As school days return, children may bring home more than just homework: pesky rashes may appear. Summer skin conditions that accompany warmer temperatures, such as heat rash and hives, are among the downsides of the season.
For many parents, an uncomfortable child will prompt a visit to a local pharmacy for advice on such matters as children’s skin care.
So, at back-to-school time, pharmacies play an important role in helping to manage the skin conditions of Aussie kids.
Babies and children can frequently appear with different types of skin conditions. Heat rash and hives are common types that often cause the skin to feel itchy.
In Australia, skin conditions are sometimes caused by the hot weather and skin reacting to a range of triggers. This often appears on the skin as hives or heat rash.
Pharmacies are well equipped to help alleviate symptoms and to offer advice to parents seeking to prevent heat rash and hives.
We spoke to Dr Saxon Smith, a dermatologist, Fellow at the Australasian College of Dermatologists, and Clinical Professor at the Australian National University, who offers advice to pharmacy assistants on heat rash and hives as they deal with common skin issues during back-to-school season.
Hives
Hives are a common skin condition that causes an itchy rash. It can be smooth or raised in appearance. Hives are caused by an immune system reaction resulting in red patches on the skin and can be itchy, although this usually subsides within 24 hours.1
“Hives, also known as urticaria, is thought to affect about 20 per cent of people at some time during their lives,” Dr Smith said. “It’s driven by an immune reaction in the skin that causes a specific cell [called mast cells] to release a chemical [histamine].
“The release of histamine locally in the skin causes blood vessels to dilate and become somewhat leakier, which allows some localised fluids to spread into the surrounding tissue. This results in the red [from the dilated blood vessels being more visible on the skin] and puffy [localised swelling called oedema] patches of skin, which are the ‘hives’ we see clinically.
“Sometimes the affected skin has small, raised bumps. At other times large surface areas of the skin [are affected]. Typically, these lesions in the skin self-resolve within 24 hours but can occur elsewhere on the body, almost like they’re moving around the body. Itch is the key symptom that patients suffer from.”
Getting to know your triggers
A range of triggers can cause hives.
According to Health Direct, in children, a virus is the most common cause of hives, which are rarely due to allergies.2
Dr Smith says the triggers causing the immune reaction in the skin that leads to hives can include bacterial and viral infections, medications (prescribed or non-prescribed), environmental factors (pollens and plants, for example), and even some foods.
“However,” he said, “there are times when the actual trigger cannot be easily identified.”
Management
Hives usually resolve themselves and last only for a short time. Meanwhile, the itching can be relieved in a number of ways.
According to the Raising Children Network, ways in which hives can be relieved at home include placing a cool face washer on the hives, using a fan to blow air on the skin, taking a cool bath or shower, and applying calamine lotion and letting this dry.3
Dr Smith says most hives events are self-limiting and may not need active treatment if the trigger can be avoided.
“However, antihistamines are the cornerstone of treatment, he said. “These are highly effective on many patients. There are other treatments – such as oral prednisone and other prescription medications, which can help in more recalcitrant disease – that your doctor can prescribe.”
According to the Royal Children’s Hospital Melbourne, hives can usually be self-managed at home, or a non-drowsy antihistamine may be used. Antihistamines can be used from six months of age, once or twice daily, as required.
“Antihistamines work by blocking the effect of the chemical histamine when it’s released by the immune cells [mast cells],” Dr Smith said. “They’re effective, long-lasting [may be taken once a day] and have few side effects. It typically takes around 30 minutes for the antihistamines to start to have an effect after hives have developed. Cold compresses or anti-itch balms may also help ease the symptoms.”
In some cases, while hives are usually harmless, they can be a sign of an allergic reaction, and symptoms of anaphylaxis should be watched for. If the child has hives accompanied by any of the following symptoms, an ambulance should be called immediately:
- Difficulty breathing.
- Wheeze or persistent cough.
- Swelling of the tongue.
- Swelling or tightness in the throat.
- Difficulty talking or a hoarse voice.
- Loss of consciousness, collapse or the child becoming pale and floppy.4
Heat rash
Heat rash, also known as miliaria, is common in babies, occurring in 15 per cent of newborns as their sweat ducts are not fully developed. Heat rash is caused when sweat ducts are blocked, commonly from excess sweating and high temperatures.5
“Heat rash can occur at any age,” Dr Smith said. “In adults, it usually develops in the skin folds and where clothing rubs against the skin. On the other hand, in infants, the rash is mainly found on the neck, shoulders and chest. It can also show up in the armpits, elbow creases and groin.”
Sweat is the body’s natural way of cooling itself, says Dr Smith.
“Sweat is generated by glands under the skin and then transported by a connecting duct (eccrine duct) to reach the skin surface,” he said.
“Once on the surface, it helps to cool the skin by evaporation. Heat rash develops when this duct becomes blocked or inflamed. This means that the sweat cannot reach the surface of the skin [sweat pore]. Instead of evaporating, sweat is trapped beneath the skin, causing irritation and bumps on the skin. There are different types of heat rash, depending on the depth where the sweat is trapped in the skin.”
Dr Smith adds that for those who have developed heat rash, cooling the skin is key, then identifying what’s causing the sweat duct blockages, such as clothing, medications, or other issue.
Putting prevention first
Dr Smith offers these tips to aid in preventing these skin conditions:
- In hot weather, dress in loose, lightweight clothing that wicks moisture away from the skin. Natural fibres such as cotton will allow more air movement than many artificial fibres. With newborns, don’t wrap them in too many layers.
- In hot weather, limit physical activity. Stay in the shade or an air-conditioned building. Or use a fan to circulate the air.
- Keep the sleeping area cool and well-ventilated.
- Avoid creams and ointments that can block pores.
When to see a doctor
Dr Smith says a GP should be consulted if the skin condition lasts a few weeks or is accompanied by other symptoms.
“See your doctor if you or your child has symptoms that last longer than a few days or the rash seems to be getting worse,” he advised pharmacy staff to tell patients. “If the condition lasts more than four weeks or continues to get worse, then a referral to a dermatologist may be of benefit.”
References:
- The Australasian College of Dermatologists. ‘Urticaria’. 2019. dermcoll.edu.au/atoz/urticaria/ [accessed 29/11/22].
- Health Direct. ‘Hives’. 2021. healthdirect.gov.au/hives [accessed 12/1/23].
- Raising Children Network. ‘Hives’. 2021. raisingchildren.net.au/guides/a-z-health-reference/hives [accessed 11/1/23].
- The Royal Children’s Hospital Melbourne. ‘Hives’. 2021. rch.org.au/kidsinfo/fact_sheets/Hives/ [accessed 29/11/22].
- The Australasian College of Dermatologists. ‘Miliaria’. 2015. dermcoll.edu.au/atoz/miliaria/ [accessed 15/12/22].
This feature was originally published in the February issue of Retail Pharmacy Assistants e-magazine.
