My 7 year old was seen by the doctor and treated for a bacterial sinus infection a week ago Friday, and she was diagnosed with impetigo and we were given a topical antibiotic cream.
She only had the rash on her face, and it cleared up very quickly, as the doctor said it would. She's taken the antibiotic (amoxicillin) and it's one she's taken before and never had any trouble with.
Well, today when she got dressed in her leotard for gymnastics I was shocked to see a rash all over her legs and her arms. Further investigation found that her belly was covered as well.
Would the impetigo have spread, even after the antibiotic treatments? She was already through with the oral medication and I had stopped the topical as well.
Another thing that disturbs me is she ran a fever Friday, more than a week after going to the doctor and while taking the antibiotics. It was 102.
Now, a few days following that fever she has a trunk and extremities covered in a rash. It also doesn't appear to be impetigo - it's just red bumps, no blistering, and it's itchy. She's had all her immunizations including the chicken pox vaccine.
I naturally noticed it after the doctor's office was closed for the day.
I decided to keep her home from gymnastics (much to her dismay) just in case it's contagious. I'm concerned about sending her to school tomorrow though - should I keep her home and call the doctor for advice?
If it's just impetigo again, I can just treat it with the rest of the antiotic cream. But what if it's something else?
Any ideas? I'm not even sure if the fever and rash are related...but I don't know what to do. She insists she feels fine. Very upset at me for making her miss gymnastics practice.
[ March 02, 2005, 12:00 PM: Message edited by: Belle ]
Posted by Ela (Member # 1365) on :
When my daughter had impetigo, her pediatrician prescribed oral erythromycin, IIRC. I don't remember if this was in addition to a topical or not.
CT should be able to help you with this one, if she's around.
Posted by ketchupqueen (Member # 6877) on :
Could she have developed an allergy to the amoxicillin? It sounds like a reaction my friend had to it. Call your doctor!
Posted by Ela (Member # 1365) on :
Impetigo is contagious, so it was reasonable to keep her home from gymnastics.
Impetigo is described here.
Posted by beverly (Member # 6246) on :
I actually had impetigo a few years back. It was stubborn, but with both topical and internal antibiotics, it finally left.
I remember many, many children in the Philippines had impetigo on their legs. I didn't know what it was at the time, or I would have tried to get them antibiotics.
I can't help much with why it might have spread, only that it is very, very contagious--both to others and oneself--and that topical antibiotics might not have been enough.
Edit: Sorry, I see now that she had internal and external antibiotics.
[ March 01, 2005, 07:20 PM: Message edited by: beverly ]
Posted by Belle (Member # 2314) on :
kq, I don't think it's a reaction to the amixicillin, she's taken it before and no sign of reactions ever, and she's finished the 10 day course already (it was actually prescribed a week ago Thursday, I checked.) So she's not taking it anymore, and I had stopped the topical antbiotic after putting it on a few days after it cleared up. That's what the doctor recommended - use it until the rash is gone, then put it on her face for a few more days after to prevent it coming back.
So this is weird. I guess it could still be impetigo, in the early stages. It's not blistered over and impetigo usually blisters then scabs and stuff, which is what her face looked like.
I know it's contagious...I just find it strange she would have developed it again after being treated successfully. Nobody else in the house has any indication of rash, I checked all the little ones over.
If it is still there in the morning I'm keeping her home and calling the pediatrician.
Posted by ketchupqueen (Member # 6877) on :
Hmm, okay. It sounds to me like you've got the right idea how to deal with it.
Posted by Belle (Member # 2314) on :
You guys are my substitute husband right now - I can't reach him, he's out of the country on a mission trip, and he normally makes all the medical decisions.
I'm prone to over-reaction, so I always run things by him, and he tells me what he thinks is best.
In the absence of my husband's calming influence, I need you guys to tell me to just relax, and wait to call the doctor.
As opposed to, say, rushing her to the ER RIGHT NOW!
Posted by maui babe (Member # 1894) on :
Allergies can manifest at any time, so the fact that she's never had a reaction to amoxicillin does not eliminate the fact that it could be a reaction to the medication.
Since the new rash does not look like impetigo, I would recommend you consult with a physician. Does your HMO or doctor have an advice nurse you can call after hours?
Posted by beverly (Member # 6246) on :
I was just wondering if this might be a case of imbalance caused by killing off all the bacteria? You know, like how people are more at risk for candida after taking antibiotics? I wonder if candida can cause skin conditions.
Posted by ClaudiaTherese (Member # 923) on :
Candida is the most common cause of diaper rash and inflammation under the breasts, but this does not sound like a Candidal infection. That tends to spread through the moist, wet creases of the body with "satellite lesions" at the edge of the spreading redness.
Like maui babe said, this could be an allergic reaction to the antibiotic. I developed an allergy to penicillin at age twelve, and my father developed his at age 63. We'd both had it plenty of times before. The body just can develop a hypersensitivity at any time.
There are two most likely causes for this rash. First, consider allergic reaction. If the bumps are raised welts (like mosquito bites) that you can see from across the room, especially if they are extending into the hairline, I'd be more worried about allergic reaction. As long as she doesn't have any signs of respiratory compromise (wheezing, throat or lips swelling), then you can just treat this with over-the-counter anthistamines (like Benedryl -- I can help you with dosing, if need be) and cool (not cold!) sponge baths. Of course, stop the medications immediately.
There is also a type of reaction which is called an "amoxicillin rash." Technically it is a side effect, not an allergic reaction. It often comes in conjunction with amoxicillin (or augmentin, which is amoxicllin + clavulinic acid) taken while the body is also responding to a virus. Regardless, it tends to be more confluent (as opposed to the welts of hives) fine, tiny bumps over the extremities and trunk. This often leads to kids being mistakenly diagnosed with an allergy.
The itching makes me suspect allergy, though, and if the rash is at all welt-like, I'd call it that. Let me see if I can find pictures.
[ March 01, 2005, 08:31 PM: Message edited by: ClaudiaTherese ]
Posted by ClaudiaTherese (Member # 923) on :
Impetigo is the secondary infection of a break in the skin by "superinfection" (i.e., infection on top of) with Streptococcus or Staphylococcus species of bacteria. It has a stereotypical "honey-crusted" appearance.
I will look for pictures of this, too.
Posted by Amka (Member # 690) on :
Since she was still taking antibiotics and developed the rash a couple of days after the fever, I would wonder about it being a viral infection.
A little later than usual, but I think I had mine when I was 5.
Posted by Amka (Member # 690) on :
Of course, CT is more of an expert than me.
Posted by ClaudiaTherese (Member # 923) on :
Impetigo here, here, and here. Note the characteristic flat red area suporting the golden "honey-crusting" on the surface. it can be very very mild (as in the middle) or more widespread. It can occur anywhere, but the most typical area for kids is around the mouth and nose.
Here is a bad case of amoxicillin rash, and here is a much milder version. This is a dermatology site with 3 nice pictures of an amoxicillin rash. It is called "morbilliform" because this translates to "measles-like." Note that it is widespread, patchy, and generalized.
This, this, and this are examples of allergic reactions to antibiotics. You can see why it is often confused with an allergic reaction. Note, though, that there is a characteristic "puffiness" and more widespread diffuse underlying pinkness to the allergic reactions. Also, they are highly itchy, whereas the amoxicillin rash does not seem to trouble kids much.
Rashes are notoriously hard to distinguish, even if you know what you are doing and have seen hundreds. Your best bet it to stop the antibiotics, watch for any signs of swollen lips or throat (or trouble breathing), and give an anti-histamine. This is the standard course for emergency room care, unless there are the problems noted above. With trouble breathing, we will often give a shot of epinephrine. However, this can be very unpleasant (see sndrake's Million Dollar Baby thread), and you wouldn't wnt it just for the heck of it. However, if you need it, it's great.
I'd also have someone sleep near her tonight, just in case she has trouble breathing. You don't have to stay awake all night to watch her, just be there if she is thrashing needs to wake you up.
[ March 01, 2005, 08:52 PM: Message edited by: ClaudiaTherese ]
Posted by ClaudiaTherese (Member # 923) on :
And Amka is a sharp cookie. Posted by Belle (Member # 2314) on :
Thanks CT. It looks most like your 2nd "this" under the antibiotic reactions.
I did give her some benadryl and send her to bed. No troubles breathing whatsoever, she was turning cartwheels in the basement and practicing her handstand since she missed gymnastics practice. I gave her a lukewarm bath with oatmeal to soothe the itching.
I don't know if it's anything contagious, because Abigail shares both a room and a bed and she's not got anything.
Thing is she's not taking the antibiotics anymore - she stopped 2 days ago. Would she get the rash after she stopped taking it?
It's definitely not impetigo - her case of impetigo was a lot like that picture - right around the nose and mouth and definitely had blisters that broke open and crusted over. This is not like that.
The nurse at school said there is an outbreak of fifth disease in the school system, and she does have red cheeks, but fifth disease doesn't involve any other rash than the "slapped cheek" one, does it?
And one other thing, the doctor did mention she had a rash underneath the impetigo - a raw looking red scaly patch of skin underneath her nose and on her cheek. That cleared up pretty well, too, but it's back now. The impetigo is definitely gone.
I'm gonna call the nurse at the doctor's office first thing in the morning.
Posted by Belle (Member # 2314) on :
Well, after talking to the nurse, it looks like its chicken pox.
The good news is she has had the vaccine so it probably means the case will be mild.
The nurse said there is an outbreak at the school right now, and I called to tell them she'd be out and they confirmed they've had a lot of cases recently.
She feels fine, except for me having to prevent her from scratching.
Been a long time since I've seen chicken pox, but my confidence is very high that it's what we have. The nurse said no need to bring her in, unless something changes, just wait it out.
It means no church for a while, for certain, because we have a church member who just had a kidney transplant on Monday, and I don't want to expose anyone who might then go see him in the hospital.
Emily is most upset that she will continue to miss gymnastics.
Posted by ludosti (Member # 1772) on :
Just tell her to be glad she's not wasting her Spring Break with having chicken pox. I woke up with it on Saturday morning and only ended up missing one day day of school for it. Posted by quidscribis (Member # 5124) on :
ludosti - that sucks.
Belle - well, yeah, that sucks, too. At least you know what it is. Good luck with the itchy fingers.
Posted by ClaudiaTherese (Member # 923) on :
Wow. Talk about a left-fielder!
I'm so glad she is okay. Are there the classic clear vesicles on a red base (aka "dewdrop on a rose petal")? The last time I saw chicken pox, I missed it. Of course, it was on my 20-something year-old stepson, and so I was definitely not in pediatrics mode.
You are correct about Fifth Disease and the slapped-cheeks look.
Glad you are protective of your friend with the transplant. Smart, savvy, wise Belle. Keep us updated on how it goes!
Posted by Belle (Member # 2314) on :
CT, yeah that's pretty much what we have. I wasn't really looking for it either, since she had the vaccine.
But, after talking to the nurse and looking at some pictures online, I'm pretty sure. At any rate, since she seems to be doing fine, regardless, it won't hurt to keep her home for a day or so and see if anything changes.
Posted by ketchupqueen (Member # 6877) on :
My brother had 5 cases of chicken pox. Some kids are just more susceptible, I guess. Posted by mackillian (Member # 586) on :
I had the chicken pox twice. The second time, on Christmas Eve. >_<
Posted by Stray (Member # 4056) on :
I have three scars from it on my forehead above my left eyebrow. I had it when I was about 4, I think. My most vivid memory of it involves this old recliner chair we had that was upholstered in very rough, scratchy brown fabric. I was constantly scurrying around behind it to do the bear-against-a-tree maneuver to scratch my back Posted by mackillian (Member # 586) on :
I remember the oatmeal baths. Ugh.
Posted by maui babe (Member # 1894) on :
My youngest daughter had chicken pox twice. The first time, she only had 2 or 3 lesions, and I wasn't sure afterwards that it was really chickenpox. But two weeks later, her older sister got chickenpox, and two weeks after that, the younger one got them again. So basically, she got them the first time just badly enough to infect her sister, but not enough to develop immunity herself. The second time, she had a moderately severe case, so hopefully she's immune now.
Posted by 0range7Penguin (Member # 7337) on :
I feel sorry for your daughter Belle getting one thing and then the other is awful. My little eight year old sister is hard core gymnastics and she would explode(Quite literally) if kept from it for very long.
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