Infectious and Infestation-Related Pediatric Skin Rashes: Diagnosis and Treatment

Conclusions

• The presentation argues that clinicians should keep a broad differential for rash in children because common infections and infestations are frequently misidentified as eczema, yeast, or nonspecific dermatitis.
• Measles remains an important diagnosis to recognize promptly in febrile children with cough, coryza, conjunctivitis, and cephalocaudal rash spread, especially amid ongoing outbreaks.
• Group A streptococcal skin infection is underrecognized in infants and young children, can present as intensely red intertrigo or perianal dermatitis, and may trigger widespread psoriasiform eruptions.
• Deep-seated pustules in children, especially those with eczema, should raise suspicion for bacterial infection such as group A strep rather than automatically being attributed to Candida or eczema herpeticum.
• Malassezia folliculitis is likely underdiagnosed in both adolescents and infants, often overlaps with acne or other facial eruptions, and can improve quickly with antifungal-directed therapy.
• Congenital and neonatal candidiasis can look very different in full-term infants versus preterm infants, and severe or premature cases require systemic antifungal treatment rather than reassurance alone.
• Staphylococcal skin disease can be transmitted through contaminated topical products and may cause diffuse pustular or bullous eruptions, so practical hygiene measures matter.
• Resistant dermatophyte infections are emerging and may require molecular confirmation and alternative antifungal choices such as itraconazole.
• Scabies treatment failure is sometimes due to true resistance but often reflects re-exposure or incomplete household treatment, and crusted scabies can occur even in children.
• Demodex-associated disease is likely much more common than previously appreciated in children, particularly in those with Down syndrome, leukemia, facial pustules, blepharitis, or on dupilumab.
• Pediatric periorificial dermatitis appears to sit at the intersection of rosacea/demodicosis and irritant or granulomatous inflammation, so treatment must be individualized and steroid exposure avoided when possible.
• Topical or oral ivermectin and other anti-demodex approaches may be helpful in selected pediatric facial eruptions, especially when routine acne or dermatitis therapies fail.
• Overall, the talk emphasizes that careful morphology, location, and response to therapy can reveal treatable infectious or infestation-related causes of “big rashes” in little patients.