Dermatology Expert Forum
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This forum is for questions regarding Dermatology issues, such as: rashes, acne, birthmarks, skin infections, rosacea, and general skin care. All questions will be answered by a medical professional.

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5

Six months ago, our 3 kids went to an indoor playground. May not be related, but, 3-4 days later, 2 of our kids, and a friend they went with, developed a rash around the mouth. Currently their friend is fine. His rash around the mouth went away and he never had any other symptoms.

However, 2 of my children, ages 5 and 7, still have a terrible rash. It started around mouth, but now covers all of the cheek area as well. There was only a difference of a couple of days between the appearance of the rash in the 5 year old and the appearance of the rash in the 7 year old. When around mouth, rash was red & scaly. Now that covering cheeks, is small white pimply rash. Occasionally cheeks become very flush & red. Occasionally children complain that cheeks are sore. From onset to present has been steady & consistent in both children. Have seen several dermatologists. Some diagnose as keratosis pilaris, some say kind of contact allergy or dermatitis. (note - they have rash ONLY on face, not on arms, not on legs, or any other part). None have found effective treatment. Have tried cortisone, aclovate, zithromax, topical erythromycin, several different lotions and moisturizers. Some say could be hereditary, but I have hard time accepting this, since no previous history or problems like this, and the rash occurred simultaneously in 2 children of different ages. Some say they just plain don't know and maybe they'll outgrow it. (To me it seems like it must be contagious. My 2 year old started showing symptoms of rash around mouth 3 months ago. Looks like same thing the 5 & 7 year started with 6 months ago.)

When rash was around mouth, and was red and scaly, zithromax seemed to be the best treatment. But didn't get rid of it. One explanation we've been given was that we are looking at 2 different rashes. The first around the mouth had been treated with alcovate and zithromax at the same time... and a later dermatologist said the alcovate could have caused the second rash which they now have covering the cheeks, but he didn't have a solution for treatment.

Any advice or suggestions you could provide would be greatly appreciated. We'd like to find a solution now that it looks like we have 3 children with this problem, and no solution in sight.
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The rash, or better, rashes, you describe don't sound like any infectious rash I know of: not bacterial, viral, or fungal.  I cannot explain the apparent onset in close proximity to the playground incident.  I understand your conviction that this time sequence implies contagion, but I cannot share it, especially since your children have been examined by several dermatologists.  Also, contagious rashes would have spread to other parts of the body and to other people.  

Children of your kids' age are prone to several common rashes.  One is keratosis pilaris, in which small, flesh-coloed bumps dot the cheeks.  These last till early-to-mid adolescence, then resolve, but often remain on the outer apect of the upper arms.  You might examine family members for this.

The other rash common at this age is eczema around the mouth from lip-licking.  I don't know why kids this age do this, but I see it all the time.  Cortisone creams help diminish the problem, but it doesn't go away till they stop the habit, which they always manage to do on their own.

As to your observation that, "Occasionally cheeks become very flush & red. Occasionally children complain that cheeks are sore," these are common changes which have no particular significance.

Without examining your children, I can obviously do little more than infer and speculate.  Still, it seems to me most likely that your kids have keratosis pilaris on their cheeks and perhaps mild dermatitis around their mouth.  The former should be ignored, the latter palliated with a weak cortisone preparation.

One invokes coincidence with caution, but the circumstances you describe do not, it seems to me, allow for any other reasonable interpretation.  Infection makes no sense at all.  

Time is on your side.  Now that you have done your due diligence, I would advise that you let time do its work.

Best.

Dr. Rockoff

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