser-sized dots moving from head to toe with fever, often very sick with cough, headache, etc.)
Many of these sound scary, and can cause complications in some cases, but it’s usually safe to wait and see me until the next daytime appointment as long as your child does not have other concerning symptoms (severely ill appearance/looks out of it, respiratory distress, decreased responsiveness, severe headache, severe cough and vomiting, etc). If mild, just treat their other symptoms as you normally would and make sure to keep them away from other children/daycare/etc until I can see them and figure out what their rash is. If they look more concerning to you, give me a call or seek medical attention right away.
Rashes can change rather quickly, and may not be as visible by the time you see me, so take a photo and bring it in just in case! Make sure you have really good lighting, good resolution, and no blur.
If your rash doesn’t fit any of these common descriptions, please make an appointment with me so I can take a look and figure out what it might be. And again, while most rashes are not urgent, as always, if your child has other symptoms that are concerning for something more urgent, please page me.
For urgent needs, same-day appointments are available Monday through Friday. Please call as early in the day as possible, the more notice we have the easier it is to fit everyone in.
Need help outside of office hours?
Firstly, if your child has an emergency, please call 911 or go directly to the ER - they will contact us if needed once your child has been evaluated.
Urgent Care centers can also be helpful when something needs to be seen outside of office hours but it's not an emergency.
For our list of preferred Urgent Cares and ERs, see our resources page.
And if you have something that might need urgent attention but you're not sure/don't know what to do, we can help: