The Itch That Rashes

Very few rashes belong in the Emergency Department.  Just about all rashes can wait until the next day to see the doctor.  Parents bring their kids in anyway, often because they are afraid: afraid of infection, allergy, contagiousness, or the rash just plain looks weird.   As we often say here in this blog, it is not an emergency if the child is breathing well, drinking well, alert, and smiling.  This time of year we are seeing a lot of eczema, and the moms bring in the kids because of the ferocious itching.  Eczema is a medical term for very sensitive, dry skin.  It is often called the itch that rashes, because that sensitive dry skin itches first, then the kid scratches the heck out of it until it gets red, cracked, bleeding, and weepy.  What makes sensitive skin so bad this time of year?  First, the  air conditioning we all live in now is drying, because A/C extracts water from the air when it cools the air.  The colder it is, the dryer it is.  When you see water dripping out of the bottom of an A/C unit, that is the water that should be in the air moisturizing your skin.  Secondly, kids get dirtier now that they are out playing more.  Then the soaps they wash with are often too strong, and can wash out the natural oils their skin makes to protect itself.  Examples of drying soaps are Zest, Ivory, Irish Spring, or Dial.  Scrubbing skin with washcloths, and scrubbing dry with towels can damage skin too. Finally, much of eczema is genetic.  Some people are born with sensitive skin, some more sensitive than others.  Some have eczema so bad that even dermatologists and strong medicines barely control the cracking and scarring.  Here is what you can do to make your kid with dry, itchy skin happier until you see their doctor. Turn your A/C unit to 75 degrees.  That should be comfortable for you in shorts and t shirts in the house and a sheet only in bed at night.  Switch to moisturizing soaps like Dove, Caress, or Lever 2000.  Apply moisturizing lotion three times daily, especially after the bath.  Use your hand instead of a wash cloth when bathing your child, and pat dry with the towel instead of scrubbing dry.  Keep your kid's fingernails trimmed- long, sharp fingernails are better at tearing skin and making itching and infection worse. Finally, for bad dry patches that just won't heal with this care, see your doctor about medium-strength steroid ointments.  You only need a small ball of ointment (a little bigger than the size of a BB) for each bad patch.  Ibuprofen or acetaminophen (Tylenol) take the edge off itching, just like they take away pain.  High strength steroid creams, steroid pills or liquids, or other medications should be prescribed only by dermatologists for severe cases.    So next time you or your child get a bad itchy rash, try the above things to make skin better.  Before you go to the Emergency Department for a rash, call your doctor.  Unless your doctor says otherwise, rashes can wait for the next appointment.   And find those fingernail clippers!