Beyond a Rash: When to Worry About Skin Changes

Systemic lupus erythematosus (SLE) is an inflammatory disorder that can affect any part of the body and cause the rash mentioned above. To diagnose this, a pediatric rheumatologist will look for: 

• unexplained fatigue;
• fevers when not ill (no cough, runny nose, sore throat, diarrhea);
• unexpected weight loss; 
• rashes, particularly over the nose and cheeks; 
• joint pain or swelling;
• oral ulcers;
• hair loss leading to bald areas; and
• red/pink/brown urine.

Is there anything I can do to improve the rash while waiting to see a doctor?

Rashes caused by lupus are often sensitive to the sun. The following may help: 

• Wear sunscreen.  
• Wear a hat and sun protective clothing (long sleeves, pants) when going outside.

>Related: 8 Sun and Skin Safety Tips from Pediatric Experts 

If you see the following in your child, you should bring them right away to be seen by their doctor, who might suggest a trip to the emergency room: 

• Severe abdominal pain
• Swelling of feet, lower legs, abdomen, or around the eyes
• Red/pink/brown color in your child’s urine
• Persistent fevers and decreased alertness 

My child has a red/purple rash on their feet. Should I be concerned?

We all know children get rashes for many reasons. Red/purple rashes that can be felt, like a bump, and that are present below the waist (feet, legs, or buttocks) could be a sign of Henoch-Schonlein Purpura (HSP), which is also called immunoglobulin A (IgA) vasculitis. Sometimes the rash can occur on the arms and face, too.  

What is HSP/IgA vasculitis?

HSP/IgA vasculitis is inflammation of blood vessels. It can cause several different symptoms, which may be present before or after the rash starts: 

• Belly pain 
• Joint pain  
• Joint swelling  
• Red/brown/pink urine  

Is there anything I can do to help the rash?

The rash will stay until the condition resolves, which for most children/adolescents is within 4 weeks.

Will the rash come back?

Some children/adolescents will have the rash occur again within a few weeks of the original rash resolving. For others, it may occur years later. When it does occur, it often happens when the child/adolescent is sick with an illness, such as a cough.

When should I worry?

You should see your pediatrician or go to an emergency department if your child has any of these symptoms:   

• Severe abdominal pain  
• Has red/pink/brown urine  
   

Color change that happens when the skin is cold could be a normal response if it resolves easily when putting on gloves. If there is numbness, pain, or other sensation changes, you might want to rule out two rheumatic conditions: chilblains and Raynaud’s phenomenon. 

• Chilblains occurs when skin is cold. The skin is usually wet, but it may be dry. Chilblains can occur by itself, but it can also occur with systemic lupus erythematosus.
• Raynaud phenomenon usually occurs when a person is cold and is caused by blood vessels becoming smaller, leading to decreased blood flow. There is often a clear line where there is a color change on toe(s) and finger(s). 

What should I do if my child/adolescent has chilblains or Raynaud phenomenon?

Preventing hands and feet from getting cold is the best way to stop symptoms. It also helps to keep your entire body warm. This gear can help: 

• Mittens, scarves and hats  
• Coats 
• Sweaters and warm sweatshirts 
• Long pants 
• Warm socks  
• Shoes that do not have mesh 
• Foot and hand warmers 

What should I do if my child is still having symptoms?

Set up an appointment with a rheumatologist to have an evaluation for these conditions. There are treatments if symptoms are persisting.

When should I worry?

You should see your pediatrician or go to an emergency department if: 

• your child has severe hand/foot pain that does not get better with warming treatments; or
• you notice that the skin is breaking down at the finger or toe tips.